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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: Image created by the Authors; Copyright: The Authors; URL: http://publichealth.jmir.org/2019/1/e11313/; License: Creative Commons Attribution (CC-BY).
    Rapid Surveillance Report

    Feb 20, 2019

    The Annual American Men's Internet Survey of Behaviors of Men Who Have Sex With Men in the United States: 2016 Key Indicators Report

    Authors List:

    Abstract:

    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 fourth cycle of data collection (September 2016 through February 2017; AMIS 2016). The key indicators are the same as previously reported for AMIS (December 2013 through May 2014, AMIS 2013; November 2014 through April 2015, AMIS 2014; and September 2015 through April 2016, AMIS 2015). The AMIS survey methodology has not substantively changed since AMIS 2015. MSM were recruited from a variety of websites using banner advertisements and email blasts. Additionally, participants from AMIS 2015 who agreed to be recontacted for future research were emailed a link to the AMIS 2016 survey. Men were eligible to participate if they were ≥15 years old, resided in the United States, provided a valid US zone improvement plan code, and reported ever having sex with a man or identified as gay or bisexual. We examined demographic and recruitment characteristics using multivariable regression modeling (P<.05) stratified by participants’ self-reported HIV status. The AMIS 2016 round of data collection resulted in 10,166 completed surveys from MSM representing every US state, Puerto Rico, Guam, and the US Virgin Islands. Participants were mainly non-Hispanic white, over the age of 40 years, living in the Southern United States and urban areas, and recruited from general social networking websites. Self-reported HIV prevalence was 10.80% (1098/10,166). Compared to HIV-negative/unknown-status participants, HIV-positive participants were more likely to have had anal sex without a condom with a male partner in the past 12 months (75.77% vs 65.88%, P<.001) and more likely to have had anal sex without a condom with a serodiscordant or unknown-status partner (33.24% vs 16.06%, P<.001). The reported use of marijuana, methamphetamines, and other illicit substances in the past 12 months was higher among HIV-positive participants than among HIV-negative/unknown-status participants (28.05% vs 24.99%, 11.48% vs 2.16%, and 27.60% vs 18.22%, respectively; all P<.001). Most HIV-negative/unknown-status participants (79.93%, 7248/9068) reported ever having a previous HIV test, and 56.45% (5119/9068) reported undergoing HIV testing in the past 12 months. HIV-positive participants were more likely to report testing and diagnosis of sexually transmitted infections than HIV-negative/unknown-status participants (70.86% vs 40.13% and 24.04% vs 8.97%, respectively; both P<.001).

  • Source: Colourbox; Copyright: Colourbox; URL: https://www.colourbox.com/image/support-dental-health-image-35647720; License: Licensed by the authors.
    Infoveillance, Infodemiology and...

    Feb 6, 2019

    Differences in Emotional and Pain-Related Language in Tweets About Dentists and Medical Doctors: Text Analysis of Twitter Content

    Authors List:

    Abstract:

