%0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e66062 %T Evaluation of a Digital Media Campaign to Promote Knowledge and Awareness of the GPFirst Program for Nonurgent Conditions: Repeated Survey Study %A Ong Hui Shan,Rebecca %A Oh,Hong Choon %A Goh Sook Kheng,Priscilla %A Lee Sze Hui,Lyndia %A Riza Bte Mohd Razali,Mas %A Ahmad,Edris Atikah %A Raghuram,Jagadesan %A How,Choon How %A Lim Hoon Chin,Steven %+ Health Services Research, Changi General Hospital, SingHealth, 2 Simei Street 3, Singapore, 529889, Singapore, 65 64267479, rebecca.ong.h.s@singhealth.com.sg %K digital media campaign %K public awareness campaign %K primary care partnership %K social media %K nonurgent emergency department visits %K Andersen model %D 2025 %7 14.4.2025 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: GPFirst is a primary care partnership program designed to encourage patients with nonurgent conditions to seek care at participating general practitioner clinics instead of visiting the emergency department. In 2019, a digital media campaign (DMC) was launched to raise awareness and knowledge about GPFirst among residents in eastern Singapore. Objective: This study aims to assess the DMC’s impact on awareness and knowledge of GPFirst across different age groups, and the acceptability and satisfaction of GPFirst. Methods: The DMC, comprising Facebook posts and a website designed using the Andersen behavioral model, was evaluated through 2 repeated cross-sectional surveys. The first cross-sectional survey (CS1) was conducted with eastern Singapore residents aged 21 years and older, 2 1 year before the campaign’s launch, and the second survey (CS2) 4 months after. Satisfaction was measured on a 5-point Likert scale (very poor to excellent) about GPFirst experiences. Acceptability was assessed with 3 yes or no questions on decisions to visit or recommend GPFirst clinics. Analyses used tests of proportions, adjusted multiregression models, and age-stratified secondary analyses. Results: The Facebook posts generated 38,404 engagements within 5 months, with “#ThankYourGP” posts being the most viewed (n=24,602) and engaged (n=2618). Overall, 1191 and 1161 participants completed CS1 and CS2 respectively. Compared to CS1, CS2 participants were more aware (odds ratio [OR] 2.64, 95% CI 2.11-3.31; P<.001) and knowledgeable of GPFirst (OR 4.20, 95% CI 2.62-6.73; P<.001). Awareness was higher among married individuals (OR 1.31, 95% CI 1.04-1.66; P=.03), those without a regular primary care physician (OR 1.79, 95% CI 1.44-2.22; P<.001), and with higher education levels. Similarly, knowledge was greater among individuals with secondary (OR 2.88, 95% CI 1.35-6.17; P=.006) and preuniversity education (OR 2.56, 95% CI 1.14-5.70; P=.02), and those without a regular primary care physician (OR 1.54, 95% CI 1.02-2.34; P=.04). For acceptability, among participants who visited a GPFirst clinic, 98.2% (163/166) reported they would continue to visit a GPFirst clinic before the emergency department in the future, 95.2% (158/166) would recommend the clinic, 60.2% (100/166) cited the clinic’s participation in GPFirst as a factor in their provider’s choice and 87.3% (145/166) were satisfied with GPFirst. Among those unaware of GPFirst, 88.3% (1680/1903) would consider visiting a GPFirst clinic before the emergency department in the future. Conclusions: The DMC improved awareness and knowledge of GPFirst, with high satisfaction and acceptability among participants. Age-dependent strategies may improve GPFirst participation. The “#ThankYourGP” campaign demonstrated the potential of user-generated content to boost social media engagement, a strategy that international health systems could adopt. %M 40228291 %R 10.2196/66062 %U https://publichealth.jmir.org/2025/1/e66062 %U https://doi.org/10.2196/66062 %U http://www.ncbi.nlm.nih.gov/pubmed/40228291 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e68724 %T Assessing the Dissemination of Federal Risk Communication by News Media Outlets During Enteric Illness Outbreaks: Canadian Content Analysis %A Shereefdeen,Hisba %A Grant,Lauren Elizabeth %A Patel,Vayshali %A MacKay,Melissa %A Papadopoulos,Andrew %A Cheng,Leslie %A Phypers,Melissa %A McWhirter,Jennifer Elizabeth %K risk communication %K health communication %K enteric illness %K foodborne illness %K zoonotic disease %K media %K content analysis %K health belief model %K public health %K Canada %D 2025 %7 10.4.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Effective dissemination of federal risk communication by news media during multijurisdictional enteric illness outbreaks can increase message reach to rapidly contain outbreaks, limit adverse outcomes, and promote informed decision-making by the public. However, dissemination of risk communication from the federal government by mass media has not been evaluated. Objective: This study aimed to describe and assess the dissemination of federal risk communication by news media outlets during multijurisdictional enteric illness outbreaks in Canada. Methods: A comprehensive systematic search of 2 databases, Canadian Newsstream and Canadian Business & Current Affairs, was run using search terms related to the source of enteric illnesses, general outbreak characteristics, and relevant enteric pathogen names to retrieve news media articles issued between 2014 and 2023, corresponding to 46 public health notices (PHNs) communicating information about multijurisdictional enteric illness outbreaks during the same period. A codebook comprised of 3 sections—general characteristics of the article, consistency and accuracy of information presented between PHNs and news media articles, and presence of health belief model constructs—was developed and applied to the dataset. Data were tabulated and visualized using RStudio (Posit). Results: News media communicated about almost all PHNs (44/46, 96%). News media commonly developed their own articles (320/528, 60.6%) to notify the public about an outbreak and its associated product recall (121/320, 37.8%), but rarely communicated about the conclusion of an outbreak (12/320, 3.8%). News media communicated most outbreak characteristics, such as the number of cases (237/319, 74.3%), but the number of deaths was communicated less than half the time (114/260, 43.8%). Benefit and barrier constructs of the health belief model were infrequently present (50/243, 20.6% and 15/243, 6.2%, respectively). Conclusions: Canadian news media disseminated information about most multijurisdictional enteric illness outbreaks. However, differences in coverage of multijurisdictional enteric illness outbreaks by news media were evident. Federal organizations can improve future risk communication of multijurisdictional enteric illness outbreaks by news media by maintaining and strengthening interorganizational connections and ensuring the information quality of PHNs as a key information source for news media. %R 10.2196/68724 %U https://publichealth.jmir.org/2025/1/e68724 %U https://doi.org/10.2196/68724 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65745 %T Using Social Media Platforms to Raise Health Awareness and Increase Health Education in Pakistan: Structural Equation Modeling Analysis and Questionnaire Study %A Munir,Malik Mamoon %A Ahmed,Nabil %K social media %K health awareness %K health education %K innovation diffusion theory %K structural equation modeling %K disease burden %K healthcare facilities %K health professionals %K misinformation %K cost effective %D 2025 %7 7.4.2025 %9 %J JMIR Hum Factors %G English %X Background: Current health care education methods in Pakistan use traditional media (eg, television and radio), community health workers, and printed materials, which often fall short of reach and engagement among most of the population. The health care sector in Pakistan has not yet used social media effectively to raise awareness and provide education about diseases. Research on the impact social media can have on health care education in Pakistan may expand current efforts, engage a wider audience, and reduce the disease burden on health care facilities. Objective: This study aims to evaluate the perceptions of health care professionals and paramedic staff regarding social media use to raise awareness and educate people about diseases as a potential means of reducing the disease burden in Pakistan. Methods: The study used two-stage structural equation modeling (SEM). Data analysis used AMOS 26.0 software, adopting scales from previous literature. Four-item scales for each social media usefulness and health awareness construct and 8-item scales for health care education constructs were adopted on the basis of their higher loading in alignment with psychometric literature. A 7-point Likert scale was used to measure each item. Data collection used convenience sampling, with questionnaires distributed to more than 450 health care professionals and paramedic staff from 2 private hospitals in Lahore, Pakistan. There were 389 useful responses received. However, 340 completed questionnaires were included in the data analysis. Results: The study found that all the squared multiple correlation (SMC) values were greater than 0.30. Furthermore, convergent validity was measured using (1) standardized factor loading (found greater than 0.5), (2) average variance explained (found greater than 0.5), and (3) composite reliability (found greater than 0.7). The confirmatory factor analysis (CFA) of the measurement model indicated the fitness of the constructs (Chi-square minimum [CMIN]=357.62; CMIN/degrees of freedom [DF]=1.80; Goodness of Fit [GFI]=0.90; Adjusted Goodness of Fit Index [AGFI]=0.89; Buntler-Bonett Normed Fit Index [NFI]=0:915; Comparative Fit Index [CFI]=0:93; Root Mean Square Residual [RMR]=0:075; Root Mean Square Error of Approximation [RMSEA]=0:055). Moreover, the structural model fitness was also confirmed (CMIN=488.6; CMIN/DF=1.85; GFI=0.861; AGFI=0.893; NFI=0.987; CFI=0.945; RMR=0:079; RMSEA=0.053). Hence, the results indicated that social media usefulness has a positive and significant effect on health awareness (hypothesis 1: β=.669, P<.001), and health awareness has a positive and significant effect on health care education in Pakistan (hypothesis 2: β=.557, P<.001). Conclusions: This study concludes that health care professionals and paramedic staff in private hospitals support the use of social media to raise awareness and provide health care education. It is considered an effective tool for reducing the disease burden in Pakistan. The study results also revealed that young health care professionals are more inclined toward social media usage and express the need for legislation to support it and establish a monitoring process to avoid misinformation. %R 10.2196/65745 %U https://humanfactors.jmir.org/2025/1/e65745 %U https://doi.org/10.2196/65745 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69609 %T The Impact of a Human Papillomavirus Facebook-Based Intervention (#HPVVaxTalks) Among Young Black (African American and Sub-Saharan African Immigrants) Adults: Pilot Pre- and Poststudy %A Adegboyega,Adebola %A Wiggins,Amanda %A Wuni,Abubakari %A Ickes,Melinda %K human papillomavirus vaccination %K HPV vaccination %K Facebook-based intervention %K young Black adults %K social media %D 2025 %7 2.4.2025 %9 %J JMIR Form Res %G English %X Background: Despite the availability of prophylactic human papillomavirus (HPV) vaccines, uptake remains suboptimal among young Black adults. Social media is a platform for the dissemination of health information and can be used to promote HPV vaccination among young Black adults. Objective: This study aimed to assess the impact of a Facebook-based intervention (#HPVVaxTalks), which consisted of 40 posts over 8 weeks in improving cognitive outcomes, reducing vaccine hesitancy, and increasing vaccine intention, and uptake among young Black adults aged 18-26 years. Methods: A pilot 1-group pre- and poststudy was conducted among 43 young Black adults who engaged in an 8-week Facebook intervention (#HPVVaxTalks). #HPVVaxTalks was developed in collaboration with a youth community advisory committee. Participants were actively recruited by research staff from community settings using flyers, and flyers were posted in public places in communities. Eligible participants were screened for eligibility and consented prior to study participation. Participants completed baseline surveys and were added to a Facebook page created for the study to receive intervention posts. Participants completed pre- and postdata on HPV knowledge, HPV vaccine knowledge, vaccine hesitancy, and vaccine uptake via REDCap (Research Electronic Data Capture) surveys distributed by email. Participants’ satisfaction with the intervention was collected via individual interviews. Data were analyzed using 2-tailed paired t tests and repeated measures analysis Results: Overall, 32 of the 43 (74%) participants completed the follow-up survey, and of the 23 participants who reported not having ever received the vaccine at baseline, 7 (30%) reported receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge and receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge (pre: mean 7.3, SD 4.2 and post: mean 11.1, SD 4.3; P=.004) and HPV vaccine knowledge (pre: mean 2.8, SD 2.5 and post: mean 4.7, SD 2.2; P=.003) and reduction in vaccine hesitancy (pre: mean 28.3, SD 4.2 and post: mean 29.9, SD 3.6; P=.007) after the intervention. However, there were no significant changes in other outcomes. Feedback from open-ended questions and qualitative interviews highlighted participants’ satisfaction with the intervention and its role in increasing HPV and HPV vaccine awareness. Conclusions: The findings from this study underscore the potential of social media platforms for health promotion among underrepresented populations and the importance of advocating for culturally appropriate interventions to improve HPV vaccination rates and reduce disparities. %R 10.2196/69609 %U https://formative.jmir.org/2025/1/e69609 %U https://doi.org/10.2196/69609 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e67367 %T Dissemination and Implementation Approach to Increasing Access to Local Pre-Exposure Prophylaxis (PrEP) Resources With Black Cisgender Women: Intervention Study With Vlogs Shared on Social Media %A Hill,Mandy J %A Mangum,Laurenia %A Coker,Sandra J %A Sutton,Tristen %A Santa Maria,Diane M %K PrEP %K cisgender Black women %K social media campaign %K PrEP access %K HIV prevention %K vlogging %K dissemination and implementation %K pre-exposure prophylaxis %K dissemination %K implementation %K HIV %K prevention %K human immunodeficiency virus %K cisgender %K social media %K marketing %K campaign %K education %K sexually transmitted diseases %K STDs %K vlog %D 2025 %7 28.3.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Black cisgender women account for only 2% of pre-exposure prophylaxis (PrEP)-eligible people in the United States who use PrEP to prevent HIV. Owing to the low PrEP use, Black cisgender women continue to contract HIV more frequently than women from every other racial group. Intervention efforts that can bridge the link between knowing that PrEP prevents HIV and support with access to PrEP are necessary for Black cisgender women. Objective: The purposes of the vlogs through the campaign were to share information about ways to prevent HIV using PrEP and fact-based education and provide access to PrEP resources with active links to local PrEP providers at local community health centers. Methods: In Phase 1, the study team formerly piloted full-length video blog posts (ie, vlogs; 10‐12 min each) with 26 women during an emergency department visit. Using the findings from Phase 1, Phase 2 involved a prospective 6-month social media marketing campaign. The study team led a Texas-Development CFAR-funded pilot grant to disseminate brief vlog snippets (30 s) of excerpts from full-length vlogs with a larger group of Black women in Harris County. Community members, who were aged 18‐55 years, usually consume content that is often viewed by Black cisgender women (ie, health and beauty) and reside in neighborhoods (based on zip code) in Harris County where most residents are Black or African American. They were shown a series of brief vlog snippets on their social media pages, along with a brief message about PrEP and an active hyperlink to local PrEP resources. The study team assessed implementation outcomes, including the feasibility and acceptability, appropriateness of vlogs, access to PrEP resources at local clinics, and clinical outcomes such as increased PrEP awareness among Black cisgender women. Results: Within 6 months, the campaign reached 110.8k unique individuals (the number of unique accounts that have seen your content at least once) who identified as women. When stratified by age, video plays (the number of times a video starts playing) at 50% of the vlogs (n=30,877) were most common among women aged 18‐24 years (n=12,017) and least common among women aged 45‐54 years (n=658). Key performance indicators showed that 1,098,629 impressions (the number of times a user saw the vlog) and 1,002,244 total video plays resulted in 15,952 link clicks to local PrEP resources. Conclusions: The campaign demonstrated the feasibility and acceptability of this approach with Black cisgender women and illustrated preliminary effectiveness at supporting access to local PrEP resources with Black cisgender women. Further dissemination and implementation of this approach is necessary to fully assess whether vlog viewership and clicks on links to PrEP resources can meaningfully empower Black cisgender women to access PrEP and help them to assess whether PrEP is personally a useful HIV prevention option. %R 10.2196/67367 %U https://publichealth.jmir.org/2025/1/e67367 %U https://doi.org/10.2196/67367 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63822 %T Engaging End Users to Inform the Design and Social Marketing Strategy for a Web-Based Sexually Transmitted Infection/Blood-Borne Virus (STI/BBV) Testing Service for Young People in Victoria, Australia: Qualitative Study %A Cardwell,Ethan T %A Ludwick,Teralynn %A Chang,Shanton %A Walsh,Olivia %A Lim,Megan %A Podbury,Rachel %A Evans,David %A Fairley,Christopher K %A Kong,Fabian Y S %A Hocking,Jane S %+ Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, The University of Melbourne, 207 Bouverie Street, Level 3, Parkville, Australia, 61 3 9035 3039, t.cardwell@unimelb.edu.au %K web-based STI/HIV testing %K social marketing %K sexual health %K participatory design %K codesign %K sexually transmitted infections %K STI %K HIV %K Australia %K social media %K survey %K blood-borne viruses %D 2025 %7 27.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The rates of sexually transmitted infections (STIs) continue to rise across Australia among 16- to 29-year-olds. Timely testing is needed to reduce transmission, but sexual health clinics are at capacity. This demand, coupled with barriers to getting tested faced by young people, has led to web-based services as a pragmatic solution. However, for young people to use these services, they must be acceptable, attractive, and usable. Social marketing principles combined with end user engagement can be used to guide the development of a web-based service and create a marketing strategy to attract them to the service. Objective: Working closely with end users and guided by social marketing, this project explored messaging, design elements (imagery), and promotional strategies that will support high usage of a web-based STI/blood-borne virus (BBV) testing service for young people in Victoria, Australia. Methods: Young people were recruited to participate in half-day workshops via youth organizations and targeted Meta (Facebook/Instagram) advertisements. An initial web-based survey was deployed to inform workshop content. Workshops were held in metropolitan, outer metropolitan, and regional Victoria. Young people were presented with a range of “image territories” developed by a social marketing firm and social marketing messages that were informed by the literature on communicating health messages. Participants discussed the feelings and reactions evoked by the content. Data collected through mixed methods (transcribed notes, audio recording, and physical outputs) were thematically analyzed to understand features of messaging and imagery that would attract young people to use the service. Results: A total of 45 people completed the initial survey with 17 participating in focus group workshops (metropolitan: n=8, outer metropolitan: n=6, and regional: n=3). Young people preferred messages that highlight the functional benefits (confidential, affordable, and accessible) of a web-based service and include professional imagery and logos that elicit trust. Young people indicated that the service should be promoted through digital communications (eg, dating apps and social media), with endorsement from government or other recognized institutions, and via word-of-mouth communications. Conclusions: This study has highlighted the value of applying social marketing theory with end user engagement in developing a web-based STI/BBV testing service. Through the voices of young people, we have established the foundations to inform the design and marketing for Victoria’s first publicly funded web-based STI/BBV testing clinic. Future research will measure the reach and efficacy of social marketing, and how this service complements existing services in increasing STI/BBV testing uptake among young Victorians. %M 40146201 %R 10.2196/63822 %U https://www.jmir.org/2025/1/e63822 %U https://doi.org/10.2196/63822 %U http://www.ncbi.nlm.nih.gov/pubmed/40146201 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65847 %T Theory-Based Social Media Intervention for Nonmedical Use of Prescription Opioids in Young Adults: Protocol for a Randomized Controlled Trial %A Tam,Cheuk Chi %A Young,Sean D %A Harrison,Sayward %A Li,Xiaoming %A Litwin,Alain H %+ Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, United States, 1 8037776883, ctam@mailbox.sc.edu %K nonmedical use of prescription opioids %K opioid misuse %K young adults %K social media %K psychosocial intervention %K randomized controlled trial %K mixed methods %D 2025 %7 26.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The nonmedical use of prescription opioids (NMUPO) in young adults in the United States is concerning and is robustly influenced by many psychosocial factors. Given the advantages of flexibility, wide coverage, and real-time responses and assessment, using social media appears to be a promising and innovative approach to delivering psychosocial intervention to young adults. However, few theory-based social media interventions are available for NMUPO targeting this at-risk population. Objective: Guided by the information-motivation-behavioral skills model, the proposed research aims to address critical gaps by theoretically exploring psychosocial content associated with NMUPO among young adults via formative assessment. These findings will then be used to develop and evaluate the feasibility and preliminary efficacy of a peer-led social media intervention to reduce NMUPO among young adults. Methods: The proposed study will comprise serial research activities. First, formative research will be conducted through semistructured interviews among 30 young adults engaged in NMUPO. Qualitative data will be synthesized using a pragmatic approach for identifying psychosocial content associated with NMUPO. Second, qualitative findings will be used for developing a peer-led social media intervention to reduce NMUPO among young adults by integrating promising psychotherapy principles and incorporating them with well-trained recovery coaches. Third, the social media intervention will be evaluated through a 12-week randomized controlled trial among 70 young adults (n=35, 50% in the intervention group and control group) engaged in NMUPO via mixed methods, including pre- and postintervention surveys, social media paradata (eg, time-series reactions to posts) collection, and ecological momentary assessment during the intervention. The control group will not receive an intervention but will complete the pre- and postintervention surveys. The primary outcomes will be feasibility, usability, and acceptability, while the secondary outcomes will be psychosocial and behavioral measures, such as past–3-month NMUPO, intention, psychological distress, self-efficacy, resilience, and coping strategies. Results: The proposed study was funded in May 2024. Social media campaigns have received responses from a total of 379 individuals, with 24 (6.3%) identified as eligible. As of February 10, 2025, we have completed formative interviews with 8 eligible participants. Conclusions: The proposed study will be one of the first efforts to develop and deliver a theory-based peer-led intervention on social media, incorporating empirical findings on the psychosocial mechanism of NMUPO. The findings of the proposed study will provide valuable insights into opioid risk reduction for young adults through an innovative approach. If the tested trial is found to be feasible, the proposed study will contribute to future scaled-up and fully powered psychosocial interventions among young adults and other key populations at risk for NMUPO. Trial Registration: ClincialTrials.gov NCT06469749; https://clinicaltrials.gov/study/NCT06469749 International Registered Report Identifier (IRRID): DERR1-10.2196/65847 %M 40139213 %R 10.2196/65847 %U https://www.researchprotocols.org/2025/1/e65847 %U https://doi.org/10.2196/65847 %U http://www.ncbi.nlm.nih.gov/pubmed/40139213 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63584 %T Vaping, Acculturation, and Social Media Use Among Mexican American College Students: Protocol for a Mixed Methods Web-Based Cohort Study %A Bataineh,Bara S %A Marti,C Nathan %A Murthy,Dhiraj %A Badillo,David %A Chow,Sherman %A Loukas,Alexandra %A Wilkinson,Anna V %+ University of Texas Health Science Center at Houston, 1836 San Jacinto, Austin, TX, 78701, United States, 1 9723527755, Bara.bataineh@uth.tmc.edu %K vaping %K social media %K Mexican American %K college students %K marketing %K acculturation %K protocol %K artificial intelligence %D 2025 %7 24.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The tobacco industry has a history of targeting minority communities, including Hispanic individuals, by promoting vaping through social media. This marketing increases the risk of vaping among Hispanic young adults, including college students. In Texas, college enrollment among Mexican Americans has significantly increased over recent years. However, little research exists on the link between social media and vaping and the underlying mechanisms (ie, outcome expectations, attitudes, and beliefs) explaining how vaping-related social media impacts vaping among Mexican American college students. Moreover, there is limited knowledge about how acculturation moderates the association between social media and vaping. Hispanic individuals, particularly Mexican Americans, are the largest ethnic group in Texas colleges; thus, it is crucial to understand the impact of social media and acculturation on their vaping behaviors. Objective: We outline the mixed methods used in Project Vaping, Acculturation, and Media Study (VAMoS). We present descriptive analyses of the participants enrolled in the study, highlight methodological strengths, and discuss lessons learned during the implementation of the study protocol related to recruitment and data collection and management. Methods: Project VAMoS is being conducted with Mexican American students attending 1 of 6 Texas-based colleges: University of Texas (UT) Arlington, UT Dallas, UT El Paso, UT Rio Grande Valley, UT San Antonio, and the University of Houston System. This project has 2 phases. Phase 1 included an ecological momentary assessment (EMA) study and qualitative one-on-one interviews (years 1-2), and phase 2 includes cognitive interviews and a 4-wave web-based survey study (years 2-4) with objective assessments of vaping-related social media content to which participants are exposed. Descriptive statistics summarized participants’ characteristics in the EMA and web-based survey. Results: The EMA analytic sample comprised 51 participants who were primarily female (n=37, 73%), born in the United States (n=48, 94%), of middle socioeconomic status (n=38, 75%), and aged 21 years on average (SD 1.7 years). The web-based survey cohort comprised 1492 participants self-identifying as Mexican American; Tejano, Tejana, or Tejanx; or Chicano, Chicana, or Chicanx heritage who were primarily female (n=1042, 69.8%), born in the United States (n=1366, 91.6%), of middle socioeconomic status (n=1174, 78.7%), and aged 20.1 years on average at baseline (SD 2.2 years). Of the baseline cohort, the retention rate in wave 2 was 74.7% (1114/1492). Conclusions: Project VAMoS is one of the first longitudinal mixed methods studies exploring the impact of social media and acculturation on vaping behaviors specifically targeting Mexican American college students. Its innovative approach to objectively measuring social media exposure and engagement related to vaping enhances the validity of self-reported data beyond what national surveys can achieve. The results can be used to develop evidence-based, culturally relevant interventions to prevent vaping among this rapidly growing minority population. International Registered Report Identifier (IRRID): DERR1-10.2196/63584 %M 40127433 %R 10.2196/63584 %U https://www.researchprotocols.org/2025/1/e63584 %U https://doi.org/10.2196/63584 %U http://www.ncbi.nlm.nih.gov/pubmed/40127433 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e62828 %T Alternative Presentations of Overall and Statistical Uncertainty for Adults’ Understanding of the Results of a Randomized Trial of a Public Health Intervention: Parallel Web-Based Randomized Trials %A Holst,Christine %A Woloshin,Steven %A Oxman,Andrew D %A Rose,Christopher %A Rosenbaum,Sarah %A Munthe-Kaas,Heather Menzies %+ Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Myrens Verksted 3L, Oslo, 0213, Norway, 47 48234044, Christine.Holst@fhi.no %K communication %K Grading of Recommendations Assessment, Development, and Evaluation language %K GRADE language %K statistical uncertainty %K overall uncertainty %K randomized trial %D 2025 %7 18.3.2025 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Well-designed public health messages can help people make informed choices, while poorly designed messages or persuasive messages can confuse, lead to poorly informed decisions, and diminish trust in health authorities and research. Communicating uncertainties to the public about the results of health research is challenging, necessitating research on effective ways to disseminate this important aspect of randomized trials. Objective: This study aimed to evaluate people’s understanding of overall and statistical uncertainty when presented with alternative ways of expressing randomized trial results. Methods: Two parallel, web-based, individually randomized trials (3×2 factorial designs) were conducted in the United States and Norway. Participants were randomized to 1 of 6 versions of a text (summary) communicating results from a study examining the effects of wearing glasses to prevent COVID-19 infection. The summaries varied in how overall uncertainty (“Grading of Recommendations Assessment, Development and Evaluation [GRADE] language,” “plain language,” or “no explicit language”) and statistical uncertainty (whether a margin of error was shown or not) were presented. Participants completed a web-based questionnaire exploring 4 coprimary outcomes: 3 to measure understanding of overall uncertainty (benefits, harms, and sufficiency of evidence), and one to measure statistical uncertainty. Participants were adults who do not wear glasses recruited from web-based research panels in the United States and Norway. Results of the trials were analyzed separately and combined in a meta-analysis. Results: In the US and Norwegian trials, 730 and 497 individuals were randomized, respectively; data for 543 (74.4%) and 452 (90.9%) were analyzed. More participants had a correct understanding of uncertainty when presented with plain language (United States: 37/99, 37% and Norway: 40/76, 53%) than no explicit language (United States: 18/86, 21% and Norway: 34/80, 42%). Similar positive effect was seen for the GRADE language in the United States (26/79, 33%) but not in Norway (30/71, 42%). There were only small differences between groups for understanding the uncertainty of harms. Plain language improved correct understanding of evidence sufficiency (odds ratio 2.05, 95% CI 1.17-3.57), compared to no explicit language. The effect of GRADE language was inconclusive (odds ratio 1.34, 95% CI 0.79-2.28). The understanding of statistical uncertainty was improved when the participants were shown the margin of error compared to not being shown: Norway: 16/75, 21% to 24/71, 34% vs 1/71, 1% to 2/76, 3% and the United States: 21/101, 21% to 32/90, 36% vs 0/86, 0% to 3/79, 4%). Conclusions: Plain language, but not GRADE language, was better than no explicit language in helping people understand overall uncertainty of benefits and harms. Reporting margin of error improved understanding of statistical uncertainty around the effect of wearing glasses, but only for a minority of participants. Trial Registration: ClinicalTrials.gov NCT05642754; https://tinyurl.com/4mhjsm7s %M 40101228 %R 10.2196/62828 %U https://publichealth.jmir.org/2025/1/e62828 %U https://doi.org/10.2196/62828 %U http://www.ncbi.nlm.nih.gov/pubmed/40101228 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59944 %T Promoting Public Engagement in Palliative and End-of-Life Care Discussions on Chinese Social Media: Model Development and Analysis %A Wang,Yijun %A Zheng,Han %A Zhou,Yuxin %A Chukwusa,Emeka %A Koffman,Jonathan %A Curcin,Vasa %+ School of Information Management, Wuhan University, Room 614, Luojiashan Road 299, Wuchang District, Wuhan, 430072, China, 86 18523102827, hanzheng@whu.edu.cn %K palliative care %K end-of-life care %K health promotion %K social media %K China %K Weibo %K public engagement %K elaboration likelihood model %K ELM %D 2025 %7 18.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: In Chinese traditional culture, discussions surrounding death are often considered taboo, leading to a poor quality of death, and limited public awareness and knowledge about palliative and end-of-life care (PEoLC). However, the increasing prevalence of social media in health communication in China presents an opportunity to promote and educate the public about PEoLC through online discussions. Objective: This study aimed to examine the factors influencing public engagement in PEoLC discussions on a Chinese social media platform and develop practice recommendations to promote such engagement. Methods: We gathered 30,811 PEoLC-related posts on Weibo, the largest social media platform in China. Guided by the elaboration likelihood model, our study examined factors across 4 dimensions: content theme, mood, information richness, and source credibility. Content theme was examined using thematic analysis, while sentiment analysis was used to determine the mood of the posts. The impact of potential factors on post engagement was quantified using negative binomial regression. Results: Organizational accounts exhibited lower engagement compared to individual accounts (incidence rate ratio [IRR]<1; P<.001), suggesting an underuse of organizational accounts in advocating for PEoLC on Weibo. Posts centered on PEoLC-related entertainment (films, television shows, and books; IRR=1.37; P<.001) or controversial social news (IRR=1.64; P<.001) garnered more engagement, primarily published by individual accounts. An interaction effect was observed between content theme and post mood, with posts featuring more negative sentiment generally attracting higher public engagement, except for educational-related posts (IRR=2.68; P<.001). Conclusions: Overall, organizations faced challenges in capturing public attention and involving the public when promoting PEoLC on Chinese social media platforms. It is imperative to move beyond a traditional mode to incorporate cultural elements of social media, such as engaging influencers, leveraging entertainment content and social news, or using visual elements, which can serve as effective catalysts in attracting public attention. The strategies developed in this study are particularly pertinent to nonprofit organizations and academics aiming to use social media for PEoLC campaigns, fundraising efforts, or research dissemination. %M 40099801 %R 10.2196/59944 %U https://www.jmir.org/2025/1/e59944 %U https://doi.org/10.2196/59944 %U http://www.ncbi.nlm.nih.gov/pubmed/40099801 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e66524 %T Experiences of Public Health Professionals Regarding Crisis Communication During the COVID-19 Pandemic: Systematic Review of Qualitative Studies %A Okuhara,Tsuyoshi %A Terada,Marina %A Okada,Hiroko %A Yokota,Rie %A Kiuchi,Takahiro %+ Department of Health Communication, The University of Tokyo, 7 Chome-3-1 Hongo, Tokyo, 113-8654, Japan, 81 3 5800 6549, okuhara-ctr@umin.ac.jp %K COVID-19 %K health communication %K infodemic %K misinformation %K social media %K SARS-CoV-2 %K pandemic %K infectious %K digital age %K systematic review %K internet %K public health %K government %K health professional %K crisis communication %K qualitative %K disinformation %K eHealth %K digital health %K medical informatics %D 2025 %7 14.3.2025 %9 Review %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic emerged in the digital age and has been called the first “data-driven pandemic” in human history. The global response demonstrated that many countries had failed to effectively prepare for such an event. Learning through experience in a crisis is one way to improve the crisis management process. As the world has returned to normal after the pandemic, questions about crisis management have been raised in several countries and require careful consideration. Objective: This review aimed to collect and organize public health professionals’ experiences in crisis communication to the public during the COVID-19 pandemic. Methods: We searched PubMed, MEDLINE, CINAHL, Web of Science, Academic Search Complete, PsycINFO, PsycARTICLES, and Communication Abstracts in February 2024 to locate English-language articles that qualitatively investigated the difficulties and needs experienced by health professionals in their communication activities during the COVID-19 pandemic. Results: This review included 17 studies. Our analysis identified 7 themes and 20 subthemes. The 7 themes were difficulties in pandemic communication, difficulties caused by the “infodemic,” difficulties in partnerships within or outside of public health, difficulties in community engagement, difficulties in effective communication, burnout among communicators, and the need to train communication specialists and establish a permanent organization specializing in communication. Conclusions: This review identified the gaps between existing crisis communication guidelines and real-world crisis communication in the digital environment and clarified the difficulties and needs that arose from these gaps. Crisis communication strategies and guidelines should be updated with reference to the themes revealed in this review to effectively respond to subsequent public health crises. Trial Registration: PROSPERO CRD42024528975; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=528975 International Registered Report Identifier (IRRID): RR2-10.2196/58040 %M 40085849 %R 10.2196/66524 %U https://infodemiology.jmir.org/2025/1/e66524 %U https://doi.org/10.2196/66524 %U http://www.ncbi.nlm.nih.gov/pubmed/40085849 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66321 %T Online Safety When Considering Self-Harm and Suicide-Related Content: Qualitative Focus Group Study With Young People, Policy Makers, and Social Media Industry Professionals %A La Sala,Louise %A Sabo,Amanda %A Michail,Maria %A Thorn,Pinar %A Lamblin,Michelle %A Browne,Vivienne %A Robinson,Jo %+ Orygen, 35 Poplar Road, Parkville, 3052, Australia, 61 3 9966 9512, louise.lasala@orygen.org.au %K young people %K suicide prevention %K self-harm %K social media %K online safety %K policy %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Young people are disproportionately impacted by self-harm and suicide, and concerns exist regarding the role of social media and exposure to unsafe content. Governments and social media companies have taken various approaches to address online safety for young people when it comes to self-harm and suicide; however, little is known about whether key stakeholders believe current approaches are fit-for-purpose. Objective: From the perspective of young people, policy makers and professionals who work within the social media industry, this study aimed to explore (1) the perceived challenges and views regarding young people communicating on social media about self-harm and suicide, and (2) what more social media companies and governments could be doing to address these issues and keep young people safe online. Methods: This qualitative study involved 6 focus groups with Australian young people aged 12-25 years (n=7), Australian policy makers (n=14), and professionals from the global social media industry (n=7). Framework analysis was used to summarize and chart the data for each stakeholder group. Results: In total, 3 primary themes and six subthemes are presented: (1) challenges and concerns, including the reasons for, and challenges related to, online communication about self-harm and suicide as well as reasoning with a deterministic narrative of harm; (2) roles and responsibilities regarding online safety and suicide prevention, including who is responsible and where responsibility starts and stops, as well as the need for better collaborations; and (3) future approaches and potential solutions, acknowledging the limitations of current safety tools and policies, and calling for innovation and new ideas. Conclusions: Our findings highlight tensions surrounding roles and responsibilities in ensuring youth online safety and offer perspectives on how social media companies can support young people discussing self-harm and suicide online. They also support the importance of cross-industry collaborations and consideration of social media in future suicide prevention solutions intended to support young people. %M 40063940 %R 10.2196/66321 %U https://www.jmir.org/2025/1/e66321 %U https://doi.org/10.2196/66321 %U http://www.ncbi.nlm.nih.gov/pubmed/40063940 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64307 %T Ubiquitous News Coverage and Its Varied Effects in Communicating Protective Behaviors to American Adults in Infectious Disease Outbreaks: Time-Series and Longitudinal Panel Study %A Shao,Anqi %A Chen,Kaiping %A Johnson,Branden %A Miranda,Shaila %A Xing,Qidi %+ Department of Life Sciences Communication, University of Wisconsin - Madison, 1545 Observatory Drive, Madison, WI, 53706, United States, 1 6083389939, anqi.shao@wisc.edu %K risk communication %K panel study %K computational method %K intermedia agenda setting %K protective behaviors %K infectious disease %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective communication is essential for promoting preventive behaviors during infectious disease outbreaks like COVID-19. While consistent news can better inform the public about these health behaviors, the public may not adopt them. Objective: This study aims to explore the role of different media platforms in shaping public discourse on preventive measures to infectious diseases such as quarantine and vaccination, and how media exposure influences individuals’ intentions to adopt these behaviors in the United States. Methods: This study uses data from 3 selected top national newspapers in the United States, Twitter discussions, and a US nationwide longitudinal panel survey from February 2020 to April 2021. We used the Intermedia Agenda-Setting Theory and the Protective Action Decision Model to develop the theoretical framework. Results: We found a 2-way agenda flow between selected national newspapers and the social media platform Twitter, particularly in controversial topics like vaccination (F1,426=16.39; P<.001 for newspapers; F1,426=44.46; P<.001 for Twitter). Exposure to media coverage increased individuals’ perceived benefits of certain behaviors like vaccination but did not necessarily translate into behavioral adoption. For example, while individuals’ media exposure increased perceived benefits of mask-wearing (β=.057; P<.001 for household benefits; β=.049; P<.001 for community benefits), it was not consistently linked to higher intentions to wear masks (β=–.026; P=.04). Conclusions: This study integrates media flow across platforms with US national panel survey data, offering a comprehensive view of communication dynamics during the early stage of an infectious disease outbreak. The findings caution against a one-size-fits-all approach in communicating different preventive behaviors, especially where individual and community benefits may not always align. %M 40063934 %R 10.2196/64307 %U https://www.jmir.org/2025/1/e64307 %U https://doi.org/10.2196/64307 %U http://www.ncbi.nlm.nih.gov/pubmed/40063934 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66032 %T Health Communication on the Internet: Promoting Public Health and Exploring Disparities in the Generative AI Era %A Uddin,Jamal %A Feng,Cheng %A Xu,Junfang %+ Department of Pharmacy, Second Affiliated Hospital, School of Public health, Zhejiang University School of Medicine, 866 Yuhangtang road, Xihu district, Hangzhou, 310058, China, 86 18801230482 ext 000, junfangxuhappy1987@163.com %K internet %K generative AI %K artificial intelligence %K ChatGPT %K health communication %K health promotion %K health disparity %K health %K communication %K internet %K AI %K generative %K tool %K genAI %K gratification theory %K gratification %K public health %K inequity %K disparity %D 2025 %7 6.3.2025 %9 Viewpoint %J J Med Internet Res %G English %X Health communication and promotion on the internet have evolved over time, driven by the development of new technologies, including generative artificial intelligence (GenAI). These technological tools offer new opportunities for both the public and professionals. However, these advancements also pose risks of exacerbating health disparities. Limited research has focused on combining these health communication mediums, particularly those enabled by new technologies like GenAI, and their applications for health promotion and health disparities. Therefore, this viewpoint, adopting a conceptual approach, provides an updated overview of health communication mediums and their role in understanding health promotion and disparities in the GenAI era. Additionally, health promotion and health disparities associated with GenAI are briefly discussed through the lens of the Technology Acceptance Model 2, the uses and gratifications theory, and the knowledge gap hypothesis. This viewpoint discusses the limitations and barriers of previous internet-based communication mediums regarding real-time responses, personalized advice, and follow-up inquiries, highlighting the potential of new technology for public health promotion. It also discusses the health disparities caused by the limitations of GenAI, such as individuals’ inability to evaluate information, restricted access to services, and the lack of skill development. Overall, this study lays the groundwork for future research on how GenAI could be leveraged for public health promotion and how its challenges and barriers may exacerbate health inequities. It underscores the need for more empirical studies, as well as the importance of enhancing digital literacy and increasing access to technology for socially disadvantaged populations. %M 40053755 %R 10.2196/66032 %U https://www.jmir.org/2025/1/e66032 %U https://doi.org/10.2196/66032 %U http://www.ncbi.nlm.nih.gov/pubmed/40053755 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e56098 %T Assessing Health Information Seeking Behaviors Among Targeted Social Media Users Using an Infotainment Video About a Cancer Clinical Trial: Population-Based Descriptive Study %A Sommers,Jonathan %A Dizon,Don S %A Lewis,Mark A %A Stone,Erik %A Andreoli,Richard %A Henderson,Vida %K cancer clinical trials %K digital media %K social media %K infotainment %K recruitment %K education and awareness %K edutainment %K public engagement %K cancer %K lack of information %K social media %K health information %K medical awareness %K video series %K public audience %K low cost %K research participants %D 2025 %7 3.3.2025 %9 %J JMIR Cancer %G English %X Background: The lack of information and awareness about clinical trials, as well as misconceptions about them, are major barriers to cancer clinical trial participation. Digital and social media are dominant sources of health information and offer optimal opportunities to improve public medical awareness and education by providing accurate and trustworthy health information from reliable sources. Infotainment, material intended to both entertain and inform, is an effective strategy for engaging and educating audiences that can be easily disseminated using social media and may be a novel way to improve awareness of and recruitment in clinical trials. Objective: The purpose of this study was to evaluate whether an infotainment video promoting a clinical trial, disseminated using social media, could drive health information seeking behaviors. Methods: As part of a video series, we created an infotainment video focused on the promotion of a specific cancer clinical trial. We instituted a dissemination and marketing process on Facebook to measure video engagement and health information seeking behaviors among targeted audiences who expressed interest in breast cancer research and organizations. To evaluate video engagement, we measured reach, retention, outbound clicks, and outbound click-through rate. Frequencies and descriptive statistics were used to summarize each measure. Results: The video substantially increased health information seeking behavior by increasing viewership from 1 visitor one month prior to launch to 414 outbound clicks from the video to the clinical trial web page during the 21-day social media campaign period. Conclusions: Our study shows that digital and social media tools can be tailored for specific target audiences, are scalable, and can be disseminated at low cost, making it an accessible educational, recruitment, and retention strategy focused on improving the awareness of clinical trials. Trial Registration: ClinicalTrials.gov NCT03418961; https://clinicaltrials.gov/study/NCT03418961 %R 10.2196/56098 %U https://cancer.jmir.org/2025/1/e56098 %U https://doi.org/10.2196/56098 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60891 %T How TikTok Influencers Disclose Food and Beverage Brand Partnerships: Descriptive Study %A Dupuis,Roxanne %A Musicus,Aviva A %A Edghill,Brittany %A Keteku,Emma %A Bragg,Marie A %+ Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, United States, 1 646 470 4505, roxanne.dupuis@nyulangone.org %K social media %K social media marketing %K social media influencer %K food and beverage marketing %K adolescent health %D 2025 %7 28.2.2025 %9 Short Paper %J J Med Internet Res %G English %X Background: Food and beverage marketing is an important influence on the health and diets of adolescents. Food and beverage companies spend billions of dollars annually on advertisements to promote their products and are increasingly focusing on social media influencers. Influencer product endorsements blur the line between entertainment and marketing. Objective: This study aimed to quantify how often TikTok influencers promote products from food and beverage brands and document the range of ways they disclose brand relationships in their content. Methods: We collected up to 100 videos posted on or before July 1, 2022, from each of the top 100 influencers on TikTok in the United States and recorded information about the influencer (eg, number of followers) and video (eg, number of views and likes). For each video that contained food or beverage products, we identified the main product featured. A team of research assistants then coded each video for how the product was featured (ie, in the video, audio, or caption) and, for branded products, whether the video was accompanied by any disclosures of brand relationships. Average pairwise percentage agreement among coders was 92%, and average pairwise Cohen κ was 0.82. Results: Among the 8871 videos from 97 influencers that made up the final analytical sample, we identified 1360 videos (15.3%) that featured at least one food or beverage product. These 1360 videos were viewed >9 million times and received >1 million likes each. Nearly half (n=648, 47.6%) of the videos featured a branded product. Most videos featuring a branded product did not contain a brand relationship disclosure (n=449, 69.3%). Among videos that disclosed a brand relationship, influencers used 10 different types of disclosures. Tagging a brand in the video’s caption was the most common disclosure method (n=182, 28.1%). Six types of caption hashtags were used to disclose brand relationships, including #[brandname] (n=63, 9.7%) and #ad (n=30, 4.6%). Only 1 video (0.2%) made use of TikTok’s official disclosure label and only 1 video (0.2%) verbally mentioned a contractual agreement with a brand. Conclusions: Among the food and beverage videos with disclosures we identified, the most frequently used mechanism—tagging the brand—did not clearly differentiate between sponsored content and the influencer trying to attract a brand or followers who may like that brand. Social media users, particularly adolescents, need clearer, more robust disclosures from influencers to protect against the undue influence of food marketing. These findings may also inform calls for the Children’s Food and Beverage Advertising Initiative—the largest self-regulatory pledge to reduce unhealthy food marketing—to include older adolescents, who are heavily targeted by food and beverage companies on social media. %M 40053812 %R 10.2196/60891 %U https://www.jmir.org/2025/1/e60891 %U https://doi.org/10.2196/60891 %U http://www.ncbi.nlm.nih.gov/pubmed/40053812 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63344 %T Instagram Posts Promoting Colorectal Cancer Awareness: Content Analysis of Themes and Engagement During Colorectal Cancer Awareness Month %A Srivastava,Aditi %A Stimpson,Jim P %K social media %K colorectal neoplasms %K early detection of cancer %K public health %K health inequities %K harnessing %K Instagram %K colorectal cancer %K colorectal cancer awareness %K content analysis %K cancer-related deaths %K detection %K screening %K mortality %K post %K early detection %D 2025 %7 19.2.2025 %9 %J JMIR Form Res %G English %X Background: Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide, with early detection and screening being critical for reducing mortality. Social media platforms like Instagram offer a unique opportunity to raise awareness about CRC, particularly during designated awareness months. However, there is limited research on the effectiveness of CRC-related content on Instagram. Objective: This study aims to examine how Instagram is used to raise awareness about CRC during Colorectal Cancer Awareness Month by analyzing the thematic content and engagement metrics of related posts. The research seeks to identify the prevalent themes, assess audience interaction with these messages, and highlight areas for improvement in leveraging Instagram as a tool for cancer awareness campaigns. Methods: A total of 150 Instagram posts were collected based on their use of specific hashtags related to CRC awareness (#colorectalcancer, #colorectalcancerawareness, #colorectalcancerawarenessmonth) during March 2024. The text and images in the posts were categorized into themes such as screening and early detection, symptoms, general awareness, risk factors, individual’s experiences, representation of racial and ethnic minoritized communities, and representation of women. Engagement metrics, including the number of likes and comments, were also analyzed. Two researchers independently coded the posts, achieving high interrater reliability (Cohen κ=0.93). Results: Organizational accounts were more active, contributing 82% (n=123) of the 150 posts, compared to 18% (n=27) from individual users. The most frequently mentioned theme was screening and early detection, which made up 37.3% (n=56) of all posts. General awareness came in second at 19.3% (n=29), and risk factors came in third at 12% (n=18). Posts about individual experiences and general awareness received the highest engagement, indicating the effectiveness of personal narratives and broad informational content. Themes related to symptoms and representation of racial and ethnic minoritized communities and women were underrepresented. Conclusions: This study highlights the potential of Instagram as a platform for promoting CRC awareness, particularly through posts about screening and early detection and personal experiences. However, there is a need for more inclusive and diverse content to ensure a broader reach and impact. %R 10.2196/63344 %U https://formative.jmir.org/2025/1/e63344 %U https://doi.org/10.2196/63344 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66696 %T Analyzing Themes, Sentiments, and Coping Strategies Regarding Online News Coverage of Depression in Hong Kong: Mixed Methods Study %A Chen,Sihui %A Ngai,Cindy Sing Bik %A Cheng,Cecilia %A Hu,Yangna %+ Department of Chinese and Bilingual Studies, Hong Kong Polytechnic University, AG502, Hung Hom, Kowloon, China (Hong Kong), 852 27667465, cindy.sb.ngai@polyu.edu.hk %K online news coverage %K depression %K natural language processing %K NLP %K latent Dirichlet allocation %K LDA %K sentiment %K coping strategies %K content analysis %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression, a highly prevalent global mental disorder, has prompted significant research concerning its association with social media use and its impact during Hong Kong’s social unrest and COVID-19 pandemic. However, other mainstream media, specifically online news, has been largely overlooked. Despite extensive research conducted in countries, such as the United States, Australia, and Canada, to investigate the latent subthemes, sentiments, and coping strategies portrayed in depression-related news, the landscape in Hong Kong remains unexplored. Objective: This study aims to uncover the latent subthemes presented in the online news coverage of depression in Hong Kong, examine the sentiment conveyed in the news, and assess whether coping strategies have been provided in the news for individuals experiencing depression. Methods: This study used natural language processing (NLP) techniques, namely the latent Dirichlet allocation topic modeling and the Valence Aware Dictionary and Sentiment Reasoner (VADER) sentiment analysis, to fulfill the first and second objectives. Coping strategies were rigorously assessed and manually labeled with designated categories by content analysis. The online news was collected from February 2019 to May 2024 from Hong Kong mainstream news websites to examine the latest portrayal of depression, particularly during and after the social unrest and the COVID-19 pandemic. Results: In total, 2435 news articles were retained for data analysis after the news screening process. A total of 7 subthemes were identified based on the topic modeling results. Societal system, law enforcement, global recession, lifestyle, leisure, health issues, and US politics were the latent subthemes. Moreover, the overall news exhibited a slightly positive sentiment. The correlations between the sentiment scores and the latent subthemes indicated that the societal system, law enforcement, health issues, and US politics revealed negative tendencies, while the remainder leaned toward a positive sentiment. The coping strategies for depression were substantially lacking; however, the categories emphasizing information on skills and resources and individual adjustment to cope with depression emerged as the priority focus. Conclusions: This pioneering study used a mixed methods approach where NLP was used to investigate latent subthemes and underlying sentiment in online news. Content analysis was also performed to examine available coping strategies. The findings of this research enhance our understanding of how depression is portrayed through online news in Hong Kong and the preferable coping strategies being used to mitigate depression. The potential impact on readers was discussed. Future research is encouraged to address the mentioned implications and limitations, with recommendations to apply advanced NLP techniques to a new mental health issue case or language. %M 39946170 %R 10.2196/66696 %U https://www.jmir.org/2025/1/e66696 %U https://doi.org/10.2196/66696 %U http://www.ncbi.nlm.nih.gov/pubmed/39946170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68881 %T Understanding Human Papillomavirus Vaccination Hesitancy in Japan Using Social Media: Content Analysis %A Liu,Junyu %A Niu,Qian %A Nagai-Tanima,Momoko %A Aoyama,Tomoki %+ , Kyoto University, Yoshida-honmachi, Sakyo-Ku, Kyoto, 606-8501, Japan, 81 075 751 3952, aoyama.tomoki.4e@kyoto-u.ac.jp %K human papillomavirus %K HPV %K HPV vaccine %K vaccine confidence %K large language model %K stance analysis %K topic modeling %D 2025 %7 11.