    Background: Social media provides people with easy ways to communicate their attitudes and feelings to a wide audience. Many people, unfortunately, have negative associations and feelings about dental treatment due to former painful experiences. Previous research indicates that there might be a pervasive and negative occupational stereotype related to dentists and that this stereotype is expressed in many different venues, including movies and literature. Objective: This study investigates the language used in relation to dentists and medical doctors on the social media platform Twitter. The purpose is to compare the professions in terms of the use of emotional and pain-related words, which might underlie and reflect the pervasive negative stereotype identified in relation to dentists. We hypothesized that (A) tweets about dentists will have more negative emotion-related words than those about medical doctors and (B) pain-related words occur more frequently in tweets about dentists than in those about medical doctors. Methods: Twitter content (“tweets”) about dentists and medical doctors was collected using the Twitter application program interface 140Dev over a 4-week period in 2015, scanning the search terms “dentist” and “doctor”. Word content of the selected tweets was analyzed using Linguistic Inquiry and Word Count software. The research hypotheses were investigated using nonparametric Wilcoxon-Mann-Whitney tests. Results: Over 2.3 million tweets were collected in total, of which about one-third contained the word “dentist” and about two-thirds contained the word “doctor.” Hypothesis A was supported since a higher proportion of negative words was used in tweets about dentists than in those about medical doctors (z=−10.47; P<.001). Similarly, tests showed a difference in the proportions of anger words (z=−12.54; P<.001), anxiety words (z=−6.96; P<.001), and sadness words (z=−9.58; P<.001), with higher proportions of these words in tweets about dentists than in those about doctors. Also, Hypothesis B was supported since a higher proportion of pain-related words was used in tweets about dentists than in those about doctors (z=−8.02; P<.001). Conclusions: The results from this study suggest that stereotypes regarding dentists and dental treatment are spread through social media such as Twitter and that social media also might represent an avenue for improving messaging and disseminating more positive attitudes toward dentists and dental treatment.

  • Source: Flickr; Copyright: Asian Development Bank; URL: https://www.flickr.com/photos/asiandevelopmentbank/21285219506; License: Creative Commons Attribution + Noncommercial + NoDerivatives (CC-BY-NC-ND).
    Mass Media/Social Media Communication...

    Feb 5, 2019

    Considering the Impact of Social Media on Contemporary Improvement of Australian Aboriginal Health: Scoping Review

    Authors List:

    Abstract:

    Background: Social media may have a significant role in influencing the present and future health implications among Australian Aboriginal and Torres Strait Islander people, yet there has been no review of the role of social media in improving health. Objective: This study aims to examine the extent of health initiatives using social media that aimed to improve the health of Australian Aboriginal communities. Methods: A scoping review was conducted by systematically searching databases CINAHL Plus; PubMed; Scopus; Web of Science, and Ovid MEDLINE in June 2017 using the terms and their synonyms “Aboriginal” and “Social media.” In addition, reference lists of included studies and the Indigenous HealthInfonet gray literature were searched. Key information about the social media intervention and its impacts on health were extracted and data synthesized using narrative summaries. Results: Five papers met inclusion criteria. All included studies were published in the past 5 years and involved urban, rural, and remote Aboriginal or Torres Strait Islander people aged 12-60 years. No studies reported objective impacts on health. Three papers found that social media provided greater space for sharing health messages in a 2-way exchange. The negative portrayal of Aboriginal people and negative health impacts of social media were described in 2 papers. Conclusions: Social media may be a useful strategy to provide health messages and sharing of content among Aboriginal people, but objective impacts on health remain unknown. More research is necessary on social media as a way to connect, communicate, and improve Aboriginal health with particular emphasis on community control, self-empowerment, and decolonization.

  • Source: Freepik; Copyright: yanalya; URL: https://www.freepik.com/free-photo/male-hands-with-laptop-close-up_1280360.htm; License: Licensed by JMIR.
    HIV/AIDS/STI Prevention and Care

    Feb 4, 2019

    Fraud Detection Protocol for Web-Based Research Among Men Who Have Sex With Men: Development and Descriptive Evaluation

    Authors List:

    Abstract:

    Background: Internet is becoming an increasingly common tool for survey research, particularly among “hidden” or vulnerable populations, such as men who have sex with men (MSM). Web-based research has many advantages for participants and researchers, but fraud can present a significant threat to data integrity. Objective: The purpose of this analysis was to evaluate fraud detection strategies in a Web-based survey of young MSM and describe new protocols to improve fraud detection in Web-based survey research. Methods: This study involved a cross-sectional Web-based survey that examined individual- and network-level risk factors for HIV transmission and substance use among young MSM residing in 15 counties in Central Kentucky. Each survey entry, which was at least 50% complete, was evaluated by the study staff for fraud using an algorithm involving 8 criteria based on a combination of geolocation data, survey data, and personal information. Entries were classified as fraudulent, potentially fraudulent, or valid. Descriptive analyses were performed to describe each fraud detection criterion among entries. Results: Of the 414 survey entries, the final categorization resulted in 119 (28.7%) entries identified as fraud, 42 (10.1%) as potential fraud, and 253 (61.1%) as valid. Geolocation outside of the study area (164/414, 39.6%) was the most frequently violated criterion. However, 33.3% (82/246) of the entries that had ineligible geolocations belonged to participants who were in eligible locations (as verified by their request to mail payment to an address within the study area or participation at a local event). The second most frequently violated criterion was an invalid phone number (94/414, 22.7%), followed by mismatching names within an entry (43/414, 10.4%) and unusual email addresses (37/414, 8.9%). Less than 5% (18/414) of the entries had some combination of personal information items matching that of a previous entry. Conclusions: This study suggests that researchers conducting Web-based surveys of MSM should be vigilant about the potential for fraud. Researchers should have a fraud detection algorithm in place prior to data collection and should not rely on the Internet Protocol (IP) address or geolocation alone, but should rather use a combination of indicators.

  • Source: Freepik; Copyright: prostooleh; URL: https://www.freepik.com/free-photo/young-stylish-dark-skinned-boy-white-t-shirt-stands-sunny-summer-park_2612319.htm; License: Licensed by JMIR.
    HIV/AIDS/STI Prevention and Care

    Feb 4, 2019

    Spatial Access and Willingness to Use Pre-Exposure Prophylaxis Among Black/African American Individuals in the United States: Cross-Sectional Survey

    Authors List:

    Abstract:

    Background: Uptake of pre-exposure prophylaxis (PrEP) among black individuals in the United States is low and may be associated with the limited availability of clinics where PrEP is prescribed. Objective: We aimed to determine the association between spatial access to clinics where PrEP is prescribed and willingness to use PrEP. Methods: We identified locations of clinics where PrEP is prescribed from AIDSVu.org and calculated the density of PrEP clinics per 10,000 residents according to the ZIP code. Individual-level data were obtained from the 2016 National Survey on HIV in the Black Community. We used multilevel modelling to estimate the association between willingness to use PrEP and clinic density among participants with individual-level (HIV risk, age, gender, education, income, insurance, doctor visit, census region, urban/rural residence) and ZIP code–level (%poverty, %unemployed, %uninsured, %black population, and density of health care facilities) variables. Results: All participants identified as black/African American. Of the 787 participants, 45% were men and 23% were found to be at high risk based on the self-reported behavioral characteristics. The mean age of the participants was 34 years (SD 9), 54% of participants resided in the South, and 26% were willing to use PrEP. More than one-third (38%) of the sample had to drive more than 1 hour to access a PrEP provider. Participants living in areas with higher PrEP clinic density were significantly more willing to use PrEP (one SD higher density of PrEP clinics per 10,000 population was associated with 16% higher willingness [adjusted prevalence ratio=1.16, 95% CI: 1.03-1.31]). Conclusions: Willingness to use PrEP was associated with spatial availability of clinics where providers prescribe PrEP in this nationally representative sample of black African Americans.

  • Ho Chi Minh City at night. Source: Flickr; Copyright: Diana Fleischmann; URL: https://www.flickr.com/photos/dianafleischmannphoto/8742299606/in/photolist-ejwz6y-a7BDqH-QVUhoo-SFiitR-a7EDEC-2ayiTpb-828Ugr-ixULUu-bLFvAK-SCNDiw-SFidnD-2ajwbpW-SkExat-ShE2rA-66DAN3-RA6Cky-2d2nX9y-7c2jMR-Qn6eEH-SCJaQy-ShJEPo-RCD2Xt-GuPUbn-Xm9Yem-H6juwy-S; License: Creative Commons Attribution (CC-BY).
    Theme Issue 2018: Key Population Size...

    Jan 29, 2019

    Population Size Estimation of Venue-Based Female Sex Workers in Ho Chi Minh City, Vietnam: Capture-Recapture Exercise

    Authors List:

    Abstract:

    Background: There is limited population size estimation of female sex workers (FSWs) in Ho Chi Minh City (HCMC)—the largest city in Vietnam. Only 1 population size estimation among venue-based female sex workers (VFSWs) was conducted in 2012 in HCMC. Appropriate estimates of the sizes of key populations are critical for resource allocation to prevent HIV infection. Objective: The aim of this study was to estimate the population size of the VFSWs from December 2016 to January 2017 in HCMC, Vietnam. Methods: A multistage capture-recapture study was conducted in HCMC. The capture procedures included selection of districts using stratified probability proportion to size, mapping to identify venues, approaching all VFSWs to screen their eligibility, and then distribution of a unique object (a small pink makeup bag) to all eligible VFSWs in all identified venues. The recapture exercise included equal probability random selection of a sample of venues from the initial mapping and then approaching FSWs in those venues to determine the number and proportion of women who received the unique object. The proportion and associated confidence bounds, calculated using sampling weights and accounting for study design, were then divided by the number of objects distributed to calculate the number of VFSWs in the selected districts. This was then multiplied by the inverse of the proportion of districts selected to calculate the number of VFSWs in HCMC as a whole. Results: Out of 24 districts, 6 were selected for the study. Mapping identified 573 venues across which 2317 unique objects were distributed in the first capture. During the recapture round, 103 venues were selected and 645 VFSWs were approached and interviewed. Of those, 570 VFSWs reported receiving the unique object during the capture round. Total estimated VFSWs in the 6 selected districts were 2616 (95% CI 2445-3014), accounting for the fact that only 25% (6/24) of total districts were selected gives an overall estimate of 10,465 (95% CI 9782-12,055) VFSWs in HCMC. Conclusions: The capture-recapture exercise provided an estimated number of VFSWs in HCMC. However, for planning HIV prevention and care service needs among all FSWs, studies are needed to assess the number of sex workers who are not venue-based, including those who use social media platforms to sell services.

  • Source: Pxhere; Copyright: Pxhere; URL: https://pxhere.com/en/photo/663205; License: Public Domain (CC0).
    Disaster Medicine and Mass Casualty...

    Jan 28, 2019

    Evaluating the Usefulness of Translation Technologies for Emergency Response Communication: A Scenario-Based Study

    Authors List:

    Abstract:

    Background: In the United States, language barriers pose challenges to communication in emergency response and impact emergency care delivery and quality for individuals who are limited English proficient (LEP). There is a growing interest among Emergency Medical Services (EMS) personnel in using automated translation tools to improve communications with LEP individuals in the field. However, little is known about whether automated translation software can be used successfully in EMS settings to improve communication with LEP individuals. Objective: The objective of this work is to use scenario-based methods with EMS providers and nonnative English-speaking users who identified themselves as LEP (henceforth referred to as LEP participants) to evaluate the potential of two automated translation technologies in improving emergency communication. Methods: We developed mock emergency scenarios and enacted them in simulation sessions with EMS personnel and Spanish-speaking and Chinese-speaking (Mandarin) LEP participants using two automated language translation tools: an EMS domain-specific fixed-sentence translation tool (QuickSpeak) and a statistical machine translation tool (Google Translate). At the end of the sessions, we gathered feedback from both groups through a postsession questionnaire. EMS participants also completed the System Usability Scale (SUS). Results: We conducted a total of 5 group sessions (3 Chinese and 2 Spanish) with 12 Chinese-speaking LEP participants, 14 Spanish-speaking LEP participants, and 17 EMS personnel. Overall, communications between EMS and LEP participants remained limited, even with the use of the two translation tools. QuickSpeak had higher mean SUS scores than Google Translate (65.3 vs 48.4; P=.04). Although both tools were deemed less than satisfactory, LEP participants showed preference toward the domain-specific system with fixed questions (QuickSpeak) over the free-text translation tool (Google Translate) in terms of understanding the EMS personnel’s questions (Chinese 11/12, 92% vs 3/12, 25%; Spanish 12/14, 86% vs 4/14, 29%). While both EMS and LEP participants appreciated the flexibility of the free-text tool, multiple translation errors and difficulty responding to questions limited its usefulness. Conclusions: Technologies are emerging that have the potential to assist with language translation in emergency response; however, improvements in accuracy and usability are needed before these technologies can be used safely in the field.