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the reinstatement of proactive human papillomavirus (HPV) vaccine recommendations in 2022, Japan continues to face persistently low HPV vaccination rates, which pose significant public health challenges. Misinformation, complacency, and accessibility issues have been identified as key factors undermining vaccine uptake. Objective: This study aims to examine the evolution of public attitudes toward HPV vaccination in Japan by analyzing social media content. Specifically, we investigate the role of misinformation, public health events, and cross-vaccine attitudes (eg, COVID-19 vaccines) in shaping vaccine hesitancy over time. Methods: We collected tweets related to the HPV vaccine from 2011 to 2021. Natural language processing techniques and large language models (LLMs) were used for stance analysis of the collected data. Time series analysis and latent Dirichlet allocation topic modeling were used to identify shifts in public sentiment and topic trends over the decade. Misinformation within opposed-stance tweets was detected using LLMs. Furthermore, we analyzed the relationship between attitudes toward HPV and COVID-19 vaccines through logic analysis. Results: Among the tested models, Gemini 1.0 pro (Google) achieved the highest accuracy (0.902) for stance analysis, improving to 0.968 with hyperparameter tuning. Time series analysis identified significant shifts in public stance in 2013, 2016, and 2020, corresponding to key public health events and policy changes. Topic modeling revealed that discussions around vaccine safety peaked in 2015 before declining, while topics concerning vaccine effectiveness exhibited an opposite trend. Misinformation in topic "Scientific Warnings and Public Health Risk" in the sopposed-stance tweets reached a peak of 2.84% (47/1656) in 2012 and stabilized at approximately 0.5% from 2014 onward. The volume of tweets using HPV vaccine experiences to argue stances on COVID-19 vaccines was significantly higher than the reverse. Conclusions: Based on observation on the public attitudes toward HPV vaccination from social media contents over 10 years, our findings highlight the need for targeted public health interventions to address vaccine hesitancy in Japan. Although vaccine confidence has increased slowly, sustained efforts are necessary to ensure long-term improvements. Addressing misinformation, reducing complacency, and enhancing vaccine accessibility are key strategies for improving vaccine uptake. Some evidence suggests that confidence in one vaccine may positively influence perceptions of other vaccines. This study also demonstrated the use of LLMs in providing a comprehensive understanding of public health attitudes. Future public health strategies can benefit from these insights by designing effective interventions to boost vaccine confidence and uptake. %M 39933163 %R 10.2196/68881 %U https://www.jmir.org/2025/1/e68881 %U https://doi.org/10.2196/68881 %U http://www.ncbi.nlm.nih.gov/pubmed/39933163 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e70071 %T Social Media Use and Oral Health–Related Misconceptions in Saudi Arabia: Cross-Sectional Study %A BinHamdan,Rahaf Hamdan %A Alsadhan,Salwa Abdulrahman %A Gazzaz,Arwa Zohair %A AlJameel,AlBandary Hassan %+ Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Diriyah 12372, Riyadh, 11545, Saudi Arabia, 966 0114677743, rahafbinhamdan@gmail.com %K social media %K oral health %K health misinformation %K digital health %K Saudi Arabia %K public health %K Instagram %K Snapchat %K TikTok %K Twitter %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media has become a central tool in health communication, offering both opportunities and challenges. In Saudi Arabia, where platforms like WhatsApp, Snapchat, and Instagram are widely used, the quality and credibility of oral health information shared digitally remain critical issues. Misconceptions about oral health can negatively influence individuals’ behaviors and oral health outcomes. Objective: This study aimed to describe the patterns of social media use and estimate the prevalence of oral health–related misconceptions among adults in Saudi Arabia. Additionally, it assessed the associations between engagement with oral health information, self-reported oral health, and the presence and count of these misconceptions. Methods: A cross-sectional survey was conducted over 10 weeks, targeting adults aged 15 years and older in Saudi Arabia. Data were collected from a total sample size (n=387) via a questionnaire distributed through targeted advertisements on Instagram, TikTok, Snapchat, and X (Twitter). The prevalence of oral health–related misconceptions was estimated using descriptive statistics, including counts and percentages. Chi-square tests described sociodemographic, social media engagement, and self-reported oral health. Logistic and Poisson regression analyses were used to assess associations between engagement and self-reported oral health with misconceptions. Logistic regression models provided odds ratios and adjusted odds ratios with 95% CI to assess the presence of oral health misconceptions. Poisson regression was used to calculate mean ratios and adjusted mean ratios (AMRs) for the count of misconceptions. Results: WhatsApp (n=344, 89.8%) and Instagram (n=304, 78.9%) were the most frequently used social media platforms daily. Common oral health misconceptions included beliefs that “Pregnancy causes calcium loss in teeth” (n=337, 87%) and “Dental treatment should be avoided during pregnancy” (n=245, 63.3%). Following dental-specific accounts was significantly associated with lower odds of having any misconceptions (adjusted odds ratio 0.41, 95% CI 0.22-0.78) and a lower count of misconceptions (AMR 0.87, 95% CI 0.77-0.98). Conversely, trust in social media as a source of oral health information was associated with a higher count of misconceptions (AMR 1.16, 95% CI 1.02-1.31). Conclusions: Social media platforms are essential yet double-edged tools for oral health information dissemination in Saudi Arabia. Participants who followed dental-specific accounts had significantly lower misconceptions, while trust in social media as a source of information was linked to higher counts of misconceptions. These findings highlight the importance of promoting credible content from verified sources to combat misconceptions. Strategic collaborations with dental professionals are necessary to enhance the dissemination of accurate oral health information and public awareness and reduce the prevalence of oral health–related misconceptions. %M 39928937 %R 10.2196/70071 %U https://formative.jmir.org/2025/1/e70071 %U https://doi.org/10.2196/70071 %U http://www.ncbi.nlm.nih.gov/pubmed/39928937 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66446 %T Spatiotemporal Characteristics and Influential Factors of Electronic Cigarette Web-Based Attention in Mainland China: Time Series Observational Study %A Zhang,Zhongmin %A Xu,Hengyi %A Pan,Jing %A Song,Fujian %A Chen,Ting %+ Healthy Hubei Development and Social Progress Research Center of the Key Research Base of Humanities and Social Sciences in Hubei Province, School of Public Health, Wuhan University of Science and Technology, 2 Huangjiahuxi Road, Hongshan District, Wuhan, 430065, China, 86 18120237582, chent41@wust.edu.cn %K electronic cigarettes %K Baidu index %K web-based attention %K spatiotemporal characteristics %K China %D 2025 %7 10.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The popularity of electronic cigarettes (e-cigarettes) has steadily increased, prompting a considerable number of individuals to search for relevant information on them. Previous e-cigarette infodemiology studies have focused on assessing the quality and reliability of website content and quantifying the impact of policies. In reality, most low-income countries and low- and middle-income countries have not yet conducted e-cigarette use surveillance. Data sourced from web-based search engines related to e-cigarettes have the potential to serve as cost-effective supplementary means to traditional monitoring approaches. Objective: This study aimed to analyze the spatiotemporal distribution characteristics and associated sociodemographic factors of e-cigarette searches using trends from the Baidu search engine. Methods: The query data related to e-cigarettes for 31 provinces in mainland China were retrieved from the Baidu index database from January 1, 2015, to December 31, 2022. Concentration ratio methods and spatial autocorrelation analysis were applied to analyze the temporal aggregation and spatial aggregation of the e-cigarette Baidu index, respectively. A variance inflation factor test was performed to avoid multicollinearity. A spatial panel econometric model was developed to assess the determinants of e-cigarette web-based attention. Results: The daily average Baidu index for e-cigarettes increased from 53,234.873 in 2015 to 85,416.995 in 2021 and then declined to 52,174.906 in 2022. This index was concentrated in the southeastern coastal region, whereas the hot spot shifted to the northwestern region after adjusting for population size. Positive spatial autocorrelation existed in the per capita Baidu index of e-cigarettes from 2015 to 2022. The results of the local Moran’s I showed that there were mainly low-low cluster areas of the per capita Baidu index, especially in the central region. Furthermore, the male-female ratio, the proportion of high school and above education, and the per capita gross regional domestic product were positively correlated with the per capita Baidu index for e-cigarettes. A higher urbanization rate was associated with a reduced per capita Baidu index. Conclusions: With the increasing popularity of web-based searches for e-cigarettes, a targeted e-cigarette health education program for individuals in the northwest, males, rural populations, high school and above educated individuals, and high-income groups is warranted. %M 39928402 %R 10.2196/66446 %U https://www.jmir.org/2025/1/e66446 %U https://doi.org/10.2196/66446 %U http://www.ncbi.nlm.nih.gov/pubmed/39928402 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59872 %T Organ Donation Conversations on X and Development of the OrgReach Social Media Marketing Strategy: Social Network Analysis %A Ahmed,Wasim %A Hardey,Mariann %A Vidal-Alaball,Josep %+ Unitat de Recerca i Innovació, Gerència d'Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, Carrer de Soler i March, 6,, Manresa, 08242, Spain, 34 936930040, jvidal.cc.ics@gencat.cat %K organ donation %K organ transplant %K social media %K health %K social network analysis %K marketing strategy %K awareness %K public health %K health information %K qualitative %K thematic analysis %K NodeXL Pro %K algorithm %K elite tier %K digital health %K United Kingdom %K X %D 2025 %7 6.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The digital landscape has become a vital platform for public health discourse, particularly concerning important topics like organ donation. With a global rise in organ transplant needs, fostering public understanding and positive attitudes toward organ donation is critical. Social media platforms, such as X, contain conversations from the public, and key stakeholders maintain an active presence on the platform. Objective: The goal is to develop insights into organ donation discussions on a popular social media platform (X) and understand the context in which users discussed organ donation advocacy. We investigate the influence of prominent profiles on X and meta-level accounts, including those seeking health information. We use credibility theory to explore the construction and impact of credibility within social media contexts in organ donation discussions. Methods: Data were retrieved from X between October 2023 and May 2024, covering a 7-month period. The study was able to retrieve a dataset with 20,124 unique users and 33,830 posts. The posts were analyzed using social network analysis and qualitative thematic analysis. NodeXL Pro was used to retrieve and analyze the data, and a network visualization was created by drawing upon the Clauset-Newman-Moore cluster algorithm and the Harel-Koren Fast Multiscale layout algorithm. Results: This analysis reveals an “elite tier” shaping the conversation, with themes reflecting existing societal sensitivities around organ donation. We demonstrate how prominent social media profiles act as information intermediaries, navigating the tension between open dialogue and negative perceptions. We use our findings, social credibility theory, and review of existing literature to develop the OrgReach Social Media Marketing Strategy for Organ Donation Awareness. The OrgReach strategy developed is based on 5 C’s (Create, Connect, Collaborate, Correct, and Curate), 2 A’s (Access and Analyse), and 3 R’s (Recognize, Respond, and Reevaluate). Conclusions: The study highlights the crucial role of analyzing social media data by drawing upon social networks and topic analysis to understand influence and network communication patterns. By doing so, the study proposes the OrgReach strategy that can feed into the marketing strategies for organ donation outreach and awareness. %M 39914808 %R 10.2196/59872 %U https://www.jmir.org/2025/1/e59872 %U https://doi.org/10.2196/59872 %U http://www.ncbi.nlm.nih.gov/pubmed/39914808 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63910 %T Public Health Messaging on Twitter During the COVID-19 Pandemic: Observational Study %A Rao,Ashwin %A Sabri,Nazanin %A Guo,Siyi %A Raschid,Louiqa %A Lerman,Kristina %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way STE 1001, Marina del Rey, CA, 90292, United States, 1 2135050363, mohanrao@usc.edu %K public health %K public health messaging %K COVID-19 %K Twitter %K emotions %K moral foundations %K polarization %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective communication is crucial during health crises, and social media has become a prominent platform for public health experts (PHEs) to share information and engage with the public. At the same time, social media also provides a platform for pseudoexperts who may spread contrarian views. Despite the importance of social media, key elements of communication, such as the use of moral or emotional language and messaging strategy, particularly during the emergency phase of the COVID-19 pandemic, have not been explored. Objective: This study aimed to analyze how PHEs and pseudoexperts communicated with the public during the emergency phase of the COVID-19 pandemic. We focused on the emotional and moral language used in their messages on various COVID-19 pandemic–related topics. We also analyzed their interactions with political elites and the public’s engagement with PHEs to gain a deeper understanding of their influence on public discourse. Methods: For this observational study, we gathered a dataset of >539,000 original posts or reposts from 489 PHEs and 356 pseudoexperts on Twitter (subsequently rebranded X) from January 2020 to January 2021, along with the replies to the original posts from the PHEs. We identified the key issues that PHEs and pseudoexperts prioritized. We also determined the emotional and moral language in both the original posts and the replies. This allows us to characterize priorities for PHEs and pseudoexperts as well as differences in messaging strategy between these 2 groups. We also evaluated the influence of PHEs’ language and strategy on the public response. Results: Our analyses revealed that PHEs focused more on masking, health care, education, and vaccines, whereas pseudoexperts discussed therapeutics and lockdowns more frequently (P<.001). PHEs typically used positive emotional language across all issues (P<.001), expressing optimism and joy. Pseudoexperts often used negative emotions of pessimism and disgust, while limiting positive emotional language to origins and therapeutics (P<.001). Along the dimensions of moral language, PHEs and pseudoexperts differed on care versus harm and authority versus subversion across different issues. Negative emotional and moral language tends to boost engagement in COVID-19 discussions across all issues. However, the use of positive language by PHEs increases the use of positive language in the public responses. PHEs act as liberal partisans: they express more positive affect in their posts directed at liberals and more negative affect in their posts directed at conservative elites. In contrast, pseudoexperts act as conservative partisans. These results provide nuanced insights into the elements that have polarized the COVID-19 discourse. Conclusions: Understanding the nature of the public response to PHEs’ messages on social media is essential for refining communication strategies during health crises. Our findings underscore the importance of using moral-emotional language strategically to reduce polarization and build trust. %M 39908546 %R 10.2196/63910 %U https://www.jmir.org/2025/1/e63910 %U https://doi.org/10.2196/63910 %U http://www.ncbi.nlm.nih.gov/pubmed/39908546 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63864 %T Colorectal Cancer Racial Equity Post Volume, Content, and Exposure: Observational Study Using Twitter Data %A Tong,Chau %A Margolin,Drew %A Niederdeppe,Jeff %A Chunara,Rumi %A Liu,Jiawei %A Jih-Vieira,Lea %A King,Andy J %+ School of Journalism, University of Missouri, 140B Walter Williams, Columbia, MO, 65203, United States, 1 573 882 7875, ctong@missouri.edu %K racial equity information %K information exposure %K health disparities %K colorectal cancer %K cancer communication %K Twitter %K X %D 2025 %7 3.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Racial inequity in health outcomes, particularly in colorectal cancer (CRC), remains one of the most pressing issues in cancer communication and public health. Social media platforms like Twitter (now X) provide opportunities to disseminate health equity information widely, yet little is known about the availability, content, and reach of racial health equity information related to CRC on these platforms. Addressing this gap is essential to leveraging social media for equitable health communication. Objective: This study aims to analyze the volume, content, and exposure of CRC racial health equity tweets from identified CRC equity disseminator accounts on Twitter. These accounts were defined as those actively sharing information related to racial equity in CRC outcomes. By examining the behavior and impact of these disseminators, this study provides insights into how health equity content is shared and received on social media. Methods: We identified accounts that posted CRC-related content on Twitter between 2019 and 2021. Accounts were classified as CRC equity disseminators (n=798) if they followed at least 2 CRC racial equity organization accounts. We analyzed the volume and content of racial equity–related CRC tweets (n=1134) from these accounts and categorized them by account type (experts vs nonexperts). Additionally, we evaluated exposure by analyzing follower reach (n=6,266,269) and the role of broker accounts—accounts serving as unique sources of CRC racial equity information to their followers. Results: Among 19,559 tweets posted by 798 CRC equity disseminators, only 5.8% (n=1134) mentioned racially and ethnically minoritized groups. Most of these tweets (641/1134, 57%) addressed disparities in outcomes, while fewer emphasized actionable content, such as symptoms (11/1134, 1%) or screening procedures (159/1134, 14%). Expert accounts (n=479; 716 tweets) were more likely to post CRC equity tweets compared with nonexpert accounts (n=319; 418 tweets). Broker accounts (n=500), or those with a substantial portion of followers relying on them for equity-related information, demonstrated the highest capacity for exposing followers to CRC equity content, thereby extending the reach of these critical messages to underserved communities. Conclusions: This study emphasizes the critical roles played by expert and broker accounts in disseminating CRC racial equity information on social media. Despite the limited volume of equity-focused content, broker accounts were crucial in reaching otherwise unexposed audiences. Public health practitioners should focus on encouraging equity disseminators to share more actionable information, such as symptoms and screening benefits, and implement measures to amplify the reach of such content on social media. Strengthening these efforts could help bridge disparities in cancer outcomes among racially minoritized groups. %M 39899839 %R 10.2196/63864 %U https://www.jmir.org/2025/1/e63864 %U https://doi.org/10.2196/63864 %U http://www.ncbi.nlm.nih.gov/pubmed/39899839 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55275 %T Evaluating Reaction Videos of Young People Watching Edutainment Media (MTV Shuga): Qualitative Observational Study %A Baker,Venetia %A Mulwa,Sarah %A Khanyile,David %A Arnold,Georgia %A Cousens,Simon %A Cawood,Cherie %A Birdthistle,Isolde %+ Faculty of Epidemiology and Population Health, The London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom, 44 020 7636 8636, venetia.baker1@lshtm.ac.uk %K mass media %K edutainment %K adolescents %K sexual health %K HIV prevention %K participatory research %D 2025 %7 31.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mass media campaigns, particularly edutainment, are critical in disseminating sexual health information to young people. However, there is limited understanding of the authentic viewing experience or how viewing contexts influence engagement with media campaigns. Reaction videos, a popular format in web-based culture in which users film themselves reacting to television shows, can be adapted as a research method for immediate and unfiltered insights into young people’s engagement with edutainment media. Objective: We explored how physical and social context influences young people’s engagement with MTV Shuga, a dramatic television series based on sexual health and relationships among individuals aged 15 to 25 years. We trialed reaction videos as a novel research method to investigate how young people in South Africa experience the show, including sexual health themes and messages, in their viewing environments. Methods: In Eastern Cape, in 2020, purposively selected participants aged 18 to 24 years of an evaluation study were invited to take part in further research to video record themselves watching MTV Shuga episodes with their COVID-19 social bubble. To guide the analysis of the visual and audio data, we created a framework to examine the physical setting, group composition, social dynamics, coinciding activities, and viewers’ spoken and unspoken reactions to the show. We identified patterns within and across groups to generate themes about the nature and role of viewing contexts. We also reflected on the utility of the method and analytical framework. Results: In total, 8 participants recorded themselves watching MTV Shuga episodes in family or friendship groups. Viewings occurred around a laptop in the home (living room or bedroom) and outside (garden or vehicle). In same-age groups, viewers appeared relaxed, engaging with the content through discussion, comments, empathy, and laughter. Intergenerational groups experienced discomfort, with older relatives’ presence causing embarrassment and younger siblings’ distractions interrupting the engagement. Scenes featuring physical intimacy prompted some viewers to hide their eyes or leave the room. While some would prefer watching MTV Shuga alone to avoid the self-consciousness experienced in group settings, others valued the social experience and the lively discussions it spurred. This illustrates varied preferences for consuming edutainment and the factors influencing these preferences. Conclusions: The use of reaction videos for research captured real-time verbal and nonverbal reactions, physical environments, and social dynamics that other methods cannot easily measure. They revealed how group composition, dynamics, settings, and storylines can maximize engagement with MTV Shuga to enhance HIV prevention education. The presence of parents and the camera may alter young people’s behavior, limiting the authenticity of their viewing experience. Still, reaction videos offer a unique opportunity to understand audience engagement with media interventions and promote participatory digital research with young people. %M 39889281 %R 10.2196/55275 %U https://formative.jmir.org/2025/1/e55275 %U https://doi.org/10.2196/55275 %U http://www.ncbi.nlm.nih.gov/pubmed/39889281 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53188 %T Latinx and White Adolescents’ Preferences for Latinx-Targeted Celebrity and Noncelebrity Food Advertisements: Experimental Survey Study %A Bragg,Marie A %A Lutfeali,Samina %A Gabler,Daniela Godoy %A Quintana Licona,Diego A %A Harris,Jennifer L %+ Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, United States, 1 6465012717, marie.bragg@nyulangone.org %K Latinx %K Hispanic %K adolescents %K marketing %K celebrities %K Spanish %K advertisements %K products %K brands %K food %K unhealthy %K beverages %K diet %K nutrition %K consumers %K intention %K purchasing %K attitudes %K perceptions %K preferences %K youth %D 2025 %7 31.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Exposure to food advertisements is a major driver of childhood obesity, and food companies disproportionately target Latinx youth with their least healthy products. This study assessed the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents. Objective: This web-based within-subjects study aims to assess the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents’ preferences for the advertisements and featured products. Methods: Participants (N=903) were selected from a volunteer sample of adolescents, aged 13-17 years, who self-identified as Latinx or White, had daily internet access, and could read and write in English. They participated in a web-based Qualtrics study where each participant viewed 8 advertisements for novel foods and beverages, including 4 advertisements that featured Latinx celebrities and the same 4 advertisements that featured Latinx noncelebrities (matched on all other attributes), in addition to 2 neutral advertisements (featuring bland, nontargeted products and did not feature people). Primary outcomes were participants’ ratings of 4 advertisements for food and beverage brands featuring a Latinx celebrity and the same 4 advertisements featuring a Latinx noncelebrity. Multilevel linear regression models compared the effects of celebrities and differences between Latinx and White participants on attitudes (advertisement likeability; positive affect; and brand perceptions) and behavioral intentions (consumption; social media engagement—“liking;” following; commenting; tagging a friend). Results: Latinx (n=436; 48.3%) and White (n=467; 51.7%) participants rated advertisements featuring Latinx celebrities more positively than advertisements featuring noncelebrities on attitude measures except negative affect (Ps≤.002), whereas only negative affect differed between Latinx and White participants. Two of the 5 behavioral intention measures differed by celebrity advertisement status (P=.02; P<.001). Additionally, the interaction between celebrity and participant ethnicity was significant for 4 behavioral intentions; Latinx, but not White, participants reported higher willingness to consume the product (P<.001), follow brands (P<.001), and tag friends (P<.001). While White and Latinx adolescents both reported higher likelihoods of “liking” advertisements on social media endorsed by Latinx celebrities versus noncelebrities, the effect was significantly larger among Latinx adolescents (P<.01). Conclusions: This study demonstrates the power of Latinx celebrities in appealing to both Latinx and White adolescents but may be particularly persuasive in shaping behavioral intentions among Latinx adolescents. These findings suggest an urgent need to reduce celebrity endorsements in ethnically targeted advertisements that promote unhealthy food products to communities disproportionately affected by obesity and diabetes. The food industry limits food advertising to children ages 12 years and younger, but industry self-regulatory efforts and policies should expand to include adolescents and address disproportionate marketing of unhealthy food to Latinx youth and celebrity endorsements of unhealthy products. %M 39889276 %R 10.2196/53188 %U https://www.jmir.org/2025/1/e53188 %U https://doi.org/10.2196/53188 %U http://www.ncbi.nlm.nih.gov/pubmed/39889276 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e69554 %T Mindfulness Intervention for Health Information Avoidance in Older Adults: Mixed Methods Study %A Gu,Chenyu %A Qian,Liquan %A Zhuo,Xiaojie %+ School of Arts and Media, Wuhan College, No. 333 Huangjiahu Avenue, Jiangxia District, Hubei Province, Wuhan, 430212, China, 86 180 5922 1673, 3074@mju.edu.cn %K health information avoidance %K cyberchondria %K self-determination theory %K mindfulness %K elderly %D 2025 %7 28.1.2025 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The global aging population and rapid development of digital technology have made health management among older adults an urgent public health issue. The complexity of online health information often leads to psychological challenges, such as cyberchondria, exacerbating health information avoidance behaviors. These behaviors hinder effective health management; yet, little research examines their mechanisms or intervention strategies. Objective: This study investigates the mechanisms influencing health information avoidance among older adults, emphasizing the mediating role of cyberchondria. In addition, it evaluates the effectiveness of mindfulness meditation as an intervention strategy to mitigate these behaviors. Methods: A mixed methods approach was used, combining quantitative and qualitative methodologies. Substudy 1 developed a theoretical model based on self-determination theory to explore internal (positive metacognition and health self-efficacy) and external (subjective norms and health information similarity) factors influencing health information avoidance, with cyberchondria as a mediator. A cross-sectional survey (N=236) was conducted to test the proposed model. Substudy 2 involved a 4-week mindfulness meditation intervention (N=94) to assess its impact on reducing health information avoidance behaviors. Results: Study 1 showed that positive metacognition (β=.26, P=.002), health self-efficacy (β=.25, P<.001), and health information similarity (β=.29, P<.001) significantly predicted health information avoidance among older adults. Cyberchondria mediated these effects: positive metacognition (effect=0.106, 95% CI 0.035-0.189), health self-efficacy (effect=0.103, 95% CI 0.043-0.185), and health information similarity (effect=0.120, 95% CI 0.063-0.191). Subjective norms did not significantly predict health information avoidance (β=‒.11, P=.13), and cyberchondria did not mediate this relationship (effect=‒0.045, 95% CI ‒0.102 to 0.016). Study 2 found that after the 4-week mindfulness intervention, the intervention group (group 1: n=46) exhibited significantly higher mindfulness levels than the control group (group 2: n=48; Mgroup1=4.122, Mgroup2=3.606, P<.001) and higher levels compared with preintervention (Mt2=4.122, Mt1=3.502, P<.001, where t1=preintervention and t2=postintervention). However, cyberchondria levels did not change significantly (Mt1=2.848, Mt2=2.685, P=.18). Nevertheless, the results revealed a significant interaction effect between mindfulness and cyberchondria on health information avoidance (effect=‒0.357, P=.002, 95% CI ‒0.580 to ‒0.131), suggesting that mindfulness intervention effectively inhibited the transformation of cyberchondria into health information avoidance behavior. Conclusions: This study reveals the role of cyberchondria in health information avoidance and validates mindfulness meditation as an effective intervention for mitigating such behaviors. Findings offer practical recommendations for improving digital health information delivery and health management strategies for older adults. %M 39874579 %R 10.2196/69554 %U https://publichealth.jmir.org/2025/1/e69554 %U https://doi.org/10.2196/69554 %U http://www.ncbi.nlm.nih.gov/pubmed/39874579 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58656 %T Cross-Cultural Sense-Making of Global Health Crises: A Text Mining Study of Public Opinions on Social Media Related to the COVID-19 Pandemic in Developed and Developing Economies %A Kahlawi,Adham %A Masri,Firas %A Ahmed,Wasim %A Vidal-Alaball,Josep %+ Unitat de Recerca i Innovació, Gerència d'Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 36, Sant Fruitós de Bages, 08272, Spain, 34 936930040, jvidal.cc.ics@gencat.cat %K COVID-19 %K SARS-CoV-2 %K pandemic %K citizen opinion %K text mining %K LDA %K health crisis %K developing economies %K Italy %K Egypt %K UK %K dataset %K content analysis %K social media %K twitter %K tweet %K sentiment %K attitude %K perception %K perspective %K machine learning %K latent Dirichlet allocation %K vaccine %K vaccination %K public health %K infectious %D 2025 %7 27.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic reshaped social dynamics, fostering reliance on social media for information, connection, and collective sense-making. Understanding how citizens navigate a global health crisis in varying cultural and economic contexts is crucial for effective crisis communication. Objective: This study examines the evolution of citizen collective sense-making during the COVID-19 pandemic by analyzing social media discourse across Italy, the United Kingdom, and Egypt, representing diverse economic and cultural contexts. Methods: A total of 755,215 social media posts from X (formerly Twitter) were collected across 3 time periods: the virus' emergence (February 15 to March 31, 2020), strict lockdown (April 1 to May 30, 2020), and the vaccine rollout (December 1, 2020 to January 15, 2021). In total, 284,512 posts from Italy, 261,978 posts from the United Kingdom, and 209,725 posts from Egypt were analyzed using the latent Dirichlet allocation algorithm to identify key thematic topics and track shifts in discourse across time and regions. Results: The analysis revealed significant regional and temporal differences in collective sense-making during the pandemic. In Italy and the United Kingdom, public discourse prominently addressed pragmatic health care measures and government interventions, reflecting higher institutional trust. By contrast, discussions in Egypt were more focused on religious and political themes, highlighting skepticism toward governmental capacity and reliance on alternative frameworks for understanding the crisis. Over time, all 3 countries displayed a shift in discourse toward vaccine-related topics during the later phase of the pandemic, highlighting its global significance. Misinformation emerged as a recurrent theme across regions, demonstrating the need for proactive measures to ensure accurate information dissemination. These findings emphasize the role of cultural, economic, and institutional factors in shaping public responses during health crises. Conclusions: Crisis communication is influenced by cultural, economic, and institutional contexts, as evidenced by regional variations in citizen engagement. Transparent and culturally adaptive communication strategies are essential to combat misinformation and build public trust. This study highlights the importance of tailoring crisis responses to local contexts to improve compliance and collective resilience. %M 39869893 %R 10.2196/58656 %U https://www.jmir.org/2025/1/e58656 %U https://doi.org/10.2196/58656 %U http://www.ncbi.nlm.nih.gov/pubmed/39869893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64940 %T How Authoritative Media and Personal Social Media Influence Policy Compliance Through Trust in Government and Risk Perception: Quantitative Cross-Sectional Survey Study %A Zhang,Hua %A Yang,Cheng %A Deng,Xiuxian %A Luo,Chunyan %+ Guangxi Minzu University, 188 East Daxue Road, Nanning, 530000, China, 86 13538076494, 202221252000175@stu.gxmzu.edu.cn %K paradox of trust %K risk perception %K trust in government %K policy compliance %K pandemic %K authoritative media %K social media %K China %D 2025 %7 20.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies on public compliance with policies during pandemics have primarily explained it from the perspectives of motivation theory, focusing on normative motivation (trust in policy-making institutions) and calculative motivation (fear of contracting the disease). However, the social amplification of a risk framework highlights that the media plays a key role in this process. Objective: This study aims to integrate the motivation theory of compliance behavior and the social amplification of risk framework to uncover the “black boxes” of the mechanisms by which normative motivation and calculative motivation influence public policy compliance behavior through the use of media. Methods: During the COVID-19 pandemic, we conducted a web-based survey of 2309 Chinese citizens from December 4, 2022, to March 21, 2023. We treated the public’s policy compliance behavior during the pandemic as the dependent variable. Media use, specifically the use of authoritative media and “we-media,” that is, personal social media accounts and media platforms operated by individuals, was set as the independent variable. Trust in government, representing normative motivation, and risk perception, representing calculative motivation, were included as mediating variables. A structural equation model was constructed and analyzed using Stata. Results: First, the mediation effect of trust in government indicates that the use of authoritative media can enhance trust in government, which significantly increases individuals’ policy compliance behavior (β coefficient=0.108, 95% CI 0.080-0.135; P<.001). Second, the mediation effect of risk perception shows that the use of we-media heightened individual risk perception, thereby significantly enhancing policy compliance behavior (β coefficient=0.012, 95% CI 0.002-0.021; P=.02). Third, the study revealed the “paradox of trust”: the chain mediation effect in which authoritative media increased trust in government and reduced risk perception, ultimately decreasing policy compliance behavior (β coefficient=–0.005, 95% CI –0.009 to –0.001; P=.008). Conclusions: By combining the motivation theory of compliance behavior with the social amplification of risk framework in risk communication, we found that trust in government, as a normative motivation, operates through authoritative media, while risk perception, as a calculative motivation, promotes compliance behavior through we-media. In addition, in major crises, the public’s use of authoritative media can lead to the paradox of trust: on the one hand, trust in the government increases policy compliance; on the other hand, this trust reduces risk perception, thereby decreasing compliance behavior. Authoritative institutions need to balance providing authoritative information with maintaining the public’s risk perception. %M 39832177 %R 10.2196/64940 %U https://www.jmir.org/2025/1/e64940 %U https://doi.org/10.2196/64940 %U http://www.ncbi.nlm.nih.gov/pubmed/39832177 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60398 %T Sexual and Gender Minority Adolescents’ Preferences for HIV Pre-Exposure Prophylaxis Social Marketing Campaigns: Qualitative Preimplementation Study %A Macapagal,Kathryn %A Zapata,Juan Pablo %A Ma,Junye %A Gordon,Jacob D %A Owens,Christopher %A Valadez-Tapia,Silvia %A Cummings,Peter %A Walter,Nathan %A Pickett,Jim %+ Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 3605, kathryn.macapagal@northwestern.edu %K social marketing campaigns %K sexual and gender minority %K adolescent %K HIV %K pre-exposure prophylaxis %K PrEP %K human-centered design %K implementation science %K dissemination %D 2025 %7 17.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual and gender minority (SGM) adolescents in the United States are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical HIV prevention method, but its awareness and uptake among SGM adolescents are low. There are no adolescent-centered PrEP social marketing campaigns in the United States that have the potential to increase awareness and interest in PrEP. Objective: To address this gap, this qualitative study aims to examine SGM adolescents’ needs and preferences regarding adolescent-centered PrEP social marketing campaigns. Methods: SGM adolescents from Chicago and its surrounding areas participated in web-based asynchronous focus groups from February to May 2021. Questions elicited their preferences for content, design, and delivery of SGM adolescent–centered PrEP campaigns. We used rapid qualitative data analysis and organized the findings around key components of social marketing, known as the 4 Ps: product, price, place, and promotion. Results: Participants (N=56) were aged 14 to 19 years (mean 18.16, SD 1.22 y), and 64% (36/56) of them identified as a racial or ethnic minority. Among the 56 participants, 70% (n=39) were aware of PrEP; however, 95% (n=53) did not know that PrEP could be prescribed to those aged under 18 years. Adolescents expressed a need for PrEP campaign messaging that provides simple, accurate, and easily accessible information (eg, what is PrEP, for whom PrEP is indicated, and where and how to access PrEP). For product and price, SGM adolescents wanted a campaign to address barriers to, costs of, and how to access PrEP and desired to know about other adolescents’ PrEP experiences to improve campaign relatability. For place and promotion, participants preferred digital campaigns on social media to reduce the possibility of embarrassment and stigma and increase the accessibility of health content. Conclusions: These findings lay the groundwork for designing adolescent-centered educational PrEP campaigns that prioritize both user preferences in PrEP marketing design and strategies to overcome common barriers to PrEP awareness. %R 10.2196/60398 %U https://formative.jmir.org/2025/1/e60398 %U https://doi.org/10.2196/60398 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59352 %T The Association Between COVID-19 Vaccination Uptake and Information-Seeking Behaviors Using the Internet: Nationwide Cross-Sectional Study %A Taira,Kazuya %A Shiomi,Misa %A Nakabe,Takayo %A Imanaka,Yuichi %+ Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Shogoinkawara-cho, Sakyo-ku, Kyoto, 606-8501, Japan, 81 075 751 3927, taira.kazuya.5m@kyoto-u.ac.jp %K COVID-19 vaccines %K internet use %K information seeking behavior %K Japan %K vaccine %K COVID-19 %K behavior %K panel study %K longitudinal %K survey %K regression analysis %K chi-square test %K adult %K epidemiology %K health informatics %D 2025 %7 14.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic, declared in March 2020, profoundly affected global health, societal, and economic frameworks. Vaccination became a crucial tactic in combating the virus. Simultaneously, the pandemic likely underscored the internet’s role as a vital resource for seeking health information. The proliferation of misinformation on social media was observed, potentially influencing vaccination decisions and timing. Objective: This study aimed to explore the relationship between COVID-19 vaccination rates, including the timing of vaccination, and reliance on internet-based information sources in Japan. Methods: Using a cross-sectional study design using a subset of panel data, this nationwide survey was conducted in 7 waves. A total of 10,000 participants were randomly selected through an internet survey firm, narrowing down to 8724 after applying inclusion and exclusion criteria. The primary outcome was the COVID-19 vaccination date, divided into vaccinated versus unvaccinated and early versus late vaccination groups. The main exposure variable was the use of internet-based information sources. Control variables included gender, family structure, education level, employment status, household income, eligibility for priority COVID-19 vaccination due to pre-existing medical conditions, and a health literacy scale score. Two regression analyses using generalized estimating equations accounted for prefecture-specific correlations, focusing on vaccination status and timing. In addition, chi-square tests assessed the relationship between each information source and vaccination rates. Results: Representing a cross-section of the Japanese population, the regression analysis found a significant association between internet information seeking and higher vaccination rates (adjusted odds ratio [aOR] 1.42 for those younger than 65 years; aOR 1.66 for those aged 65 years and older). However, no significant link was found regarding vaccination timing. Chi-square tests showed positive associations with vaccination for television, government web pages, and web news, whereas blogs and some social networking sites were negatively correlated. Conclusions: Internet-based information seeking is positively linked to COVID-19 vaccination rates in Japan, underscoring the significant influence of online information on public health decisions. Nonetheless, certain online information sources, including blogs and some social networks, negatively affected vaccination rates, warranting caution in their use and recognition. The study highlights the critical role of credible online sources in public health communication and the challenge of combating misinformation on less regulated platforms. This research sheds light on how the digital information landscape influences health behaviors, stressing the importance of accurate and trustworthy health information amidst global health emergencies. %M 39808493 %R 10.2196/59352 %U https://www.jmir.org/2025/1/e59352 %U https://doi.org/10.2196/59352 %U http://www.ncbi.nlm.nih.gov/pubmed/39808493 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66121 %T The Use of Social Media on Enhancing Dental Care and Practice Among Dental Professionals: Cross-Sectional Survey Study %A Acosta,Joseph Macadaeg %A Detsomboonrat,Palinee %A Pisarnturakit,Pagaporn Pantuwadee %A Urwannachotima,Nipaporn %K social media %K oral health promotion %K oral health education %K dentists %K dental practice %K dental professionals %K dental practitioners %D 2025 %7 3.1.2025 %9 %J JMIR Form Res %G English %X Background: As digitalization continues to advance globally, the health care sector, including dental practice, increasingly recognizes social media as a vital tool for health care promotion, patient recruitment, marketing, and communication strategies. Objective: This study aimed to investigate the use of social media and assess its impact on enhancing dental care and practice among dental professionals in the Philippines. Methods: A cross-sectional survey was conducted among dental practitioners in the Philippines. The study used a 23-item questionnaire, which included 5 questions on dentists’ background and demographic information and 18 questions regarding the use, frequency, and purpose of social media in patient advising and quality of care improvement. Data were analyzed using SPSS software, with frequency distributions and χ2 tests used to assess the association between social media use and demographic variables and the impact on dental practice. Results: The 265 dental practitioners in this study were predominantly female (n=204, 77%) and aged between 20‐30 years (n=145, 54.7%). Most of the participants were general practitioners (n=260, 98.1%) working in a private practice (n=240, 90.6%), with 58.5% (n=155) having 0‐5 years of clinical experience. Social media use was significantly higher among younger practitioners (20‐30 years old) compared to older age groups (P<.001), though factors such as sex, dental specialty, and years of clinical practice did not significantly influence use. The majority (n=179, 67.5%) reported using social media in their practice, primarily for oral health promotion and education (n=191, 72.1%), connecting with patients and colleagues (n=165, 62.3%), and marketing (n=150, 56.6%). Facebook (n=179, 67.5%) and YouTube (n=163, 61.5%) were the most frequented platforms for clinical information, with Twitter (subsequently rebranded X) being the least used (n=4, 1.5%). Despite widespread social media engagement, only 8.7% (n=23) trusted the credibility of web-based information, and 63.4% (n=168) perceived a potential impact on the patient-dentist relationship due to patients seeking information on the internet. Social media was also perceived to enhance practice quality, with users reporting significant improvements in patient care (P=.001). Conclusions: The findings highlight that social media is widely used among younger dental practitioners, primarily for education, communication, and marketing purposes. While social media use is associated with perceived improvements in practice quality and patient care, trust in information on social media remains low, and concerns remain regarding its effect on patient relationships. It is recommended to establish enhanced guidelines and provide reliable web-based resources to help dental practitioners use social media effectively and responsibly. %R 10.2196/66121 %U https://formative.jmir.org/2025/1/e66121 %U https://doi.org/10.2196/66121 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59786 %T US State Public Health Agencies' Use of Twitter From 2012 to 2022: Observational Study %A Mendez,Samuel R %A Munoz-Najar,Sebastian %A Emmons,Karen M %A Viswanath,Kasisomayajula %+ Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States, 1 617 432 1135, smendez@g.harvard.edu %K social media %K health communication %K Twitter %K tweet %K public health %K state government %K government agencies %K information technology %K data science %K communication tool %K COVID-19 pandemic %K data collection %K theoretical framework %K message %K interaction %D 2025 %7 3.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Twitter (subsequently rebranded as X) is acknowledged by US health agencies, including the US Centers for Disease Control and Prevention (CDC), as an important public health communication tool. However, there is a lack of data describing its use by state health agencies over time. This knowledge is important amid a changing social media landscape in the wake of the COVID-19 pandemic. Objective: The study aimed to describe US state health agencies’ use of Twitter from 2012 through 2022. Furthermore, we organized our data collection and analysis around the theoretical framework of the networked public to contribute to the broader literature on health communication beyond a single platform. Methods: We used Twitter application programming interface data as indicators of state health agencies’ engagement with the 4 key qualities of communication in a networked public: scalability, persistence, replicability, and searchability. To assess scalability, we calculated tweet volume and audience engagement metrics per tweet. To assess persistence, we calculated the portion of tweets that were manual retweets or included an account mention. To assess replicability, we calculated the portion of tweets that were retweets or quote tweets. To assess searchability, we calculated the portion of tweets using at least 1 hashtag. Results: We observed a COVID-19 pandemic–era shift in state health agency engagement with scalability. The overall volume of tweets increased suddenly from less than 50,000 tweets in 2019 to over 94,000 in 2020, resulting in an average of 5.3 per day. Though mean tweets per day fell in 2021 and 2022, this COVID-19 pandemic–era low was still higher than the pre–COVID-19 pandemic peak. We also observed a more fragmented approach to searchability aligning with the start of the COVID-19 pandemic. More state-specific hashtags were among the top 10 during the COVID-19 pandemic, compared with more general hashtags related to disease outbreaks and natural disasters in years before. We did not observe such a clear COVID-19 pandemic–era shift in engagement with replicability. The portion of tweets mentioning a CDC account gradually rose and fell around a peak of 7.0% in 2018. Similarly, the rate of retweets of a CDC account rose and fell gradually around a peak of 5.4% in 2018. We did not observe a clear COVID-19 pandemic–era shift in persistence. The portion of tweets mentioning any account reached a maximum of 21% in 2013. It oscillated for much of the study period before dropping off in 2021 and reaching a minimum of 10% in 2022. Before 2018, the top 10 mentioned accounts included at least 2 non-CDC or corporate accounts. From 2018 onward, state agencies were much more prominent. Conclusions: Overall, we observed a more fragmented approach to state health agency communication on Twitter during the pandemic, prioritizing volume over searchability, formally replicating existing messages, and leaving traces of interactions with other accounts. %M 39752190 %R 10.2196/59786 %U https://www.jmir.org/2025/1/e59786 %U https://doi.org/10.2196/59786 %U http://www.ncbi.nlm.nih.gov/pubmed/39752190 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49567 %T An Analysis of the Prevalence and Trends in Drug-Related Lyrics on Twitter (X): Quantitative Approach %A Luo,Waylon %A Jin,Ruoming %A Kenne,Deric %A Phan,NhatHai %A Tang,Tang %+ Department of Computer Science, Kent State University, 1300 Lester A Lefton Esplanade, Kent, OH, 44241, United States, 1 330 672 9063, rjin1@kent.edu %K Twitter (X) %K popular music %K big data analysis %K music %K lyrics %K big data %K substance abuse %K tweet %K social media %K drug %K alcohol %D 2024 %7 30.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The pervasiveness of drug culture has become evident in popular music and social media. Previous research has examined drug abuse content in both social media and popular music; however, to our knowledge, the intersection of drug abuse content in these 2 domains has not been explored. To address the ongoing drug epidemic, we analyzed drug-related content on Twitter (subsequently rebranded X), with a specific focus on lyrics. Our study provides a novel finding on the prevalence of drug abuse by defining a new subcategory of X content: “tweets that reference established drug lyrics.” Objective: We aim to investigate drug trends in popular music on X, identify and classify popular drugs, and analyze related artists’ gender, genre, and popularity. Based on the collected data, our goal is to create a prediction model for future drug trends and gain a deeper understanding of the characteristics of users who cite drug lyrics on X. Methods: X data were collected from 2015 to 2017 through the X streaming application programming interface (API). Drug lyrics were obtained from the Genius lyrics database using the Genius API based on drug keywords. The Smith-Waterman text-matching algorithm is used to detect the drug lyrics in posts. We identified famous drugs in lyrics that were posted. Consequently, the analysis was extended to related artists, songs, genres, and popularity on X. The frequency of drug-related lyrics on X was aggregated into a time-series, which was then used to create prediction models using linear regression, Facebook Prophet, and NIXTLA TimeGPT-1. In addition, we analyzed the number of followers of users posting drug-related lyrics to explore user characteristics. Results: We analyzed over 1.97 billion publicly available posts from 2015 to 2017, identifying more than 157 million that matched drug-related keywords. Of these, 150,746 posts referenced drug-related lyrics. Cannabinoids, opioids, stimulants, and hallucinogens were the most cited drugs in lyrics on X. Rap and hip-hop dominated, with 91.98% of drug-related lyrics from these genres and 84.21% performed by male artists. Predictions from all 3 models, linear regression, Facebook Prophet, and NIXTLA TimeGPT-1, indicate a slight decline in the prevalence of drug-related lyrics on X over time. Conclusions: Our study revealed 2 significant findings. First, we identified a previously unexamined subset of drug-related content on X: drug lyrics, which could play a critical role in models predicting the surge in drug-related incidents. Second, we demonstrated the use of cutting-edge time-series forecasting tools, including Facebook Prophet and NIXTLA TimeGPT-1, in accurately predicting these trends. These insights contribute to our understanding of how social media shapes public behavior and sentiment toward drug use. %M 39753225 %R 10.2196/49567 %U https://formative.jmir.org/2024/1/e49567 %U https://doi.org/10.2196/49567 %U http://www.ncbi.nlm.nih.gov/pubmed/39753225 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e63464 %T Navigating Awareness and Strategies to Support Dementia Advocacy on Social Media During World Alzheimer’s Month: Infodemiology Study %A Bacsu,Juanita-Dawne %A Fraser,Sarah Anne %A Jamali,Ali Akbar %A Conanan,Christine %A Chasteen,Alison L %A Vellani,Shirin %A Gowda-Sookochoff,Rory %A Berger,Corinne %A Mah,Jasmine C %A Fehr,Florriann %A Virani,Anila %A Rahemi,Zahra %A Nanson,Kate %A Cammer,Allison %A Andrew,Melissa K %A Grewal,Karl S %A McGilton,Katherine S %A Lautrup,Samantha %A Spiteri,Raymond J %+ Population Health and Aging Rural Research Centre, School of Nursing, Thompson Rivers University, 805 TRU Way, Kamloops, BC, V2C 0C8, Canada, 1 1 250 371 5538, jbacsu@tru.ca %K dementia %K Alzheimer disease %K advocacy %K stigma %K myths %K awareness %K social media %K political lobbying %K lobbying %K X %K Twitter %K tweet %K thematic %K promotion %K campaign %K geriatric %K aging %D 2024 %7 27.12.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Understanding advocacy strategies is essential to improving dementia awareness, reducing stigma, supporting cognitive health promotion, and influencing policy to support people living with dementia. However, there is a dearth of evidence-based research on advocacy strategies used to support dementia awareness. Objective: This study aimed to use posts from X (formerly known as Twitter) to understand dementia advocacy strategies during World Alzheimer’s Awareness Month in September 2022. Methods: Posts were scraped from X during World Alzheimer’s Awareness Month from September 1, 2022, to September 30, 2022. After applying filters, 1981 relevant posts were analyzed using thematic analysis, and measures were taken to support trustworthiness and rigor. Results: Our study revealed a variety of advocacy strategies, including sharing the voices of lived experience, targeting ethnic and cultural groups, myth-busting strategies, and political lobbying. Although a range of strategies were identified, further research is needed to examine advocacy strategies within different countries and political contexts. Furthermore, the impact of specific strategies on stigma reduction, cognitive health promotion, and policy change needs to be scientifically evaluated. Conclusions: Our study offers valuable insight into strategies to bolster dementia advocacy and awareness campaigns to support people living with dementia. Findings from our research may provide critical insight for policymakers, organizations, and health professionals working to reduce dementia-related stigma and increase the uptake of risk-reduction activities to support the promotion of cognitive health. %M 39729354 %R 10.2196/63464 %U https://infodemiology.jmir.org/2024/1/e63464 %U https://doi.org/10.2196/63464 %U http://www.ncbi.nlm.nih.gov/pubmed/39729354 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58581 %T Implementation of a Social Media Strategy for Public Health Promotion in Black, American Indian or Alaska Native, and Hispanic or Latino Communities During the COVID-19 Pandemic: Cross-Sectional Study %A Mora Pinzon,Maria %A Hills,Ornella %A Levy,George %A James,Taryn T %A Benitez,Ashley %A Lawrence,Sacheen %A Ellis,Tiffany %A Washington,Venus %A Solorzano,Lizbeth %A Tellez-Giron,Patricia %A Cano Ospina,Fernando %A Metoxen,Melissa F %A Gleason,Carey E %+ Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin - Madison, 610 Walnut st, Madison, WI, 53726, United States, 1 6088902524, mmora2@wisc.edu %K health communications %K social media %K Hispanic %K Latino %K Black %K American Indian %K Alaska Native %K minority health %K health disparities %K COVID-19 %D 2024 %7 10.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals identifying as Black, American Indian or Alaska Native, or Hispanic or Latino lack access to culturally appropriate accurate information and are the target of disinformation campaigns, which create doubt in science and health care providers and might play a role in sustaining health disparities related to the COVID-19 pandemic. Objective: This study aims to create and disseminate culturally and medically appropriate social media messages for Black, Latino, and American Indian or Alaska Native communities in Wisconsin and evaluate their reach and effectiveness in addressing the information needs of these communities. Methods: Our team identified relevant COVID-19 topics based on feedback from their respective community, developed lay format materials, and translated materials into culturally appropriate social media messages that community advocates delivered across their respective communities. Social media metrics (reach, engagement, and impressions) were collected using Sprout Social and Facebook Analytics. We hosted 9 focus groups with community members to learn about their social media use. These data were analyzed using an inductive approach, using NVivo software (release 1.7) to code content. Results: Between August 2021 and January 2023, we created 980 unique social media posts that reached 88,790 individuals and gathered >6700 engagements. Average reach per post was similar across the 3 communities, despite differences in the number of posts and followers on each page: 119.46 (Latino individuals), 111.74 (Black individuals), and 113.11 (Oneida Nation members). The type of posts that had higher engagement rate per reached person (ERR) varied across communities and platforms, with the highest being live videos for the Latino community on Facebook (ERR 9.4%), videos for the Black community on Facebook (ERR 19.53%), and social media messages for the Oneida Nation community (ERR 59.01%). Conclusions: Our project presents a unique and effective model for health messages and highlights the need for tailoring social media messages and approaches for minoritized audiences (eg, age, gender, race, and ethnicity). Further research studies are needed to explore how specific types of information affect the dissemination of information and the implications for health communications. %R 10.2196/58581 %U https://www.jmir.org/2024/1/e58581 %U https://doi.org/10.2196/58581 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63035 %T Public Perceptions of Very Low Nicotine Content on Twitter: Observational Study %A Xie,Zidian %A Liu,Xinyi %A Lou,Xubin %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard Cu 420708, Rochester, NY, 14642-0001, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K very low nicotine %K Twitter %K public perception %K observational study %K content analysis %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Nicotine is a highly addictive agent in tobacco products. On June 21, 2022, the US Food and Drug Administration (FDA) announced a plan to propose a rule to establish a maximum nicotine level in cigarettes and other combusted tobacco products. Objective: This study aimed to understand public perception and discussion of very low nicotine content (VLNC) on Twitter (rebranded as X in July 2023). Methods: From December 12, 2021, to January 1, 2023, we collected Twitter data using relevant keywords such as “vln,” “low nicotine,” and “reduced nicotine.” After a series of preprocessing steps (such as removing duplicates, retweets, and commercial tweets), we identified 3270 unique noncommercial tweets related to VLNC. We used an inductive method to assess the public perception and discussion of VLNC on Twitter. To establish a codebook, we randomly selected 300 tweets for hand-coding, including the attitudes (positive, neutral, and negative) toward VLNC (including its proposed rule) and major topics (13 topics). The Cohen κ statistic between the 2 human coders reached over 70%, indicating a substantial interrater agreement. The rest of the tweets were single-coded according to the codebook. Results: We observed a significant peak in the discussion of VLNC on Twitter within 4 days of the FDA’s announcement of the proposed rule on June 21, 2022. The proportion of tweets with a negative attitude toward VLNC was significantly lower than those with a positive attitude, 24.5% (801/3270) versus 37.09% (1213/3270) with P<.001 from the 2-proportion z test. Among tweets with a positive attitude, the topic “Reduce cigarette consumption or help smoking cessation” was dominant (1097/1213, 90.44%). Among tweets with a negative attitude, the topic “VLNC leads to more smoking” was the most popular topic (227/801, 28.34%), followed by “Similar toxicity of VLNC as a regular cigarette” (223/801, 27.84%), and “VLNC is not a good method for quitting smoking” (211/801, 26.34%). Conclusions: There is a more positive attitude toward VLNC than a negative attitude on Twitter, resulting from different opinions about VLNC. Discussions around VLNC mainly focused on whether VLNC could help people quit smoking. %M 39631065 %R 10.2196/63035 %U https://formative.jmir.org/2024/1/e63035 %U https://doi.org/10.2196/63035 %U http://www.ncbi.nlm.nih.gov/pubmed/39631065 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e63410 %T Extent and Nature of Television Food and Nonalcoholic Beverage Marketing in 9 Asian Countries: Cross-Sectional Study Using a Harmonized Approach %A Karupaiah,Tilakavati %A Rahman,Shah Md Mahfuzur %A Zhang,Juan %A Kumar,Naveen %A Jamiyan,Batjargal %A Pokharel,Raj Kumar %A Borazon,Elaine Quintana %A Thoradeniya,Tharanga %A Tho,Nguyen Thi Thi %A Mackay,Sally %A Kelly,Bridget %A Swinburn,Boyd %A Chinna,Karuthan %A Dashzeveg,Enkhmyagmar %A Ong,Gild Rick %A Narayanan,Sreelakshmi Sankara %A Sameeha,Mohd Jamil %A Uddin,Mohammad Ahsan %A Tang,Yuxiang %A Sharma,Naresh Kumar %A Pokharel,Rishav %A Rome,Anna Christine %A Wickramasinghe,V Pujitha %A Huy,Phan Thanh %+ School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, 1, Jln Taylors, Subang Jaya, 47500, Malaysia, 60 192731400, tilakavati.karupaiah@taylors.edu.my %K children %K Asian food marketing %K television %K unhealthy food %K WHO nutrient profile model %K World Health Organization %K pediatrics %K commercial %K Asia %K unhealthy %K nutrition %K diet %K market %K advertisement %K food %K beverage %K consumption %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Rising childhood obesity rates in Asia are adding risk for the future adult burden of obesity and noncommunicable diseases. Weak policies across most Asian countries enable unrestricted marketing of obesogenic foods and beverages to children. Television is the common medium for food marketing to reach this audience. Objective: This study aimed to assess the extent and nature of television food and nonalcoholic beverage marketing in 9 Asian countries (Bangladesh, China, India, Malaysia, Mongolia, Nepal, the Philippines, Sri Lanka, and Vietnam) with capacity building support from the International Network for Food and Obesity/Non-Communicable Disease Research, Monitoring and Action Support, who enabled harmonization of data collection method and content analyses. Methods: Advertised foods were categorized as permitted or not permitted based on the nutrient profile models established by the World Health Organization regional offices for South-East Asia (SEARO) and the World Health Organization regional offices for Western Pacific (WPRO). Overall rates of food advertisements (advertisements per hour per channel) and persuasive strategy use were analyzed along with comparisons between children’s peak viewing time (PVT) and non-PVT. Results: Cross-country comparisons, irrespective of country income level, indicated that not permitted food advertising dominated children’s popular television channels, especially during PVT with rates as per WPRO or SEARO criteria ranging from 2.40/2.29 (Malaysia) to 9.70/9.41 advertisements per hour per channel (the Philippines). Persuasive strategy rates were also comparatively higher during PVT. Sugar-sweetened beverages, sugar-containing solid foods, and high salt- and fat-containing snacks and fast foods were frequently advertised. Evaluation of the application of WPRO and SEARO nutrient profile models identified inconsistencies due to regional taste and cuisine variations across Asia. Conclusions: This study clearly showed that unhealthy food marketing through popular children’s television channels is widely occurring in Asia and is a clear breach of child rights. Evidence outcomes will benefit advocacy toward stronger policy regulations to control unhealthy food marketing and strengthen strategies to promote a healthier food environment for Asia’s children. %M 39630493 %R 10.2196/63410 %U https://pediatrics.jmir.org/2024/1/e63410 %U https://doi.org/10.2196/63410 %U http://www.ncbi.nlm.nih.gov/pubmed/39630493 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54420 %T Recruitment for Voluntary Video and Mobile HIV Testing on Social Media Platforms During the COVID-19 Pandemic: Cross-Sectional Study %A Chiou,Piao-Yi %A Tsao,Wei-Wen %A Li,Chia-Lin %A Yu,Jheng-Min %A Su,Wen-Han %A Liu,Zhi-Hua %A He,Cheng-Ru %A Chang,Yu-Chun %A Tsai,Yi-Hsuan %+ School of Nursing, National Taiwan University College of Medicine, No. 2-1, Xuzhou Rd., Zhongzheng Dist.,, Taipei, 10051, Taiwan, 886 0935883722 ext 288427, purechiou2@gmail.com %K COVID-19 %K HIV testing %K mobile health %K risk-taking behavior %K social media %K video %K mobile phone %D 2024 %7 28.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic prompted social distancing policies and caused misinformation that hindered in-person HIV screening for high-risk groups. Social media platforms provide additional options for voluntary counseling and testing (VCT) for HIV, overcoming these limitations. However, there is a lack of data on HIV testing recruitment through social media platforms and its outcomes during the pandemic. Objective: This study aimed to measure the rate of face-to-face mobile and video VCT conducted after recruitment through social media platforms and friend referrals during the pandemic and compare the geographic distribution, risk feature targeting, testing outcome, and cost between the 2 models. Methods: Data were collected from March 3 to December 31, 2021, during the COVID-19 outbreak in Taiwan. Participants engaging in unprotected sex were recruited. After one-on-one message discussions through the platforms, the well-trained research assistants provided mobile or video VCT based on the participants’ availability. Primary outcomes were completion rate, testing results, and CD4 count. Secondary outcomes included demographic and HIV risk-taking and protective features from a questionnaire. Selection bias was controlled by adjusting for the testing site (Taipei vs non-Taipei) using univariable multinomial logistic regression. Results: This study gathered 5142 responses on the social media platforms, recruiting 1187 participants. Video VCT had a completion rate of 31.8% (207/651), higher than mobile VCT’s 21.8% (980/4491). Both rates were higher than those before the COVID-19 pandemic. Recruitment through friend referrals, instant messaging apps (eg, Line [LY Corporation]), and geosocial dating apps (eg, Hornet [Queer Networks Inc], Grindr [Grindr LLC], and Gsland [Tien-Hao Tsai]) resulted in higher acceptance and completion rates than social networks (eg, Facebook [Meta], X [formerly Twitter], and Instagram [Meta]). Mobile VCT had higher recruitment among urban residents and screening density, while video VCT reached a broader geographic area. The mobile group was more likely to have had more than 10 sexual partners (odds ratio [OR] 1.92, 95% CI 1.05-3.50; P=.03), history of sex work (OR 4.19, 95% CI 1.68-10.43; P=.002), and sexually transmitted diseases (OR 2.23, 95% CI 1.18-4.23; P=.01) within the past 3 months. The video group was more likely to meet sexual partners through social media. The HIV-positive rate in the mobile group was 0.7% (7/973) with an average CD4 count of 460/μL, while in the video group, it was 1% (2/205) with an average CD4 count of 347/μL, indicating a later diagnosis. Both positivity rates were higher than those before the COVID-19 pandemic, with no significant difference between the groups. The video group cost US $54.68 per participant, slightly higher than the US $50.36 for the mobile group. Conclusions: Recruiting through social media platforms that facilitate one-on-one message discussions can effectively target high-risk groups for mobile and video VCT. This approach should be integrated into the current screening model to enhance HIV case finding. %M 39607762 %R 10.2196/54420 %U https://www.jmir.org/2024/1/e54420 %U https://doi.org/10.2196/54420 %U http://www.ncbi.nlm.nih.gov/pubmed/39607762 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59742 %T Elements Influencing User Engagement in Social Media Posts on Lifestyle Risk Factors: Systematic Review %A Yip,Yan Yee %A Makmor-Bakry,Mohd %A Chong,Wei Wen %+ Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia, 60 39289711, weiwen@ukm.edu.my %K chronic disease %K health promotion %K internet %K primary prevention %K social media %K systematic reviews %K health care professional %K health personnel %K user engagement %K lifestyle %K risk %D 2024 %7 22.11.2024 %9 Review %J J Med Internet Res %G English %X Background: The high prevalence of noncommunicable diseases and the growing importance of social media have prompted health care professionals (HCPs) to use social media to deliver health information aimed at reducing lifestyle risk factors. Previous studies have acknowledged that the identification of elements that influence user engagement metrics could help HCPs in creating engaging posts toward effective health promotion on social media. Nevertheless, few studies have attempted to comprehensively identify a list of elements in social media posts that could influence user engagement metrics. Objective: This systematic review aimed to identify elements influencing user engagement metrics in social media posts by HCPs aimed to reduce lifestyle risk factors. Methods: Relevant studies in English, published between January 2006 and June 2023 were identified from MEDLINE or OVID, Scopus, Web of Science, and CINAHL databases. Included studies were those that examined social media posts by HCPs aimed at reducing the 4 key lifestyle risk factors. Additionally, the studies also outlined elements in social media posts that influenced user engagement metrics. The titles, abstracts, and full papers were screened and reviewed for eligibility. Following data extraction, narrative synthesis was performed. All investigated elements in the included studies were categorized. The elements in social media posts that influenced user engagement metrics were identified. Results: A total of 19 studies were included in this review. Investigated elements were grouped into 9 categories, with 35 elements found to influence user engagement. The 3 predominant categories of elements influencing user engagement were communication using supportive or emotive elements, communication aimed toward behavioral changes, and the appearance of posts. In contrast, the source of post content, social media platform, and timing of post had less than 3 studies with elements influencing user engagement. Conclusions: Findings demonstrated that supportive or emotive communication toward behavioral changes and post appearance could increase postlevel interactions, indicating a favorable response from the users toward posts made by HCPs. As social media continues to evolve, these elements should be constantly evaluated through further research. %M 39576982 %R 10.2196/59742 %U https://www.jmir.org/2024/1/e59742 %U https://doi.org/10.2196/59742 %U http://www.ncbi.nlm.nih.gov/pubmed/39576982 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51594 %T Social Media Marketing Strategies for Electronic Cigarettes: Content Analysis of Chinese Weibo Accounts %A Zhou,Xinyi %A Hao,Xinyu %A Chen,Yuhang %A Deng,Hui %A Fang,Ling %A Zhang,Lingyun %A Yan,Xiaotao %A Zheng,Pinpin %A Wang,Fan %+ Fudan Development Institute, Fudan University, Think Tank Building, Room 415, 220 Handan Road, Shanghai, 200433, China, 86 21 55664081, wangfan512@126.com %K e-cigarette %K marketing strategy %K social media %K teenagers %K content analysis %D 2024 %7 7.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: E-cigarettes have gained popularity among teenagers due to extensive marketing strategies on social media platforms. This widespread promotion is a risk factor, as it fosters more positive attitudes toward e-cigarette use among teenagers and increases the perception that using e-cigarettes is normal. Therefore, the marketing of e-cigarettes on social media is a serious global health concern, and its strategies and impact should be clearly identified. Objective: This study examined how e-cigarette companies popularize their products via Weibo and identified the specific strategies influencing the effectiveness of their marketing. Methods: In phase 1, we conducted a search on Qcc.com and identified 32 e-cigarette brands with active Weibo accounts between October 1 and December 31, 2020, along with 863 Weibo posts. The data were investigated through content analysis. The codebook was developed into four categories: (1) product and features, (2) sales and promotions, (3) social contact and interaction, and (4) restrictions and warnings. To further understand the factors influencing e-cigarette brand marketing, we conducted a multiple linear regression analysis. Results: Marketing tactics by e-cigarette companies on Chinese social media were documented, including emphasizing attractive product features, using trendy characters, implicit promotions, downplaying health concerns, and engaging with Weibo users in various ways. Out of 863 posts, 449 (52%) mentioned product characteristics. In 313 (36.3%) posts, visible figures were used to attract attention. Product promotion was absent in 762 (88.3%) posts, and purchase channels were not mentioned in 790 (98.3%) posts. Social interaction–related posts received attention (n=548, 63.5%), particularly those featuring hashtag content (n=538, 62.3%). Most posts did not include claims for restrictions on teenagers' purchases or use (n=687, 79.6%) or information on health warnings (n=839, 97.2%). Multiple linear regression analysis identified marketing strategies that effectively increase the exposure of e-cigarette posts on Weibo. Posts including engagement via posts encouraging reposts, comments, and likes (P<.001) and engagement topics related to e-cigarette brands were positively correlated with the number of reposts (P=.009). Posts highlighting nonmonetary incentives (P=.004), posts with age restriction statements (P<.001), engaging via stories and idea collection (P<.001), and engagement topics related to products (P<.001) and current affairs (P=.002) had a positive effect on the number of comments. Engagement topics related to brands (P<.001) or interactive sweepstakes (P<.001) had a positive effect on the number of likes. Conclusions: E-cigarette posts on Weibo that focus on product features and social interaction attract public attention, especially from teenagers. Stricter regulations and monitoring should be adopted to restrict the social media marketing of e-cigarettes. %M 39509702 %R 10.2196/51594 %U https://www.jmir.org/2024/1/e51594 %U https://doi.org/10.2196/51594 %U http://www.ncbi.nlm.nih.gov/pubmed/39509702 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52738 %T Effects of Message Framing on Human Papillomavirus Vaccination: Systematic Review %A Gong,Jie %A Gu,Dandan %A Dong,Suyun %A Shen,Wangqin %A Yan,Haiou %A Xie,Juan %+ Department of Nursing, Affiliated Hospital of Nantong University, Nursing and Rehabilitation School of Nantong University, No. 20 West Temple Road, Nantong, 226001, China, 86 13912288333, xjjx@ntu.edu.cn %K message framing %K gain-loss framing %K human papillomavirus %K vaccination %K attitude %K intention %K behavior %K systematic review %K PRISMA %D 2024 %7 7.11.2024 %9 Review %J J Med Internet Res %G English %X Background: With the advancement of cervical cancer elimination strategies, promoting human papillomavirus (HPV) vaccination is essential to achieving this goal. The issue of how to structure and develop message content to promote HPV vaccination is a debatable issue. Objective: The efficacy of gain-loss framing in vaccination contexts is disputed. Our study aimed to elucidate the consequences of message framing on attitudes, intentions, and behavioral tendencies toward HPV vaccination, with the objective of refining message framing strategies and their elements. Methods: This systematic review adhered strictly to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guideline reporting standards to comprehensively retrieve, extract, and integrate data. We searched databases, including PubMed, Embase, Scopus, and Web of Science, for literature published from database construction to August 15, 2023. Literature screening, data extraction, and quality evaluation were performed by 2 researchers. Intervention studies published in English, conducted with populations with children eligible for HPV vaccination, and involving message framing were included. Attitudes, intentions, and behaviors served as outcome evaluation criteria. Results: A total of 19 intervention studies were included. Gain-loss framing had no clear effect on vaccination attitudes nor intentions. Loss framing showed a weak advantage at improving HPV vaccination attitudes or intentions, but the evidence was not strong enough to draw definitive conclusions. The impact of gain-loss framing on HPV vaccination behaviors could not be determined due to the limited number of studies and the qualitative nature of the analysis. Conclusions: Combining gain-loss framing with other message framing approaches may be an effective way to enhance the effect of message framing. More high-quality message framing content and exploring alternative moderator or mediator variables are required to support the conclusion. Trial Registration: CRD42023451612; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=451612 %R 10.2196/52738 %U https://www.jmir.org/2024/1/e52738 %U https://doi.org/10.2196/52738 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55311 %T The Validity of Impressions as a Media Dose Metric in a Tobacco Public Education Campaign Evaluation: Observational Study %A Davis,Kevin %A Curry,Laurel %A Bradfield,Brian %A Stupplebeen,David A %A Williams,Rebecca J %A Soria,Sandra %A Lautsch,Julie %+ RTI International, 701 13th St. NW, Ste 750, Washington, DC, 20005, United States, 1 202 728 2086, lcurry@rti.org %K communication %K public education %K tobacco %K media %K public health %D 2024 %7 5.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Evaluation research increasingly needs alternatives to target or gross rating points to comprehensively measure total exposure to modern multichannel public education campaigns that use multiple channels, including TV, radio, digital video, and paid social media, among others. Ratings data typically only capture delivery of broadcast media (TV and radio) and excludes other channels. Studies are needed to validate objective cross-channel metrics such as impressions against self-reported exposure to campaign messages. Objective: This study aimed to examine whether higher a volume of total media campaign impressions is predictive of individual-level self-reported campaign exposure in California. Methods: We analyzed over 3 years of advertisement impressions from the California Tobacco Prevention Program’s statewide tobacco education campaigns from August 2019 through December 2022. Impressions data varied across designated market areas (DMAs) and across time. These data were merged to individual respondents from 45 waves of panel survey data of Californians aged 18-55 years (N=151,649). Impressions were merged to respondents based on respondents’ DMAs and time of survey completion. We used logistic regression to estimate the odds of respondents’ campaign recall as a function of cumulative and past 3-month impressions delivered to each respondent’s DMA. Results: Cumulative impressions were positively and significantly associated with recall of each of the Flavors Hook Kids (odds ratio [OR] 1.15, P<.001), Dark Balloons and Apartment (OR 1.20, P<.001), We Are Not Profit (OR 1.36, P<.001), Tell Your Story (E-cigarette, or Vaping, product use Associated Lung Injury; OR 1.06, P<.05), and Thrown Away and Little Big Lies (OR 1.05, P<.01) campaigns. Impressions delivered in the past 3 months were associated with recall of the Flavors Hook Kids (OR 1.13, P<.001), Dark Balloons and Apartment (OR 1.08, P<.001), We Are Not Profit (OR 1.14, P<.001), and Thrown Away and Little Big Lies (OR 1.04, P<.001) campaigns. Past 3-month impressions were not significantly associated with Tell Your Story campaign recall. Overall, magnitudes of these associations were greater for cumulative impressions. We visualize recall based on postestimation predicted values from our multivariate logistic regression models. Conclusions: Variation in cumulative impressions for California Tobacco Prevention Program’s long-term multichannel tobacco education campaign is predictive of increased self-reported campaign recall, suggesting that impressions may be a valid proxy for potential campaign exposure. The use of impressions for purposes of evaluating public education campaigns may help address current methodological limitations arising from the fragmented nature of modern multichannel media campaigns. %M 39499542 %R 10.2196/55311 %U https://www.jmir.org/2024/1/e55311 %U https://doi.org/10.2196/55311 %U http://www.ncbi.nlm.nih.gov/pubmed/39499542 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e58378 %T Evaluation of Drug and Herbal Medicinal Promotions on Social Media During the COVID-19 Pandemic in Relation to World Health Organization Ethical Criteria and South African Health Products Regulatory Authority Guidelines in South Africa: Cross-Sectional Content Analysis %A Chimukuche,Rujeko Samanthia %A Ndlazi,Julia %A Mtolo,Lucky Thembani %A Bird,Kristien %A Seeley,Janet %+ Social Sciences Core, Africa Health Research Institute, Nelson R Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Durban, 4013, South Africa, 27 31 521 0038, rujeko.chidawanyika@ahri.org %K drug advertising %K internet %K social media %K ethical guidelines %K traditional medicine %K COVID-19 %D 2024 %7 18.9.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Consideration of ethics in the promotion of medications is essential to safeguard the health of consumers, particularly during health crises. The World Health Organization (WHO) and the South African Health Products Regulatory Authority (SAHPRA) have established stringent standards to ensure the integrity of pharmaceutical promotions and safeguard public health, including advertisements on the internet and social media platforms. However, the dynamic nature of online advertising poses challenges for monitoring and enforcing ethical standards. Objective: The study aimed (1) to examine the COVID-19 drug and medicinal promotions across online platforms and social media from 2020 to 2022 in South Africa and (2) to ensure that drug promotions adhere to ethical guidelines outlined by the WHO and SAPHRA. Methods: A cross-sectional content analysis was conducted to assess drug and medicinal advertisements across various internet and social media platforms. A systematic approach was used to identify and analyze promotional content, focusing on adherence to ethical guidelines outlined by WHO and SAPHRA. Data were collected and analyzed to determine the extent of compliance and identify any potential violations or areas for improvement. Results: A total of 14 online drug advertisements were included in this analysis. Our findings show that most of the drugs advertised did not meet the regulations and guidelines provided by WHO and SAHPRA. There were omissions about active ingredients, proprietary names, adverse drug responses, precautions, and overdosage and adverse drug reactions. Traditional medicines were not fully consistent with the approved WHO ethical criteria data sheet. Conclusions: Our analysis highlights the critical importance of ensuring compliance with ethical guidelines in drug promotions on the internet and social media platforms. There is a need for continued vigilance and enforcement efforts to uphold ethical standards and protect the health of the public. Ongoing monitoring and collaboration between national drug regulatory agencies, pharmaceutical companies, and online platforms will be essential for promoting responsible advertising. In addition, safety monitoring and pharmacovigilance systems for herbal medicinal products are yet to be established. %M 39293046 %R 10.2196/58378 %U https://ojphi.jmir.org/2024/1/e58378 %U https://doi.org/10.2196/58378 %U http://www.ncbi.nlm.nih.gov/pubmed/39293046 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56854 %T Crisis and Emergency Risk Communication and Emotional Appeals in COVID-19 Public Health Messaging: Quantitative Content Analysis %A Ho,Shirley S %A Chuah,Agnes S F %A Ho,Vanessa S %A Rosenthal,Sonny %A Kim,Hye Kyung %A Soh,Shannon S H %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, WKWSCI Building, 31 Nanyang Link, Singapore, 637718, Singapore, tsyho@ntu.edu.sg %K COVID-19 %K crisis and emergency risk communication %K CERC %K emotional appeal %K content analysis %K public health %K Facebook %K social media %K Singapore %D 2024 %7 17.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Although COVID-19 is no longer a global health emergency, it remains pervasive in Singapore, a city-state situated in Southeast Asia, with periodic waves of infection. In addition to disease management, strong communication strategies are critical in the government’s response to the pandemic to keep the public updated and equip them in protecting themselves. Objective: Grounded in the crisis and emergency risk communication (CERC) framework and emotional appeals, this study aimed to analyze public health communication strategies in Singapore during the COVID-19 pandemic. Methods: Quantitative content analysis was conducted on 696 Facebook (Meta Platforms Inc) posts and 83 website articles published by Singapore-based public health institutions between January 2020 and September 2022. Results: The results showed that increasing communication on message themes, such as inquisitive messaging and clarification, can enhance communication strategies. The use of emotional appeals also varies with time and should be carefully used as they are context-specific. Conclusions: Theoretically, this study contributes to advancements in the CERC framework and concepts of emotional appeals by exploring the applications and changes of CERC message types and emotional appeals at different phases. The findings can provide practical guidance for authorities and communication practitioners in developing effective communication strategies. %M 39288399 %R 10.2196/56854 %U https://www.jmir.org/2024/1/e56854 %U https://doi.org/10.2196/56854 %U http://www.ncbi.nlm.nih.gov/pubmed/39288399 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53050 %T From Tweets to Streets: Observational Study on the Association Between Twitter Sentiment and Anti-Asian Hate Crimes in New York City from 2019 to 2022 %A Wei,Hanxue %A Hswen,Yulin %A Merchant,Junaid S %A Drew,Laura B %A Nguyen,Quynh C %A Yue,Xiaohe %A Mane,Heran %A Nguyen,Thu T %+ Department of Epidemiology & Biostatistics, University of Maryland, 4254 Stadium Drive College Park, Maryland, MD, 20742-2611, United States, 1 301 405 3575, ttxn@umd.edu %K anti-Asian %K hate crime %K Twitter %K racism %K social media, machine learning, sentiment analysis %D 2024 %7 9.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Anti-Asian hate crimes escalated during the COVID-19 pandemic; however, limited research has explored the association between social media sentiment and hate crimes toward Asian communities. Objective: This study aims to investigate the relationship between Twitter (rebranded as X) sentiment data and the occurrence of anti-Asian hate crimes in New York City from 2019 to 2022, a period encompassing both before and during COVID-19 pandemic conditions. Methods: We used a hate crime dataset from the New York City Police Department. This dataset included detailed information on the occurrence of anti-Asian hate crimes at the police precinct level from 2019 to 2022. We used Twitter’s application programming interface for Academic Research to collect a random 1% sample of publicly available Twitter data in New York State, including New York City, that included 1 or more of the selected Asian-related keywords and applied support vector machine to classify sentiment. We measured sentiment toward the Asian community using the rates of negative and positive sentiment expressed in tweets at the monthly level (N=48). We used negative binomial models to explore the associations between sentiment levels and the number of anti-Asian hate crimes in the same month. We further adjusted our models for confounders such as the unemployment rate and the emergence of the COVID-19 pandemic. As sensitivity analyses, we used distributed lag models to capture 1- to 2-month lag times. Results: A point increase of 1% in negative sentiment rate toward the Asian community in the same month was associated with a 24% increase (incidence rate ratio [IRR] 1.24; 95% CI 1.07-1.44; P=.005) in the number of anti-Asian hate crimes. The association was slightly attenuated after adjusting for unemployment and COVID-19 emergence (ie, after March 2020; P=.008). The positive sentiment toward Asian tweets with a 0-month lag was associated with a 12% decrease (IRR 0.88; 95% CI 0.79-0.97; P=.002) in expected anti-Asian hate crimes in the same month, but the relationship was no longer significant after adjusting for the unemployment rate and the emergence of COVID-19 pandemic (P=.11). Conclusions: A higher negative sentiment level was associated with more hate crimes specifically targeting the Asian community in the same month. The findings highlight the importance of monitoring public sentiment to predict and potentially mitigate hate crimes against Asian individuals. %M 39250221 %R 10.2196/53050 %U https://www.jmir.org/2024/1/e53050 %U https://doi.org/10.2196/53050 %U http://www.ncbi.nlm.nih.gov/pubmed/39250221 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50944 %T Identifying Effective Components of a Social Marketing Campaign to Improve Engagement With Express Sexual Health Services Among Gay, Bisexual, and Other Men Who Have Sex With Men: Case Study %A Chambers,Laura C %A Malyuta,Yelena %A Goedel,William C %A Chan,Philip A %A Sutten Coats,Cassandra %A Allen,Ken %A Nunn,Amy S %K social marketing %K sexually transmitted infection %K HIV %K sexual and gender minorities %K sexual health %K gay %K MSM %K men who have sex with men %K STI %K testing %K digital marketing %K digital %K campaign %K promote %K treatment %K prevention %K bisexual %K advertisement %K Google display %K Grindr %K Facebook %D 2024 %7 23.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Little is known about how best to reach people with social marketing messages promoting use of clinical HIV and sexually transmitted infection (STI) services. Objective: We evaluated a multiplatform, digital social marketing campaign intended to increase use of HIV/STI testing, treatment, and prevention services among gay, bisexual, and other men who have sex with men (MSM) at an LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and/or questioning) community health center. Methods: We evaluated engagement with a social marketing campaign launched by Open Door Health, the only LGBTQ+ community health center in Rhode Island, during the first 8 months of implementation (April to November 2021). Three types of advertisements encouraging use of HIV/STI services were developed and implemented on Google Search, Google Display, Grindr, and Facebook. Platforms tracked the number of times that an advertisement was displayed to a user (impressions), that a user clicked through to a landing page that facilitated scheduling (clicks), and that a user requested a call to schedule an appointment from the landing page (conversions). We calculated the click-through rate (clicks per impression), conversion rate (conversions per click), and the dollar amount spent per 1000 impressions and per click and conversion. Results: Overall, Google Search yielded the highest click-through rate (7.1%) and conversion rate (7.0%) compared to Google Display, Grindr, and Facebook (click-through rates=0.4%‐3.3%; conversion rates=0%‐0.03%). Although the spend per 1000 impressions and per click was higher for Google Search compared to other platforms, the spend per conversion—which measures the number of people intending to attend the clinic for services—was substantially lower for Google Search (US $48.19 vs US $3120.42-US $3436.03). Conclusions: Campaigns using the Google Search platform may yield the greatest return on investment for engaging MSM in HIV/STI services at community health clinics. Future studies are needed to measure clinical outcomes among those who present to the clinic for services after viewing campaign advertisements and to compare the return on investment with use of social marketing campaigns relative to other approaches. %R 10.2196/50944 %U https://publichealth.jmir.org/2024/1/e50944 %U https://doi.org/10.2196/50944 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56931 %T A Comprehensive Analysis of COVID-19 Misinformation, Public Health Impacts, and Communication Strategies: Scoping Review %A Kisa,Sezer %A Kisa,Adnan %+ Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass, Oslo, 0130, Norway, 47 92501403, sezerkisa@hotmail.com %K communication strategies %K COVID-19 %K infodemic %K misinformation %K public health %D 2024 %7 21.8.2024 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic was marked by an infodemic, characterized by the rapid spread of both accurate and false information, which significantly affected public health. This infodemic led to confusion, mistrust in health authorities, noncompliance with health guidelines, and engagement in risky health behaviors. Understanding the dynamics of misinformation during the pandemic is crucial for developing effective public health communication strategies. Objective: This comprehensive analysis aimed to examine the complexities of COVID-19 misinformation. Specifically, it sought to identify the sources and themes of misinformation, the target audiences most affected, and the effectiveness of various public health communication strategies in mitigating misinformation. Methods: This scoping review used the MEDLINE (PubMed), Embase, and Scopus databases to identify relevant studies. An established, methodical framework for scoping reviews was used to review literature published between December 2019 and September 2023. The inclusion criteria focused on peer-reviewed studies published in English that address COVID-19 misinformation and its sources, themes, and target audiences, as well as the effectiveness of public health communication strategies. Results: The scoping review identified that misinformation significantly impacted mental health, vaccine hesitancy, and health care decision-making. Social media and traditional media were major conduits for spreading misinformation. Key misinformation themes included the origins of the virus, ineffective treatments, and misunderstandings about public health measures. Misinformation sources ranged from social media platforms to traditional media outlets and informal networks. The impact of misinformation was found to vary across different regions and demographic groups, with vulnerable populations being disproportionately affected. Effective strategies to counter misinformation included enhancing health literacy; using digital technology; promoting clear, authoritative communication; and implementing fact-checking mechanisms. In addition, community engagement and targeted health campaigns played a crucial role in addressing misinformation. Conclusions: The review emphasizes the critical need for accurate and consistent messaging to combat misinformation. Cooperative efforts among policy makers, health professionals, and communication experts are essential for developing effective interventions. Addressing the infodemic is vital for building a well-informed, health-literate society capable of handling misinformation in future global health crises. The study provides valuable insights into the dynamics of misinformation and highlights the importance of robust public health communication strategies. These findings can guide future efforts to mitigate the impact of misinformation during health emergencies. %M 39167790 %R 10.2196/56931 %U https://www.jmir.org/2024/1/e56931 %U https://doi.org/10.2196/56931 %U http://www.ncbi.nlm.nih.gov/pubmed/39167790 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49600 %T Using Short-Form Videos to Get Clinical Trial Newcomers to Sign Up: Message-Testing Experiment %A Hu,Sisi %A Kirkpatrick,Ciera E %A Lee,Namyeon %A Hong,Yoorim %A Lee,Sungkyoung %A Hinnant,Amanda %+ School of Journalism and Strategic Media, University of Arkansas, 129 Kimpel Hall, 280 N. McIlroy Avenue, Fayetteville, AR, 72701, United States, 1 479 575 6717, sisih@uark.edu %K clinical trial recruitment %K TikTok %K source credibility %K framing %K psychological barriers %K logistical barriers %K integrated behavioral model %K short-form videos %K social media use %K clinical trial %K recruitment %D 2024 %7 15.