  • Source: Rawpixel; Copyright: Jira; URL: https://www.rawpixel.com/image/413224/businesswoman-reading-daily-news; License: Public Domain (CC0).
    Vaccination and Immunization in the...

    Jan 23, 2019

    Relationship Between Media Coverage and Measles-Mumps-Rubella (MMR) Vaccination Uptake in Denmark: Retrospective Study

    Authors List:

    Abstract:

    Background: Understanding the influence of media coverage upon vaccination activity is valuable when designing outreach campaigns to increase vaccination uptake. Objective: To study the relationship between media coverage and vaccination activity of the measles-mumps-rubella (MMR) vaccine in Denmark. Methods: We retrieved data on media coverage (1622 articles), vaccination activity (2 million individual registrations), and incidence of measles for the period 1997-2014. All 1622 news media articles were annotated as being provaccination, antivaccination, or neutral. Seasonal and serial dependencies were removed from the data, after which cross-correlations were analyzed to determine the relationship between the different signals. Results: Most (65%) of the anti-vaccination media coverage was observed in the period 1997-2004, immediately before and following the 1998 publication of the falsely claimed link between autism and the MMR vaccine. There was a statistically significant positive correlation between the first MMR vaccine (targeting children aged 15 months) and provaccination media coverage (r=.49, P=.004) in the period 1998-2004. In this period the first MMR vaccine and neutral media coverage also correlated (r=.45, P=.003). However, looking at the whole period, 1997-2014, we found no significant correlations between vaccination activity and media coverage. Conclusions: Following the falsely claimed link between autism and the MMR vaccine, provaccination and neutral media coverage correlated with vaccination activity. This correlation was only observed during a period of controversy which indicates that the population is more susceptible to media influence when presented with diverging opinions. Additionally, our findings suggest that the influence of media is stronger on parents when they are deciding on the first vaccine of their children, than on the subsequent vaccine because correlations were only found for the first MMR vaccine.

  • People at Denver Civic Center Park. Source: FlickR; Copyright: Xuilla; URL: https://www.flickr.com/photos/15585764@N05/5641277436/; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).
    Descriptive Epidemiology and...

    Jan 16, 2019

    Applying National Estimates of Adults With Indications for Pre-Exposure Prophylaxis to Populations of Men Who Have Sex With Men and People Who Inject Drugs...

    Authors List:

    Abstract:

    Background: Oral pre-exposure prophylaxis (PrEP) is a highly effective option for HIV prevention. To realize the full benefit of PrEP at the population level, uptake must reach those at the greatest risk of HIV acquisition. Guidance published by Centers for Disease Control and Prevention (CDC) suggests that the number of individuals with indications for PrEP is 1.1-1.2 million nationally based on survey data of key populations and local transmission patterns. We applied these estimates at state and county levels to determine the number of individuals who might benefit from PrEP locally and compared our estimates to CDC-published estimates for Colorado. Objective: This analysis aimed to produce estimates of key populations with indications for PrEP in Colorado as a whole and by county type. These estimates will be used for public health strategic planning for HIV prevention goals at the state and county jurisdictional levels. Methods: Colorado population estimates were obtained from the state demography office, which utilizes US decennial census data and input from county and local agencies to forecast the population. We limited our analysis to adults aged 18-59 years to be consistent with CDC methodology for PrEP estimates. We performed a literature review to define the best population-level percentages to determine numbers of HIV-negative men who have sex with men (MSM) and people who inject drugs (PWID) in Colorado. These percentages were applied to the state and to each county by its rural-urban designation. Finally, CDC-derived percentages of MSM and PWID with indications for PrEP were applied to these estimates to determine numbers of MSM and PWID who may benefit from PrEP use. Results: In 2017, 3,252,648 adults aged 18-59 years were living in Colorado. By applying published estimates of percentages of men who had sex with other men in the past 12 months, we determined that 41,353-49,624 adult males could be considered sexually active MSM. We estimated that 9758-13,011 adults aged 18-59 years were likely to have injected drugs in the past 12 months. By accounting for numbers of people living with HIV in those categories and applying the CDC PrEP percentages of MSM and PWID with indications for PrEP nationally, we estimated that 8792-12,528 MSM and PWID in Colorado had indications for PrEP; this number is smaller than that estimated by CDC, although within the lower CI limit. Conclusions: By employing a simple framework consisting of census data, literature review, population estimates, and national estimates for PrEP indicators, we derived estimates for potential PrEP use in our state. Statewide estimates of key populations by state and county type will enable health officials to set informed goals and track progress toward optimizing PrEP uptake. This formula may be applicable to other states with similar epidemics and resources. 

  • A method to identify the shortest period of measurement without significantly decreasing the prediction performance for a time-series analysis of disease counts (montage). Source: The Authors / Smartmockups; Copyright: JMIR Publications; URL: http://publichealth.jmir.org/2019/1/e11357/; License: Creative Commons Attribution (CC-BY).
    Statistical Methods for Surveillance...

    Jan 15, 2019

    Period of Measurement in Time-Series Predictions of Disease Counts from 2007 to 2017 in Northern Nevada: Analytics Experiment

    Authors List:

    Abstract:

    Background: The literature in statistics presents methods by which autocorrelation can identify the best period of measurement to improve the performance of a time-series prediction. The period of measurement plays an important role in improving the performance of disease-count predictions. However, from the operational perspective in public health surveillance, there is a limitation to the length of the measurement period that can offer meaningful and valuable predictions. Objective: This study aimed to establish a method that identifies the shortest period of measurement without significantly decreasing the prediction performance for time-series analysis of disease counts. Methods: The data used in this evaluation include disease counts from 2007 to 2017 in northern Nevada. The disease counts for chlamydia, salmonella, respiratory syncytial virus, gonorrhea, viral meningitis, and influenza A were predicted. Results: Our results showed that autocorrelation could not guarantee the best performance for prediction of disease counts. However, the proposed method with the change-point analysis suggests a period of measurement that is operationally acceptable and performance that is not significantly different from the best prediction. Conclusions: The use of change-point analysis with autocorrelation provides the best and most practical period of measurement.

  • Source: Pixabay; Copyright: StockSnap; URL: https://pixabay.com/en/people-woman-exercise-fitness-2592247/; License: Public Domain (CC0).
    Mass Media/Social Media Communication...

    Jan 14, 2019

    Generating Engagement on the Make Healthy Normal Campaign Facebook Page: Analysis of Facebook Analytics

    Authors List:

    Abstract:

    Background: Facebook is increasingly being used as part of mass media campaigns in public health, including the Make Healthy Normal (MHN) campaign in New South Wales, Australia. Therefore, it is important to understand what role Facebook can play in mass media campaigns and how best to use it to augment or amplify campaign effects. However, few studies have explored this. Objective: This study aimed to investigate usage of and engagement with the MHN Facebook page and to identify influential factors in driving engagement with the page. Methods: We examined both post-level and page-level analytic data from Facebook from the campaign’s launch in June 2015 to September 2017. For post-level data, we conducted a series of negative binomial regressions with four different outcome measures (likes, shares, comments, post consumers), including some characteristics of Facebook posts as predictors. We also conducted time series analyses to examine associations between page-level outcomes (new page likes or “fans” and number of engaged users) and different measures of exposure to the page (number of unique users reached and total count of impressions) and to television advertising. Results: Of the 392 posts reviewed, 20.7% (n=81) received a paid boost and 58.9% (n=231) were photo posts. We found that posts that received a paid boost reached significantly more users and subsequently received significantly more engagement than organic (unpaid) posts (P<.001). After adjusting for reach, we found the effect of being paid was incremental for all outcome measures for photos and links, but not videos. There were also associations between day of the week and time of post and engagement, with Mondays generally receiving less engagement and posts on a Friday and those made between 8 AM and 5 PM receiving more. At the page level, our time series analyses found that organic impressions predicted a higher number of new fans and engaged users, compared to paid impressions, especially for women. We also found no association between television advertising and engagement with the Facebook page. Conclusions: Our study shows that paying for posts is important for increasing their reach, but that page administrators should look to maximize organic reach because it is associated with significantly higher engagement. Once reach is accounted for, video posts do not benefit from being paid, unlike the other post types. This suggests that page administrators should carefully consider how they use videos as part of a Facebook campaign. Additionally, the lack of association between television advertising and engagement suggests that future campaigns consider how best to link different channels to amplify effects. These results highlight the need for ongoing evaluation of Facebook pages if administrators are to maximize engagement.

  • Source: Flickr; Copyright: Mike Mozart; URL: https://www.flickr.com/photos/jeepersmedia/14988475790/in/album-72157647301282296/; License: Creative Commons Attribution (CC-BY).
    Surveillance Systems

    Dec 21, 2018

    Real Time Influenza Monitoring Using Hospital Big Data in Combination with Machine Learning Methods: Comparison Study

    Authors List:

    Abstract:

    Background: Traditional surveillance systems produce estimates of influenza-like illness (ILI) incidence rates, but with 1- to 3-week delay. Accurate real-time monitoring systems for influenza outbreaks could be useful for making public health decisions. Several studies have investigated the possibility of using internet users’ activity data and different statistical models to predict influenza epidemics in near real time. However, very few studies have investigated hospital big data. Objective: Here, we compared internet and electronic health records (EHRs) data and different statistical models to identify the best approach (data type and statistical model) for ILI estimates in real time. Methods: We used Google data for internet data and the clinical data warehouse eHOP, which included all EHRs from Rennes University Hospital (France), for hospital data. We compared 3 statistical models—random forest, elastic net, and support vector machine (SVM). Results: For national ILI incidence rate, the best correlation was 0.98 and the mean squared error (MSE) was 866 obtained with hospital data and the SVM model. For the Brittany region, the best correlation was 0.923 and MSE was 2364 obtained with hospital data and the SVM model. Conclusions: We found that EHR data together with historical epidemiological information (French Sentinelles network) allowed for accurately predicting ILI incidence rates for the entire France as well as for the Brittany region and outperformed the internet data whatever was the statistical model used. Moreover, the performance of the two statistical models, elastic net and SVM, was comparable.

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  • Social Media Use and HIV Screening Uptake Among Deaf Adults in the United States

    Date Submitted: Feb 10, 2019

    Open Peer Review Period: Feb 13, 2019 - Feb 27, 2019

    Background: About 46% of U.S. adults obtain recommended HIV screening at least once during one’s lifetime. There is little knowledge of testing rates among deaf and hard-of-hearing adults who primar...