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Recruiting participants for clinical trials poses challenges. Major barriers to participation include psychological factors (eg, fear and mistrust) and logistical constraints (eg, transportation, cost, and scheduling). The strategic design of clinical trial messaging can help overcome these barriers. While strategic communication can be done through various channels (eg, recruitment advertisements), health care providers on the internet have been found to be key sources for communicating clinical trial information to US adults in the social media era. Objective: This study aims to examine how communication source (ie, medical doctors and peers) and message framing of TikTok videos (ie, psychological and logistical framing) influence clinical trial–related attitudes, perceptions, and sign-up behaviors under the guidance of the integrated behavioral model. Methods: This study used a 2 (source: doctor vs peer) × 2 (framing: psychological vs logistical) between-participant factorial design web-based experiment targeting adults in the United States who had never participated in clinical trials (ie, newcomers). A Qualtrics panel was used to recruit and compensate the study respondents (n=561). Participants viewed short-form videos with doctors or peers, using psychological or logistical framing. The main outcome measures included perceived source credibility, self-efficacy, attitude toward clinical trial participation, behavioral intention, and sign-up behavior. Structural equation modeling was used to analyze the direct and indirect effects of message factors on the outcome variables. Source (doctor=1; peer=0) and framing (psychological=1; logistical=0) were dummy-coded. Results: Doctor-featured messages led to greater perceived source credibility (β=.31, P<.001), leading to greater self-efficacy (95% CI 0.13-0.30), which in turn enhanced behavioral intention (95% CI 0.12-0.29) and clinical trial sign-up behavior (95% CI 0.02-0.04). Logistical barrier–framed messages led to greater self-efficacy (β=–.09, P=.02), resulting in higher intention to participate in clinical trials (95% CI –0.38 to –0.03) and improved sign-up behavior (95% CI –0.06 to –0.004). Logistical barrier–framed messages were also directly associated with an increased likelihood of signing up for a clinical trial (β=–.08, P=.03). The model accounted for 21% of the variance in clinical trial sign-up behavior. Attitude did not significantly affect behavioral intention in this study (β=.08, P=.14), and psychological and logistical barrier–framed messages did not significantly differ in attitudes toward clinical trial participation (β=–.04, P=.09). Conclusions: These findings advance our understanding of how people process popular message characteristics in short-form videos and lend practical guidance for communicators. We encourage medical professionals to consider short-form video sites (eg, TikTok and Instagram Reels) as effective tools for discussing clinical trials and participation opportunities. Specifically, featuring doctors discussing efforts to reduce logistical barriers is recommended. Our measuring of actual behavior as an outcome is a rare and noteworthy contribution to this research. %M 39146532 %R 10.2196/49600 %U https://www.jmir.org/2024/1/e49600 %U https://doi.org/10.2196/49600 %U http://www.ncbi.nlm.nih.gov/pubmed/39146532 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e52018 %T Crowdfunding for Complementary and Alternative Cancer Treatments in Tijuana, Mexico: Content Analysis %A Snyder,Jeremy %A Zenone,Marco %A Grewal,Ashmita %A Caulfield,Timothy %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Blusson Hall 11300, Burnaby, BC, V5A1S6, Canada, 1 7787823258, jcs12@sfu.ca %K cancer %K crowdfunding %K Tijuana %K CAM %K patient %K patients %K insurance %K crowdfunding platforms %K GoFundMe %K GiveSendGo %K cancer clinic %K Mexico %K campaigns %K cancer treatment %K medical intervention %K CAM cancer treatments %K misinformation %K alternate care %K women's health %K internet research %K international medical tourism %K alternative cancer therapy %K financial toxicity %D 2024 %7 14.8.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Complementary and alternative (CAM) cancer treatment is often expensive and not covered by insurance. As a result, many people turn to crowdfunding to access this treatment. Objective: The aim of this study is to identify the rationales of patients with cancer seeking CAM treatment abroad by looking specifically at crowdfunding campaigns to support CAM cancer treatment in Tijuana, Mexico. Methods: We scraped the GoFundMe.com and GiveSendGo.com crowdfunding platforms for campaigns referencing CAM cancer clinics in Tijuana, initiated between January 1, 2022, and February 28, 2023. The authors created a coding framework to identify rationales for seeking CAM treatment in Tijuana. To supplement campaign metadata, we coded the beneficiary’s cancer stage, type, age, specific treatment sought, whether the beneficiary died, gender, and race. Results: Patients sought CAM cancer treatment in Tijuana because the (1) treatment offers the greatest efficacy (29.9%); (2) treatment offered domestically was not curative (23.2%); (3) the clinic treats the whole person, and addresses the spiritual dimension of the person (20.1%); (4) treatments are nontoxic, natural, or less invasive (18.2%); and (5) clinic offers the newest technology (8.5%). Campaigns raised US $5,275,268.37 and most campaign beneficiaries were women (69.7%) or White individuals (71.1%). Conclusions: These campaigns spread problematic misinformation about the likely efficacy of CAM treatments, funnel money and endorsements to CAM clinics in Tijuana, and leave many campaigners short of the money needed to pay for CAM treatments while costing beneficiaries and their loved one’s time, privacy, and dignity. This study affirms that Tijuana, Mexico, is a very popular destination for CAM cancer treatment. %M 39141902 %R 10.2196/52018 %U https://cancer.jmir.org/2024/1/e52018 %U https://doi.org/10.2196/52018 %U http://www.ncbi.nlm.nih.gov/pubmed/39141902 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51325 %T Linking Opinions Shared on Social Media About COVID-19 Public Health Measures to Adherence: Repeated Cross-Sectional Surveys of Twitter Use in Canada %A Denis-Robichaud,José %A Rees,Erin E %A Daley,Patrick %A Zarowsky,Christina %A Diouf,Assane %A Nasri,Bouchra R %A de Montigny,Simon %A Carabin,Hélène %+ Faculté de médecine vétérinaire, Université de Montréal, 3190, rue Sicotte, Saint-Hyacinthe, QC, J2S 2M2, Canada, 1 514 343 6111 ext 8569, helene.carabin@umontreal.ca %K adherence to mask wearing %K adherence to vaccination %K social media %K sociodemographic characteristics %K Twitter %K COVID-19 %K survey data %D 2024 %7 13.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The effectiveness of public health measures (PHMs) depends on population adherence. Social media were suggested as a tool to assess adherence, but representativeness and accuracy issues have been raised. Objective: The objectives of this repeated cross-sectional study were to compare self-reported PHM adherence and sociodemographic characteristics between people who used Twitter (subsequently rebranded X) and people who did not use Twitter. Methods: Repeated Canada-wide web-based surveys were conducted every 14 days from September 2020 to March 2022. Weighted proportions were calculated for descriptive variables. Using Bayesian logistic regression models, we investigated associations between Twitter use, as well as opinions in tweets, and self-reported adherence with mask wearing and vaccination. Results: Data from 40,230 respondents were analyzed. As self-reported, Twitter was used by 20.6% (95% CI 20.1%-21.2%) of Canadians, of whom 29.9% (95% CI 28.6%-31.3%) tweeted about COVID-19. The sociodemographic characteristics differed across categories of Twitter use and opinions. Overall, 11% (95% CI 10.6%-11.3%) of Canadians reported poor adherence to mask-wearing, and 10.8% (95% CI 10.4%-11.2%) to vaccination. Twitter users who tweeted about COVID-19 reported poorer adherence to mask wearing than nonusers, which was modified by the age of the respondents and their geographical region (odds ratio [OR] 0.79, 95% Bayesian credibility interval [BCI] 0.18-1.69 to OR 4.83, 95% BCI 3.13-6.86). The odds of poor adherence to vaccination of Twitter users who tweeted about COVID-19 were greater than those of nonusers (OR 1.76, 95% BCI 1.48-2.07). English- and French-speaking Twitter users who tweeted critically of PHMs were more likely (OR 4.07, 95% BCI 3.38-4.80 and OR 7.31, 95% BCI 4.26-11.03, respectively) to report poor adherence to mask wearing than non–Twitter users, and those who tweeted in support were less likely (OR 0.47, 95% BCI 0.31-0.64 and OR 0.96, 95% BCI 0.18-2.33, respectively) to report poor adherence to mask wearing than non–Twitter users. The OR of poor adherence to vaccination for those tweeting critically about PHMs and for those tweeting in support of PHMs were 4.10 (95% BCI 3.40-4.85) and 0.20 (95% BCI 0.10-0.32), respectively, compared to non–Twitter users. Conclusions: Opinions shared on Twitter can be useful to public health authorities, as they are associated with adherence to PHMs. However, the sociodemographics of social media users do not represent the general population, calling for caution when using tweets to assess general population-level behaviors. %M 39137009 %R 10.2196/51325 %U https://www.jmir.org/2024/1/e51325 %U https://doi.org/10.2196/51325 %U http://www.ncbi.nlm.nih.gov/pubmed/39137009 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e53624 %T Data-Driven Fundraising: Strategic Plan for Medical Education %A Jalali,Alireza %A Nyman,Jacline %A Loeffelholz,Ouida %A Courtney,Chantelle %K fundraising %K philanthropy %K crowdfunding %K funding %K charity %K higher education %K university %K medical education %K educators %K advancement %K data analytics %K ethics %K ethical %K education %K medical school %K school %K support %K financial %K community %D 2024 %7 22.7.2024 %9 %J JMIR Med Educ %G English %X Higher education institutions, including medical schools, increasingly rely on fundraising to bridge funding gaps and support their missions. This paper presents a viewpoint on data-driven strategies in fundraising, outlining a 4-step approach for effective planning while considering ethical implications. It outlines a 4-step approach to creating an effective, end-to-end, data-driven fundraising plan, emphasizing the crucial stages of data collection, data analysis, goal establishment, and targeted strategy formulation. By leveraging internal and external data, schools can create tailored outreach initiatives that resonate with potential donors. However, the fundraising process must be grounded in ethical considerations. Ethical challenges, particularly in fundraising with grateful medical patients, necessitate transparent and honest practices prioritizing donors’ and beneficiaries’ rights and safeguarding public trust. This paper presents a viewpoint on the critical role of data-driven strategies in fundraising for medical education. It emphasizes integrating comprehensive data analysis with ethical considerations to enhance fundraising efforts in medical schools. By integrating data analytics with fundraising best practices and ensuring ethical practice, medical institutions can ensure financial support and foster enduring, trust-based relationships with their donor communities. %R 10.2196/53624 %U https://mededu.jmir.org/2024/1/e53624 %U https://doi.org/10.2196/53624 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55797 %T Japanese Perception of Organ Donation and Implications for New Medical Technologies: Quantitative and Qualitative Social Media Analyses %A Vargas Meza,Xanat %A Oikawa,Masanori %+ Institute for the Advanced Study of Human Biology, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Japan Faculty of Medicine Bldg.B, Kyoto, 606-8501, Japan, 81 0757539882, vargasmeza.xanat.8z@kyoto-u.ac.jp %K Japan %K organ donation %K social media %K multidimensional analysis %K Twitter/X %K YouTube %D 2024 %7 19.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Rapid Autopsy Program (RAP) is a valuable procedure for studying human biology and diseases such as cancer. However, implementing the RAP in Japan necessitates a thorough understanding of concepts such as good death and the integration of sociocultural aspects. By revising perceptions of organ donation on social media, we bring attention to the challenges associated with implementing new medical research procedures such as the RAP. Objective: This study aims to examine YouTube and Twitter/X to identify stakeholders, evaluate the quality of organ donation communication, and analyze sociocultural aspects associated with organ donation. Based on our findings, we propose recommendations for the implementation of new medical research procedures. Methods: Using the term “臓器提供” (organ donation), we collected data from YouTube and Twitter/X, categorizing them into 5 dimensions: time, individuality, place, activity, and relationships. We utilized a scale to evaluate the quality of organ donation information and categorized YouTube videos into 3 groups to analyze their differences using statistical methods. Additionally, we conducted a text-based analysis to explore narratives associated with organ donation. Results: Most YouTube videos were uploaded in 2021 (189/638, 29.6%) and 2022 (165/638, 25.9%), while tweets about organ donation peaked between 2019 and 2022. Citizens (184/770, 23.9%), media (170/770, 22.0%), and unknown actors (121/770, 15.7%) were the primary uploaders of videos on organ donation. In a sample of average retweeted and liked tweets, citizens accounted for the majority of identified users (64/91, 70%, and 65/95, 68%, respectively). Regarding Japanese regions, there were numerous information videos about organ donation in Hokkaido (F2.46,147.74=–5.28, P=.005) and Kyushu and Okinawa (F2.46,147.74=–5.28, P=.005). On Twitter/X, Japan and China were the most frequently mentioned countries in relation to organ donation discussions. Information videos often focused on themes such as borrowed life and calls to register as donors, whereas videos categorized as no information and misinformation frequently included accusations of organ trafficking, often propagated by Chinese-American media. Tweets primarily centered around statements of donation intention and discussions about family consent. The majority of video hyperlinks directed users to YouTube and Twitter/X platforms, while Twitter/X hyperlinks predominantly led to news reports from Japanese media outlets. Conclusions: There is significant potential to implement new medical research procedures such as the RAP in Japan. Recommendations include conceptualizing research data as borrowed data, implementing horizontally diversified management of donation programs, and addressing issues related to science misinformation and popular culture trends. %M 39028549 %R 10.2196/55797 %U https://formative.jmir.org/2024/1/e55797 %U https://doi.org/10.2196/55797 %U http://www.ncbi.nlm.nih.gov/pubmed/39028549 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50240 %T The Impact of Incentives on Data Collection for Online Surveys: Social Media Recruitment Study %A Sobolewski,Jessica %A Rothschild,Allie %A Freeman,Andrew %+ RTI International, 3040 E Cornwallis Road, Research Triangle Park, NC, 27709, United States, 1 203 770 3115, jsobolewski@rti.org %K social media %K online survey recruitment %K incentive %K experiment %K online surveys %K Facebook %K Instagram %K data collection %K users %K cost %K social media recruitment %K survey %D 2024 %7 4.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of targeted advertisements on social media platforms (eg, Facebook and Instagram) has become increasingly popular for recruiting participants for online survey research. Many of these surveys offer monetary incentives for survey completion in the form of gift cards; however, little is known about whether the incentive amount impacts the cost, speed, and quality of data collection. Objective: This experiment addresses this gap in the literature by examining how different incentives in paid advertising campaigns on Instagram for completing a 10-minute online survey influence the response rate, recruitment advertising cost, data quality, and length of data collection. Methods: This experiment tested three incentive conditions using three Instagram campaigns that were each allocated a US $1400 budget to spend over a maximum of 4 days; ads targeted users aged 15-24 years in three nonadjacent designated market areas of similar size to avoid overlapping audiences. Four ad creatives were designed for each campaign; all ads featured the same images and text, but the incentive amount varied: no incentive, US $5 gift card, and US $15 gift card. All ads had a clickable link that directed users to an eligibility screener and a 10-minute online survey, if eligible. Each campaign ran for either the full allotted time (4 days) or until there were 150 total survey completes, prior to data quality checks for fraud. Results: The US $15 incentive condition resulted in the quickest and cheapest data collection, requiring 17 hours and ad spending of US $338.64 to achieve 142 survey completes. The US $5 condition took more than twice as long (39 hours) and cost US $864.33 in ad spending to achieve 148 survey completes. The no-incentive condition ran for 60 hours, spending nearly the full budget (US $1398.23), and achieved only 24 survey completes. The US $15 and US $5 incentive conditions had similar levels of fraudulent respondents, whereas the no-incentive condition had no fraudulent respondents. The completion rate for the US $15 and US $5 incentive conditions were 93.4% (155/166) and 89.8% (149/166), respectively, while the completion rate for the no-incentive condition was 43.6% (24/55). Conclusions: Overall, we found that a higher incentive resulted in quicker data collection, less money spent on ads, and higher response rates, despite some fraudulent cases that had to be dropped from the sample. However, when considering the total incentive amounts in addition to the ad spending, a US $5 incentive appeared to be the most cost-effective data collection option. Other costs associated with running a campaign for a longer period should also be considered. A longer experiment is warranted to determine whether fraud varies over time across conditions. %M 38963924 %R 10.2196/50240 %U https://formative.jmir.org/2024/1/e50240 %U https://doi.org/10.2196/50240 %U http://www.ncbi.nlm.nih.gov/pubmed/38963924 %0 Journal Article %@ 2368-7959 %I %V 11 %N %P e59198 %T Media Use and Its Associations With Paranoia in Schizophrenia and Bipolar Disorder: Ecological Momentary Assessment %A Paquin,Vincent %A Ackerman,Robert A %A Depp,Colin A %A Moore,Raeanne C %A Harvey,Philip D %A Pinkham,Amy E %K paranoia %K social media %K digital media %K technology %K psychosis %K schizophrenia %K schizoaffective %K bipolar disorder %K ecological momentary assessment %K spectrum %K sociodemographic %K linear mixed model %K media use %K mental health %K digital intervention %K adult %K adults %K medical center %K mental health clinic %K psychiatry %K psychiatrist %D 2024 %7 3.7.2024 %9 %J JMIR Ment Health %G English %X Background: Paranoia is a spectrum of fear-related experiences that spans diagnostic categories and is influenced by social and cognitive factors. The extent to which social media and other types of media use are associated with paranoia remains unclear. Objective: We aimed to examine associations between media use and paranoia at the within- and between-person levels. Methods: Participants were 409 individuals diagnosed with schizophrenia spectrum or bipolar disorder. Measures included sociodemographic and clinical characteristics at baseline, followed by ecological momentary assessments (EMAs) collected 3 times daily over 30 days. EMA evaluated paranoia and 5 types of media use: social media, television, music, reading or writing, and other internet or computer use. Generalized linear mixed models were used to examine paranoia as a function of each type of media use and vice versa at the within- and between-person levels. Results: Of the 409 participants, the following subgroups reported at least 1 instance of media use: 261 (63.8%) for using social media, 385 (94.1%) for watching TV, 292 (71.4%) for listening to music, 191 (46.7%) for reading or writing, and 280 (68.5%) for other internet or computer use. Gender, ethnoracial groups, educational attainment, and diagnosis of schizophrenia versus bipolar disorder were differentially associated with the likelihood of media use. There was a within-person association between social media use and paranoia: using social media was associated with a subsequent decrease of 5.5% (fold-change 0.945, 95% CI 0.904-0.987) in paranoia. The reverse association, from paranoia to subsequent changes in social media use, was not statistically significant. Other types of media use were not significantly associated with paranoia. Conclusions: This study shows that social media use was associated with a modest decrease in paranoia, perhaps reflecting the clinical benefits of social connection. However, structural disadvantage and individual factors may hamper the accessibility of media activities, and the mental health correlates of media use may further vary as a function of contents and contexts of use. %R 10.2196/59198 %U https://mental.jmir.org/2024/1/e59198 %U https://doi.org/10.2196/59198 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58040 %T Experiences of Governments and Public Health Agencies Regarding Crisis Communication During the COVID-19 Pandemic in the Digital Age: Protocol for a Systematic Review of Qualitative Studies %A Okuhara,Tsuyoshi %A Terada,Marina %A Okada,Hiroko %A Kiuchi,Takahiro %+ Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan, 81 03 5800 8781, okuhara-ctr@umin.ac.jp %K COVID-19 %K health communication %K infodemic %K misinformation %K social media %K SARS-CoV-2 %K coronavirus %K pandemic %K infectious %K digital age %K systematic review %K internet %K public health %K government %K governments %K crisis communication %K qualitative %K methodology %K disinformation %K eHealth %K digital health %K medical informatics %D 2024 %7 27.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Governments and public health agencies worldwide experienced difficulties with social media–mediated infodemics on the internet during the COVID-19 pandemic. Existing public health crisis communication strategies need to be updated. However, crisis communication experiences of governments and public health agencies worldwide during the COVID-19 pandemic have not been systematically compiled, necessitating updated crisis communication strategies. Objective: This systematic review aims to collect and organize the crisis communication experiences of senders (ie, governments and public health agencies) during the COVID-19 pandemic. Our focus is on exploring the difficulties that governments and public health agencies experienced, best practices in crisis communication by governments and public health agencies during the COVID-19 pandemic in times of infodemic, and challenges that should be overcome in future public health crises. Methods: We plan to begin the literature search on May 1, 2024. We will search PubMed, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, Communication Abstracts, and Web of Science. We will filter our database searches to search from the year 2020 and beyond. We will use a combination of keywords by referring to the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) tool to search the abstracts in databases. We intend to include qualitative studies on crisis communication by governments and public health agencies (eg, officials, staff, health professionals, and researchers) to the public. Quantitative data–based studies will be excluded. Only papers written in English will be included. Data on study characteristics, study aim, participant characteristics, methodology, theoretical framework, object of crisis communication, and key results will be extracted. The methodological quality of eligible studies will be assessed using the Joanna Briggs Institute critical appraisal checklist for qualitative research. A total of 2 independent reviewers will share responsibility for screening publications, data extraction, and quality assessment. Disagreement will be resolved through discussion, and the third reviewer will be consulted, if necessary. The findings will be summarized in a table and a conceptual diagram and synthesized in a descriptive and narrative review. Results: The results will be systematically integrated and presented in a way that corresponds to our research objectives and interests. We expect the results of this review to be submitted for publication by the end of 2024. Conclusions: To our knowledge, this will be the first systematic review of the experiences of governments and public health agencies regarding their crisis communication to the public during the COVID-19 pandemic. This review will contribute to the future improvement of the guidelines for crisis communication by governments and public health agencies to the public. Trial Registration: PROSPERO CRD42024528975; https://tinyurl.com/4fjmd8te International Registered Report Identifier (IRRID): PRR1-10.2196/58040 %M 38935414 %R 10.2196/58040 %U https://www.researchprotocols.org/2024/1/e58040 %U https://doi.org/10.2196/58040 %U http://www.ncbi.nlm.nih.gov/pubmed/38935414 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51292 %T How College Students Used Information From Institutions of Higher Education in the United States During COVID-19: Web-Based Cross-Sectional Survey Study %A Peprah,Emmanuel %A Amesimeku,Etornam %A Angulo,Brian %A Chhetri,Himani %A Fordjuoh,Judy %A Ruan,Christina %A Wang,Cong %A Patena,John %A Vieira,Dorice %A Ryan,Nessa %A Iloegbu,Chukwuemeka %A Gyamfi,Joyce %A Odumegwu,Jonathan %+ Implementing Evidence-Based Interventions Through Engagement (ISEE) Lab, Department of Global and Environmental Health, New York University School of Global Public Health, 708 Broadway, New York, NY, 10012, United States, 1 212 992 6095, ep91@nyu.edu %K COVID-19 %K pandemic %K public health %K preventative %K prevention %K social distancing %K masks %K personal protective equipment %K cross-sectional %K surveys %K higher learning %K higher education %K university students %K information source %K web-based information %K health information %K dissemination %K awareness %K information spread %K young adults %K social media %K university %K postsecondary %K students %K young adult %K college %K concern %K worry %K anxiety %K perceptions %D 2024 %7 17.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The start of the COVID-19 pandemic resulted in the implementation of nonpharmaceutical interventions by US institutions of higher education at an unprecedented level. During the backdrop of an emerging pandemic, younger adults (eg, college students) had an overall lower risk for severe outcomes for SARS-CoV-2, making this population a potential source of transmission for age groups with high susceptibility and negative health outcomes. We examine how college students’ level of concern for COVID-19 was influenced by different sources of information, their living status, income level, and other demographic identifiers and its association with prevention behavior change. Objective: We sought to examine the level of concern, defined as the extent to which the participant would take corrective action to mitigate contracting or spreading the virus (to family or friends) by using personal protective equipment such as a face mask, practicing social distancing, and following other public health recommendations, among college students during the COVID-19 pandemic. Methods: A cross-sectional, web-based survey was conducted in 2021 among 185 college students aged 18-41 years, with most living in New York City and the United States (n=134, 72.4%). Out of 185 college students, 94 provided their zip codes, with 51 of those college students indicating they lived in New York City areas. The participants completed the survey via a QR code. Study participants who did not complete the full survey or were not college students in any US college or university were excluded. Analyses were conducted using R (version 4.2.2; R Foundation for Statistical Computing). Results: Of 185 respondents participated in the study, 25 (13.5.%) used emails from their schools, 51 (27.6%) used mainstream media, and 109 (58.9%) used social media and other sources to obtain information about COVID-19. Of the 109 participants who learned about the pandemic from social media, 91 (83.5%) were concerned; however, only 63% (32/51) and 60% (15/25) of the participants who sourced information from mainstream media and their schools’ email, respectively, were concerned. Further, the participants who received information from social media and other sources were about 3 times more likely to be concerned about COVID-19 than participants who received information from the university via email (P=.036; OR=3.07, 95% CI: 1.06-8.83).. Conclusions: College students who received information from social media and other sources were more likely to be concerned about COVID-19 than students who received information from their school via emails. %M 38885019 %R 10.2196/51292 %U https://formative.jmir.org/2024/1/e51292 %U https://doi.org/10.2196/51292 %U http://www.ncbi.nlm.nih.gov/pubmed/38885019 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53574 %T Understanding COVID-19 Impacts on the Health Workforce: AI-Assisted Open-Source Media Content Analysis %A Pienkowska,Anita %A Ravaut,Mathieu %A Mammadova,Maleyka %A Ang,Chin-Siang %A Wang,Hanyu %A Ong,Qi Chwen %A Bojic,Iva %A Qin,Vicky Mengqi %A Sumsuzzman,Dewan Md %A Ajuebor,Onyema %A Boniol,Mathieu %A Bustamante,Juana Paola %A Campbell,James %A Cometto,Giorgio %A Fitzpatrick,Siobhan %A Kane,Catherine %A Joty,Shafiq %A Car,Josip %+ Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd, Clinical Sciences Building, Singapore, 308232, Singapore, 65 6513 8572, iva.bojic@ntu.edu.sg %K World Health Organization %K WHO %K public surveillance %K natural language processing %K NLP %K artificial intelligence %K AI %K COVID-19 %K SARS-COV-2 %K COVID-19 pandemic %K human-generated analysis %K decision-making %K strategic policy %K health workforce %K news article %K media content analysis %K news coverage %K health care worker %K mental health %K death risk %K intervention %K efficiency %K public health %K surveillance %K innovation %K innovative method %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To investigate the impacts of the COVID-19 pandemic on the health workforce, we aimed to develop a framework that synergizes natural language processing (NLP) techniques and human-generated analysis to reduce, organize, classify, and analyze a vast volume of publicly available news articles to complement scientific literature and support strategic policy dialogue, advocacy, and decision-making. Objective: This study aimed to explore the possibility of systematically scanning intelligence from media that are usually not captured or best gathered through structured academic channels and inform on the impacts of the COVID-19 pandemic on the health workforce, contributing factors to the pervasiveness of the impacts, and policy responses, as depicted in publicly available news articles. Our focus was to investigate the impacts of the COVID-19 pandemic and, concurrently, assess the feasibility of gathering health workforce insights from open sources rapidly. Methods: We conducted an NLP-assisted media content analysis of open-source news coverage on the COVID-19 pandemic published between January 2020 and June 2022. A data set of 3,299,158 English news articles on the COVID-19 pandemic was extracted from the World Health Organization Epidemic Intelligence through Open Sources (EIOS) system. The data preparation phase included developing rules-based classification, fine-tuning an NLP summarization model, and further data processing. Following relevancy evaluation, a deductive-inductive approach was used for the analysis of the summarizations. This included data extraction, inductive coding, and theme grouping. Results: After processing and classifying the initial data set comprising 3,299,158 news articles and reports, a data set of 5131 articles with 3,007,693 words was devised. The NLP summarization model allowed for a reduction in the length of each article resulting in 496,209 words that facilitated agile analysis performed by humans. Media content analysis yielded results in 3 sections: areas of COVID-19 impacts and their pervasiveness, contributing factors to COVID-19–related impacts, and responses to the impacts. The results suggest that insufficient remuneration and compensation packages have been key disruptors for the health workforce during the COVID-19 pandemic, leading to industrial actions and mental health burdens. Shortages of personal protective equipment and occupational risks have increased infection and death risks, particularly at the pandemic’s onset. Workload and staff shortages became a growing disruption as the pandemic progressed. Conclusions: This study demonstrates the capacity of artificial intelligence–assisted media content analysis applied to open-source news articles and reports concerning the health workforce. Adequate remuneration packages and personal protective equipment supplies should be prioritized as preventive measures to reduce the initial impact of future pandemics on the health workforce. Interventions aimed at lessening the emotional toll and workload need to be formulated as a part of reactive measures, enhancing the efficiency and maintainability of health delivery during a pandemic. %M 38869940 %R 10.2196/53574 %U https://formative.jmir.org/2024/1/e53574 %U https://doi.org/10.2196/53574 %U http://www.ncbi.nlm.nih.gov/pubmed/38869940 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48491 %T News Coverage of the COVID-19 Pandemic on Social Media and the Public’s Negative Emotions: Computational Study %A Wang,Hanjing %A Li,Yupeng %A Ning,Xuan %+ Department of Interactive Media, Hong Kong Baptist University, Kowloon Tong, Kowloon, Hong Kong, 000000, China (Hong Kong), 852 3411 8263, ivanypli@gmail.com %K web news coverage %K emotions %K social media %K Facebook %K COVID-19 %D 2024 %7 6.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media has become an increasingly popular and critical tool for users to digest diverse information and express their perceptions and attitudes. While most studies endeavor to delineate the emotional responses of social media users, there is limited research exploring the factors associated with the emergence of emotions, particularly negative ones, during news consumption. Objective: We aim to first depict the web coverage by news organizations on social media and then explore the crucial elements of news coverage that trigger the public’s negative emotions. Our findings can act as a reference for responsible parties and news organizations in times of crisis. Methods: We collected 23,705 Facebook posts with 1,019,317 comments from the public pages of representative news organizations in Hong Kong. We used text mining techniques, such as topic models and Bidirectional Encoder Representations from Transformers, to analyze news components and public reactions. Beyond descriptive analysis, we used regression models to shed light on how news coverage on social media is associated with the public’s negative emotional responses. Results: Our results suggest that occurrences of issues regarding pandemic situations, antipandemic measures, and supportive actions are likely to reduce the public’s negative emotions, while comments on the posts mentioning the central government and the Government of Hong Kong reveal more negativeness. Negative and neutral media tones can alleviate the rage and interact with the subjects and issues in the news to affect users’ negative emotions. Post length is found to have a curvilinear relationship with users’ negative emotions. Conclusions: This study sheds light on the impacts of various components of news coverage (issues, subjects, media tone, and length) on social media on the public’s negative emotions (anger, fear, and sadness). Our comprehensive analysis provides a reference framework for efficient crisis communication for similar pandemics at present or in the future. This research, although first extending the analysis between the components of news coverage and negative user emotions to the scenario of social media, echoes previous studies drawn from traditional media and its derivatives, such as web newspapers. Although the era of COVID-19 pandemic gradually brings down the curtain, the commonality of this research and previous studies also contributes to establishing a clearer territory in the field of health crises. %M 38843521 %R 10.2196/48491 %U https://www.jmir.org/2024/1/e48491 %U https://doi.org/10.2196/48491 %U http://www.ncbi.nlm.nih.gov/pubmed/38843521 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51418 %T Examining the Effectiveness of Social Media for the Dissemination of Research Evidence for Health and Social Care Practitioners: Systematic Review and Meta-Analysis %A Roberts-Lewis,Sarah %A Baxter,Helen %A Mein,Gill %A Quirke-McFarlane,Sophia %A Leggat,Fiona J %A Garner,Hannah %A Powell,Martha %A White,Sarah %A Bearne,Lindsay %+ Population Health Research Institute, St George’s University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom, 44 20 8725 0368, sroberts@sgul.ac.uk %K social media %K dissemination %K health care %K social care %K research evidence %K practitioners %K effectiveness %K meta-analysis %K systematic review %K randomized controlled trial %K RCT %D 2024 %7 5.6.2024 %9 Review %J J Med Internet Res %G English %X Background: Social media use has potential to facilitate the rapid dissemination of research evidence to busy health and social care practitioners. Objective: This study aims to quantitatively synthesize evidence of the between- and within-group effectiveness of social media for dissemination of research evidence to health and social care practitioners. It also compared effectiveness between different social media platforms, formats, and strategies. Methods: We searched electronic databases for articles in English that were published between January 1, 2010, and January 10, 2023, and that evaluated social media interventions for disseminating research evidence to qualified, postregistration health and social care practitioners in measures of reach, engagement, direct dissemination, or impact. Screening, data extraction, and risk of bias assessments were carried out by at least 2 independent reviewers. Meta-analyses of standardized pooled effects were carried out for between- and within-group effectiveness of social media and comparisons between platforms, formats, and strategies. Certainty of evidence for outcomes was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework. Results: In total, 50 mixed-quality articles that were heterogeneous in design and outcome were included (n=9, 18% were randomized controlled trials [RCTs]). Reach (measured in number of practitioners, impressions, or post views) was reported in 26 studies. Engagement (measured in likes or post interactions) was evaluated in 21 studies. Direct dissemination (measured in link clicks, article views, downloads, or altmetric attention score) was analyzed in 23 studies (8 RCTs). Impact (measured in citations or measures of thinking and practice) was reported in 13 studies. Included studies almost universally indicated effects in favor of social media interventions, although effect sizes varied. Cumulative evidence indicated moderate certainty of large and moderate between-group effects of social media interventions on direct dissemination (standardized mean difference [SMD] 0.88; P=.02) and impact (SMD 0.76; P<.001). After social media interventions, cumulative evidence showed moderate certainty of large within-group effects on reach (SMD 1.99; P<.001), engagement (SMD 3.74; P<.001), and direct dissemination (SMD 0.82; P=.004) and low certainty of a small within-group effect on impacting thinking or practice (SMD 0.45; P=.02). There was also evidence for the effectiveness of using multiple social media platforms (including Twitter, subsequently rebranded X; and Facebook), images (particularly infographics), and intensive social media strategies with frequent, daily posts and involving influential others. No included studies tested the dissemination of research evidence to social care practitioners. Conclusions: Social media was effective for disseminating research evidence to health care practitioners. More intense social media campaigns using specific platforms, formats, and strategies may be more effective than less intense interventions. Implications include recommendations for effective dissemination of research evidence to health care practitioners and further RCTs in this field, particularly investigating the dissemination of social care research. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022378793; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=378793 International Registered Report Identifier (IRRID): RR2-10.2196/45684 %M 38838330 %R 10.2196/51418 %U https://www.jmir.org/2024/1/e51418 %U https://doi.org/10.2196/51418 %U http://www.ncbi.nlm.nih.gov/pubmed/38838330 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56899 %T Social Media Promotion of Health Tests With Potential for Overdiagnosis or Overuse: Protocol for a Content Analysis %A Nickel,Brooke %A Heiss,Raffael %A Shih,Patti %A Gram,Emma Grundtvig %A Copp,Tessa %A Taba,Melody %A Moynihan,Ray %A Zadro,Joshua %+ Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, 127A Edward Ford Building (A27), Sydney, 2006, Australia, 61 2 9351 7829, brooke.nickel@sydney.edu.au %K social media %K influencers %K tests %K overdiagnosis %K overuse %K evidence-based medicine %K promotion %D 2024 %7 4.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In recent years, social media have emerged as important spaces for commercial marketing of health tests, which can be used for the screening and diagnosis of otherwise generally healthy people. However, little is known about how health tests are promoted on social media, whether the information provided is accurate and balanced, and if there is transparency around conflicts of interest. Objective: This study aims to understand and quantify how social media is being used to discuss or promote health tests with the potential for overdiagnosis or overuse to generally healthy people. Methods: Content analysis of social media posts on the anti-Mullerian hormone test, whole-body magnetic resonance imaging scan, multicancer early detection, testosterone test, and gut microbe test from influential international social media accounts on Instagram and TikTok. The 5 tests have been identified as having the following criteria: (1) there are evidence-based concerns about overdiagnosis or overuse, (2) there is evidence or concerns that the results of tests do not lead to improved health outcomes for generally healthy people and may cause harm or waste, and (3) the tests are being promoted on social media to generally healthy people. English language text-only posts, images, infographics, articles, recorded videos including reels, and audio-only posts are included. Posts from accounts with <1000 followers as well as stories, live videos, and non-English posts are excluded. Using keywords related to the test, the top posts were searched and screened until there were 100 eligible posts from each platform for each test (total of 1000 posts). Data from the caption, video, and on-screen text are being summarized and extracted into a Microsoft Excel (Microsoft Corporation) spreadsheet and included in the analysis. The analysis will take a combined inductive approach when generating key themes and a deductive approach using a prespecified framework. Quantitative data will be analyzed in Stata SE (version 18.0; Stata Corp). Results: Data on Instagram and TikTok have been searched and screened. Analysis has now commenced. The findings will be disseminated via publications in peer-reviewed international medical journals and will also be presented at national and international conferences in late 2024 and 2025. Conclusions: This study will contribute to the limited evidence base on the nature of the relationship between social media and the problems of overdiagnosis and overuse of health care services. This understanding is essential to develop strategies to mitigate potential harm and plan solutions, with the aim of helping to protect members of the public from being marketed low-value tests, becoming patients unnecessarily, and taking resources away from genuine needs within the health system. International Registered Report Identifier (IRRID): DERR1-10.2196/56899 %M 38833693 %R 10.2196/56899 %U https://www.researchprotocols.org/2024/1/e56899 %U https://doi.org/10.2196/56899 %U http://www.ncbi.nlm.nih.gov/pubmed/38833693 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51530 %T Evaluating the Problem of Fraudulent Participants in Health Care Research: Multimethod Pilot Study %A Kumarasamy,Vithusa %A Goodfellow,Nicole %A Ferron,Era Mae %A Wright,Amy L %+ Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada, 1 416 978 0695, amyl.wright@utoronto.ca %K fraudulent participants %K threats to data integrity %K online recruitment %K multimethod study %K health care research %K bots %K social media %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The shift toward online recruitment methods, accelerated by the COVID-19 pandemic, has brought to the forefront the growing concern of encountering fraudulent participants in health care research. The increasing prevalence of this issue poses a serious threat to the reliability and integrity of research data and subsequent findings. Objective: This study aims to explore the experiences of health care researchers (HCRs) who have encountered fraudulent participants while using online recruitment methods and platforms. The primary objective was to gain insights into how researchers detect and mitigate fraudulent behavior in their work and provide prevention recommendations. Methods: A multimethod sequential design was used for this pilot study, comprising a quantitative arm involving a web-based survey followed by a qualitative arm featuring semistructured interviews. The qualitative description approach framed the qualitative arm of the study. Sample sizes for the quantitative and qualitative arms were based on pragmatic considerations that in part stemmed from encountering fraudulent participants in a concurrent study. Content analysis was used to analyze open-ended survey questions and interview data. Results: A total of 37 HCRs participated, with 35% (13/37) of them engaging in qualitative interviews. Online platforms such as Facebook, email, Twitter (subsequently rebranded X), and newsletters were the most used methods for recruitment. A total of 84% (31/37) of participants indicated that fraudulent participation occurred in studies that mentioned incentives in their recruitment communications, with 71% (26/37) of HCRs offering physical or electronic gift cards as incentives. Researchers identified several indicators of suspicious behavior, including email surges, discrepancies in contact or personal information, geographical inconsistencies, and suspicious responses to survey questions. HCRs emphasized the need for a comprehensive screening protocol that extends beyond eligibility checks and is seamlessly integrated into the study protocol, grant applications, and research ethics board submissions. Conclusions: This study sheds light on the intricate and pervasive problem of fraudulent participation in health care research using online recruitment methods. The findings underscore the importance of vigilance and proactivity among HCRs in identifying, preventing, and addressing fraudulent behavior. To effectively tackle this challenge, researchers are encouraged to develop a comprehensive prevention strategy and establish a community of practice, facilitating real-time access to solutions and support and the promotion of ethical research practices. This collaborative approach will enable researchers to effectively address the issue of fraudulent participation, ensuring the conduct of high-quality and ethically sound research in the digital age. %M 38833292 %R 10.2196/51530 %U https://formative.jmir.org/2024/1/e51530 %U https://doi.org/10.2196/51530 %U http://www.ncbi.nlm.nih.gov/pubmed/38833292 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e54663 %T TikTok as a Source of Health Information and Misinformation for Young Women in the United States: Survey Study %A Kirkpatrick,Ciera E %A Lawrie,LaRissa L %+ College of Journalism & Mass Communications, University of Nebraska-Lincoln, 331 Andersen Hall, Lincoln, NE, 68588, United States, 1 3165594397, ciera.kirkpatrick@unl.edu %K credibility perceptions %K health information %K health misinformation %K information seeking %K misinformation perceptions %K public health %K social media %K strategic communication %K third-person effect %K TikTok %D 2024 %7 21.5.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: TikTok is one of the most-used and fastest-growing social media platforms in the world, and recent reports indicate that it has become an increasingly popular source of news and information in the United States. These trends have important implications for public health because an abundance of health information exists on the platform. Women are among the largest group of TikTok users in the United States and may be especially affected by the dissemination of health information on TikTok. Prior research has shown that women are not only more likely to look for information on the internet but are also more likely to have their health-related behaviors and perceptions affected by their involvement with social media. Objective: We conducted a survey of young women in the United States to better understand their use of TikTok for health information as well as their perceptions of TikTok’s health information and health communication sources. Methods: A web-based survey of US women aged 18 to 29 years (N=1172) was conducted in April-May 2023. The sample was recruited from a Qualtrics research panel and 2 public universities in the United States. Results: The results indicate that the majority of young women in the United States who have used TikTok have obtained health information from the platform either intentionally (672/1026, 65.5%) or unintentionally (948/1026, 92.4%). Age (959/1026, 93.47%; r=0.30; P<.001), education (959/1026, 93.47%; ρ=0.10; P=.001), and TikTok intensity (ie, participants’ emotional connectedness to TikTok and TikTok’s integration into their daily lives; 959/1026, 93.47%; r=0.32; P<.001) were positively correlated with overall credibility perceptions of the health information. Nearly the entire sample reported that they think that misinformation is prevalent on TikTok to at least some extent (1007/1026, 98.15%), but a third-person effect was found because the young women reported that they believe that other people are more susceptible to health misinformation on TikTok than they personally are (t1025=21.16; P<.001). Both health professionals and general users were common sources of health information on TikTok: 93.08% (955/1026) of the participants indicated that they had obtained health information from a health professional, and 93.86% (963/1026) indicated that they had obtained health information from a general user. The respondents showed greater preference for health information from health professionals (vs general users; t1025=23.75; P<.001); the respondents also reported obtaining health information from health professionals more often than from general users (t1025=8.13; P<.001), and they were more likely to act on health information from health professionals (vs general users; t1025=12.74; P<.001). Conclusions: The findings suggest that health professionals and health communication scholars need to proactively consider using TikTok as a platform for disseminating health information to young women because young women are obtaining health information from TikTok and prefer information from health professionals. %M 38772020 %R 10.2196/54663 %U https://infodemiology.jmir.org/2024/1/e54663 %U https://doi.org/10.2196/54663 %U http://www.ncbi.nlm.nih.gov/pubmed/38772020 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48564 %T Difference in Rumor Dissemination and Debunking Before and After the Relaxation of COVID-19 Prevention and Control Measures in China: Infodemiology Study %A Liu,Xiaoqi %A Hu,Qingyuan %A Wang,Jie %A Wu,Xusheng %A Hu,Dehua %+ Department of Biomedical Informatics, School of Life Sciences, Central South University, 172 Tongzipo Road, Changsha, Hunan, 410013, China, 86 13975869106, hudehua@csu.edu.cn %K new stage %K public health emergency %K information epidemic %K propagation characteristic %K debunking mechanism %K China %D 2024 %7 15.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The information epidemic emerged along with the COVID-19 pandemic. While controlling the spread of COVID-19, the secondary harm of epidemic rumors to social order cannot be ignored. Objective: The objective of this paper was to understand the characteristics of rumor dissemination before and after the pandemic and the corresponding rumor management and debunking mechanisms. This study aimed to provide a theoretical basis and effective methods for relevant departments to establish a sound mechanism for managing network rumors related to public health emergencies such as COVID-19. Methods: This study collected data sets of epidemic rumors before and after the relaxation of the epidemic prevention and control measures, focusing on large-scale network rumors. Starting from 3 dimensions of rumor content construction, rumor propagation, and rumor-refuting response, the epidemic rumors were subdivided into 7 categories, namely, involved subjects, communication content, emotional expression, communication channels, communication forms, rumor-refuting subjects, and verification sources. Based on this framework, content coding and statistical analysis of epidemic rumors were carried out. Results: The study found that the rumor information was primarily directed at a clear target audience. The main themes of rumor dissemination were related to the public’s immediate interests in the COVID-19 field, with significant differences in emotional expression and mostly negative emotions. Rumors mostly spread through social media interactions, community dissemination, and circle dissemination, with text content as the main form, but they lack factual evidence. The preferences of debunking subjects showed differences, and the frequent occurrence of rumors reflected the unsmooth channels of debunking. The χ2 test of data before and after the pandemic showed that the P value was less than .05, indicating that the difference in rumor content before and after the pandemic had statistical significance. Conclusions: This study’s results showed that the themes of rumors during the pandemic are closely related to the immediate interests of the public, and the emotions of the public accelerate the spread of these rumors, which are mostly disseminated through social networks. Therefore, to more effectively prevent and control the spread of rumors during the pandemic and to enhance the capability to respond to public health crises, relevant authorities should strengthen communication with the public, conduct emotional risk assessments, and establish a joint mechanism for debunking rumors. %M 38748460 %R 10.2196/48564 %U https://www.jmir.org/2024/1/e48564 %U https://doi.org/10.2196/48564 %U http://www.ncbi.nlm.nih.gov/pubmed/38748460 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51910 %T Understanding the Impact of Communicating Uncertainty About COVID-19 in the News: Randomized Between-Subjects Factorial Experiment %A Zhao,Rui %A Lu,Xuerong %A Yang,Jiayi %A Li,Biao %+ School of Journalism, Renmin University of China, 19 Zhong Guancun Street, Beijing, 100081, China, 86 18810386586, libiao@ruc.edu.cn %K information uncertainty %K health communication %K uncertainty management %K COVID-19 %K public health perception %K health information %D 2024 %7 14.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Whether and how the uncertainty about a public health crisis should be communicated to the general public have been important and yet unanswered questions arising over the past few years. As the most threatening contemporary public health crisis, the COVID-19 pandemic has renewed interest in these unresolved issues by both academic scholars and public health practitioners. Objective: The aim of this study was to investigate the impact of communicating uncertainty about COVID-19–related threats and solutions on individuals’ risk perceptions and misinformation vulnerability, as well as the sequential impact of these effects on health information processing and preventative behavioral intentions. Methods: A 2×2 (threat uncertainty [presence vs absence]×solution uncertainty [presence vs absence]) full-fractional between-subjects online experiment was conducted with 371 Chinese adults. Focusing on the discussion of whether the asymptomatic cases detected during the COVID-19 pandemic would further lead to an uncontrolled pandemic, news articles were manipulated in terms of whether the infectiousness of asymptomatic cases and the means to control the transmission are presented in terms of their certainty or uncertainty. Participants were randomly assigned to one of the four experimental conditions, being instructed to read one news article. After reading the news article assigned, participants were asked to respond to a series of questions to assess their cognitive and behavioral responses. Results: Individuals were more susceptible to believing false COVID-19–related information when a certain threat and uncertain solution were framed in the news article. Moreover, individuals’ perceptions of crisis severity increased when exposed to news information containing uncertain solutions. Both misinformation vulnerability and perceived severity were positively associated with information processing. Information seeking was positively associated with protective behavioral intention, whereas information avoidance was negatively associated with protective behavioral intention. Conclusions: Our findings imply that uncertainty, depending on its aspect, can be effectively communicated to the public during an emerging public health crisis. These results have theoretical and practical implications for health communicators and journalists. Given its limited influence on individuals’ cognitive and behavioral responses, uncertainty related to a health threat should be disseminated to meet the public’s expectation of information transparency. However, caution is advised when communicating uncertainty related to potential solutions, as this factor exhibited a mixed impact on individual responses during a crisis. %M 38743940 %R 10.2196/51910 %U https://www.jmir.org/2024/1/e51910 %U https://doi.org/10.2196/51910 %U http://www.ncbi.nlm.nih.gov/pubmed/38743940 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e55750 %T Understanding the Impacts of Online Mental Health Peer Support Forums: Realist Synthesis %A Marshall,Paul %A Booth,Millissa %A Coole,Matthew %A Fothergill,Lauren %A Glossop,Zoe %A Haines,Jade %A Harding,Andrew %A Johnston,Rose %A Jones,Steven %A Lodge,Christopher %A Machin,Karen %A Meacock,Rachel %A Nielson,Kristi %A Puddephatt,Jo-Anne %A Rakic,Tamara %A Rayson,Paul %A Robinson,Heather %A Rycroft-Malone,Jo %A Shryane,Nick %A Swithenbank,Zoe %A Wise,Sara %A Lobban,Fiona %+ Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Health Innovation One, Lancaster, LA1 4YW, United Kingdom, 44 01524 522187, p.marshall4@lancaster.ac.uk %K digital mental health %K peer-to-peer support %K social networking %K moderation %K systematic review %D 2024 %7 9.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Online forums are widely used for mental health peer support. However, evidence of their safety and effectiveness is mixed. Further research focused on articulating the contexts in which positive and negative impacts emerge from forum use is required to inform innovations in implementation. Objective: This study aimed to develop a realist program theory to explain the impacts of online mental health peer support forums on users. Methods: We conducted a realist synthesis of literature published between 2019 and 2023 and 18 stakeholder interviews with forum staff. Results: Synthesis of 102 evidence sources and 18 interviews produced an overarching program theory comprising 22 context-mechanism-outcome configurations. Findings indicate that users’ perceptions of psychological safety and the personal relevance of forum content are foundational to ongoing engagement. Safe and active forums that provide convenient access to information and advice can lead to improvements in mental health self-efficacy. Within the context of welcoming and nonjudgmental communities, users may benefit from the opportunity to explore personal difficulties with peers, experience reduced isolation and normalization of mental health experiences, and engage in mutual encouragement. The program theory highlights the vital role of moderators in creating facilitative online spaces, stimulating community engagement, and limiting access to distressing content. A key challenge for organizations that host mental health forums lies in balancing forum openness and anonymity with the need to enforce rules, such as restrictions on what users can discuss, to promote community safety. Conclusions: This is the first realist synthesis of online mental health peer support forums. The novel program theory highlights how successful implementation depends on establishing protocols for enhancing safety and strategies for maintaining user engagement to promote forum sustainability. Trial Registration: PROSPERO CRD42022352528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=352528 %M 38722680 %R 10.2196/55750 %U https://mental.jmir.org/2024/1/e55750 %U https://doi.org/10.2196/55750 %U http://www.ncbi.nlm.nih.gov/pubmed/38722680 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51698 %T A Typology of Social Media Use by Human Service Nonprofits: Mixed Methods Study %A Xue,Jia %A Shier,Micheal L %A Chen,Junxiang %A Wang,Yirun %A Zheng,Chengda %A Chen,Chen %+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada, 1 4169465429, jia.xue@utoronto.ca %K human service nonprofits %K sexual assault support centers %K Canada %K typology %K theory %K Twitter %K machine learning %K social media %K tweet %K tweets %K nonprofit %K nonprofits %K crisis %K sexual assault %K sexual violence %K sexual abuse %K support center %K support centers %K communication %K communications %K organization %K organizations %K organizational %K sentiment analysis %K business %K marketing %D 2024 %7 8.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Nonprofit organizations are increasingly using social media to improve their communication strategies with the broader population. However, within the domain of human service nonprofits, there is hesitancy to fully use social media tools, and there is limited scope among organizational personnel in applying their potential beyond self-promotion and service advertisement. There is a pressing need for greater conceptual clarity to support education and training on the varied reasons for using social media to increase organizational outcomes. Objective: This study leverages the potential of Twitter (subsequently rebranded as X [X Corp]) to examine the online communication content within a sample (n=133) of nonprofit sexual assault (SA) centers in Canada. To achieve this, we developed a typology using a qualitative and supervised machine learning model for the automatic classification of tweets posted by these centers. Methods: Using a mixed methods approach that combines machine learning and qualitative analysis, we manually coded 10,809 tweets from 133 SA centers in Canada, spanning the period from March 2009 to March 2023. These manually labeled tweets were used as the training data set for the supervised machine learning process, which allowed us to classify 286,551 organizational tweets. The classification model based on supervised machine learning yielded satisfactory results, prompting the use of unsupervised machine learning to classify the topics within each thematic category and identify latent topics. The qualitative thematic analysis, in combination with topic modeling, provided a contextual understanding of each theme. Sentiment analysis was conducted to reveal the emotions conveyed in the tweets. We conducted validation of the model with 2 independent data sets. Results: Manual annotation of 10,809 tweets identified seven thematic categories: (1) community engagement, (2) organization administration, (3) public awareness, (4) political advocacy, (5) support for others, (6) partnerships, and (7) appreciation. Organization administration was the most frequent segment, and political advocacy and partnerships were the smallest segments. The supervised machine learning model achieved an accuracy of 63.4% in classifying tweets. The sentiment analysis revealed a prevalence of neutral sentiment across all categories. The emotion analysis indicated that fear was predominant, whereas joy was associated with the partnership and appreciation tweets. Topic modeling identified distinct themes within each category, providing valuable insights into the prevalent discussions surrounding SA and related issues. Conclusions: This research contributes an original theoretical model that sheds light on how human service nonprofits use social media to achieve their online organizational communication objectives across 7 thematic categories. The study advances our comprehension of social media use by nonprofits, presenting a comprehensive typology that captures the diverse communication objectives and contents of these organizations, which provide content to expand training and education for nonprofit leaders to connect and engage with the public, policy experts, other organizations, and potential service users. %M 38718390 %R 10.2196/51698 %U https://www.jmir.org/2024/1/e51698 %U https://doi.org/10.2196/51698 %U http://www.ncbi.nlm.nih.gov/pubmed/38718390 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54433 %T Examining the Gateway Hypothesis and Mapping Substance Use Pathways on Social Media: Machine Learning Approach %A Yuan,Yunhao %A Kasson,Erin %A Taylor,Jordan %A Cavazos-Rehg,Patricia %A De Choudhury,Munmun %A Aledavood,Talayeh %+ Department of Computer Science, Aalto University, P.O. Box 11000 (Otakaari 1B), FI-00076 AALTO, Espoo, FI-00076, Finland, 358 509113635, Yunhao.Yuan@aalto.fi %K gateway hypothesis %K substance use %K social media %K deep learning %K natural language processing %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Substance misuse presents significant global public health challenges. Understanding transitions between substance types and the timing of shifts to polysubstance use is vital to developing effective prevention and recovery strategies. The gateway hypothesis suggests that high-risk substance use is preceded by lower-risk substance use. However, the source of this correlation is hotly contested. While some claim that low-risk substance use causes subsequent, riskier substance use, most people using low-risk substances also do not escalate to higher-risk substances. Social media data hold the potential to shed light on the factors contributing to substance use transitions. Objective: By leveraging social media data, our study aimed to gain a better understanding of substance use pathways. By identifying and analyzing the transitions of individuals between different risk levels of substance use, our goal was to find specific linguistic cues in individuals’ social media posts that could indicate escalating or de-escalating patterns in substance use. Methods: We conducted a large-scale analysis using data from Reddit, collected between 2015 and 2019, consisting of over 2.29 million posts and approximately 29.37 million comments by around 1.4 million users from subreddits. These data, derived from substance use subreddits, facilitated the creation of a risk transition data set reflecting the substance use behaviors of over 1.4 million users. We deployed deep learning and machine learning techniques to predict the escalation or de-escalation transitions in risk levels, based on initial transition phases documented in posts and comments. We conducted a linguistic analysis to analyze the language patterns associated with transitions in substance use, emphasizing the role of n-gram features in predicting future risk trajectories. Results: Our results showed promise in predicting the escalation or de-escalation transition in risk levels, based on the historical data of Reddit users created on initial transition phases among drug-related subreddits, with an accuracy of 78.48% and an F1-score of 79.20%. We highlighted the vital predictive features, such as specific substance names and tools indicative of future risk escalations. Our linguistic analysis showed that terms linked with harm reduction strategies were instrumental in signaling de-escalation, whereas descriptors of frequent substance use were characteristic of escalating transitions. Conclusions: This study sheds light on the complexities surrounding the gateway hypothesis of substance use through an examination of web-based behavior on Reddit. While certain findings validate the hypothesis, indicating a progression from lower-risk substances such as marijuana to higher-risk ones, a significant number of individuals did not show this transition. The research underscores the potential of using machine learning with social media analysis to predict substance use transitions. Our results point toward future directions for leveraging social media data in substance use research, underlining the importance of continued exploration before suggesting direct implications for interventions. %M 38713904 %R 10.2196/54433 %U https://formative.jmir.org/2024/1/e54433 %U https://doi.org/10.2196/54433 %U http://www.ncbi.nlm.nih.gov/pubmed/38713904 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 16 %N %P e49262 %T Investigating Patient Satisfaction Through Web-Based Reviews of Norwegian Dentists: Quantitative Study Using the Meaning Extraction Method %A Larsen,Maria %A Holde,Gro Eirin %A Johnsen,Jan-Are Kolset %+ Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens veg 86, Tromsø, 9019, Norway, 47 77 64 67 51, jan.a.johnsen@uit.no %K internet use %K Linguistic Inquiry and Word Count %K LIWC %K patient satisfaction %K patient preference %K challenging encounters %K preventive dentistry %K population surveillance %D 2024 %7 3.5.2024 %9 Original Paper %J J Particip Med %G English %X Background: Challenging encounters in health care professions, including in dentistry, are relatively common. Challenging encounters can be defined as stressful or emotional situations involving patients that could impact both treatment outcomes and patients’ experiences. Through written web-based reviews, patients can share their experiences with health care providers, and these posts can be a useful source for investigating patient satisfaction and their experiences of challenging encounters. Objective: This study aims to identify dominant themes from patient-written, web-based reviews of dentists and investigate how these themes are related to patient satisfaction with dental treatment. Methods: The study data consisted of 11,764 reviews written by dental patients, which included 1- to 5-star ratings on overall satisfaction and free-text comments. The free-text comments were analyzed using Linguistic Inquiry and Word Count software, and the meaning extraction method was used to group words into thematic categories. These themes were used as variables in a multilevel logistic regression analysis to predict patient satisfaction. Results: Eight themes emerged from the analyses, of which 6 (75%)—explanation (odds ratio [OR] 2.56, 95% CI 2.16-3.04; P<.001), assurance (OR 3.61, 95% CI 2.57-5.06; P<.001), performance assessment (OR 2.17, 95% CI 1.84-2.55; P<.001), professional advice (OR 1.81, 95% CI 1.55-2.13; P<.001), facilities (OR 1.78, 95% CI 1.08-2.91; P=.02), and recommendation (OR 1.31, 95% CI 1.12-1.53; P<.001)—increased the odds of high patient satisfaction. The remaining themes (2/8, 25%)—consequences of treatment need (OR 0.24, 95% CI 0.20-0.29; P<.001) and patient-centered care (OR 0.62, 95% CI 0.52-0.74; P<.001)—reduced the odds of high patient satisfaction. Conclusions: The meaning extraction method is an interesting approach to explore patients’ written accounts of encounters with dental health professionals. The experiences described by patients provide insight into key elements related to patient satisfaction that can be used in the education of dental health professionals and to improve the provision of dental health services. %M 38700933 %R 10.2196/49262 %U https://jopm.jmir.org/2024/1/e49262 %U https://doi.org/10.2196/49262 %U http://www.ncbi.nlm.nih.gov/pubmed/38700933 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e49335 %T Experiences of Women With Medical Abortion Care Reflected in Social Media (VEILLE Study): Noninterventional Retrospective Exploratory Infodemiology Study %A Gouy,Giulia %A Attali,Luisa %A Voillot,Paméla %A Fournet,Patrick %A Agostini,Aubert %+ Service de Gynécologie-Obstétrique, Hôpital de la Croix-Rousse, 103 Gd Rue de la Croix-Rousse, Lyon, 69004, France, 33 472 071 936, giulia.gouy@chu-lyon.fr %K infodemiology %K medical abortion %K patient experience %K real-world evidence %K social media %K abortion %K women's health %K reproduction %K reproductive %K obstetric %K obstetrics %K gynecology %K gynecological %K text mining %K topic model %K topic modeling %K natural language processing %K NLP %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Abortion (also known as termination of pregnancy) is an essential element of women’s reproductive health care. Feedback from women who underwent medical termination of pregnancy about their experience is crucial to help practitioners identify women’s needs and develop necessary tools to improve the abortion care process. However, the collection of this feedback is quite challenging. Social media offer anonymity for women who share their abortion experience. Objective: This exploratory infodemiology study aimed to analyze, through French social media posts, personal medical symptoms and the different experiences and information dynamics associated with the medical abortion process. Methods: A retrospective study was performed by analyzing posts geolocated in France and published from January 1, 2017, to November 30, 2021. Posts were extracted from all French-language general and specialized publicly available web forums using specific keywords. Extracted messages were cleaned and pseudonymized. Automatic natural language processing methods were used to identify posts from women having experienced medical abortion. Biterm topic modeling was used to identify the main discussion themes and the Medical Dictionary for Regulatory Activities was used to identify medical terms. Encountered difficulties were explored using qualitative research methods until the saturation of concepts was reached. Results: Analysis of 5398 identified posts (3409 users) led to the identification of 9 major topics: personal experience (n=2413 posts, 44.7%), community support (n=1058, 19.6%), pain and bleeding (n=797, 14.8%), psychological experience (n=760, 14.1%), questioned efficacy (n=410, 7.6%), social pressure (n=373, 6.9%), positive experiences (n=257, 4.8%), menstrual cycle disorders (n=107, 2%), and reported inefficacy (n=104, 1.9%). Pain, which was mentioned in 1627 (30.1%) of the 5398 posts by 1024 (30.0%) of the 3409 users, was the most frequently reported medical term. Pain was considered severe to unbearable in 24.5% of the cases (399 of the 1627 posts). Lack of information was the most frequently reported difficulty during and after the process. Conclusions: Our findings suggest that French women used social media to share their experiences, offer and find support, and provide and receive information regarding medical abortion. Infodemiology appears to be a useful tool to obtain women’s feedback, therefore offering the opportunity to enhance care in women undergoing medical abortion. %M 38696232 %R 10.2196/49335 %U https://infodemiology.jmir.org/2024/1/e49335 %U https://doi.org/10.2196/49335 %U http://www.ncbi.nlm.nih.gov/pubmed/38696232 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53646 %T Lack of Diversity in Research on Females with Ehlers-Danlos Syndromes: Recruitment Protocol for a Quantitative Online Survey %A Glayzer,Jennifer E %A Bray,Bethany C %A Kobak,William H %A Steffen,Alana D %A Schlaeger,Judith M %+ Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, 845 S. Damen Ave, Chicago, IL, 60622, United States, 1 2487629576, jglayzer@iu.edu %K Ehlers-Danlos syndrome %K hypermobility %K social media %K recruitment %K Facebook %K hereditary disease %K connective tissue disorders %K racial %K ethnic %K diversity %K challenges %K strategies %K strategy %K online %K information seeking %K cross-sectional survey %K dyspareunia %K painful sex %K United States %D 2024 %7 2.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Ehlers-Danlos syndromes (EDS) are a group of connective tissue disorders caused by fragile lax collagen. Current EDS research lacks racial and ethnic diversity. The lack of diversity may be associated with the complexities of conducting a large international study on an underdiagnosed condition and a lack of EDS health care providers who diagnose and conduct research outside of the United States and Europe. Social media may be the key to recruiting a large diverse EDS sample. However, studies that have used social media to recruit have not been able to recruit diverse samples. Objective: This study aims to discuss challenges, strategies, outcomes, and lessons learned from using social media to recruit a large sample of females with EDS. Methods: Recruitment on social media for a cross-sectional survey examining dyspareunia (painful sexual intercourse) in females was examined. Inclusion criteria were (1) older than 18 years of age, (2) assigned female at birth, and (3) diagnosed with EDS. Recruitment took place on Facebook and Twitter (now X), from June 1 to June 25, 2019. Results: A total of 1178 females with EDS were recruited from Facebook (n=1174) and X (n=4). On Facebook, participants were recruited via support groups. A total of 166 EDS support groups were identified, 104 permitted the principal investigator to join, 90 approved posting, and the survey was posted in 54 groups. Among them, 30 of the support groups posted in were globally focused and not tied to any specific country or region, 21 were for people in the United States, and 3 were for people outside of the United States. Recruitment materials were posted on X with the hashtag #EDS. A total of 1599 people accessed the survey and 1178 people were eligible and consented. The average age of participants was 38.6 (SD 11.7) years. Participants were predominantly White (n=1063, 93%) and non-Hispanic (n=1046, 92%). Participants were recruited from 29 countries, with 900 (79%) from the United States and 124 (11%) from Great Britain. Conclusions: Our recruitment method was successful at recruiting a large sample. The sample was predominantly White and from North America and Europe. More research needs to be conducted on how to recruit a diverse sample. Areas to investigate may include connecting with more support groups from outside the United States and Europe, researching which platforms are popular in different countries, and translating study materials into different languages. A larger obstacle to recruiting diverse samples may be the lack of health care providers that diagnose EDS outside the United States and Europe, making the pool of potential participants small. There needs to be more health care providers that diagnose and treat EDS in countries that are predominantly made up of people of color as well as research that specifically focuses on these populations. International Registered Report Identifier (IRRID): RR1-10.2196/53646 %M 38696252 %R 10.2196/53646 %U https://www.researchprotocols.org/2024/1/e53646 %U https://doi.org/10.2196/53646 %U http://www.ncbi.nlm.nih.gov/pubmed/38696252 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e51127 %T Perceptions of Health Misinformation on Social Media: Cross-Sectional Survey Study %A Gaysynsky,Anna %A Senft Everson,Nicole %A Heley,Kathryn %A Chou,Wen-Ying Sylvia %+ Health Communication and Informatics Research Branch, Behavioral Research Program, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, United States, 1 240 276 5284, anna.gaysynsky@nih.gov %K social media %K misinformation %K health communication %K health literacy %K patient-provider communication %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Health misinformation on social media can negatively affect knowledge, attitudes, and behaviors, undermining clinical care and public health efforts. Therefore, it is vital to better understand the public’s experience with health misinformation on social media. Objective: The goal of this analysis was to examine perceptions of the social media information environment and identify associations between health misinformation perceptions and health communication behaviors among US adults. Methods: Analyses used data from the 2022 Health Information National Trends Survey (N=6252). Weighted unadjusted proportions described respondents’ perceptions of the amount of false or misleading health information on social media (“perceived misinformation amount”) and how difficult it is to discern true from false information on social media (“perceived discernment difficulty”). Weighted multivariable logistic regressions examined (1) associations of sociodemographic characteristics and subjective literacy measures with misinformation perceptions and (2) relationships between misinformation perceptions and health communication behaviors (ie, sharing personal or general health information on social media and using social media information in health decisions or in discussions with health care providers). Results: Over one-third of social media users (35.61%) perceived high levels of health misinformation, and approximately two-thirds (66.56%) reported high perceived discernment difficulty. Odds of perceiving high amounts of misinformation were lower among non-Hispanic Black/African American (adjusted odds ratio [aOR] 0.407, 95% CI 0.282-0.587) and Hispanic (aOR 0.610, 95% CI 0.449-0.831) individuals compared to White individuals. Those with lower subjective health literacy were less likely to report high perceived misinformation amount (aOR 0.602, 95% CI 0.374-0.970), whereas those with lower subjective digital literacy were more likely to report high perceived misinformation amount (aOR 1.775, 95% CI 1.400-2.251). Compared to White individuals, Hispanic individuals had lower odds of reporting high discernment difficulty (aOR 0.620, 95% CI 0.462-0.831). Those with lower subjective digital literacy (aOR 1.873, 95% CI 1.478-2.374) or numeracy (aOR 1.465, 95% CI 1.047-2.049) were more likely to report high discernment difficulty. High perceived misinformation amount was associated with lower odds of sharing general health information on social media (aOR 0.742, 95% CI 0.568-0.968), using social media information to make health decisions (aOR 0.273, 95% CI 0.156-0.479), and using social media information in discussions with health care providers (aOR 0.460, 95% CI 0.323-0.655). High perceived discernment difficulty was associated with higher odds of using social media information in health decisions (aOR 1.724, 95% CI 1.208-2.460) and health care provider discussions (aOR 1.389, 95% CI 1.035-1.864). Conclusions: Perceptions of high health misinformation prevalence and discernment difficulty are widespread among social media users, and each has unique associations with sociodemographic characteristics, literacy, and health communication behaviors. These insights can help inform future health communication interventions. %M 38687591 %R 10.2196/51127 %U https://infodemiology.jmir.org/2024/1/e51127 %U https://doi.org/10.2196/51127 %U http://www.ncbi.nlm.nih.gov/pubmed/38687591 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50656 %T A Machine Learning Model for Identifying Sexual Health Influencers to Promote the Secondary Distribution of HIV Self-Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men in China: Quasi-Experimental Study %A Ni,Yuxin %A Lu,Ying %A Jing,Fengshi %A Wang,Qianyun %A Xie,Yewei %A He,Xi %A Wu,Dan %A Tan,Rayner Kay Jin %A Tucker,Joseph D %A Yan,Xumeng %A Ong,Jason J %A Zhang,Qingpeng %A Jiang,Hongbo %A Dai,Wencan %A Huang,Liqun %A Mei,Wenhua %A Zhou,Yi %A Tang,Weiming %+ Dermatology Hospital of Southern Medical University, 2 Lujing Rd, Yuexiu District, Guangzhou, 510091, China, 86 13302391532, weiming_tang@med.unc.edu %K artificial intelligence %K HIV testing %K key opinion leaders %K machine learning %K men who have sex with men %K self-testing %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Sexual health influencers (SHIs) are individuals actively sharing sexual health information with their peers, and they play an important role in promoting HIV care services, including the secondary distribution of HIV self-testing (SD-HIVST). Previous studies used a 6-item empirical leadership scale to identify SHIs. However, this approach may be biased as it does not consider individuals’ social networks. Objective: This study used a quasi-experimental study design to evaluate how well a newly developed machine learning (ML) model identifies SHIs in promoting SD-HIVST compared to SHIs identified by a scale whose validity had been tested before. Methods: We recruited participants from BlueD, the largest social networking app for gay men in China. Based on their responses to the baseline survey, the ML model and scale were used to identify SHIs, respectively. This study consisted of 2 rounds, differing in the upper limit of the number of HIVST kits and peer-referral links that SHIs could order and distribute (first round ≤5 and second round ≤10). Consented SHIs could order multiple HIV self-testing (HIVST) kits and generate personalized peer-referral links through a web-based platform managed by a partnered gay-friendly community-based organization. SHIs were encouraged to share additional kits and peer-referral links with their social contacts (defined as “alters”). SHIs would receive US $3 incentives when their corresponding alters uploaded valid photographic testing results to the same platform. Our primary outcomes included (1) the number of alters who conducted HIVST in each group and (2) the number of newly tested alters who conducted HIVST in each. We used negative binomial regression to examine group differences during the first round (February-June 2021), the second round (June-November 2021), and the combined first and second rounds, respectively. Results: In January 2021, a total of 1828 men who have sex with men (MSM) completed the survey. Overall, 393 SHIs (scale=195 and ML model=198) agreed to participate in SD-HIVST. Among them, 229 SHIs (scale=116 and ML model=113) ordered HIVST on the web. Compared with the scale group, SHIs in the ML model group motivated more alters to conduct HIVST (mean difference [MD] 0.88, 95% CI 0.02-2.22; adjusted incidence risk ratio [aIRR] 1.77, 95% CI 1.07-2.95) when we combined the first and second rounds. Although the mean number of newly tested alters was slightly higher in the ML model group than in the scale group, the group difference was insignificant (MD 0.35, 95% CI –0.17 to –0.99; aIRR 1.49, 95% CI 0.74-3.02). Conclusions: Among Chinese MSM, SHIs identified by the ML model can motivate more individuals to conduct HIVST than those identified by the scale. Future research can focus on how to adapt the ML model to encourage newly tested individuals to conduct HIVST. Trial Registration: Chinese Clinical Trials Registry ChiCTR2000039632; https://www.chictr.org.cn/showprojEN.html?proj=63068 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-021-11817-2 %M 38656769 %R 10.2196/50656 %U https://publichealth.jmir.org/2024/1/e50656 %U https://doi.org/10.2196/50656 %U http://www.ncbi.nlm.nih.gov/pubmed/38656769 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48356 %T Electronic Media Use and Sleep Quality: Updated Systematic Review and Meta-Analysis %A Han,Xiaoning %A Zhou,Enze %A Liu,Dong %+ School of Journalism and Communication, Renmin University of China, No. 59 Zhongguancun Street, Haidian District, Beijing, 100872, China, 86 13693388506, bnuliudong@gmail.com %K electronic media %K sleep quality %K meta-analysis %K media types %K cultural difference %D 2024 %7 23.4.2024 %9 Review %J J Med Internet Res %G English %X Background: This paper explores the widely discussed relationship between electronic media use and sleep quality, indicating negative effects due to various factors. However, existing meta-analyses on the topic have some limitations. Objective: The study aims to analyze and compare the impacts of different digital media types, such as smartphones, online games, and social media, on sleep quality. Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the study performed a systematic meta-analysis of literature across multiple databases, including Web of Science, MEDLINE, PsycINFO, PubMed, Science Direct, Scopus, and Google Scholar, from January 2018 to October 2023. Two trained coders coded the study characteristics independently. The effect sizes were calculated using the correlation coefficient as a standardized measure of the relationship between electronic media use and sleep quality across studies. The Comprehensive Meta-Analysis software (version 3.0) was used to perform the meta-analysis. Statistical methods such as funnel plots were used to assess the presence of asymmetry and a p-curve test to test the p-hacking problem, which can indicate publication bias. Results: Following a thorough screening process, the study involved 55 papers (56 items) with 41,716 participants from over 20 countries, classifying electronic media use into “general use” and “problematic use.” The meta-analysis revealed that electronic media use was significantly linked with decreased sleep quality and increased sleep problems with varying effect sizes across subgroups. A significant cultural difference was also observed in these effects. General use was associated with a significant decrease in sleep quality (P<.001). The pooled effect size was 0.28 (95% CI 0.21-0.35; k=20). Problematic use was associated with a significant increase in sleep problems (P≤.001). The pooled effect size was 0.33 (95% CI 0.28-0.38; k=36). The subgroup analysis indicated that the effect of general smartphone use and sleep problems was r=0.33 (95% CI 0.27-0.40), which was the highest among the general group. The effect of problematic internet use and sleep problems was r=0.51 (95% CI 0.43-0.59), which was the highest among the problematic groups. There were significant differences among these subgroups (general: Qbetween=14.46, P=.001; problematic: Qbetween=27.37, P<.001). The results of the meta-regression analysis using age, gender, and culture as moderators indicated that only cultural difference in the relationship between Eastern and Western culture was significant (Qbetween=6.69; P=.01). All funnel plots and p-curve analyses showed no evidence of publication and selection bias. Conclusions: Despite some variability, the study overall confirms the correlation between increased electronic media use and poorer sleep outcomes, which is notably more significant in Eastern cultures. %M 38533835 %R 10.2196/48356 %U https://www.jmir.org/2024/1/e48356 %U https://doi.org/10.2196/48356 %U http://www.ncbi.nlm.nih.gov/pubmed/38533835 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50443 %T The Role of Social Media in the Experiences of COVID-19 Among Long-Hauler Women: Qualitative Study %A Garrett,Camryn %A Aghaei,Atefeh %A Aggarwal,Abhishek %A Qiao,Shan %+ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States, 1 803 777 6844, camrynmg@email.sc.edu %K COVID-19 %K long COVID %K long-haulers %K women %K gender %K social media %K digital media %K qualitative study %D 2024 %7 23.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The extant literature suggests that women are more vulnerable to COVID-19 infection and at higher risk for developing long COVID. Due to pandemic mitigation recommendations, social media was relied upon for various aspects of daily life, likely with differences of usage between genders. Objective: This study aimed to explore the role and functions of social media in the lives of long-hauler women. Methods: Participants were purposively snowball-sampled from an online health promotion intervention for long-hauler women with COVID-19 from March to June 2021. During this time, one-on-one, semistructured interviews were conducted online until data saturation was agreed to have been achieved (ie, 15 interviews). Interview transcripts and field notes were analyzed using an emergent, inductive approach. Results: In total, 15 women were enrolled. The main roles of social media included facilitating support group participation, experience sharing, interpersonal connections, and media consumption. Emergent themes demonstrated that participants rely on social media to fulfill needs of emotional support, social engagement, spirituality, health planning, information gathering, professional support, and recreationally for relaxation. As long-hauler women turn to social media to discuss symptom and health management as well as the intention to vaccinate, this study demonstrates both the associated benefits (ie, decreased isolation) and challenges (ie, misinformation, rumination, resentment, jealousy). Conclusions: The public health implications of these findings support the development of gender-tailored health promotion interventions that leverage the benefits of social media, while mitigating the negative impacts, for women with long COVID. %M 38652515 %R 10.2196/50443 %U https://humanfactors.jmir.org/2024/1/e50443 %U https://doi.org/10.2196/50443 %U http://www.ncbi.nlm.nih.gov/pubmed/38652515 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53336 %T Professional Social Media Use Among Orthopedic and Trauma Surgeons in Germany: Cross-Sectional Questionnaire-Based Study %A Youssef,Yasmin %A Gehlen,Tobias %A Ansorg,Jörg %A Back,David Alexander %A Scherer,Julian %+ Department of Traumatology, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland, 41 762030775, julian.scherer@usz.ch %K social media %K digitalization %K digital communication %K orthopedics %K traumatology %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media (SM) has been recognized as a professional communication tool in the field of orthopedic and trauma surgery that can enhance communication with patients and peers, and increase the visibility of research and offered services. The specific purposes of professional SM use and the benefits and concerns among orthopedic and trauma surgeons, however, remain unexplored. Objective: This study aims to demonstrate the specific uses of different SM platforms among orthopedic and trauma surgeons in Germany as well as the advantages and concerns. Methods: A web-based questionnaire was developed on the use of SM in a professional context by considering the current literature and the authors’ topics of interest. The final questionnaire consisted of 33 questions and was distributed among German orthopedic and trauma surgeons via the mail distributor of the Berufsverband für Orthopädie und Unfallchirurgie (Professional Association of Orthopaedic Surgeons in Germany). The study was conducted between June and July 2022. A subgroup analysis was performed for sex (male vs female), age (<60 years vs ≥60 years), and type of workplace (practice vs hospital). Results: A total of 208 participants answered the questionnaire (male: n=166, 79.8%; younger than 60 years: n=146, 70.2%). In total, all of the participants stated that they use SM for professional purposes. In contrast, the stated specific uses of SM were low. Overall, the most used platforms were employment-oriented SM, messenger apps, and Facebook. Instagram emerged as a popular choice among female participants and participants working in hospital settings. The highest specific use of SM was for professional networking, followed by receiving and sharing health-related information. The lowest specific use was for education and the acquisition of patients. Conventional websites occupied a dominating position, exceeding the use of SM across all specific uses. The key benefit of SM was professional networking. Under 50% of the participants stated that SM could be used to enhance communication with their patients, keep up-to-date, or increase their professional visibility. In total, 65.5% (112/171) of participants stated that SM use was time-consuming, 43.9% (76/173) stated that they lacked application knowledge, and 45.1% (78/173) stated that they did not know what content to post. Additionally, 52.9% (91/172) mentioned medicolegal concerns. Conclusions: Overall, SM did not seem to be used actively in the professional context among orthopedic and trauma surgeons in Germany. The stated advantages were low, while the stated concerns were high. Adequate education and information material are needed to elucidate the possible professional applications of SM and to address legal concerns. %M 38639987 %R 10.2196/53336 %U https://formative.jmir.org/2024/1/e53336 %U https://doi.org/10.2196/53336 %U http://www.ncbi.nlm.nih.gov/pubmed/38639987 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50139 %T Twitter Analysis of Health Care Workers’ Sentiment and Discourse Regarding Post–COVID-19 Condition in Children and Young People: Mixed Methods Study %A Chepo,Macarena %A Martin,Sam %A Déom,Noémie %A Khalid,Ahmad Firas %A Vindrola-Padros,Cecilia %+ Department of Targeted Intervention, University College London, Charles Bell House 43-45, Foley Street, London, W1W 7TY, United Kingdom, 44 (0)20 3108 3232, sam.martin@ucl.ac.uk %K COVID-19 %K postacute sequelae of SARS-CoV-2 %K PASC %K post–COVID-19 condition %K children %K vaccines %K social media %K social network analysis %K Twitter %D 2024 %7 17.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had a significant global impact, with millions of cases and deaths. Research highlights the persistence of symptoms over time (post–COVID-19 condition), a situation of particular concern in children and young people with symptoms. Social media such as Twitter (subsequently rebranded as X) could provide valuable information on the impact of the post–COVID-19 condition on this demographic. Objective: With a social media analysis of the discourse surrounding the prevalence of post–COVID-19 condition in children and young people, we aimed to explore the perceptions of health care workers (HCWs) concerning post–COVID-19 condition in children and young people in the United Kingdom between January 2021 and January 2022. This will allow us to contribute to the emerging knowledge on post–COVID-19 condition and identify critical areas and future directions for researchers and policy makers. Methods: From a pragmatic paradigm, we used a mixed methods approach. Through discourse, keyword, sentiment, and image analyses, using Pulsar and InfraNodus, we analyzed the discourse about the experience of post–COVID-19 condition in children and young people in the United Kingdom shared on Twitter between January 1, 2021, and January 31, 2022, from a sample of HCWs with Twitter accounts whose biography identifies them as HCWs. Results: We obtained 300,000 tweets, out of which (after filtering for relevant tweets) we performed an in-depth qualitative sample analysis of 2588 tweets. The HCWs were responsive to announcements issued by the authorities regarding the management of the COVID-19 pandemic in the United Kingdom. The most frequent sentiment expressed was negative. The main themes were uncertainty about the future, policies and regulations, managing and addressing the COVID-19 pandemic and post–COVID-19 condition in children and young people, vaccination, using Twitter to share scientific literature and management strategies, and clinical and personal experiences. Conclusions: The perceptions described on Twitter by HCWs concerning the presence of the post–COVID-19 condition in children and young people appear to be a relevant and timely issue and responsive to the declarations and guidelines issued by health authorities over time. We recommend further support and training strategies for health workers and school staff regarding the manifestations and treatment of children and young people with post–COVID-19 condition. %M 38630514 %R 10.2196/50139 %U https://www.jmir.org/2024/1/e50139 %U https://doi.org/10.2196/50139 %U http://www.ncbi.nlm.nih.gov/pubmed/38630514 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53417 %T Moderating Effect of Coping Strategies on the Association Between the Infodemic-Driven Overuse of Health Care Services and Cyberchondria and Anxiety: Partial Least Squares Structural Equation Modeling Study %A Xu,Richard Huan %A Chen,Caiyun %+ Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, China (Hong Kong), 852 27664199, richard.xu@polyu.edu.hk %K infodemic %K health care %K cyberchondria %K anxiety %K coping %K structural equation modeling %D 2024 %7 9.