    Background: About 46% of U.S. adults obtain recommended HIV screening at least once during one’s lifetime. There is little knowledge of testing rates among deaf and hard-of-hearing adults who primarily use American Sign Language (ASL), or of social media as a potentially efficacious route for HIV prevention outreach, despite lower HIV/AIDS-specific health literacy and potentially higher HIV seropositivity rates than hearing peers. Objective: We investigated the likelihood of HIV screening uptake among deaf adults in the past year and over one year ago, and the relationship between social media use and HIV screening uptake among deaf adult ASL users. Methods: The Health Information National Trends in ASL (HINTS-ASL) was administered to 1340 deaf U.S. adults between 2015- 2018. The relationship between HIV screening and social media use was evaluated using multinomial regression. Results: The estimated lifetime prevalence of HIV screening uptake among our sample is 54%, with 32% in the past year. Being younger age, male, Black, LGBTQ, or having some college education or a prior STD were associated with HIV screening uptake. Adjusting for correlates, social media use was significantly associated with HIV testing in the past year, compared to either lifetime or never. Conclusions: Despite higher screening rates in our sample, screening falls well short of universal, with gaps among heterosexual, female, White, or older deaf adults. HIV testing outreach may not be effective because of technological or linguistic inaccessibility, rendering ASL users an underrecognized minority group. Social media remains a powerful tool particularly among younger deaf adults.

  • Rosacea and Associated Comorbidities: A Google Search Trends Analysis

    Date Submitted: Feb 6, 2019

    Open Peer Review Period: Feb 11, 2019 - Feb 25, 2019

    Background: Rosacea is a common skin condition that affects millions of individuals across the globe. While the pathogenesis of rosacea remains unclear, there is mounting evidence linking rosacea with...

    Background: Rosacea is a common skin condition that affects millions of individuals across the globe. While the pathogenesis of rosacea remains unclear, there is mounting evidence linking rosacea with systemic conditions. In recent years numerous reports have demonstrated correlations between rosacea and gastrointestinal, neurologic, and psychiatric disease. Given the mounting evidence linking rosacea with systemic disease, we sought to assess whether the general public is aware and seeking information regarding these trends. Objective: Our aim was to evaluate whether there exists a correlation between Google searches for rosacea and common comorbid conditions over the time period of January 2004 to February 2018. Methods: Using data acquired from Google, we assessed for correlations between search terms involving rosacea and systemic diseases to ascertain whether this is an area of emerging interest in the general public. The search term rosacea along with 24 other search terms for common comorbid conditions were investigated over the time period of January 1, 2004 to February 28, 2018 in the four majority English-speaking countries of US, Canada, UK, and Australia. Search volume index (SVI) data were plotted over time and Pearson correlation coefficients were calculated from search data to assess for correlations between search terms. Statistical analysis was performed using IBM SPSS Statistics version 25.0. Results: Interest in rosacea was highest in spring months (March, April, May) and lowest in winter months (December, January, February) in the US, Canada, and UK from January 2004 to February 2018. Search trends for gastrointestinal disorders IBS (R = .399, P < .001) and ulcerative colitis (R = .514, P = .032) correlated significantly with rosacea in Canada and the UK respectively. A significant correlation was found between rosacea and depression SVI in the US (R = .481, P < .001), while no significant correlation was found between the two search terms in the UK, Canada, or Australia. A very strong positive correlation between dementia and rosacea SVI was found in the UK (R= .774, P = .011). A robust correlation was found between rosacea and hypothyroidism SVI (R = .752, P < .001) in the UK, while a significant negative correlation was noted between rosacea and hyperthyroidism SVI in Australia (R= -.180, P = .003). Conclusions: In light of increasing awareness of links between rosacea and systemic disease, our results demonstrate several strong correlations in public interest of rosacea and comorbid disease. These correlations were strongest for gastrointestinal (IBS and UC), neuropsychiatric (depression and dementia), and metabolic conditions (hypothyroidism, diabetes). Overall, our findings indicate growing interest in the general public regarding rosacea and comorbid diseases, which behooves clinicians to take a more comprehensive approach in managing rosacea patients.

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