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to a substantial increase in health information, which has, in turn, caused a significant rise in cyberchondria and anxiety among individuals who search for web-based medical information. To cope with this information overload and safeguard their mental well-being, individuals may adopt various strategies. However, the effectiveness of these strategies in mitigating the negative effects of information overload and promoting overall well-being remains uncertain. Objective: This study aimed to investigate the moderating effect of coping strategies on the relationship between the infodemic-driven misuse of health care and depression and cyberchondria. The findings could add a new dimension to our understanding of the psychological impacts of the infodemic, especially in the context of a global health crisis, and the moderating effect of different coping strategies on the relationship between the overuse of health care and cyberchondria and anxiety. Methods: The data used in this study were obtained from a cross-sectional web-based survey. A professional survey company was contracted to collect the data using its web-based panel. The survey was completed by Chinese individuals aged 18 years or older without cognitive problems. Model parameters of the relationships between infodemic-driven overuse of health care, cyberchondria, and anxiety were analyzed using bootstrapped partial least squares structural equation modeling. Additionally, the moderating effects of coping strategies on the aforementioned relationships were also examined. Results: A total of 986 respondents completed the web-based survey. The mean scores of the Generalized Anxiety Disorder-7 and Cyberchondria Severity Scale-12 were 8.4 (SD 3.8) and 39.7 (SD 7.5), respectively. The mean score of problem-focused coping was higher than those of emotion- and avoidant-focused coping. There was a significantly positive relationship between a high level of infodemic and increased overuse of health care (bootstrapped mean 0.21, SD 0.03; 95% CI 0.1581-0.271). The overuse of health care resulted in more severe cyberchondria (bootstrapped mean 0.107, SD 0.032) and higher anxiety levels (bootstrapped mean 0.282, SD 0.032) in all the models. Emotion (bootstrapped mean 0.02, SD 0.008 and 0.037, SD 0.015)- and avoidant (bootstrapped mean 0.026, SD 0.009 and 0.049, SD 0.016)-focused coping strategies significantly moderated the relationship between the overuse of health care and cyberchondria and that between the overuse of health care and anxiety, respectively. Regarding the problem-based model, the moderating effect was significant for the relationship between the overuse of health care and anxiety (bootstrapped mean 0.007, SD 0.011; 95% CI 0.005-0.027). Conclusions: This study provides empirical evidence about the impact of coping strategies on the relationship between infodemic-related overuse of health care services and cyberchondria and anxiety. Future research can build on the findings of this study to further explore these relationships and develop and test interventions aimed at mitigating the negative impact of the infodemic on mental health. %M 38593427 %R 10.2196/53417 %U https://www.jmir.org/2024/1/e53417 %U https://doi.org/10.2196/53417 %U http://www.ncbi.nlm.nih.gov/pubmed/38593427 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e53373 %T The New Media Landscape and Its Effects on Skin Cancer Diagnostics, Prognostics, and Prevention: Scoping Review %A Haff,Priscilla L %A Jacobson,Alli %A Taylor,Madison M %A Schandua,Hayden P %A Farris,David P %A Doan,Hung Q %A Nelson,Kelly C %+ McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin, Houston, TX, 77030, United States, 1 2108678712, priscilla.l.haff@uth.tmc.edu %K social media %K communication %K skin cancer %K melanoma %K misinformation %K scoping review %D 2024 %7 8.4.2024 %9 Review %J JMIR Dermatol %G English %X Background: The wide availability of web-based sources, including social media (SM), has supported rapid, widespread dissemination of health information. This dissemination can be an asset during public health emergencies; however, it can also present challenges when the information is inaccurate or ill-informed. Of interest, many SM sources discuss cancer, specifically cutaneous melanoma and keratinocyte cancers (basal cell and squamous cell carcinoma). Objective: Through a comprehensive and scoping review of the literature, this study aims to gain an actionable perspective of the state of SM information regarding skin cancer diagnostics, prognostics, and prevention. Methods: We performed a scoping literature review to establish the relationship between SM and skin cancer. A literature search was conducted across MEDLINE, Embase, Cochrane Library, Web of Science, and Scopus from January 2000 to June 2023. The included studies discussed SM and its relationship to and effect on skin cancer. Results: Through the search, 1009 abstracts were initially identified, 188 received full-text review, and 112 met inclusion criteria. The included studies were divided into 7 groupings based on a publication’s primary objective: misinformation (n=40, 36%), prevention campaign (n=19, 17%), engagement (n=16, 14%), research (n=12, 11%), education (n=11, 10%), demographics (n=10, 9%), and patient support (n=4, 3%), which were the most common identified themes. Conclusions: Through this review, we gained a better understanding of the SM environment addressing skin cancer information, and we gained insight into the best practices by which SM could be used to positively influence the health care information ecosystem. %M 38587890 %R 10.2196/53373 %U https://derma.jmir.org/2024/1/e53373 %U https://doi.org/10.2196/53373 %U http://www.ncbi.nlm.nih.gov/pubmed/38587890 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49921 %T The Influence of Joe Wicks on Physical Activity During the COVID-19 Pandemic: Thematic, Location, and Social Network Analysis of X Data %A Ahmed,Wasim %A Aiyenitaju,Opeoluwa %A Chadwick,Simon %A Hardey,Mariann %A Fenton,Alex %+ Management School, University of Stirling, Airthrey Road, Stirling, FK9 4LA, United Kingdom, 44 1482 346311, w.ahmed@hull.ac.uk %K social media %K social network analysis %K COVID-19 %K influencers %K public health %K social network %K physical activity %K promotion %K fitness %K exercise %K workout %K Twitter %K content creation %K communication %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background:  Social media (SM) was essential in promoting physical activity during the COVID-19 pandemic, especially among people confined to their homes. Joe Wicks, a fitness coach, became particularly popular on SM during this time, posting daily workouts that millions of people worldwide followed. Objective:  This study aims to investigate the influence of Joe Wicks on SM and the impact of his content on physical activity levels among the public. Methods:  We used NodeXL Pro (Social Media Research Foundation) to collect data from X (formerly Twitter) over 54 days (March 23, 2020, to May 15, 2020), corresponding to the strictest lockdowns in the United Kingdom. We collected 290,649 posts, which we analyzed using social network analysis, thematic analysis, time-series analysis, and location analysis. Results:  We found that there was significant engagement with content generated by Wicks, including reposts, likes, and comments. The most common types of posts were those that contained images, videos, and text of young people (school-aged children) undertaking physical activity by watching content created by Joe Wicks and posts from schools encouraging pupils to engage with the content. Other shared posts included those that encouraged others to join the fitness classes run by Wicks and those that contained general commentary. We also found that Wicks’ network of influence was extensive and complex. It contained numerous subcommunities and resembled a broadcast network shape. Other influencers added to engagement with Wicks via their networks. Our results show that influencers can create networks of influence that are exhibited in distinctive ways. Conclusions: Our study found that Joe Wicks was a highly influential figure on SM during the COVID-19 pandemic and that his content positively impacted physical activity levels among the public. Our findings suggest that influencers can play an important role in promoting public health and that government officials should consider working with influencers to communicate health messages and promote healthy behaviors. Our study has broader implications beyond the status of fitness influencers. Recognizing the critical role of individuals such as Joe Wicks in terms of health capital should be a critical area of inquiry for governments, public health authorities, and policy makers and mirrors the growing interest in health capital as part of embodied and digital experiences in everyday life. %M 38551627 %R 10.2196/49921 %U https://www.jmir.org/2024/1/e49921 %U https://doi.org/10.2196/49921 %U http://www.ncbi.nlm.nih.gov/pubmed/38551627 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48130 %T Medical Misinformation in Polish on the World Wide Web During the COVID-19 Pandemic Period: Infodemiology Study %A Chlabicz,Małgorzata %A Nabożny,Aleksandra %A Koszelew,Jolanta %A Łaguna,Wojciech %A Szpakowicz,Anna %A Sowa,Paweł %A Budny,Wojciech %A Guziejko,Katarzyna %A Róg-Makal,Magdalena %A Pancewicz,Sławomir %A Kondrusik,Maciej %A Czupryna,Piotr %A Cudowska,Beata %A Lebensztejn,Dariusz %A Moniuszko-Malinowska,Anna %A Wierzbicki,Adam %A Kamiński,Karol A %+ Department of Software Engineering, Gdańsk University of Technology, ul. Gabriela Narutowicza 11/12, Gdańsk, 80-233, Poland, 48 58 348 67 00, alenaboz@pg.edu.pl %K infodemic %K fake news %K information credibility %K online health information %K evidence based medicine %K EBM %K false %K credibility %K credible %K health information %K online information %K information quality %K infoveillance %K infodemiology %K misinformation %K disinformation %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Although researchers extensively study the rapid generation and spread of misinformation about the novel coronavirus during the pandemic, numerous other health-related topics are contaminating the internet with misinformation that have not received as much attention. Objective: This study aims to gauge the reach of the most popular medical content on the World Wide Web, extending beyond the confines of the pandemic. We conducted evaluations of subject matter and credibility for the years 2021 and 2022, following the principles of evidence-based medicine with assessments performed by experienced clinicians. Methods: We used 274 keywords to conduct web page searches through the BuzzSumo Enterprise Application. These keywords were chosen based on medical topics derived from surveys administered to medical practitioners. The search parameters were confined to 2 distinct date ranges: (1) January 1, 2021, to December 31, 2021; (2) January 1, 2022, to December 31, 2022. Our searches were specifically limited to web pages in the Polish language and filtered by the specified date ranges. The analysis encompassed 161 web pages retrieved in 2021 and 105 retrieved in 2022. Each web page underwent scrutiny by a seasoned doctor to assess its credibility, aligning with evidence-based medicine standards. Furthermore, we gathered data on social media engagements associated with the web pages, considering platforms such as Facebook, Pinterest, Reddit, and Twitter. Results: In 2022, the prevalence of unreliable information related to COVID-19 saw a noteworthy decline compared to 2021. Specifically, the percentage of noncredible web pages discussing COVID-19 and general vaccinations decreased from 57% (43/76) to 24% (6/25) and 42% (10/25) to 30% (3/10), respectively. However, during the same period, there was a considerable uptick in the dissemination of untrustworthy content on social media pertaining to other medical topics. The percentage of noncredible web pages covering cholesterol, statins, and cardiology rose from 11% (3/28) to 26% (9/35) and from 18% (5/28) to 26% (6/23), respectively. Conclusions: Efforts undertaken during the COVID-19 pandemic to curb the dissemination of misinformation seem to have yielded positive results. Nevertheless, our analysis suggests that these interventions need to be consistently implemented across both established and emerging medical subjects. It appears that as interest in the pandemic waned, other topics gained prominence, essentially “filling the vacuum” and necessitating ongoing measures to address misinformation across a broader spectrum of health-related subjects. %M 38551638 %R 10.2196/48130 %U https://www.jmir.org/2024/1/e48130 %U https://doi.org/10.2196/48130 %U http://www.ncbi.nlm.nih.gov/pubmed/38551638 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e51267 %T Social Media Use in Dermatology in Turkey: Challenges and Tips for Patient Health %A Karadag,Ayse Serap %A Kandi,Basak %A Sanlı,Berna %A Ulusal,Hande %A Basusta,Hasan %A Sener,Seray %A Calıka,Sinem %+ Department of Dermatology, Medical School of Istanbul Arel University, Türkoba, Erguvan Sk No: 26, Istanbul, 34537, Turkey, 90 533 655 22 60, karadagaserap@gmail.com %K social media %K dermatology %K internet %K health promotion %K patient education %K Instagram %K YouTube %K online social networking %K social networking %K Turkey %K patient health %K skin %K skin disease %K skincare %K cosmetics %K digital communication %K misinformation %D 2024 %7 28.3.2024 %9 Viewpoint %J JMIR Dermatol %G English %X Social media has established its place in our daily lives, especially with the advent of the COVID-19 pandemic. It has become the leading source of information for dermatological literacy on various topics, ranging from skin diseases to everyday skincare and cosmetic purposes in the present digital era. Accumulated evidence indicates that accurate medical content constitutes only a tiny fraction of the exponentially growing dermatological information on digital platforms, highlighting an unmet patient need for access to evidence-based information on social media. However, there have been no recent local publications from Turkey analyzing and assessing the key elements in raising dermatological literacy and awareness in digital communication for patients. To the best of our knowledge, this study is the first collaborative work between health care professionals and a social media specialist in the medical literature. Furthermore, it represents the first author-initiated implementation science attempt focusing on the use of social media in addressing dermatological problems, with the primary end point of increasing health literacy and patient benefits. The multidisciplinary expert panel was formed by 4 dermatologists with academic credentials and significant influence in public health and among patients on digital platforms. A social media specialist, who serves as a guest lecturer on “How social media works” at Istanbul Technical University, Turkey, was invited to the panel as an expert on digital communication. The panel members had a kickoff meeting to establish the context for the discussion points. The context of the advisory board meeting was outlined under 5 headlines. Two weeks later, the panel members presented their social media account statistics, defined the main characteristics of dermatology patients on social media, and discussed their experiences with patients on digital platforms. These discussions were organized under the predefined headlines and in line with the current literature. We aimed to collect expert opinions on identifying the main characteristics of individuals interested in dermatological topics and to provide recommendations to help dermatologists increase evidence-based dermatological content on social media. Additionally, experts discussed paradigms for dermatological outreach and the role of dermatologists in reducing misleading information on digital platforms in Turkey. The main concluding remark of this study is that dermatologists should enhance their social media presence to increase evidence-based knowledge by applying the principles of patient-physician communication on digital platforms while maintaining a professional stance. To achieve this goal, dermatologists should share targeted scientific content after increasing their knowledge about the operational rules of digital channels. This includes correctly identifying the needs of those seeking information on social media and preparing a sustainable social media communication plan. This viewpoint reflects Turkish dermatologists’ experiences with individuals searching for dermatological information on local digital platforms; therefore, the applicability of recommendations may be limited and should be carefully considered. %M 38546714 %R 10.2196/51267 %U https://derma.jmir.org/2024/1/e51267 %U https://doi.org/10.2196/51267 %U http://www.ncbi.nlm.nih.gov/pubmed/38546714 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50552 %T Bridging and Bonding Social Capital by Analyzing the Demographics, User Activities, and Social Network Dynamics of Sexual Assault Centers on Twitter: Mixed Methods Study %A Xue,Jia %A Zhang,Qiaoru %A Zhang,Yun %A Shi,Hong %A Zheng,Chengda %A Fan,Jingchuan %A Zhang,Linxiao %A Chen,Chen %A Li,Luye %A Shier,Micheal L %+ Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada, 1 416 946 5429, jia.xue@utoronto.ca %K social media %K Twitter %K sexual assault %K nonprofits %K Canada %K violence %K geolocation %K communication %D 2024 %7 27.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms have gained popularity as communication tools for organizations to engage with clients and the public, disseminate information, and raise awareness about social issues. From a social capital perspective, relationship building is seen as an investment, involving a complex interplay of tangible and intangible resources. Social media–based social capital signifies the diverse social networks that organizations can foster through their engagement on social media platforms. Literature underscores the great significance of further investigation into the scope and nature of social media use, particularly within sectors dedicated to service delivery, such as sexual assault organizations. Objective: This study aims to fill a research gap by investigating the use of Twitter by sexual assault support agencies in Canada. It seeks to understand the demographics, user activities, and social network structure within these organizations on Twitter, focusing on building social capital. The research questions explore the demographic profile, geographic distribution, and Twitter activity of these organizations as well as the social network dynamics of bridging and bonding social capital. Methods: This study used purposive sampling to investigate sexual assault centers in Canada with active Twitter accounts, resulting in the identification of 124 centers. The Twitter handles were collected, yielding 113 unique handles, and their corresponding Twitter IDs were obtained and validated. A total of 294,350 tweets were collected from these centers, covering >93.54% of their Twitter activity. Preprocessing was conducted to prepare the data, and descriptive analysis was used to determine the center demographics and age. Furthermore, geolocation mapping was performed to visualize the center locations. Social network analysis was used to explore the intricate relationships within the network of sexual assault center Twitter accounts, using various metrics to assess the network structure and connectivity dynamics. Results: The results highlight the substantial presence of sexual assault organizations on Twitter, particularly in provinces such as Ontario, British Columbia, and Quebec, underscoring the importance of tailored engagement strategies considering regional disparities. The analysis of Twitter account creation years shows a peak in 2012, followed by a decline in new account creations in subsequent years. The monthly tweet activity shows November as the most active month, whereas July had the lowest activity. The study also reveals variations in Twitter activity, account creation patterns, and social network dynamics, identifying influential social queens and marginalized entities within the network. Conclusions: This study presents a comprehensive landscape of the demographics and activities of sexual assault centers in Canada on Twitter. This study suggests that future research should explore the long-term consequences of social media use and examine stakeholder perceptions, providing valuable insights to improve communication practices within the nonprofit human services sector and further the missions of these organizations. %M 38536222 %R 10.2196/50552 %U https://www.jmir.org/2024/1/e50552 %U https://doi.org/10.2196/50552 %U http://www.ncbi.nlm.nih.gov/pubmed/38536222 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e47770 %T Development of a Medical Social Media Ethics Scale and Assessment of #IRad, #CardioTwitter, and #MedTwitter Posts: Mixed Methods Study %A Mlambo,Vongai Christine %A Keller,Eric %A Mussatto,Caroline %A Hwang,Gloria %+ School of Medicine, Stanford University, 751 Layne Court, Apartment 25, Palo Alto, CA, 94306, United States, 1 6506605737, vmlambo@stanford.edu %K ethics %K social media %K conflict of interest %K interventional radiology %K X %K Twitter %K cardiology %K privacy %K ethical issues %K medical social media %K prevalence %K professional %K professionalism %D 2024 %7 27.3.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Social media posts by clinicians are not bound by the same rules as peer-reviewed publications, raising ethical concerns that have not been extensively characterized or quantified. Objective: We aim to develop a scale to assess ethical issues on medical social media (SoMe) and use it to determine the prevalence of these issues among posts with 3 different hashtags: #MedTwitter, #IRad, and #CardioTwitter. Methods: A scale was developed based on previous descriptions of professionalism and validated via semistructured cognitive interviewing with a sample of 11 clinicians and trainees, interrater agreement, and correlation of 100 posts. The final scale assessed social media posts in 6 domains. This was used to analyze 1500 Twitter posts, 500 each from the 3 hashtags. Analysis of posts was limited to original Twitter posts in English made by health care professionals in North America. The prevalence of potential issues was determined using descriptive statistics and compared across hashtags using the Fisher exact and χ2 tests with Yates correction. Results: The final scale was considered reflective of potential ethical issues of SoMe by participants. There was good interrater agreement (Cohen κ=0.620, P<.01) and moderate to strong positive interrater correlation (=0.602, P<.001). The 6 scale domains showed minimal to no interrelation (Cronbach α=0.206). Ethical concerns across all hashtags had a prevalence of 1.5% or less except the conflict of interest concerns on #IRad, which had a prevalence of 3.6% (n=18). Compared to #MedTwitter, posts with specialty-specific hashtags had more patient privacy and conflict of interest concerns. Conclusions: The SoMe professionalism scale we developed reliably reflects potential ethical issues. Ethical issues on SoMe are rare but important and vary in prevalence across medical communities. %M 38536206 %R 10.2196/47770 %U https://infodemiology.jmir.org/2024/1/e47770 %U https://doi.org/10.2196/47770 %U http://www.ncbi.nlm.nih.gov/pubmed/38536206 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45855 %T Youth is Prized in Medicine, Old Age is Valued in Law: Analysis of Media Narratives Over 200 Years %A Ng,Reuben %A Indran,Nicole %+ Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Road, Singapore, 259772, Singapore, 65 66013967, spprng@nus.edu.sg %K older professionals %K ageism %K media %K historical analysis %K reframe aging %K learned professions %K psychomics %D 2024 %7 26.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: This is the first study to explore how age has influenced depictions of doctors and lawyers in the media over the course of 210 years, from 1810 to 2019. The media represents a significant platform for examining age stereotypes and possesses tremendous power to shape public opinion. Insights could be used to improve depictions of older professionals in the media. Objective: This study aims to understand how age shapes the portrayals of doctors and lawyers. Specifically, it compares the difference in sentiments toward younger and older doctors as well as younger and older lawyers in the media over 210 years. Methods: Leveraging a 600-million-word corpus of American media publications spanning 210 years, we compiled top descriptors (N=478,452) of nouns related to youth × occupation (eg, younger doctor or physician) and old age × occupation (eg, older lawyer or attorney). These descriptors were selected using well-established criteria including co-occurrence frequency and context relevance, and were rated on a Likert scale from 1 (very negative) to 5 (very positive). Sentiment scores were generated for “doctor/physician,” “young(er) doctor/physician,” “old(er) doctor/physician,” “lawyer/attorney,” “young(er) lawyer/attorney,” and “old(er) lawyer/attorney.” The scores were calculated per decade for 21 decades from 1810 to 2019. Topic modeling was conducted on the descriptors of each occupation in both the 1800s and 1900s using latent Dirichlet allocation. Results: As hypothesized, the media placed a premium on youth in the medical profession, with portrayals of younger doctors becoming 10% more positive over 210 years, and those of older doctors becoming 1.4% more negative. Meanwhile, a premium was placed on old age in law. Positive portrayals of older lawyers increased by 22.6% over time, while those of younger lawyers experienced a 4.3% decrease. In the 1800s, narratives on younger doctors revolved around their participation in rural health care. In the 1900s, the focus shifted to their mastery of new medical technologies. There was no marked change in narratives surrounding older doctors from the 1800s to the 1900s, though less attention was paid to their skills in the 1900s. Narratives on younger lawyers in the 1800s referenced their limited experience. In the 1900s, there was more focus on courtroom affairs. In both the 1800s and 1900s, narratives on older lawyers emphasized their prestige, especially in the 1900s. Conclusions: Depending on the occupation, one’s age may either be seen as an asset or a liability. Efforts must be expended to ensure that older professionals are recognized for their wealth of knowledge and skills. Failing to capitalize on the merits of an older workforce could ultimately be a grave disservice not only to older adults but to society in general. %M 38530338 %R 10.2196/45855 %U https://www.jmir.org/2024/1/e45855 %U https://doi.org/10.2196/45855 %U http://www.ncbi.nlm.nih.gov/pubmed/38530338 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51152 %T A Snapshot of COVID-19 Vaccine Discourse Related to Ethnic Minority Communities in the United Kingdom Between January and April 2022: Mixed Methods Analysis %A Ullah,Nazifa %A Martin,Sam %A Poduval,Shoba %+ Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 (0)20 3549 5969, s.poduval@ucl.ac.uk %K COVID-19 %K ethnic minorities %K vaccine %K hesitancy %K social media %K discourse %K minority groups %D 2024 %7 26.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing literature highlights the role of social media as a key source of information for the public during the COVID-19 pandemic and its influence on vaccination attempts. Yet there is little research exploring its role in the public discourse specifically among ethnic minority communities, who have the highest rates of vaccine hesitancy (delay or refusal of vaccination despite availability of services). Objective: This study aims to understand the discourse related to minority communities on social media platforms Twitter and YouTube. Methods: Social media data from the United Kingdom was extracted from Twitter and YouTube using the software Netlytics and YouTube Data Tools to provide a “snapshot” of the discourse between January and April 2022. A mixed method approach was used where qualitative data were contextualized into codes. Network analysis was applied to provide insight into the most frequent and weighted keywords and topics of conversations. Results: A total of 260 tweets and 156 comments from 4 YouTube videos were included in our analysis. Our data suggests that the most popular topics of conversation during the period sampled were related to communication strategies adopted during the booster vaccine rollout. These were noted to be divisive in nature and linked to wider conversations around racism and historical mistrust toward institutions. Conclusions: Our study suggests a shift in narrative from concerns about the COVID-19 vaccine itself, toward the strategies used in vaccination implementation, in particular the targeting of ethnic minority groups through vaccination campaigns. The implications for public health communication during crisis management in a pandemic context include acknowledging wider experiences of discrimination when addressing ethnic minority communities. %M 38530334 %R 10.2196/51152 %U https://formative.jmir.org/2024/1/e51152 %U https://doi.org/10.2196/51152 %U http://www.ncbi.nlm.nih.gov/pubmed/38530334 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e51113 %T Government-Nongovernmental Organization (NGO) Collaboration in Macao’s COVID-19 Vaccine Promotion: Social Media Case Study %A Xian,Xuechang %A Neuwirth,Rostam J %A Chang,Angela %+ Department of Communication, University of Macau, Avenida da Universidade, Taipa, Macao SAR, 999078, China, 86 88228991, wychang@um.edu.mo %K COVID-19 %K government %K vaccine %K automated content analysis %K Granger causality test %K network agenda setting %K QAP %K social media %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic triggered unprecedented global vaccination efforts, with social media being a popular tool for vaccine promotion. Objective: This study probes into Macao’s COVID-19 vaccine communication dynamics, with a focus on the multifaceted impacts of government agendas on social media. Methods: We scrutinized 22,986 vaccine-related Facebook posts from January 2020 to August 2022 in Macao. Using automated content analysis and advanced statistical methods, we unveiled intricate agenda dynamics between government and nongovernment entities. Results: “Vaccine importance” and “COVID-19 risk” were the most prominent topics co-occurring in the overall vaccine communication. The government tended to emphasize “COVID-19 risk” and “vaccine effectiveness,” while regular users prioritized vaccine safety and distribution, indicating a discrepancy in these agendas. Nonetheless, the government has limited impact on regular users in the aspects of vaccine importance, accessibility, affordability, and trust in experts. The agendas of government and nongovernment users intertwined, illustrating complex interactions. Conclusions: This study reveals the influence of government agendas on public discourse, impacting environmental awareness, public health education, and the social dynamics of inclusive communication during health crises. Inclusive strategies, accommodating public concerns, and involving diverse stakeholders are paramount for effective social media communication during health crises. %M 38502184 %R 10.2196/51113 %U https://infodemiology.jmir.org/2024/1/e51113 %U https://doi.org/10.2196/51113 %U http://www.ncbi.nlm.nih.gov/pubmed/38502184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50741 %T Effects of a Social Media Intervention on Vaping Intentions: Randomized Dose-Response Experiment %A Evans,William Douglas %A Bingenheimer,Jeffrey %A Cantrell,Jennifer %A Kreslake,Jennifer %A Tulsiani,Shreya %A Ichimiya,Megumi %A D'Esterre,Alexander P %A Gerard,Raquel %A Martin,Madeline %A Hair,Elizabeth C %+ Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, Washington, DC, 20052, United States, 1 2023519546, wdevans@gwu.edu %K randomized controlled trial %K e-cigarettes %K vaping %K nicotine %K tobacco control %K social media %K dose-response effects %D 2024 %7 12.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: e-Cigarette use, especially by young adults, is at unacceptably high levels and represents a public health risk factor. Digital media are increasingly being used to deliver antivaping campaigns, but little is known about their effectiveness or the dose-response effects of content delivery. Objective: The objectives of this study were to evaluate (1) the effectiveness of a 60-day antivaping social media intervention in changing vaping use intentions and beliefs related to the stimulus content and (2) the dose-response effects of varying levels of exposure to the intervention on vaping outcomes, including anti-industry beliefs, vaping intentions, and other attitudes and beliefs related to vaping. Methods: Participants were adults aged 18 to 24 years in the United States. They were recruited into the study through Facebook (Meta Platforms) and Instagram (Meta Platforms), completed a baseline survey, and then randomized to 1 of the 5 conditions: 0 (control), 4, 8, 16, and 32 exposures over a 15-day period between each survey wave. Follow-up data were collected 30 and 60 days after randomization. We conducted stratified analyses of the full sample and in subsamples defined by the baseline vaping status (never, former, and current). Stimulus was delivered through Facebook and Instagram in four 15-second social media videos focused on anti-industry beliefs about vaping. The main outcome measures reported in this study were self-reported exposure to social media intervention content, attitudes and beliefs about vaping, and vaping intentions. We estimated a series of multivariate linear regressions in Stata 17 (StataCorp). To capture the dose-response effect, we assigned each study arm a numerical value corresponding to the number of advertisements (exposures) delivered to participants in each arm and used this number as our focal independent variable. In each model, the predictor was the treatment arm to which each participant was assigned. Results: The baseline sample consisted of 1491 participants, and the final analysis sample consisted of 57.28% (854/1491) of the participants retained at the 60-day follow-up. We compared the retained participants with those lost to follow-up and found no statistically significant differences across demographic variables. We found a significant effect of the social media treatment on vaping intentions (β=−0.138, 95% CI −0.266 to −0.010; P=.04) and anti-industry beliefs (β=−0.122, 95% CI 0.008-0.237; P=.04) targeted by the intervention content among current vapers but not among the full sample or other strata. We found no significant effects of self-reported exposure to the stimulus. Conclusions: Social media interventions are a promising approach to preventing vaping among young adults. More research is needed on how to optimize the dosage of such interventions and the extent to which long-term exposure may affect vaping use over time. Trial Registration: ClinicalTrials.gov NCT04867668; https://clinicaltrials.gov/study/NCT04867668 %M 38470468 %R 10.2196/50741 %U https://www.jmir.org/2024/1/e50741 %U https://doi.org/10.2196/50741 %U http://www.ncbi.nlm.nih.gov/pubmed/38470468 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47128 %T Impact of Traditional and New Media on Smoking Intentions and Behaviors: Secondary Analysis of Tasmania’s Tobacco Control Mass Media Campaign Program, 2019-2021 %A Kite,James %A Grunseit,Anne %A Mitchell,Glenn %A Cooper,Pip %A Chan,Lilian %A Huang,Bo-Huei %A Thomas,Margaret %A O'Hara,Blythe %A Smith,Abby %+ Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, The University of Sydney, L6 Charles Perkins Centre (D17), Camperdown, NSW, 2006, Australia, 61 286270838, james.kite@sydney.edu.au %K mass media campaign %K tobacco control %K evaluation %K social media campaign %K social media %K digital platform %K tobacco %K smoking %K survey %D 2024 %7 5.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Tasmania, the smallest state by population in Australia, has a comprehensive tobacco control mass media campaign program that includes traditional (eg, television) and “new” channels (eg, social media), run by Quit Tasmania. The campaign targets adult smokers, in particular men aged 18-44 years, and people from low socioeconomic areas. Objective: This study assesses the impact of the 2019-2021 campaign program on smokers’ awareness of the campaign program, use of Quitline, and smoking-related intentions and behaviors. Methods: We used a tracking survey (conducted 8 times per year, immediately following a burst of campaign activity) to assess campaign recall and recognition, intentions to quit, and behavioral actions taken in response to the campaigns. The sample size was approximately 125 participants at each survey wave, giving a total sample size of 2000 participants over the 2 years. We merged these data with metrics including television target audience rating points, digital and Facebook (Meta) analytics, and Quitline activity data, and conducted regression and time-series modeling. Results: Over the evaluation period, unprompted recall of any Quit Tasmania campaign was 18%, while prompted recognition of the most recent campaign was 50%. Over half (52%) of those who recognized a Quit Tasmania campaign reported that they had performed or considered a quitting-related behavioral action in response to the campaign. In the regression analyses, we found having different creatives within a single campaign burst was associated with higher campaign recall and recognition and an increase in the strength of behavioral actions taken. Higher target audience rating points were associated with higher campaign recall (but not recognition) and an increase in quit intentions, but not an increase in behavioral actions taken. Higher Facebook advertisement reach was associated with lower recall among survey participants, but recognition was higher when digital channels were used. The time-series analyses showed no systematic trends in Quitline activity over the evaluation period, but Quitline activity was higher when Facebook reach and advertisement spending were higher. Conclusions: Our evaluation suggests that a variety of creatives should be used simultaneously and supports the continued use of traditional broadcast channels, including television. However, the impact of television on awareness and behavior may be weakening. Future campaign evaluations should closely monitor the effectiveness of television as a result. We are also one of the first studies to explicitly examine the impact of digital and social media, finding some evidence that they influence quitting-related outcomes. While this evidence is promising for campaign implementation, future evaluations should consider adopting rigorous methods to further investigate this relationship. %M 38441941 %R 10.2196/47128 %U https://www.jmir.org/2024/1/e47128 %U https://doi.org/10.2196/47128 %U http://www.ncbi.nlm.nih.gov/pubmed/38441941 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48134 %T Newspaper Coverage of Hospitals During a Prolonged Health Crisis: Longitudinal Mixed Methods Study %A van de Baan,Frank %A Gifford,Rachel %A Ruwaard,Dirk %A Fleuren,Bram %A Westra,Daan %+ Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229GT, Netherlands, 31 043 38 81 553, f.vandebaan@maastrichtuniversity.nl %K health communication %K news coverage %K media %K misinformation %K accuracy %K news %K reporting %K newspaper %K knowledge translation %K COVID-19 %K dissemination %K communication %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: It is important for health organizations to communicate with the public through newspapers during health crises. Although hospitals were a main source of information for the public during the COVID-19 pandemic, little is known about how this information was presented to the public through (web-based) newspaper articles. Objective: This study aims to examine newspaper reporting on the situation in hospitals during the first year of the COVID-19 pandemic in the Netherlands and to assess the degree to which the reporting in newspapers aligned with what occurred in practice. Methods: We used a mixed methods longitudinal design to compare internal data from all hospitals (n=5) located in one of the most heavily affected regions of the Netherlands with the information reported by a newspaper covering the same region. The internal data comprised 763 pages of crisis meeting documents and 635 minutes of video communications. A total of 14,401 newspaper articles were retrieved from the LexisNexis Academic (RELX Group) database, of which 194 (1.3%) articles were included for data analysis. For qualitative analysis, we used content and thematic analyses. For quantitative analysis, we used chi-square tests. Results: The content of the internal data was categorized into 12 themes: COVID-19 capacity; regular care capacity; regional, national, and international collaboration; human resources; well-being; public support; material resources; innovation; policies and protocols; finance; preparedness; and ethics. Compared with the internal documents, the newspaper articles focused significantly more on the themes COVID-19 capacity (P<.001), regular care capacity (P<.001), and public support (P<.001) during the first year of the pandemic, whereas they focused significantly less on the themes material resources (P=.004) and policies and protocols (P<.001). Differences in attention toward themes were mainly observed between the first and second waves of the pandemic and at the end of the third wave. For some themes, the attention in the newspaper articles preceded the attention given to these themes in the internal documents. Reporting was done through various forms, including diary articles written from the perspective of the hospital staff. No indication of the presence of misinformation was found in the newspaper articles. Conclusions: Throughout the first year of the pandemic, newspaper articles provided coverage on the situation of hospitals and experiences of staff. The focus on themes within newspaper articles compared with internal hospital data differed significantly for 5 (42%) of the 12 identified themes. The discrepancies between newspapers and hospitals in their focus on themes could be attributed to their gatekeeping roles. Both parties should be aware of their gatekeeping role and how this may affect information distribution. During health crises, newspapers can be a credible source of information for the public. The information can also be valuable for hospitals themselves, as it allows them to anticipate internal and external developments. %M 38381496 %R 10.2196/48134 %U https://publichealth.jmir.org/2024/1/e48134 %U https://doi.org/10.2196/48134 %U http://www.ncbi.nlm.nih.gov/pubmed/38381496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48538 %T Testing Behavioral Messages to Increase Recruitment to Health Research When Embedded Within Social Media Campaigns on Twitter: Web-Based Experimental Study %A Stoffel,Sandro T %A Law,Jing Hui %A Kerrison,Robert %A Brewer,Hannah R %A Flanagan,James M %A Hirst,Yasemin %+ Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 2076792000, s.stoffel@ucl.ac.uk %K advertise %K advertisement %K advertisements %K advertising %K behavior change %K behavioral %K behaviour change %K behavioural %K campaign %K campaigns %K experimental design %K message %K messages %K messaging %K recruit %K recruiting %K recruitment %K social media %K social norms %K Twitter %D 2024 %7 5.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media is rapidly becoming the primary source to disseminate invitations to the public to consider taking part in research studies. There is, however, little information on how the contents of the advertisement can be communicated to facilitate engagement and subsequently promote intentions to participate in research. Objective: This paper describes an experimental study that tested different behavioral messages for recruiting study participants for a real-life observational case-control study. Methods: We included 1060 women in a web-based experiment and randomized them to 1 of 3 experimental conditions: standard advertisement (n=360), patient endorsement advertisement (n=345), and social norms advertisement (n=355). After seeing 1 of the 3 advertisements, participants were asked to state (1) their intention to take part in the advertised case-control study, (2) the ease of understanding the message and study aims, and (3) their willingness to be redirected to the website of the case-control study after completing the survey. Individuals were further asked to suggest ways to improve the messages. Intentions were compared between groups using ordinal logistic regression, reported in percentages, adjusted odds ratio (aOR), and 95% CIs. Results: Those who were in the patient endorsement and social norms–based advertisement groups had significantly lower intentions to take part in the advertised study compared with those in the standard advertisement group (aOR 0.73, 95% CI 0.55-0.97; P=.03 and aOR 0.69, 95% CI 0.52-0.92; P=.009, respectively). The patient endorsement advertisement was perceived to be more difficult to understand (aOR 0.65, 95% CI 0.48-0.87; P=.004) and to communicate the study aims less clearly (aOR 0.72, 95% CI 0.55-0.95; P=.01). While the patient endorsement advertisement had no impact on intention to visit the main study website, the social norms advertisement decreased willingness compared with the standard advertisement group (157/355, 44.2% vs 191/360, 53.1%; aOR 0.74, 95% CI 0.54-0.99; P=.02). The majority of participants (395/609, 64.8%) stated that the messages did not require changes, but some preferred clearer (75/609, 12.3%) and shorter (59/609, 9.7%) messages. Conclusions: The results of this study indicate that adding normative behavioral messages to simulated tweets decreased participant intention to take part in our web-based case-control study, as this made the tweet harder to understand. This suggests that simple messages should be used for participant recruitment through Twitter (subsequently rebranded X). %M 38315543 %R 10.2196/48538 %U https://formative.jmir.org/2024/1/e48538 %U https://doi.org/10.2196/48538 %U http://www.ncbi.nlm.nih.gov/pubmed/38315543 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e49881 %T Social Media, Public Health Research, and Vulnerability: Considerations to Advance Ethical Guidelines and Strengthen Future Research %A Massey,Philip M %A Murray,Regan M %A Chiang,Shawn C %A Russell,Alex M %A Yudell,Michael A %+ Department of Community Health Sciences, Fielding School of Public Health, UCLA, Box 951772, Suite 16-035 CHS, 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, United States, 1 310 825 5308, pmassey@ucla.edu %K research ethics %K social media %K vulnerable populations %K public health %K ethical guidelines %K algorithms %K manipulation %D 2023 %7 29.12.2023 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The purpose of this article is to build upon prior work in social media research and ethics by highlighting an important and as yet underdeveloped research consideration: how should we consider vulnerability when conducting public health research in the social media environment? The use of social media in public health, both platforms and their data, has advanced the field dramatically over the past 2 decades. Applied public health research in the social media space has led to more robust surveillance tools and analytic strategies, more targeted recruitment activities, and more tailored health education. Ethical guidelines when using social media for public health research must also expand alongside these increasing capabilities and uses. Privacy, consent, and confidentiality have been hallmarks for ethical frameworks both in public health and social media research. To date, public health ethics scholarship has focused largely on practical guidelines and considerations for writing and reviewing social media research protocols. Such ethical guidelines have included collecting public data, reporting anonymized or aggregate results, and obtaining informed consent virtually. Our pursuit of the question related to vulnerability and public health research in the social media environment extends this foundational work in ethical guidelines and seeks to advance research in this field and to provide a solid ethical footing on which future research can thrive. %M 38157235 %R 10.2196/49881 %U https://publichealth.jmir.org/2023/1/e49881 %U https://doi.org/10.2196/49881 %U http://www.ncbi.nlm.nih.gov/pubmed/38157235 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50367 %T Incivility in COVID-19 Vaccine Mandate Discourse and Moral Foundations: Natural Language Processing Approach %A Tin,Jason %A Stevens,Hannah %A Rasul,Muhammad Ehab %A Taylor,Laramie D %+ Department of Communication, University of California, Davis, 1 Shields Avenue, Davis, CA, 95616, United States, 1 530 752 1011, merasul@ucdavis.edu %K incivility %K vaccine hesitancy %K moral foundations %K COVID-19 %K vaccines %K morality %K social media %K natural language processing %K machine learning %D 2023 %7 29.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Vaccine hesitancy poses a substantial threat to efforts to mitigate the harmful effects of the COVID-19 pandemic. To combat vaccine hesitancy, officials in the United States issued vaccine mandates, which were met with strong antivaccine discourse on social media platforms such as Reddit. The politicized and polarized nature of COVID-19 on social media has fueled uncivil discourse related to vaccine mandates, which is known to decrease confidence in COVID-19 vaccines. Objective: This study examines the moral foundations underlying uncivil COVID-19 vaccine discourse. Moral foundations theory poses that individuals make decisions to express approval or disapproval (ie, uncivil discourse) based on innate moral values. We examine whether moral foundations are associated with dimensions of incivility. Further, we explore whether there are any differences in the presence of incivility between the r/coronaviruscirclejerk and r/lockdownskepticism subreddits. Methods: Natural language processing methodologies were leveraged to analyze the moral foundations underlying uncivil discourse in 2 prominent antivaccine subreddits, r/coronaviruscirclejerk and r/lockdownskepticism. All posts and comments from both of the subreddits were collected since their inception in March 2022. This was followed by filtering the data set for key terms associated with the COVID-19 vaccine (eg, “vaccinate” and “Pfizer”) and mandates (eg, “forced” and “mandating”). These key terms were selected based on a review of existing literature and because of their salience in both of the subreddits. A 10% sample of the filtered key terms was used for the final analysis. Results: Findings suggested that moral foundations play a role in the psychological processes underlying uncivil vaccine mandate discourse. Specifically, we found substantial associations between all moral foundations (ie, care and harm, fairness and cheating, loyalty and betrayal, authority and subversion, and sanctity and degradation) and dimensions of incivility (ie, toxicity, insults, profanity, threat, and identity attack) except for the authority foundation. We also found statistically significant differences between r/coronaviruscirclejerk and r/lockdownskepticism for the presence of the dimensions of incivility. Specifically, the mean of identity attack, insult, toxicity, profanity, and threat in the r/lockdownskepticism subreddit was significantly lower than that in the r/coronaviruscirclejerk subreddit (P<.001). Conclusions: This study shows that moral foundations may play a substantial role in the presence of incivility in vaccine discourse. On the basis of the findings of the study, public health practitioners should tailor messaging by addressing the moral values underlying the concerns people may have about vaccines, which could manifest as uncivil discourse. Another way to tailor public health messaging could be to direct it to parts of social media platforms with increased uncivil discourse. By integrating moral foundations, public health messaging may increase compliance and promote civil discourse surrounding COVID-19. %M 38019581 %R 10.2196/50367 %U https://formative.jmir.org/2023/1/e50367 %U https://doi.org/10.2196/50367 %U http://www.ncbi.nlm.nih.gov/pubmed/38019581 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49416 %T Twitter Misinformation Discourses About Vaping: Systematic Content Analysis %A Al-Rawi,Ahmed %A Blackwell,Breanna %A Zemenchik,Kiana %A Lee,Kelley %+ Simon Fraser University, School of Communication, Schrum Science Centre-K 9653, Burnaby, BC, V5A1S6, Canada, 1 7787824419, aalrawi@sfu.ca %K vaping %K e-cigarette %K smoking %K misinformation %K fact checking %K social media %K Twitter %K nicotine %K content analysis %K fact-checking %K disinformation %K weaponized %K health risk %K risk %K health education %K education %K communication %K electronic nicotine delivery systems %K ENDS %D 2023 %7 10.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: While there has been substantial analysis of social media content deemed to spread misinformation about electronic nicotine delivery systems use, the strategic use of misinformation accusations to undermine opposing views has received limited attention. Objective: This study aims to fill this gap by analyzing how social media users discuss the topic of misinformation related to electronic nicotine delivery systems, notably vaping products. Additionally, this study identifies and analyzes the actors commonly blamed for spreading such misinformation and how these claims support both the provaping and antivaping narratives. Methods: Using Twitter’s (subsequently rebranded as X) academic application programming interface, we collected tweets referencing #vape and #vaping and keywords associated with fake news and misinformation. This study uses systematic content analysis to analyze the tweets and identify common themes and actors who discuss or possibly spread misinformation. Results: This study found that provape users dominate the platform regarding discussions about misinformation about vaping, with provaping tweets being more frequent and having higher overall user engagement. The most common narrative for provape tweets surrounds the conversation of vaping being perceived as safe. On the other hand, the most common topic from the antivape narrative is that vaping is indeed harmful. This study also points to a general distrust in authority figures, with news outlets, public health authorities, and political actors regularly accused of spreading misinformation, with both placing blame. However, specific actors differ depending on their positionalities. The vast number of accusations from provaping advocates is found to shape what is considered misinformation and works to silence other narratives. Additionally, allegations against reliable and proven sources, such as public health authorities, work to discredit assessments about the health impacts, which is detrimental to public health overall for both provaping and antivaping advocates. Conclusions: We conclude that the spread of misinformation and the accusations of misinformation dissemination using terms such as “fact check,” “misinformation,” “fake news,” and “disinformation” have become weaponized and co-opted by provaping actors to delegitimize criticisms about vaping and to increase confusion about the potential health risks. The study discusses the mixed types of impact of vaping on public health for both smokers and nonsmokers. Additionally, we discuss the implications for effective health education and communication about vaping and how misinformation claims can affect evidence-based discourse on Twitter as well as informed vaping decisions. %M 37948118 %R 10.2196/49416 %U https://www.jmir.org/2023/1/e49416 %U https://doi.org/10.2196/49416 %U http://www.ncbi.nlm.nih.gov/pubmed/37948118 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48789 %T Topic and Trend Analysis of Weibo Discussions About COVID-19 Medications Before and After China’s Exit from the Zero-COVID Policy: Retrospective Infoveillance Study %A Lan,Duo %A Ren,Wujiong %A Ni,Ke %A Zhu,Yicheng %+ School of Journalism and Communication, Beijing Normal University, 19 Xinjiekou Outer St Haidian District, Beijing, 100875, China, 86 13436952270, yicheng@bnu.edu.cn %K zero-COVID policy %K topic modeling %K Weibo %K COVID-19 medications %K social risk %K personal risk %K social media %K COVID-19 %K China %K pandemic %K self-medication %D 2023 %7 27.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: After 3 years of its zero-COVID policy, China lifted its stringent pandemic control measures with the announcement of the 10 new measures on December 7, 2022. Existing estimates suggest 90%-97% of the total population was infected during December. This change created a massive demand for COVID-19 medications and treatments, either modern medicines or traditional Chinese medicine (TCM). Objective: This study aimed to explore (1) how China’s exit from the zero-COVID policy impacted media and the public’s attention to COVID-19 medications; (2) how social COVID-19 medication discussions were related to existing model estimates of daily cases during that period; (3) what the diversified themes and topics were and how they changed and developed from November 1 to December 31, 2022; and (4) which topics about COVID-19 medications were focused on by mainstream and self-media accounts during the exit. The answers to these questions could help us better understand the consequences of exit strategies and explore the utilities of Sina Weibo data for future infoveillance studies. Methods: Using a scrapper for data retrieval and the structural topic modeling (STM) algorithm for analysis, this study built 3 topic models (all data, before a policy change, and after a policy change) of relevant discussions on the Chinese social media platform Weibo. We compared topic distributions against existing estimates of daily cases and between models before and after the change. We also compared proportions of weibos published by mainstream versus self-media accounts over time on different topics. Results: We found that Weibo discussions shifted sharply from concerns of social risks (case tracking, governmental regulations, etc) to those of personal risks (symptoms, purchases, etc) surrounding COVID-19 infection after the exit from the zero-COVID policy. Weibo topics of “symptom sharing” and “purchase and shortage” of modern medicines correlated more strongly with existing susceptible-exposed-infected-recovered (SEIR) model estimates compared to “TCM formulae” and other topics. During the exit, mainstream accounts showed efforts to specifically engage in topics related to worldwide pandemic control policy comparison and regulations about import and reimbursement of medications. Conclusions: The exit from the zero-COVID policy in China was accompanied by a sudden increase in social media discussions about COVID-19 medications, the demand for which substantially increased after the exit. A large proportion of Weibo discussions were emotional and expressed increased risk concerns over medication shortage, unavailability, and delay in delivery. Topic keywords showed that self-medication was sometimes practiced alone or with unprofessional help from others, while mainstream accounts also tried to provide certain medication instructions. Of the 16 topics identified in all 3 STM models, only “symptom sharing” and “purchase and shortage” showed a considerable correlation with SEIR model estimates of daily cases. Future studies could consider topic exploration before conducting predictive infoveillance analysis, even with narrowly defined search criteria with Weibo data. %M 37889532 %R 10.2196/48789 %U https://www.jmir.org/2023/1/e48789 %U https://doi.org/10.2196/48789 %U http://www.ncbi.nlm.nih.gov/pubmed/37889532 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e43685 %T Content and User Engagement of Health-Related Behavior Tweets Posted by Mass Media Outlets From Spain and the United States Early in the COVID-19 Pandemic: Observational Infodemiology Study %A Alvarez-Mon,Miguel Angel %A Pereira-Sanchez,Victor %A Hooker,Elizabeth R %A Sanchez,Facundo %A Alvarez-Mon,Melchor %A Teo,Alan R %+ Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Campus Universitario – C/ 19, Av de Madrid, Km 33,600., Alcala de Henares, 28871, Spain, 34 918854505, maalvarezdemon@icloud.com %K COVID-19 %K health communication %K social media %K Twitter %K health promotion %K public health %K mass media %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the early pandemic, there was substantial variation in public and government responses to COVID-19 in Europe and the United States. Mass media are a vital source of health information and news, frequently disseminating this information through social media, and may influence public and policy responses to the pandemic. Objective: This study aims to describe the extent to which major media outlets in the United States and Spain tweeted about health-related behaviors (HRBs) relevant to COVID-19, compare the tweeting patterns between media outlets of both countries, and determine user engagement in response to these tweets. Methods: We investigated tweets posted by 30 major media outlets (n=17, 57% from Spain and n=13, 43% from the United States) between December 1, 2019 and May 31, 2020, which included keywords related to HRBs relevant to COVID-19. We classified tweets into 6 categories: mask-wearing, physical distancing, handwashing, quarantine or confinement, disinfecting objects, or multiple HRBs (any combination of the prior HRB categories). Additionally, we assessed the likes and retweets generated by each tweet. Poisson regression analyses compared the average predicted number of likes and retweets between the different HRB categories and between countries. Results: Of 50,415 tweets initially collected, 8552 contained content associated with an HRB relevant to COVID-19. Of these, 600 were randomly chosen for training, and 2351 tweets were randomly selected for manual content analysis. Of the 2351 COVID-19–related tweets included in the content analysis, 62.91% (1479/2351) mentioned at least one HRB. The proportion of COVID-19 tweets mentioning at least one HRB differed significantly between countries (P=.006). Quarantine or confinement was mentioned in nearly half of all the HRB tweets in both countries. In contrast, the least frequently mentioned HRBs were disinfecting objects in Spain 6.9% (56/809) and handwashing in the United States 9.1% (61/670). For tweets from the United States mentioning at least one HRB, disinfecting objects had the highest median likes and retweets, whereas mask-wearing– and handwashing-related tweets achieved the highest median number of likes in Spain. Tweets from Spain that mentioned social distancing or disinfecting objects had a significantly lower predicted count of likes compared with tweets mentioning a different HRB (P=.02 and P=.01, respectively). Tweets from the United States that mentioned quarantine or confinement or disinfecting objects had a significantly lower predicted number of likes compared with tweets mentioning a different HRB (P<.001), whereas mask- and handwashing-related tweets had a significantly greater predicted number of likes (P=.04 and P=.02, respectively). Conclusions: The type of HRB content and engagement with media outlet tweets varied between Spain and the United States early in the pandemic. However, content related to quarantine or confinement and engagement with handwashing was relatively high in both countries. %M 37347948 %R 10.2196/43685 %U https://infodemiology.jmir.org/2023/1/e43685 %U https://doi.org/10.2196/43685 %U http://www.ncbi.nlm.nih.gov/pubmed/37347948 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44774 %T Public Opinions About Palliative and End-of-Life Care During the COVID-19 Pandemic: Twitter-Based Content Analysis %A Wang,Yijun %A Chukwusa,Emeka %A Koffman,Jonathan %A Curcin,Vasa %+ Department of Population Health Sciences, King's College London, Addison House, Guy's Campus, Great Maze Pond, London, SE1 1UL, United Kingdom, 44 07746123151, k1924020@kcl.ac.uk %K palliative care %K end-of-life care %K COVID-19 %K Twitter %K public opinions %D 2023 %7 7.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Palliative and end-of-life care (PEoLC) played a critical role in relieving distress and providing grief support in response to the heavy toll caused by the COVID-19 pandemic. However, little is known about public opinions concerning PEoLC during the pandemic. Given that social media have the potential to collect real-time public opinions, an analysis of this evidence is vital to guide future policy-making. Objective: This study aimed to use social media data to investigate real-time public opinions regarding PEoLC during the COVID-19 crisis and explore the impact of vaccination programs on public opinions about PEoLC. Methods: This Twitter-based study explored tweets across 3 English-speaking countries: the United States, the United Kingdom, and Canada. From October 2020 to March 2021, a total of 7951 PEoLC-related tweets with geographic tags were retrieved and identified from a large-scale COVID-19 Twitter data set through the Twitter application programming interface. Topic modeling realized through a pointwise mutual information–based co-occurrence network and Louvain modularity was used to examine latent topics across the 3 countries and across 2 time periods (pre- and postvaccination program periods). Results: Commonalities and regional differences among PEoLC topics in the United States, the United Kingdom, and Canada were identified specifically: cancer care and care facilities were of common interest to the public across the 3 countries during the pandemic; the public expressed positive attitudes toward the COVID-19 vaccine and highlighted the protection it affords to PEoLC professionals; and although Twitter users shared their personal experiences about PEoLC in the web-based community during the pandemic, this was more prominent in the United States and Canada. The implementation of the vaccination programs raised the profile of the vaccine discussion; however, this did not influence public opinions about PEoLC. Conclusions: Public opinions on Twitter reflected a need for enhanced PEoLC services during the COVID-19 pandemic. The insignificant impact of the vaccination program on public discussion on social media indicated that public concerns regarding PEoLC continued to persist even after the vaccination efforts. Insights gleaned from public opinions regarding PEoLC could provide some clues for policy makers on how to ensure high-quality PEoLC during public health emergencies. In this post–COVID-19 era, PEoLC professionals may wish to continue to examine social media and learn from web-based public discussion how to ease the long-lasting trauma caused by this crisis and prepare for public health emergencies in the future. Besides, our results showed social media’s potential in acting as an effective tool to reflect public opinions in the context of PEoLC. %M 37368840 %R 10.2196/44774 %U https://formative.jmir.org/2023/1/e44774 %U https://doi.org/10.2196/44774 %U http://www.ncbi.nlm.nih.gov/pubmed/37368840 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46345 %T A Model of Social Media Effects in Public Health Communication Campaigns: Systematic Review %A Kite,James %A Chan,Lilian %A MacKay,Kathryn %A Corbett,Lucy %A Reyes-Marcelino,Gillian %A Nguyen,Binh %A Bellew,William %A Freeman,Becky %+ Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Lvl 6 Charles Perkins Centre (D17), Camperdown, 2006, Australia, 61 286270838, james.kite@sydney.edu.au %K awareness %K behavior change %K campaign development %K campaign evaluation %K engagement %K hierarchy of effects %K social media %K systematic review %D 2023 %7 14.7.2023 %9 Review %J J Med Internet Res %G English %X Background: Social media platforms are frequently used in health communication campaigns. Common understandings of campaign effects posit a sequential and linear series of steps from exposure to behavior change, commonly known as the hierarchy of effects model (HOE). These concepts need to be reevaluated in the age of social media, which are interactional and communal. Objective: This review aims to update the traditional HOE for health communication campaigns in the context of social media, including identifying indicators of effectiveness and how these are conceptualized to lead to health-related outcomes. Methods: We conducted a systematic review of studies following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines reporting on the use of social media as part of health communication campaigns, extracting campaign information such as objectives, platforms used, and measures of campaign performance. We used these data, combined with our understanding of the HOE, to develop an updated conceptual model of social media campaign effects. Results: We identified 99 eligible studies reporting on 93 campaigns, published between 2012 and 2022. The campaigns were conducted in over 20 countries, but nearly half (n=42) were conducted in the United States. Campaigns targeted a variety of health issues and predominantly used Facebook, Twitter, Instagram, and YouTube. Most campaigns (n=81) set objectives targeting awareness or individual behavior change. Process measures (n=68; eg, reach and impressions) and engagement measures (n=73; eg, likes and retweets) were reported most frequently, while two-fifths (n=42) did not report any outcomes beyond engagement, such as changes in knowledge, behavior, or social norms. Most campaigns (n=55) collected measures that did not allow them to determine if the campaign objective had been met; that is, they were process evaluations only. Based on our review, our updated model suggests that campaign exposure can lead to individual behavior change and improved health outcomes, either through a direct or indirect pathway. Indirect pathways include exposure through social and policy changes. “Engagement” is positioned as critical to success, replacing awareness in the traditional HOE, and all types of engagement are treated as equal and good. No consideration is being given to potential negative engagement, such as the distribution of misinformation. Additionally, the process is no longer linear and sequential, with circular pathways evident, such as engagement not only influencing behavior change but also generating additional exposure to campaign messages. Conclusions: Our review has highlighted a change in conventional understandings of how campaigns can influence health outcomes in the age of social media. The updated model we propose provides social media campaigners with a starting point to develop and tailor campaign messages and allows evaluators to identify critical assumptions to test, including the role and value of “engagement.” Trial Registration: PROSPERO CRD42021287257; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=287257 %M 37450325 %R 10.2196/46345 %U https://www.jmir.org/2023/1/e46345 %U https://doi.org/10.2196/46345 %U http://www.ncbi.nlm.nih.gov/pubmed/37450325 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45897 %T A 4D Theoretical Framework for Measuring Topic-Specific Influence on Twitter: Development and Usability Study on Dietary Sodium Tweets %A Mao,Lingchao %A Chu,Emily %A Gu,Jinghong %A Hu,Tao %A Weiner,Bryan J %A Su,Yanfang %+ Department of Global Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, United States, 1 206 616 5418, yfsu@uw.edu %K social media %K health education %K health promotion %K dissemination strategy %K influence %K Twitter %K activity %K priority %K originality %K popularity %D 2023 %7 13.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media has emerged as a prominent approach for health education and promotion. However, it is challenging to understand how to best promote health-related information on social media platforms such as Twitter. Despite commercial tools and prior studies attempting to analyze influence, there is a gap to fill in developing a publicly accessible and consolidated framework to measure influence and analyze dissemination strategies. Objective: We aimed to develop a theoretical framework to measure topic-specific user influence on Twitter and to examine its usability by analyzing dietary sodium tweets to support public health agencies in improving their dissemination strategies. Methods: We designed a consolidated framework for measuring influence that can capture topic-specific tweeting behaviors. The core of the framework is a summary indicator of influence decomposable into 4 dimensions: activity, priority, originality, and popularity. These measures can be easily visualized and efficiently computed for any Twitter account without the need for private access. We demonstrated the proposed methods by using a case study on dietary sodium tweets with sampled stakeholders and then compared the framework with a traditional measure of influence. Results: More than half a million dietary sodium tweets from 2006 to 2022 were retrieved for 16 US domestic and international stakeholders in 4 categories, that is, public agencies, academic institutions, professional associations, and experts. We discovered that World Health Organization, American Heart Association, Food and Agriculture Organization of the United Nations (UN-FAO), and World Action on Salt (WASH) were the top 4 sodium influencers in the sample. Each had different strengths and weaknesses in their dissemination strategies, and 2 stakeholders with similar overall influence, that is, UN-FAO and WASH, could have significantly different tweeting patterns. In addition, we identified exemplars in each dimension of influence. Regarding tweeting activity, a dedicated expert published more sodium tweets than any organization in the sample in the past 16 years. In terms of priority, WASH had more than half of its tweets dedicated to sodium. UN-FAO had both the highest proportion of original sodium tweets and posted the most popular sodium tweets among all sampled stakeholders. Regardless of excellence in 1 dimension, the 4 most influential stakeholders excelled in at least 2 out of 4 dimensions of influence. Conclusions: Our findings demonstrate that our method not only aligned with a traditional measure of influence but also advanced influence analysis by analyzing the 4 dimensions that contribute to topic-specific influence. This consolidated framework provides quantifiable measures for public health entities to understand their bottleneck of influence and refine their social media campaign strategies. Our framework can be applied to improve the dissemination of other health topics as well as assist policy makers and public campaign experts to maximize population impact. %M 37310774 %R 10.2196/45897 %U https://www.jmir.org/2023/1/e45897 %U https://doi.org/10.2196/45897 %U http://www.ncbi.nlm.nih.gov/pubmed/37310774 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41358 %T Understanding Recruitment Yield From Social Media Advertisements and Associated Costs of a Telehealth Randomized Controlled Trial: Descriptive Study %A Aily,Jéssica Bianca %A Copson,Jennifer %A Voinier,Dana %A Jakiela,Jason %A Hinman,Rana %A Grosch,Megan %A Noonan,Colleen %A Armellini,Megan %A Schmitt,Laura %A White,Mika %A White,Daniel %+ Department of Physical Therapy, University of Delaware, 540 S. College ave 210l, Newark, DE, 19716, United States, 1 3028317607, dkw@udel.edu %K remote recruitment %K Facebook ads %K knee osteoarthritis %K consent %K screening %K social media %K telehealth %K clinical %K recruitment %K treatment %K osteoarthritis %K knee %D 2023 %7 18.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Recruiting study participants for clinical research is a challenging yet essential task. Social media platforms, such as Facebook, offer the opportunity to recruit participants through paid advertisements. These ad campaigns may be a cost-effective approach to reaching and recruiting participants who meet specific study criteria. However, little is known about the extent to which clicks on social media advertisements translate to the actual consent and enrollment of participants who meet the study criteria. Understanding this is especially important for clinical trials conducted remotely, such as telehealth-based studies, which open the possibility to recruit over large geographical areas and are becoming more common for the treatment of chronic health conditions, such as osteoarthritis (OA). Objective: The aim of this study was to report on the conversion of clicks on a Facebook advertisement campaign to consent to enrollment in an ongoing telehealth physical therapy study for adults with knee OA, and the costs associated with recruitment. Methods: This was a secondary analysis using data collected over the first 5 months of an ongoing study of adults with knee OA. The Delaware Physical Exercise and Activity for Knee Osteoarthritis program compares a virtually delivered exercise program to a control group receiving web-based resources among adults with knee OA. Advertisement campaigns were configured on Facebook to reach an audience who could be potentially eligible. Clicking on the advertisement directed potential participants to a web-based screening form to answer 6 brief questions related to the study criteria. Next, a research team member called individuals who met the criteria from the screening form and verbally asked additional questions related to the study criteria. Once considered eligible, an electronic informed consent form (ICF) was sent. We described the number of potential study participants who made it through each of these steps and then calculated the cost per participant who signed the ICF. Results: In sum, between July and November 2021, a total of 33,319 unique users saw at least one advertisement, 9879 clicks were made, 423 web-based screening forms were completed, 132 participants were successfully contacted, 70 were considered eligible, and 32 signed the ICF. Recruitment costed an average of US $51.94 per participant. Conclusions: While there was a low conversion from clicks to actual consent, 32% (32/100) of the total sample required for the study were expeditiously consented over 5 months with a per-subject cost well below traditional means of recruitment, which ranges from US $90 to US $1000 per participant. Trial Registration: Clinicaltrails.gov NCT04980300; https://clinicaltrials.gov/ct2/show/NCT04980300 %M 37200067 %R 10.2196/41358 %U https://www.jmir.org/2023/1/e41358 %U https://doi.org/10.2196/41358 %U http://www.ncbi.nlm.nih.gov/pubmed/37200067 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44754 %T The Digital Impact of Neurosurgery Awareness Month: Retrospective Infodemiology Study %A Malhotra,Kashish %A Dagli,Mert Marcel %A Santangelo,Gabrielle %A Wathen,Connor %A Ghenbot,Yohannes %A Goyal,Kashish %A Bawa,Ashvind %A Ozturk,Ali K %A Welch,William C %+ Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 800 Spruce Street, Philadelphia, PA, 19107, United States, 1 4459429977, Marcel.Dagli@Pennmedicine.upenn.edu %K #NeurosurgeryAwarenessMonth %K #Neurosurgery %K Neurosurgery Awareness Month %K neurosurgery %K neural %K neuro %K health care awareness event %K health care %K awareness %K infodemiology %K social media %K campaign %K neuroscience %K neurological %K sentiment %K public opinion %K Google Trends %K tweet %K Twitter %K brain %K cognition %K cognitive %K machine learning algorithm %K network analysis %K digital media %K sentiment analysis %K node %K Sentiment Viz %K scatterplot %K circumplex model %D 2023 %7 8.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Neurosurgery Awareness Month (August) was initiated by the American Association of Neurological Surgeons with the aim of bringing neurological conditions to the forefront and educating the public about these conditions. Digital media is an important tool for disseminating information and connecting with influencers, general public, and other stakeholders. Hence, it is crucial to understand the impact of awareness campaigns such as Neurosurgery Awareness Month to optimize resource allocation, quantify the efficiency and reach of these initiatives, and identify areas for improvement. Objective: The purpose of our study was to examine the digital impact of Neurosurgery Awareness Month globally and identify areas for further improvement. Methods: We used 4 social media (Twitter) assessment tools (Sprout Social, SocioViz, Sentiment Viz, and Symplur) and Google Trends to extract data using various search queries. Using regression analysis, trends were studied in the total number of tweets posted in August between 2014 and 2022. Two search queries were used in this analysis: one specifically targeting tweets related to Neurosurgery Awareness Month and the other isolating all neurosurgery-related posts. Total impressions and top influencers for #neurosurgery were calculated using Symplur’s machine learning algorithm. To study the context of the tweets, we used SocioViz to isolate the top 100 popular hashtags, keywords, and collaborations between influencers. Network analysis was performed to illustrate the interactions and connections within the digital media environment using ForceAtlas2 model. Sentiment analysis was done to study the underlying emotion of the tweets. Google Trends was used to study the global search interest by studying relative search volume data. Results: A total of 10,007 users were identified as tweeting about neurosurgery during Neurosurgery Awareness Month using the “#neurosurgery” hashtag. These tweets generated over 29.14 million impressions globally. Of the top 10 most influential users, 5 were faculty neurosurgeons at US university hospitals. Other influential users included notable organizations and journals in the field of neurosurgery. The network analysis of the top 100 influencers showed a collaboration rate of 81%. However, only 1.6% of the total neurosurgery tweets were advocating about neurosurgery awareness during Neurosurgery Awareness Month, and only 13 tweets were posted by verified users using the #neurosurgeryawarenessmonth hashtag. The sentiment analysis revealed that the majority of the tweets about Neurosurgery Awareness Month were pleasant with subdued emotion. Conclusions: The global digital impact of Neurosurgery Awareness Month is nascent, and support from other international organizations and neurosurgical influencers is needed to yield a significant digital reach. Increasing collaboration and involvement from underrepresented communities may help to increase the global reach. By better understanding the digital impact of Neurosurgery Awareness Month, future health care awareness campaigns can be optimized to increase global awareness of neurosurgery and the challenges facing the field. %M 37155226 %R 10.2196/44754 %U https://formative.jmir.org/2023/1/e44754 %U https://doi.org/10.2196/44754 %U http://www.ncbi.nlm.nih.gov/pubmed/37155226 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42024 %T Intervening on Social Comparisons on Social Media: Electronic Daily Diary Pilot Study %A Andrade,Fernanda C %A Erwin,Savannah %A Burnell,Kaitlyn %A Jackson,Jalisa %A Storch,Marley %A Nicholas,Julia %A Zucker,Nancy %+ Department of Psychology & Neuroscience, Duke University, 417 Chapel Drive, Campus Box 90086, Durham, NC, 27708, United States, 1 (919) 660 5640, fernanda.andrade@duke.edu %K social media %K social comparison %K young adults %K social savoring %K intervention %K self-esteem %K depression %D 2023 %7 28.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Literature has underscored the dark aspects of social media use, including associations with depressive symptoms, feelings of social isolation, and diminished self-esteem. Social comparison, the process of evaluating oneself relative to another person, is thought to contribute to these negative experiences such that people with a stronger tendency to compare themselves with others are particularly susceptible to the detrimental effects of social media. Social media as a form of social connection and communication is nevertheless an inevitable—and arguably integral—part of life, particularly for young adults. Therefore, there is a need to investigate strategies that could alter the manner in which people interact with social media to minimize its detrimental effects and maximize the feelings of affiliation and connection. Objective: This pilot study examined the feasibility, acceptability, and effectiveness of a brief web-based intervention designed to alter engagement with social media and promote psychological well-being by encouraging social savoring as an alternative to social comparison. Social savoring was operationalized as experiencing joyful emotions related to the happiness of someone else’s experiences (ie, feeling happy for someone else). Methods: Following an intensive longitudinal design, 55 college students (mean age 19.29, SD 0.93 years; n=43, 78% women and n=23, 42% White) completed baseline measures (individual differences, psychological well-being, connectedness, and social media use) and then 14 days of daily surveys on their social media activity and well-being. On day 8, the group that was randomized to receive the intervention watched a video instructing them on the skill of social savoring and was asked to practice this skill during days 8 to 14. Results: Overall, participants reported positive perceptions of the intervention. Participants who watched the intervention video reported significantly higher performance self-esteem (P=.02) at posttest than those in the control condition, after controlling for baseline levels. Participants also reported significantly higher state self-esteem (P=.01) on days in which they engaged in more social savoring while using social media, and the use of social savoring increased significantly (P=.01) over time, suggesting that participants found it helpful. Participants in both conditions reported significantly lower levels of social comparison (control: P=.01; intervention: P=.002) and higher levels of connectedness (control: P<.001; intervention: P=.001) at posttest than at baseline. Conclusions: Initial evidence from this pilot study suggests that a web-based social savoring intervention may help minimize the potentially harmful consequences of social media use, at least in some domains. Future work is needed to examine the effectiveness and acceptance of this intervention in different age groups and in clinical samples that are in part characterized by higher levels of comparison with others (eg, people with eating disorders). %M 37115607 %R 10.2196/42024 %U https://mental.jmir.org/2023/1/e42024 %U https://doi.org/10.2196/42024 %U http://www.ncbi.nlm.nih.gov/pubmed/37115607 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42227 %T One Year of COVID-19 Vaccine Misinformation on Twitter: Longitudinal Study %A Pierri,Francesco %A DeVerna,Matthew R %A Yang,Kai-Cheng %A Axelrod,David %A Bryden,John %A Menczer,Filippo %+ Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Via Giuseppe Ponzio 34, Milano, 20129, Italy, 39 02 2399 3400, francesco.pierri@polimi.it %K content analysis %K COVID-19 %K infodemiology %K misinformation %K online health information %K social media %K trend analysis %K Twitter %K vaccines %K vaccine hesitancy %D 2023 %7 24.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccinations play a critical role in mitigating the impact of COVID-19 and other diseases. Past research has linked misinformation to increased hesitancy and lower vaccination rates. Gaps remain in our knowledge about the main drivers of vaccine misinformation on social media and effective ways to intervene. Objective: Our longitudinal study had two primary objectives: (1) to investigate the patterns of prevalence and contagion of COVID-19 vaccine misinformation on Twitter in 2021, and (2) to identify the main spreaders of vaccine misinformation. Given our initial results, we further considered the likely drivers of misinformation and its spread, providing insights for potential interventions. Methods: We collected almost 300 million English-language tweets related to COVID-19 vaccines using a list of over 80 relevant keywords over a period of 12 months. We then extracted and labeled news articles at the source level based on third-party lists of low-credibility and mainstream news sources, and measured the prevalence of different kinds of information. We also considered suspicious YouTube videos shared on Twitter. We focused our analysis of vaccine misinformation spreaders on verified and automated Twitter accounts. Results: Our findings showed a relatively low prevalence of low-credibility information compared to the entirety of mainstream news. However, the most popular low-credibility sources had reshare volumes comparable to those of many mainstream sources, and had larger volumes than those of authoritative sources such as the US Centers for Disease Control and Prevention and the World Health Organization. Throughout the year, we observed an increasing trend in the prevalence of low-credibility news about vaccines. We also observed a considerable amount of suspicious YouTube videos shared on Twitter. Tweets by a small group of approximately 800 “superspreaders” verified by Twitter accounted for approximately 35% of all reshares of misinformation on an average day, with the top superspreader (@RobertKennedyJr) responsible for over 13% of retweets. Finally, low-credibility news and suspicious YouTube videos were more likely to be shared by automated accounts. Conclusions: The wide spread of misinformation around COVID-19 vaccines on Twitter during 2021 shows that there was an audience for this type of content. Our findings are also consistent with the hypothesis that superspreaders are driven by financial incentives that allow them to profit from health misinformation. Despite high-profile cases of deplatformed misinformation superspreaders, our results show that in 2021, a few individuals still played an outsized role in the spread of low-credibility vaccine content. As a result, social media moderation efforts would be better served by focusing on reducing the online visibility of repeat spreaders of harmful content, especially during public health crises. %M 36735835 %R 10.2196/42227 %U https://www.jmir.org/2023/1/e42227 %U https://doi.org/10.2196/42227 %U http://www.ncbi.nlm.nih.gov/pubmed/36735835 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e37711 %T Effects of Social Media Use on Connectivity and Emotions During Pandemic-Induced School Closures: Qualitative Interview Study Among Adolescents %A Liang,Elisa %A Kutok,Emily R %A Rosen,Rochelle K %A Burke,Taylor A %A Ranney,Megan L %+ Brown-Lifespan Center for Digital Health, 139 Point St., Providence, RI, 02903, United States, 1 401 444 2557, megan_ranney@brown.edu %K social media %K adolescents %K COVID-19 %K emotions %K connectivity %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic provided a unique opportunity to examine social media and technology use during a time in which technology served as adolescents’ primary form of socialization. The literature is mixed regarding how increased screen time during this period affected adolescent mental health and well-being. The mechanisms by which screen time use affected adolescent psychosocial outcomes are also unknown. Objective: We aimed to deepen our understanding of how social media and technology use, social connectivity, and emotional well-being intersected during pandemic-related school closures. Methods: English-speaking adolescents aged 13 to 17 years were recruited on Instagram for a brief screening survey; 39 participants were purposefully selected to complete a semistructured interview regarding their social media and technology use during the pandemic. Interview summaries were abstracted from recordings, and deductive codes were created for the primary question stems. These codes were subsequently reviewed for the main themes. Results: The main themes were as follows: adolescent social media and technology use during school closures usually allowed for more and easier social connectivity, but the amount and relative ease of connectivity differed according to purpose and type of use. Emotions, particularly those of stress and happiness, were connected to whether adolescents actively or passively engaged with social media and technology. Conclusions: Our results suggest a nuanced relationship among social media and technology use, adolescent social support, and emotional well-being, including during the pandemic. Specifically, how adolescents use or engage with web-based platforms greatly influences their ability to connect with others and their feelings of stress and happiness. In the context of the COVID-19 pandemic and as technology in general remains at the core of the adolescent experience, future research should continue to examine how adolescents navigate and use web-based spaces in beneficial and harmful ways. This will inform education and interventions that foster healthy social media and technological habits. %M 36054613 %R 10.2196/37711 %U https://mental.jmir.org/2023/1/e37711 %U https://doi.org/10.2196/37711 %U http://www.ncbi.nlm.nih.gov/pubmed/36054613 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40371 %T Web-Based Conversations Regarding Fathers Before and During the COVID-19 Pandemic: Qualitative Content Analysis %A Bouchacourt,Lindsay %A Henson-García,Mike %A Sussman,Kristen Leah %A Mandell,Dorothy %A Wilcox,Gary %A Mackert,Michael %+ Stan Richards School of Advertising and Public Relations, The University of Texas at Austin, 300 W Dean Keeton St, Austin, TX, 78712, United States, 1 512 471 5775, lbouchacourt@utexas.edu %K social media %K expecting fathers %K new fathers %K Twitter %K Reddit %K content analysis %K topic model %K topic analysis %K parent %K father %D 2023 %7 15.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Studies of new and expecting parents largely focus on the mother, leaving a gap in knowledge about fathers. Objective: This study aimed to understand web-based conversations regarding new and expecting fathers on social media and to explore whether the COVID-19 pandemic has changed the web-based conversation. Methods: A social media analysis was conducted. Brandwatch (Cision) captured social posts related to new and expecting fathers between February 1, 2019, and February 12, 2021. Overall, 2 periods were studied: 1 year before and 1 year during the pandemic. SAS Text Miner analyzed the data and produced 47% (9/19) of the topics in the first period and 53% (10/19) of the topics in the second period. The 19 topics were organized into 6 broad themes. Results: Overall, 26% (5/19) of the topics obtained during each period were the same, showing consistency in conversation. In total, 6 broad themes were created: fatherhood thoughts, fatherhood celebrations, advice seeking, fatherhood announcements, external parties targeting fathers, and miscellaneous. Conclusions: Fathers use social media to make announcements, celebrate fatherhood, seek advice, and interact with other fathers. Others used social media to advertise baby products and promote baby-related resources for fathers. Overall, the arrival of the COVID-19 pandemic appeared to have little impact on the excitement and resiliency of new fathers as they transition to parenthood. Altogether, these findings provide insight and guidance on the ways in which public health professionals can rapidly gather information about special populations—such as new and expecting fathers via the web—to monitor their beliefs, attitudes, emotional reactions, and unique lived experiences in context (ie, throughout a global pandemic). %M 36790850 %R 10.2196/40371 %U https://pediatrics.jmir.org/2023/1/e40371 %U https://doi.org/10.2196/40371 %U http://www.ncbi.nlm.nih.gov/pubmed/36790850 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42863 %T Social Media Data Mining of Antitobacco Campaign Messages: Machine Learning Analysis of Facebook Posts %A Lin,Shuo-Yu %A Cheng,Xiaolu %A Zhang,Jun %A Yannam,Jaya Sindhu %A Barnes,Andrew J %A Koch,J Randy %A Hayes,Rashelle %A Gimm,Gilbert %A Zhao,Xiaoquan %A Purohit,Hemant %A Xue,Hong %+ Department of Health Administration and Policy, College of Public Health, George Mason University, 4400 University Dr, Fairfax, Fairfax, VA, 22030, United States, 1 703 993 9833, hxue4@gmu.edu %K tobacco control %K social media campaign %K content analysis %K natural language processing %K topic modeling %K social media %K public health %K tobacco %K youth %K Facebook %K engagement %K use %K smoking %D 2023 %7 13.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms provide a valuable source of public health information, as one-third of US adults seek specific health information online. Many antitobacco campaigns have recognized such trends among youth and have shifted their advertising time and effort toward digital platforms. Timely evidence is needed to inform the adaptation of antitobacco campaigns to changing social media platforms. Objective: In this study, we conducted a content analysis of major antitobacco campaigns on Facebook using machine learning and natural language processing (NLP) methods, as well as a traditional approach, to investigate the factors that may influence effective antismoking information dissemination and user engagement. Methods: We collected 3515 posts and 28,125 associated comments from 7 large national and local antitobacco campaigns on Facebook between 2018 and 2021, including the Real Cost, Truth, CDC Tobacco Free (formally known as Tips from Former Smokers, where “CDC” refers to the Centers for Disease Control and Prevention), the Tobacco Prevention Toolkit, Behind the Haze VA, the Campaign for Tobacco-Free Kids, and Smoke Free US campaigns. NLP methods were used for content analysis, including parsimonious rule–based models for sentiment analysis and topic modeling. Logistic regression models were fitted to examine the relationship of antismoking message-framing strategies and viewer responses and engagement. Results: We found that large campaigns from government and nonprofit organizations had more user engagements compared to local and smaller campaigns. Facebook users were more likely to engage in negatively framed campaign posts. Negative posts tended to receive more negative comments (odds ratio [OR] 1.40, 95% CI 1.20-1.65). Positively framed posts generated more negative comments (OR 1.41, 95% CI 1.19-1.66) as well as positive comments (OR 1.29, 95% CI 1.13-1.48). Our content analysis and topic modeling uncovered that the most popular campaign posts tended to be informational (ie, providing new information), where the key phrases included talking about harmful chemicals (n=43, 43%) as well as the risk to pets (n=17, 17%). Conclusions: Facebook users tend to engage more in antitobacco educational campaigns that are framed negatively. The most popular campaign posts are those providing new information, with key phrases and topics discussing harmful chemicals and risks of secondhand smoke for pets. Educational campaign designers can use such insights to increase the reach of antismoking campaigns and promote behavioral changes. %M 36780224 %R 10.2196/42863 %U https://www.jmir.org/2023/1/e42863 %U https://doi.org/10.2196/42863 %U http://www.ncbi.nlm.nih.gov/pubmed/36780224 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40057 %T Applications of Social Media and Digital Technologies in COVID-19 Vaccination: Scoping Review %A Zang,Shujie %A Zhang,Xu %A Xing,Yuting %A Chen,Jiaxian %A Lin,Leesa %A Hou,Zhiyuan %+ School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032, China, 86 21 33563935, zyhou@fudan.edu.cn %K social media %K digital health %K COVID-19 %K vaccination %K review %D 2023 %7 10.2.2023 %9 Review %J J Med Internet Res %G English %X Background: Social media and digital technologies have played essential roles in disseminating information and promoting vaccination during the COVID-19 pandemic. There is a need to summarize the applications and analytical techniques of social media and digital technologies in monitoring vaccine attitudes and administering COVID-19 vaccines. Objective: We aimed to synthesize the global evidence on the applications of social media and digital technologies in COVID-19 vaccination and to explore their avenues to promote COVID-19 vaccination. Methods: We searched 6 databases (PubMed, Scopus, Web of Science, Embase, EBSCO, and IEEE Xplore) for English-language articles from December 2019 to August 2022. The search terms covered keywords relating to social media, digital technology, and COVID-19 vaccines. Articles were included if they provided original descriptions of applications of social media or digital health technologies/solutions in COVID-19 vaccination. Conference abstracts, editorials, letters, commentaries, correspondence articles, study protocols, and reviews were excluded. A modified version of the Appraisal Tool for Cross-Sectional Studies (AXIS tool) was used to evaluate the quality of social media–related studies. The review was undertaken with the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Results: A total of 178 articles were included in our review, including 114 social media articles and 64 digital technology articles. Social media has been applied for sentiment/emotion analysis, topic analysis, behavioral analysis, dissemination and engagement analysis, and information quality analysis around COVID-19 vaccination. Of these, sentiment analysis and topic analysis were the most common, with social media data being primarily analyzed by lexicon-based and machine learning techniques. The accuracy and reliability of information on social media can seriously affect public attitudes toward COVID-19 vaccines, and misinformation often leads to vaccine hesitancy. Digital technologies have been applied to determine the COVID-19 vaccination strategy, predict the vaccination process, optimize vaccine distribution and delivery, provide safe and transparent vaccination certificates, and perform postvaccination surveillance. The applied digital technologies included algorithms, blockchain, mobile health, the Internet of Things, and other technologies, although with some barriers to their popularization. Conclusions: The applications of social media and digital technologies in addressing COVID-19 vaccination–related issues represent an irreversible trend. Attention should be paid to the ethical issues and health inequities arising from the digital divide while applying and promoting these technologies. %M 36649235 %R 10.2196/40057 %U https://www.jmir.org/2023/1/e40057 %U https://doi.org/10.2196/40057 %U http://www.ncbi.nlm.nih.gov/pubmed/36649235 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43055 %T Preference and Willingness to Pay for the Regular COVID-19 Booster Shot in the Vietnamese Population: Theory-Driven Discrete Choice Experiment %A Tran,Bach Xuan %A Do,Anh Linh %A Boyer,Laurent %A Auquier,Pascal %A Le,Huong Thi %A Le Vu,Minh Ngoc %A Dang,Trang Huyen Thi %A Cao,Khuy Minh %A Le,Linh Dieu Thi %A Cu,Lam Tung Ngoc %A Ly,Bang Viet %A Nguyen,Duong Anh Thi %A Nguyen,Manh Duc %A Latkin,Carl A %A Ho,Roger C M %A Ho,Cyrus S H %A Zhang,Melvyn W B %+ Institute for Preventive Medicine and Public Health, Hanoi Medical University, 1 Ton That Tung Street, Kim Lien Ward, Dong Da District, Hanoi, 100000, Vietnam, 84 888288399, bach.ipmph@gmail.com %K COVID-19 %K epidemic %K vaccine %K booster %K willingness to take %K willingness to pay %K Vietnam %K policy %K feasibility %K acceptability %K infection %K vaccination %K social media %K intervention %D 2023 %7 31.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 booster vaccination rate has declined despite the wide availability of vaccines. As COVID-19 is becoming endemic and charges for regular booster vaccination are being introduced, measuring public acceptance and the willingness to pay for regular COVID-19 boosters is ever more crucial. Objective: This study aims to (1) investigate public acceptance for regular COVID-19 boosters, (2) assess the willingness to pay for a COVID-19 booster shot, and (3) identify factors associated with vaccine hesitancy. Our results will provide crucial insights into and implications for policy response as well as the development of a feasible and effective vaccination campaign during Vietnam’s waning vaccine immunity period. Methods: A cross-sectional study was conducted among 871 Vietnamese online participants from April to August 2022. An online questionnaire based on the discrete choice experiment (DCE) design was developed, distributed using the snowball sampling method, and subsequently conjointly analyzed on the Qualtrics platform. A history of COVID-19 infection and vaccination, health status, willingness to vaccinate, willingness to pay, and other factors were examined. Results: Among the participants, 761 (87.4%) had received or were waiting for a COVID-19 booster shot. However, the willingness to pay was low at US $8.02, and most participants indicated an unwillingness to pay (n=225, 25.8%) or a willingness to pay for only half of the vaccine costs (n=222, 25.4%). Although information insufficiency and a wariness toward vaccines were factors most associated with the unwillingness to pay, long-term side effects, immunity duration, and mortality rate were the attributes the participants were most concerned with during the vaccine decision-making period. Participants who had children less than 18 years old in their homes infected with COVID-19 had a lower willingness to pay (odds ratio [OR] 0.54, 95% CI 0.39-0.74). Respondents who had children under 12 years old in their family who received at least 1 vaccine dose had a higher willingness to pay (OR 2.03, 95% CI 1.12-3.66). The burden of medical expenses (OR 0.33, 95% CI 0.25-0.45) and fear of the vaccine (OR 0.93, 95% CI 0.86-1.00) were negative factors associated with the level of willingness to pay. Conclusions: A significant inconsistency between high acceptance and a low willingness to pay underscores the role of vaccine information and public trust. In addition to raising awareness about the most concerning characteristics of the COVID-19 booster, social media and social listening should be used in collaboration with health professionals to establish a 2-way information exchange. Work incentives and suitable mandates should continue to encourage workforce participation. Most importantly, all interventions should be conducted with informational transparency to strengthen trust between the public and authorities. %M 36599156 %R 10.2196/43055 %U https://publichealth.jmir.org/2023/1/e43055 %U https://doi.org/10.2196/43055 %U http://www.ncbi.nlm.nih.gov/pubmed/36599156 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e34132 %T Comparison of the Users’ Attitudes Toward Cannabidiol on Social Media Platforms: Topic Modeling Study %A Li,Yongjie %A Yan,Xiangyu %A Wang,Zekun %A Ma,Mingchang %A Zhang,Bo %A Jia,Zhongwei %+ School of Public Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, China, 86 18813052163, urchinjj@163.com %K cannabidiol %K drug policy %K latent Dirichlet allocation %K social media %K sentiment analysis %D 2023 %7 11.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As one of the major constituents of the cannabis sativa plant, cannabidiol (CBD) is approved for use in medical treatment and cosmetics because of its potential health benefits. With the rapid growth of the CBD market, customers purchase these products, and relevant discussions are becoming more active on social media. Objective: In this study, we aimed to understand the users’ attitudes toward CBD products in various countries by conducting text mining on social media in countries with different substance management policies. Methods: We collected posts from Reddit and Xiaohongshu, conducted topic mining using the latent Dirichlet allocation model, and analyzed the characteristics of topics on different social media. Subsequently, a co-occurrence network of high-frequency keywords was constructed to explore potential relationships among topics. Moreover, we conducted sentiment analysis on the posts’ comments and compared users’ attitudes toward CBD products on Reddit and Xiaohongshu using chi-square test. Results: CBD-related posts on social media have been rapidly increasing, especially on Xiaohongshu since 2019. A total of 1790 posts from Reddit and 1951 posts from Xiaohongshu were included in the final analysis. The posts on the 2 social media platforms, Reddit and Xiaohongshu, were categorized into 7 and 8 topics, respectively, by the latent Dirichlet allocation model, and these topics on the 2 social media were grouped into 5 themes. Our study showed that the themes on Reddit were mainly related to the therapeutic effects of CBD, whereas the themes on Xiaohongshu concentrated on cosmetics, such as facial masks. Theme 2 (CBD market information) and theme 3 (attitudes toward CBD) on Reddit had more connections with other themes in the co-occurrence network, and theme 3 and theme 1 (CBD therapeutic effects) had a high co-occurrence frequency (22,803/73,865, 30.87%). Meanwhile, theme 1 (CBD cosmetics) on Xiaohongshu had various connections with others (169,961/384,575, 44.19%), and the co-occurrence frequency of theme 4 (CBD ingredients) and theme 1 was relatively prominent (27,128/49,312, 55.01%). Overall, users’ comments tended to be positive for CBD-related information on both Reddit and Xiaohongshu, but the percentage was higher on Xiaohongshu (82.25% vs 86.18%; P<.001), especially in cosmetics and medical health care products. Conclusions: The CBD market has grown rapidly, and the topics related to CBD on social media have become active. There are apparent differences in users’ attitudes toward CBD in countries with different substance management policies. Targeted CBD management measures should be formulated to suit the prevalence of CBD use of each country. %M 36630175 %R 10.2196/34132 %U https://publichealth.jmir.org/2023/1/e34132 %U https://doi.org/10.2196/34132 %U http://www.ncbi.nlm.nih.gov/pubmed/36630175 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e40198 %T Platform Effects on Public Health Communication: A Comparative and National Study of Message Design and Audience Engagement Across Twitter and Facebook %A DePaula,Nic %A Hagen,Loni %A Roytman,Stiven %A Alnahass,Dana %+ School of Information Sciences, Wayne State University, 42 W Warren Ave, Detroit, MI, 48202, United States, 1 313 577 1825, ndepaula@wayne.edu %K platform effects %K COVID-19 %K social media %K health communication %K message design %K risk communication %K Twitter %K Facebook %K user engagement %K e-government %D 2022 %7 20.12.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Public health agencies widely adopt social media for health and risk communication. Moreover, different platforms have different affordances, which may impact the quality and nature of the messaging and how the public engages with the content. However, these platform effects are not often compared in studies of health and risk communication and not previously for the COVID-19 pandemic. Objective: This study measures the potential media effects of Twitter and Facebook on public health message design and engagement by comparing message elements and audience engagement in COVID-19–related posts by local, state, and federal public health agencies in the United States during the pandemic, to advance theories of public health messaging on social media and provide recommendations for tailored social media communication strategies. Methods: We retrieved all COVID-19–related posts from major US federal agencies related to health and infectious disease, all major state public health agencies, and selected local public health departments on Twitter and Facebook. A total of 100,785 posts related to COVID-19, from 179 different accounts of 96 agencies, were retrieved for the entire year of 2020. We adopted a framework of social media message elements to analyze the posts across Facebook and Twitter. For manual content analysis, we subsampled 1677 posts. We calculated the prevalence of various message elements across the platforms and assessed the statistical significance of differences. We also calculated and assessed the association between message elements with normalized measures of shares and likes for both Facebook and Twitter. Results: Distributions of message elements were largely similar across both sites. However, political figures (P<.001), experts (P=.01), and nonpolitical personalities (P=.01) were significantly more present on Facebook posts compared to Twitter. Infographics (P<.001), surveillance information (P<.001), and certain multimedia elements (eg, hyperlinks, P<.001) were more prevalent on Twitter. In general, Facebook posts received more (normalized) likes (0.19%) and (normalized) shares (0.22%) compared to Twitter likes (0.08%) and shares (0.05%). Elements with greater engagement on Facebook included expressives and collectives, whereas posts related to policy were more engaged with on Twitter. Science information (eg, scientific explanations) comprised 8.5% (73/851) of Facebook and 9.4% (78/826) of Twitter posts. Correctives of misinformation only appeared in 1.2% (11/851) of Facebook and 1.4% (12/826) of Twitter posts. Conclusions: In general, we find a data and policy orientation for Twitter messages and users and a local and personal orientation for Facebook, although also many similarities across platforms. Message elements that impact engagement are similar across platforms but with some notable distinctions. This study provides novel evidence for differences in COVID-19 public health messaging across social media sites, advancing knowledge of public health communication on social media and recommendations for health and risk communication strategies on these online platforms. %M 36575712 %R 10.2196/40198 %U https://infodemiology.jmir.org/2022/2/e40198 %U https://doi.org/10.2196/40198 %U http://www.ncbi.nlm.nih.gov/pubmed/36575712 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e42179 %T Social Media for Public Health: Framework for Social Media–Based Public Health Campaigns %A de Vere Hunt,Isabella %A Linos,Eleni %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, United Kingdom, 44 1865289300, isabella.deverehunt@phc.ox.ac.uk %K social media %K digital heath %K health communication %K campaign %K public health %K framework %K health promotion %K public awareness %K misinformation %K tailored message %K tailored messaging %K information sharing %K information exchange %K advertise %K advertising %D 2022 %7 14.12.2022 %9 Viewpoint %J J Med Internet Res %G English %X The pervasiveness of social media is irrefutable, with 72% of adults reporting using at least one social media platform and an average daily usage of 2 hours. Social media has been shown to influence health-related behaviors, and it offers a powerful tool through which we can rapidly reach large segments of the population with tailored health messaging. However, despite increasing interest in using social media for dissemination of public health messaging and research exploring the dangers of misinformation on social media, the specifics of how public health practitioners can effectively use social media for health promotion are not well described. In this viewpoint, we propose a novel framework with the following 5 key principles to guide the use of social media for public health campaigns: (1) tailoring messages and targeting them to specific populations—this may include targeting messages to specific populations based on age, sex, or language spoken; interests; or geotargeting messages at state, city, or zip code level; (2) including members of the target population in message development—messages should be designed with and approved by members of the community they are designed to reach, to ensure cultural sensitivity and trust-building; (3) identifying and addressing misinformation—public health practitioners can directly address misinformation through myth-busting messages, in which false claims are highlighted and explained and accurate information reiterated; (4) leveraging information sharing—when designing messages for social media, it is crucial to consider their “shareability,” and consider partnering with social media influencers who are trusted messengers among their online followers; and (5) evaluating impact by measuring real-world outcomes, for example measuring foot traffic data. Leveraging social media to deliver public health campaigns enables us to capitalize on sophisticated for-profit advertising techniques to disseminate tailored messaging directly to communities that need it most, with a precision far beyond the reaches of conventional mass media. We call for the Centers for Disease Control and Prevention as well as state and local public health agencies to continue to optimize and rigorously evaluate the use of social media for health promotion. %M 36515995 %R 10.2196/42179 %U https://www.jmir.org/2022/12/e42179 %U https://doi.org/10.2196/42179 %U http://www.ncbi.nlm.nih.gov/pubmed/36515995 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40380 %T Ethical and Methodological Considerations of Twitter Data for Public Health Research: Systematic Review %A Takats,Courtney %A Kwan,Amy %A Wormer,Rachel %A Goldman,Dari %A Jones,Heidi E %A Romero,Diana %+ City University of New York School of Public Health, 55 W 125th St, New York City, NY, 10027, United States, 1 6313988664, courttakats14@gmail.com %K systematic review %K Twitter %K social media %K public health ethics %K public health %K ethics %K ethical considerations %K public health research %K research topics %K Twitter data %K ethical framework %K research ethics %D 2022 %7 29.11.2022 %9 Review %J J Med Internet Res %G English %X Background: Much research is being carried out using publicly available Twitter data in the field of public health, but the types of research questions that these data are being used to answer and the extent to which these projects require ethical oversight are not clear. Objective: This review describes the current state of public health research using Twitter data in terms of methods and research questions, geographic focus, and ethical considerations including obtaining informed consent from Twitter handlers. Methods: We implemented a systematic review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of articles published between January 2006 and October 31, 2019, using Twitter data in secondary analyses for public health research, which were found using standardized search criteria on SocINDEX, PsycINFO, and PubMed. Studies were excluded when using Twitter for primary data collection, such as for study recruitment or as part of a dissemination intervention. Results: We identified 367 articles that met eligibility criteria. Infectious disease (n=80, 22%) and substance use (n=66, 18%) were the most common topics for these studies, and sentiment mining (n=227, 62%), surveillance (n=224, 61%), and thematic exploration (n=217, 59%) were the most common methodologies employed. Approximately one-third of articles had a global or worldwide geographic focus; another one-third focused on the United States. The majority (n=222, 60%) of articles used a native Twitter application programming interface, and a significant amount of the remainder (n=102, 28%) used a third-party application programming interface. Only one-third (n=119, 32%) of studies sought ethical approval from an institutional review board, while 17% of them (n=62) included identifying information on Twitter users or tweets and 36% of them (n=131) attempted to anonymize identifiers. Most studies (n=272, 79%) included a discussion on the validity of the measures and reliability of coding (70% for interreliability of human coding and 70% for computer algorithm checks), but less attention was paid to the sampling frame, and what underlying population the sample represented. Conclusions: Twitter data may be useful in public health research, given its access to publicly available information. However, studies should exercise greater caution in considering the data sources, accession method, and external validity of the sampling frame. Further, an ethical framework is necessary to help guide future research in this area, especially when individual, identifiable Twitter users and tweets are shared and discussed. Trial Registration: PROSPERO CRD42020148170; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=148170 %M 36445739 %R 10.2196/40380 %U https://www.jmir.org/2022/11/e40380 %U https://doi.org/10.2196/40380 %U http://www.ncbi.nlm.nih.gov/pubmed/36445739 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40160 %T Using Natural Language Processing to Explore “Dry January” Posts on Twitter: Longitudinal Infodemiology Study %A Russell,Alex M %A Valdez,Danny %A Chiang,Shawn C %A Montemayor,Ben N %A Barry,Adam E %A Lin,Hsien-Chang %A Massey,Philip M %+ Center for Public Health and Technology, Department of Health, Human Performance, and Recreation, University of Arkansas, HPER Building, 308-V, Fayetteville, AR, 72701, United States, 1 479 575 8672, ar117@uark.edu %K alcohol %K drinking %K social media %K Twitter %K Dry January %K infodemiology %K infoveillance %K natural language processing %D 2022 %7 18.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Dry January, a temporary alcohol abstinence campaign, encourages individuals to reflect on their relationship with alcohol by temporarily abstaining from consumption during the month of January. Though Dry January has become a global phenomenon, there has been limited investigation into Dry January participants’ experiences. One means through which to gain insights into individuals’ Dry January-related experiences is by leveraging large-scale social media data (eg, Twitter chatter) to explore and characterize public discourse concerning Dry January. Objective: We sought to answer the following questions: (1) What themes are present within a corpus of tweets about Dry January, and is there consistency in the language used to discuss Dry January across multiple years of tweets (2020-2022)? (2) Do unique themes or patterns emerge in Dry January 2021 tweets after the onset of the COVID-19 pandemic? and (3) What is the association with tweet composition (ie, sentiment and human-authored vs bot-authored) and engagement with Dry January tweets? Methods: We applied natural language processing techniques to a large sample of tweets (n=222,917) containing the term “dry january” or “dryjanuary” posted from December 15 to February 15 across three separate years of participation (2020-2022). Term frequency inverse document frequency, k-means clustering, and principal component analysis were used for data visualization to identify the optimal number of clusters per year. Once data were visualized, we ran interpretation models to afford within-year (or within-cluster) comparisons. Latent Dirichlet allocation topic modeling was used to examine content within each cluster per given year. Valence Aware Dictionary and Sentiment Reasoner sentiment analysis was used to examine affect per cluster per year. The Botometer automated account check was used to determine average bot score per cluster per year. Last, to assess user engagement with Dry January content, we took the average number of likes and retweets per cluster and ran correlations with other outcome variables of interest. Results: We observed several similar topics per year (eg, Dry January resources, Dry January health benefits, updates related to Dry January progress), suggesting relative consistency in Dry January content over time. Although there was overlap in themes across multiple years of tweets, unique themes related to individuals’ experiences with alcohol during the midst of the COVID-19 global pandemic were detected in the corpus of tweets from 2021. Also, tweet composition was associated with engagement, including number of likes, retweets, and quote-tweets per post. Bot-dominant clusters had fewer likes, retweets, or quote tweets compared with human-authored clusters. Conclusions: The findings underscore the utility for using large-scale social media, such as discussions on Twitter, to study drinking reduction attempts and to monitor the ongoing dynamic needs of persons contemplating, preparing for, or actively pursuing attempts to quit or cut down on their drinking. %M 36343184 %R 10.2196/40160 %U https://www.jmir.org/2022/11/e40160 %U https://doi.org/10.2196/40160 %U http://www.ncbi.nlm.nih.gov/pubmed/36343184 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e35730 %T Fear of COVID-19 and Prevention Behaviors: Cross-Lagged Panel Analysis %A Anderson,Katherine M %A Stockman,Jamila K %+ Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Dr, MC 0507, La Jolla, CA, 92093, United States, 1 7209036196, k4anderson@health.ucsd.edu %K fear appeals %K structural equation modelling %K cross-lagged model %K prevention behavior %K COVID-19 %K fear %K women %K behavior %K change %K health %K physical distance %K relationships %K pandemic %K research %K association %K prevention %K experience %K panel %K interest %K public %K distancing %D 2022 %7 17.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The ongoing COVID-19 pandemic has brought forth conversations about effective behavior change models for increasing prevention behavior, ranging from wearing masks in public to physical distancing. Among the considered behavior change techniques is the use of fear appeals, through which a negative possible outcome is emphasized to invoke fear, which in turn may promote prevention behaviors to counter the likelihood of the negative outcome. Although fear is hypothesized as health promoting in some theories of health behavior, little research has rigorously assessed the relationship. Objective: In our exploratory analyses, we aim to examine the association, including directionality of the association between fear of COVID-19 and COVID-19 prevention behaviors across 2 time points during the early COVID-19 pandemic among a sample of US women. Methods: The COPE study, a web-based survey of US women’s COVID-19 experiences, was deployed in May-June 2020 (time 1) with follow-up in December 2020-January 2021 (time 2; n=200). Demographic characteristics as well as fear of COVID-19 and COVID-19 prevention behaviors (eg, staying home except for essential activities, physical distancing in public, and masking in public) were measured. Descriptive and bivariate analyses were used to characterize COVID-19 prevention behaviors and fear of COVID-19 among participants. Cross-lagged panel analysis, a type of structural equation modeling that assesses directionality of temporal associations, was used to understand relationships, if any, between variables of interest. Results: We found cross-sectional associations between fear of COVID-19 and staying home and physical distancing, as well as temporal associations between fear at time 1 and time 2 and prevention behaviors at time 1 and time 2. However, results of the cross-lagged panel analysis indicated no cross-lagged temporal relationships between fear of COVID-19 and COVID-19 prevention behaviors 6 months apart. Conclusions: Fear of COVID-19 did not appear to predict COVID-19 prevention behaviors 6 months after initial measurements among the sample of women recruited for our study. Future research should rigorously test these associations longitudinally, and alternative methods of public health prevention promotion should be considered. %M 36346895 %R 10.2196/35730 %U https://formative.jmir.org/2022/11/e35730 %U https://doi.org/10.2196/35730 %U http://www.ncbi.nlm.nih.gov/pubmed/36346895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e40049 %T Examining the Twitter Discourse on Dementia During Alzheimer’s Awareness Month in Canada: Infodemiology Study %A Bacsu,Juanita-Dawne %A Cammer,Allison %A Ahmadi,Soheila %A Azizi,Mehrnoosh %A Grewal,Karl S %A Green,Shoshana %A Gowda-Sookochoff,Rory %A Berger,Corinne %A Knight,Sheida %A Spiteri,Raymond J %A O'Connell,Megan E %+ Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada, 1 306 250 4399, juanita.bacsu@usask.ca %K Twitter %K social media %K dementia %K Alzheimer disease %K awareness %K public health campaigns %D 2022 %7 26.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Twitter has become a primary platform for public health campaigns, ranging from mental health awareness week to diabetes awareness month. However, there is a paucity of knowledge about how Twitter is being used during health campaigns, especially for Alzheimer’s Awareness Month. Objective: The purpose of our study was to examine dementia discourse during Canada’s Alzheimer’s Awareness Month in January to inform future awareness campaigns. Methods: We collected 1289 relevant tweets using the Twint application in Python from January 1 to January 31, 2022. Thematic analysis was used to analyze the data. Results: Guided by our analysis, 4 primary themes were identified: dementia education and advocacy, fundraising and promotion, experiences of dementia, and opportunities for future actions. Conclusions: Although our study identified many educational, promotional, and fundraising tweets to support dementia awareness, we also found numerous tweets with cursory messaging (ie, simply referencing January as Alzheimer’s Awareness Month in Canada). While these tweets promoted general awareness, they also highlight an opportunity for targeted educational content to counter stigmatizing messages and misinformation about dementia. In addition, awareness strategies partnering with diverse stakeholders (such as celebrities, social media influencers, and people living with dementia and their care partners) may play a pivotal role in fostering dementia dialogue and education. Further research is needed to develop, implement, and evaluate dementia awareness strategies on Twitter. Increased knowledge, partnerships, and research are essential to enhancing dementia awareness during Canada’s Alzheimer’s Awareness Month and beyond. %M 36287605 %R 10.2196/40049 %U https://formative.jmir.org/2022/10/e40049 %U https://doi.org/10.2196/40049 %U http://www.ncbi.nlm.nih.gov/pubmed/36287605 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e40171 %T A Social Media–Based Intervention for Chinese American Caregivers of Persons With Dementia: Protocol Development %A Hong,Y Alicia %A Shen,Kang %A Lu,Huixing Kate %A Chen,Hsiaoyin %A Gong,Yang %A Ta Park,Van %A Han,Hae-Ra %+ Department of Health Administration and Policy, College of Public Health, George Mason University, 4400 University Dr. MS 1j3, Fairfax, VA, 22030, United States, 1 703 993 1929, yhong22@gmu.edu %K Alzheimer disease %K dementia %K caregivers %K Chinese Americans %K mHealth intervention %K mobile health %K WeChat %K social media %K aging %D 2022 %7 29.9.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Racial/ethnic minority and immigrant caregivers of persons with dementia experience high rates of psychosocial stress and adverse health outcomes. Few culturally tailored mobile health (mHealth) programs were designed for these vulnerable populations. Objective: This study reports the development of a culturally tailored mHealth program called Wellness Enhancement for Caregivers (WECARE) to improve caregiving skills, reduce distress, and improve the psychosocial well-being of Chinese American family caregivers of persons with dementia. Methods: Community-based user-centered design principles were applied in the program development. First, the structure and curriculum of the WECARE program were crafted based on existing evidence-based interventions for caregivers with input from 4 experts. Second, through working closely with 8 stakeholders, we culturally adapted evidence-based programs into multimedia program components. Lastly, 5 target users tested the initial WECARE program; their experience and feedback were used to further refine the program. Results: The resulting WECARE is a 7-week mHealth program delivered via WeChat, a social media app highly popular in Chinese Americans. By subscribing to the official WECARE account, users can receive 6 interactive multimedia articles pushed to their WeChat accounts each week for 7 weeks. The 7 major themes include (1) facts of dementia and caregiving; (2) the enhancement of caregiving skills; (3) effective communication with health care providers, care partners, and family members; (4) problem-solving skills for caregiving stress management; (5) stress reduction and depression prevention; (6) the practice of self-care and health behaviors; and (7) social support and available resources. Users also have the option of joining group chats for peer support. The WECARE program also includes a back-end database that manages intervention delivery and tracks user engagement. Conclusions: The WECARE program represents one of the first culturally tailored social media–based interventions for Chinese American caregivers of persons with dementia. It demonstrates the use of community-based user-centered design principles in developing an mHealth intervention program in underserved communities. We call for more cultural adaptation and development of mHealth interventions for immigrant and racial/ethnic minority caregivers of persons with dementia. %M 36173667 %R 10.2196/40171 %U https://aging.jmir.org/2022/3/e40171 %U https://doi.org/10.2196/40171 %U http://www.ncbi.nlm.nih.gov/pubmed/36173667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e35035 %T Using Social Media to Facilitate Communication About Women’s Testing: Tool Validation Study %A Coffin,Tara %A Bowen,Deborah %A Lu,Karen %A Swisher,Elizabeth M %A Rayes,Nadine %A Norquist,Barbara %A Blank,Stephanie V %A Levine,Douglas A %A Bakkum-Gamez,Jamie Nadine %A Fleming,Gini F %A I Olopade,Olufunmilayo %A Romero,Iris %A D'Andrea,Alan %A Nebgen,Denise R %A Peterson,Christine %A Munsell,Mark F %A Gavin,Kathleen %A Crase,Jamie %A Polinsky,Deborah %A Lechner,Rebecca %+ University of Washington, 1400 NE Campus Parkway, Seattle, WA, 98195-4550, United States, 1 (206) 543 2100, tbcoffin@uw.edu %K ovarian cancer %K hereditary cancer %K genetic testing %K online social media recruitment %K Facebook %K social media %K mobile phone %D 2022 %7 26.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Strong participant recruitment practices are critical to public health research but are difficult to achieve. Traditional recruitment practices are often time consuming, costly, and fail to adequately target difficult-to-reach populations. Social media platforms such as Facebook are well-positioned to address this area of need, enabling researchers to leverage existing social networks and deliver targeted information. The MAGENTA (Making Genetic Testing Accessible) study aimed to improve the availability of genetic testing for hereditary cancer susceptibility in at-risk individuals through the use of a web-based communication system along with social media advertisements to improve reach. Objective: This paper is aimed to evaluate the effectiveness of Facebook as an outreach tool for targeting women aged ≥30 years for recruitment in the MAGENTA study. Methods: We designed and implemented paid and unpaid social media posts with ongoing assessment as a primary means of research participant recruitment in collaboration with patient advocates. Facebook analytics were used to assess the effectiveness of paid and unpaid outreach efforts. Results: Over the course of the reported recruitment period, Facebook materials had a reach of 407,769 people and 57,248 (14.04%) instances of engagement, indicating that approximately 14.04% of people who saw information about the study on Facebook engaged with the content. Paid advertisements had a total reach of 373,682. Among those reached, just <15% (54,117/373,682, 14.48%) engaged with the page content. Unpaid posts published on the MAGENTA Facebook page resulted in a total of 34,087 reach and 3131 instances of engagement, indicating that around 9.19% (3131/34,087) of people who saw unpaid posts engaged. Women aged ≥65 years reported the best response rate, with approximately 43.95% (15,124/34,410) of reaches translating to engagement. Among the participants who completed the eligibility questionnaire, 27.44% (3837/13,983) had heard about the study through social media or another webpage. Conclusions: Facebook is a useful way of enhancing clinical trial recruitment of women aged ≥30 years who have a potentially increased risk for ovarian cancer by promoting news stories over social media, collaborating with patient advocacy groups, and running paid and unpaid campaigns. Trial Registration: ClinicalTrials.gov NCT02993068; https://clinicaltrials.gov/ct2/show/NCT02993068 %M 36155347 %R 10.2196/35035 %U https://formative.jmir.org/2022/9/e35035 %U https://doi.org/10.2196/35035 %U http://www.ncbi.nlm.nih.gov/pubmed/36155347 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e38839 %T Data Exploration and Classification of News Article Reliability: Deep Learning Study %A Zhan,Kevin %A Li,Yutong %A Osmani,Rafay %A Wang,Xiaoyu %A Cao,Bo %+ Department of Psychiatry, University of Alberta, 4-142 KATZ Group Centre for Pharmacy and Health Research, 87 Avenue and 114 Street, Edmonton, AB, T6G 2E1, Canada, 1 403 926 6628, yutong5@ualberta.ca %K COVID-19 %K deep learning %K news article reliability %K false information %K infodemic %K ensemble model %D 2022 %7 22.9.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the ongoing COVID-19 pandemic, we are being exposed to large amounts of information each day. This “infodemic” is defined by the World Health Organization as the mass spread of misleading or false information during a pandemic. This spread of misinformation during the infodemic ultimately leads to misunderstandings of public health orders or direct opposition against public policies. Although there have been efforts to combat misinformation spread, current manual fact-checking methods are insufficient to combat the infodemic. Objective: We propose the use of natural language processing (NLP) and machine learning (ML) techniques to build a model that can be used to identify unreliable news articles online. Methods: First, we preprocessed the ReCOVery data set to obtain 2029 English news articles tagged with COVID-19 keywords from January to May 2020, which are labeled as reliable or unreliable. Data exploration was conducted to determine major differences between reliable and unreliable articles. We built an ensemble deep learning model using the body text, as well as features, such as sentiment, Empath-derived lexical categories, and readability, to classify the reliability. Results: We found that reliable news articles have a higher proportion of neutral sentiment, while unreliable articles have a higher proportion of negative sentiment. Additionally, our analysis demonstrated that reliable articles are easier to read than unreliable articles, in addition to having different lexical categories and keywords. Our new model was evaluated to achieve the following performance metrics: 0.906 area under the curve (AUC), 0.835 specificity, and 0.945 sensitivity. These values are above the baseline performance of the original ReCOVery model. Conclusions: This paper identified novel differences between reliable and unreliable news articles; moreover, the model was trained using state-of-the-art deep learning techniques. We aim to be able to use our findings to help researchers and the public audience more easily identify false information and unreliable media in their everyday lives. %M 36193330 %R 10.2196/38839 %U https://infodemiology.jmir.org/2022/2/e38839 %U https://doi.org/10.2196/38839 %U http://www.ncbi.nlm.nih.gov/pubmed/36193330 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 9 %P e37274 %T The Relationships Between Social Media and Human Papillomavirus Awareness and Knowledge: Cross-sectional Study %A Jo,Soojung %A Pituch,Keenan A %A Howe,Nancy %+ School of Nursing, Purdue University, 502 N University Street, West Lafayette, IN, 47907, United States, 1 7654942225, soojungj@purdue.edu %K papillomavirus infections %K vaccination %K social media %K health promotion %K public reporting of health care data %K human papillomavirus %D 2022 %7 20.9.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Human papillomavirus (HPV) is the most common sexually transmitted infection. HPV can infect both females and males, and it can cause many cancers, including anal, cervical, vaginal, vulvar, and penile cancers. HPV vaccination rates are lower than vaccination rates within other national vaccination programs, despite its importance. Research literature indicates that people obtain health-related information from internet sources and social media; however, the association between such health-seeking behavior on social media and HPV-related behaviors has not been consistently demonstrated in the literature. Objective: This study aims to examine the association between social media usage and HPV knowledge and HPV awareness. Methods: This study analyzed public health data collected through the Health Information National Trends Survey (HINTS) conducted by the US National Cancer Institute. The analysis used data collected in 2020; in total, 2948 responses were included in the analysis. Six HPV-related questions were used to identify HPV awareness, HPV vaccine awareness, and HPV knowledge about HPV-related cancers. Four questions about social media usage and one question about online health information–seeking behavior were used to analyze the associations between social media usage and HPV-related behaviors. Initially, six logistic regressions were conducted using replicate weights. Based on the results, significant factors were included in a second set of regression analyses that also included demographic variables. Results: About half of the respondents were aware of HPV (68.40%), the HPV vaccine (64.04%), and the relationship between HPV and cervical cancer (48.00%). However, fewer respondents were knowledgeable about the relationships between HPV and penile cancer (19.18%), anal cancer (18.33%), and oral cancer (19.86%). Although social media usage is associated with HPV awareness, HPV vaccine awareness, and knowledge of cervical cancer, these associations were not significant after adjusting for demographic variables. Those less likely to report HPV awareness and knowledge included older participants, males, those with a household income of less than US $20,000, those with a formal education equal to or less than high school, or those who resided in a household where adults are not fluent in English. Conclusions: After adjusting for demographic variables, social media use was not related to HPV knowledge and awareness, and survey respondents were generally not aware that HPV can lead to specific types of cancer, other than cervical cancer. These results suggest that perhaps a lack of high-quality information on social media may impede HPV awareness and knowledge. Efforts to educate the public about HPV via social media might be improved by using techniques like storytelling or infographics, especially targeting vulnerable populations, such as older participants, males, those with low incomes, those with less formal education, or those who reside in the United States but are not fluent in English. %M 36125858 %R 10.2196/37274 %U https://publichealth.jmir.org/2022/9/e37274 %U https://doi.org/10.2196/37274 %U http://www.ncbi.nlm.nih.gov/pubmed/36125858 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e35121 %T Quantifying Changes in Vaccine Coverage in Mainstream Media as a Result of the COVID-19 Outbreak: Text Mining Study %A Christensen,Bente %A Laydon,Daniel %A Chelkowski,Tadeusz %A Jemielniak,Dariusz %A Vollmer,Michaela %A Bhatt,Samir %A Krawczyk,Konrad %+ Department of Mathematics and Computer Science, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 5551122, konradk@imada.sdu.dk %K data mining %K COVID-19 %K vaccine %K text mining %K change %K coverage %K communication %K media %K social media %K news %K outbreak %K acceptance %K hesitancy %K understanding %K knowledge %K sentiment %D 2022 %7 20.9.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Achieving herd immunity through vaccination depends upon the public’s acceptance, which in turn relies on their understanding of its risks and benefits. The fundamental objective of public health messaging on vaccines is therefore the clear communication of often complex information and, increasingly, the countering of misinformation. The primary outlet shaping public understanding is mainstream online news media, where coverage of COVID-19 vaccines was widespread. Objective: We used text-mining analysis on the front pages of mainstream online news to quantify the volume and sentiment polarization of vaccine coverage. Methods: We analyzed 28 million articles from 172 major news sources across 11 countries between July 2015 and April 2021. We employed keyword-based frequency analysis to estimate the proportion of overall articles devoted to vaccines. We performed topic detection using BERTopic and named entity recognition to identify the leading subjects and actors mentioned in the context of vaccines. We used the Vader Python module to perform sentiment polarization quantification of all collated English-language articles. Results: The proportion of front-page articles mentioning vaccines increased from 0.1% to 4% with the outbreak of COVID-19. The number of negatively polarized articles increased from 6698 in 2015-2019 to 28,552 in 2020-2021. However, overall vaccine coverage before the COVID-19 pandemic was slightly negatively polarized (57% negative), whereas coverage during the pandemic was positively polarized (38% negative). Conclusions: Throughout the pandemic, vaccines have risen from a marginal to a widely discussed topic on the front pages of major news outlets. Mainstream online media has been positively polarized toward vaccines, compared with mainly negative prepandemic vaccine news. However, the pandemic was accompanied by an order-of-magnitude increase in vaccine news that, due to low prepandemic frequency, may contribute to a perceived negative sentiment. These results highlight important interactions between the volume of news and overall polarization. To the best of our knowledge, our work is the first systematic text mining study of front-page vaccine news headlines in the context of COVID-19. %M 36348981 %R 10.2196/35121 %U https://infodemiology.jmir.org/2022/2/e35121 %U https://doi.org/10.2196/35121 %U http://www.ncbi.nlm.nih.gov/pubmed/36348981 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e38297 %T Social Media Perceptions and Internet Verification Skills Associated With Human Papillomavirus Vaccine Decision-Making Among Parents of Children and Adolescents: Cross-sectional Survey %A Thompson,Erika L %A Preston,Sharice M %A Francis,Jenny K R %A Rodriguez,Serena A %A Pruitt,Sandi L %A Blackwell,James-Michael %A Tiro,Jasmin A %+ Department of Biostatistics & Epidemiology, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, United States, 1 817 735 5162, Erika.Thompson@unthsc.edu %K HPV vaccination %K human papillomavirus %K social media %K decision-making %K vaccination %K teens %K adolescents %K parent %K USA %K United States %K misinformation %K internet %K survey %K unvaccinated %K child %K online %K health %K literacy %K decision %K health care %K decision %K teen %K vaccine %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Human Papillomavirus (HPV) vaccination is recommended for children aged 11-12 years in the United States. One factor that may contribute to low national HPV vaccine uptake is parental exposure to misinformation on social media. Objective: This study aimed to examine the association between parents’ perceptions of the HPV vaccine information on social media and internet verification strategies used with the HPV vaccine decision-making stage for their child. Methods: Parents of children and adolescents aged 9-17 years were recruited for a cross-sectional survey in North Texas (n=1192) and classified into 3 groups: children and adolescents who (1) were vaccinated, (2) unvaccinated and did not want the vaccine, and (3) unvaccinated and wanted the vaccine. Multinomial logistic regression models were estimated to identify factors associated with the HPV vaccine decision-making stage with children and adolescents who were vaccinated as the referent group. Results: Of the 1192 respondents, 44.7% (n=533) had an HPV-vaccinated child, 38.8% (n=463) had an unvaccinated child and did not want the vaccine, and 16.4% (n=196) had an unvaccinated child and wanted the vaccine. Respondents were less likely to be “undecided/not wanting the vaccine” if they agreed that HPV information on social media is credible (adjusted odds ratio [aOR] 0.40, 95% CI 0.26-0.60; P=.001), disagreed that social media makes them question the HPV vaccine (aOR 0.22, 95% CI 0.15-0.33; P<.001), or had a higher internet verification score (aOR 0.74, 95% CI 0.62-0.88; P<.001). Conclusions: Interventions that promote web-based health literacy skills are needed so parents can protect their families from misinformation and make informed health care decisions. %M 36103216 %R 10.2196/38297 %U https://pediatrics.jmir.org/2022/3/e38297 %U https://doi.org/10.2196/38297 %U http://www.ncbi.nlm.nih.gov/pubmed/36103216 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e39805 %T Public Discourse and Sentiment Toward Dementia on Chinese Social Media: Machine Learning Analysis of Weibo Posts %A Kong,Dexia %A Chen,Anfan %A Zhang,Jingwen %A Xiang,Xiaoling %A Lou,W Q Vivian %A Kwok,Timothy %A Wu,Bei %+ School of Journalism and Communication, The Chinese University of Hong Kong, NAH313B, Humanities Building, New Asia College, Hong Kong, 999077, Hong Kong, 852 68436916, anfanchen@cuhk.edu.hk %K dementia %K public discourse %K sentiment %K Weibo %K social media %K machine learning %K infodemiology %K aging %K elderly population %K content analysis %K topic modeling %K thematic analysis %K social support %K sentiment analysis %K public discourse %D 2022 %7 2.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Dementia is a global public health priority due to rapid growth of the aging population. As China has the world’s largest population with dementia, this debilitating disease has created tremendous challenges for older adults, family caregivers, and health care systems on the mainland nationwide. However, public awareness and knowledge of the disease remain limited in Chinese society. Objective: This study examines online public discourse and sentiment toward dementia among the Chinese public on a leading Chinese social media platform Weibo. Specifically, this study aims to (1) assess and examine public discourse and sentiment toward dementia among the Chinese public, (2) determine the extent to which dementia-related discourse and sentiment vary among different user groups (ie, government, journalists/news media, scientists/experts, and the general public), and (3) characterize temporal trends in public discourse and sentiment toward dementia among different user groups in China over the past decade. Methods: In total, 983,039 original dementia-related posts published by 347,599 unique users between 2010 and 2021, together with their user information, were analyzed. Machine learning analytical techniques, including topic modeling, sentiment analysis, and semantic network analyses, were used to identify salient themes/topics and their variations across different user groups (ie, government, journalists/news media, scientists/experts, and the general public). Results: Topic modeling results revealed that symptoms, prevention, and social support are the most prevalent dementia-related themes on Weibo. Posts about dementia policy/advocacy have been increasing in volume since 2018. Raising awareness is the least discussed topic over time. Sentiment analysis indicated that Weibo users generally attach negative attitudes/emotions to dementia, with the general public holding a more negative attitude than other user groups. Conclusions: Overall, dementia has received greater public attention on social media since 2018. In particular, discussions related to dementia advocacy and policy are gaining momentum in China. However, disparaging language is still used to describe dementia in China; therefore, a nationwide initiative is needed to alter the public discourse on dementia. The results contribute to previous research by providing a macrolevel understanding of the Chinese public’s discourse and attitudes toward dementia, which is essential for building national education and policy initiatives to create a dementia-friendly society. Our findings indicate that dementia is associated with negative sentiments, and symptoms and prevention dominate public discourse. The development of strategies to address unfavorable perceptions of dementia requires policy and public health attention. The results further reveal that an urgent need exists to increase public knowledge about dementia. Social media platforms potentially could be leveraged for future dementia education interventions to increase dementia awareness and promote positive attitudes. %M 36053565 %R 10.2196/39805 %U https://www.jmir.org/2022/9/e39805 %U https://doi.org/10.2196/39805 %U http://www.ncbi.nlm.nih.gov/pubmed/36053565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35563 %T Analyzing Suicide Risk From Linguistic Features in Social Media: Evaluation Study %A Lao,Cecilia %A Lane,Jo %A Suominen,Hanna %+ School of Computing, College of Engineering and Computer Science, The Australian National University, 145 Science Road, Canberra, ACT, 2600, Australia, 61 416236920, cecilia.lao@anu.edu.au %K evaluation study %K interdisciplinary research %K linguistics %K machine learning %K mental health %K natural language processing %K social media %K suicide risk %D 2022 %7 30.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective suicide risk assessments and interventions are vital for suicide prevention. Although assessing such risks is best done by health care professionals, people experiencing suicidal ideation may not seek help. Hence, machine learning (ML) and computational linguistics can provide analytical tools for understanding and analyzing risks. This, therefore, facilitates suicide intervention and prevention. Objective: This study aims to explore, using statistical analyses and ML, whether computerized language analysis could be applied to assess and better understand a person’s suicide risk on social media. Methods: We used the University of Maryland Suicidality Dataset comprising text posts written by users (N=866) of mental health–related forums on Reddit. Each user was classified with a suicide risk rating (no, low, moderate, or severe) by either medical experts or crowdsourced annotators, denoting their estimated likelihood of dying by suicide. In language analysis, the Linguistic Inquiry and Word Count lexicon assessed sentiment, thinking styles, and part of speech, whereas readability was explored using the TextStat library. The Mann-Whitney U test identified differences between at-risk (low, moderate, and severe risk) and no-risk users. Meanwhile, the Kruskal-Wallis test and Spearman correlation coefficient were used for granular analysis between risk levels and to identify redundancy, respectively. In the ML experiments, gradient boost, random forest, and support vector machine models were trained using 10-fold cross validation. The area under the receiver operator curve and F1-score were the primary measures. Finally, permutation importance uncovered the features that contributed the most to each model’s decision-making. Results: Statistically significant differences (P<.05) were identified between the at-risk (671/866, 77.5%) and no-risk groups (195/866, 22.5%). This was true for both the crowd- and expert-annotated samples. Overall, at-risk users had higher median values for most variables (authenticity, first-person pronouns, and negation), with a notable exception of clout, which indicated that at-risk users were less likely to engage in social posturing. A high positive correlation (ρ>0.84) was present between the part of speech variables, which implied redundancy and demonstrated the utility of aggregate features. All ML models performed similarly in their area under the curve (0.66-0.68); however, the random forest and gradient boost models were noticeably better in their F1-score (0.65 and 0.62) than the support vector machine (0.52). The features that contributed the most to the ML models were authenticity, clout, and negative emotions. Conclusions: In summary, our statistical analyses found linguistic features associated with suicide risk, such as social posturing (eg, authenticity and clout), first-person singular pronouns, and negation. This increased our understanding of the behavioral and thought patterns of social media users and provided insights into the mechanisms behind ML models. We also demonstrated the applicative potential of ML in assisting health care professionals to assess and manage individuals experiencing suicide risk. %M 36040781 %R 10.2196/35563 %U https://formative.jmir.org/2022/8/e35563 %U https://doi.org/10.2196/35563 %U http://www.ncbi.nlm.nih.gov/pubmed/36040781 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37856 %T Assessing the Feasibility of Studying Awareness of a Digital Health Campaign on Facebook: Pilot Study Comparing Young Adult Subsamples %A Tulsiani,Shreya %A Ichimiya,Megumi %A Gerard,Raquel %A Mills,Sarah %A Bingenheimer,Jeffrey B %A Hair,Elizabeth C %A Vallone,Donna %A Evans,W Douglas %+ Schroeder Institute, Truth Initiative, 900 G St NW, 4th Fl, Washington, DC, 20001, United States, 1 202 454 5765, stulsiani@truthinitiative.org %K campaign evaluation %K outcome evaluation %K young adults %K social marketing %K health communications %K tobacco control and policy %K health campaign %K youth %K Facebook %K digital media %D 2022 %7 29.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mass media campaigns for preventive health messaging have been shown to be effective through years of research. However, few studies have assessed the effectiveness of campaigns on digital media, which is currently how youths and young adults are primarily consuming media. In particular, a platform that can accurately assess exposure to digital messaging in a real-life setting has yet to be developed. Objective: This study examines the feasibility of a unique survey platform, Virtual Lab, to conduct a study on exposure to a media campaign within Facebook using a chatbot-style survey administration technique. Methods: Virtual Lab is a survey platform that was used to recruit and survey participants within Facebook and Facebook Messenger, respectively. We created a Facebook business account with 2 Facebook pages: one for recruitment and disseminating the survey and the other one for serving the target advertisements. Pre- and postexposure surveys were administered via Facebook Messenger using a chatbot-style questionnaire 1 week apart. During this time, the target advertisements were shown to participants who completed the pre-exposure survey. The total time from recruitment to completion of the postexposure survey was 13 days, and incentive costs were US $10 per participant. Survey data were compared between those who completed both pre- and postexposure surveys and those who only completed the pre-exposure survey; that is, those who were lost to follow-up. The demographics of the complete cases were also compared to the US census data. Results: A total of 375 Facebook users aged between 18 and 24 years met eligibility requirements and consented to the study, which consisted of complete cases (n=234) and participants lost to follow-up (n=141). A few differences between complete cases and participants lost to follow-up were observed. Regarding gender, complete cases comprised 40.2% males and 59.4% females, and among participants lost to follow-up, 44.0% were male and 50.4% were female (P=.003). Differences were also observed for e-cigarette use status, where a greater number of current users and fewer past and never users were lost to follow-up than complete cases (P=.01). Conclusions: The use of Virtual Lab yielded a diverse sample quickly and cost-effectively. Demographic characteristics of participants who completed the study and those who were lost to follow-up were similar, indicating that no biases were caused by the platform during recruitment or testing. This study suggests the feasibility of the Virtual Lab survey platform for studies of media campaign exposure within Facebook. This platform can advance health campaign research by providing more accurate data to inform digital messaging. %M 36036974 %R 10.2196/37856 %U https://formative.jmir.org/2022/8/e37856 %U https://doi.org/10.2196/37856 %U http://www.ncbi.nlm.nih.gov/pubmed/36036974 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39519 %T Social Media Use and Well-being With Bipolar Disorder During the COVID-19 Pandemic: Path Analysis %A Pollock Star,Ariel %A Bachner,Yaacov G %A Cohen,Bar %A Haglili,Ophir %A O'Rourke,Norm %+ Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Ben-Gurion University of the Negev, P.O. Box 653, Be'er Sheva, Israel, 972 08 647 7301, ORourke@bgu.ac.il %K bipolar disorder %K COVID-19 %K life satisfaction %K loneliness %K social media use %K social media %K Facebook %K social support %K mental health %K mental illness %K mental disorder %K social media advertising %K advertising %K advertisement %K mania %K hypo/mania %K manic %K depressive %K depression %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Reliable and consistent social support is associated with the mental health and well-being of persons with severe mental illness, including bipolar disorder (BD). Yet the COVID-19 pandemic and associated social distancing measures (eg, shelter in place) reduced access to regular social contacts, while social media use (SMU) increased concomitantly. Little is currently known about associations between the well-being of adults with BD and different types of SMU (eg, passive and active). Objective: For this study, we had two goals. First, we report descriptive information regarding SMU by persons with BD during COVID-19 (all platforms). Specific to Facebook, we next developed and tested a hypothesized model to identify direct and indirect associations between BD symptoms, social support, loneliness, life satisfaction, and SMU. Responses were collected during the global spread of the Delta variant and prior/concurrent with the Omicron variant, 20 months after the World Health Organization declared COVID-19 a global pandemic. Methods: Over 8 weeks, we obtained responses from an international sample of 102 adults with BD using the Qualtrics online platform. Most had previously participated in the BADAS (Bipolar Affective Disorders and older Adults) Study (n=89, 87.3%); the remainder were recruited specifically for this research (n=13, 2.7%). The subsamples did not differ in age (t100=1.64; P=.10), gender (χ22=0.2; P=.90), socioeconomic status (χ26=9.9; P=.13), or time since BD diagnosis (t97=1.27; P=.21). Both were recruited using social media advertising micro-targeted to adults with BD. On average, participants were 53.96 (SD 13.22, range 20-77) years of age, they had completed 15.4 (SD 4.28) years of education, and were diagnosed with BD 19.6 (SD 10.31) years ago. Path analyses were performed to develop and test our hypothesized model. Results: Almost all participants (n=95, 93.1%) reported having both Facebook and LinkedIn accounts; 91.2% (n=93) reported regular use of either or both. During the pandemic, most (n=62, 60.8%) reported accessing social media several times a day; 36.3% (n=37) reported using social media more often since the emergence of COVID-19. Specific to Facebook, the model we hypothesized differed somewhat from what emerged. The resulting model suggests that symptoms of depression predict loneliness and, inversely, social support and life satisfaction. Social support predicts social Facebook use, whereas passive Facebook use predicts life satisfaction. Symptoms of depression emerged as indirect predictors of SMU via social support. Conclusions: Our findings suggest that the operational definition of passive-active SMU requires further analysis and refinement. In contrast to theory, passive Facebook use appears positively associated with well-being among certain populations. Longitudinal data collection over multiple points is required to identify associations between BD symptoms, SMU, and well-being over time. %M 35980726 %R 10.2196/39519 %U https://formative.jmir.org/2022/8/e39519 %U https://doi.org/10.2196/39519 %U http://www.ncbi.nlm.nih.gov/pubmed/35980726 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e35937 %T Trends and Characteristics of #HIVPrevention Tweets Posted Between 2014 and 2019: Retrospective Infodemiology Study %A Burgess,Raquel %A Feliciano,Josemari T %A Lizbinski,Leonardo %A Ransome,Yusuf %+ Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT, 06510, United States, 1 203 785 2867, raquel.burgess@yale.edu %K HIV %K social media %K Twitter %K prevention %K infodemiology %D 2022 %7 11.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Twitter is becoming an increasingly important avenue for people to seek information about HIV prevention. Tweets about HIV prevention may reflect or influence current norms about the acceptability of different HIV prevention methods. Therefore, it may be useful to empirically investigate trends in the level of attention paid to different HIV prevention topics on Twitter over time. Objective: The primary objective of this study was to investigate temporal trends in the frequency of tweets about different HIV prevention topics on Twitter between 2014 and 2019. Methods: We used the Twitter application programming interface to obtain English-language tweets employing #HIVPrevention between January 1, 2014, and December 31, 2019 (n=69,197, globally). Using iterative qualitative content analysis on samples of tweets, we developed a keyword list to categorize the tweets into 10 prevention topics (eg, condom use, preexposure prophylaxis [PrEP]) and compared the frequency of tweets mentioning each topic over time. We assessed the overall change in the proportions of #HIVPrevention tweets mentioning each prevention topic in 2019 as compared with 2014 using chi-square and Fisher exact tests. We also conducted descriptive analyses to identify the accounts posting the most original tweets, the accounts retweeted most frequently, the most frequently used word pairings, and the spatial distribution of tweets in the United States compared with the number of state-level HIV cases. Results: PrEP (13,895 tweets; 20.08% of all included tweets) and HIV testing (7688, 11.11%) were the most frequently mentioned topics, whereas condom use (2941, 4.25%) and postexposure prophylaxis (PEP; 823, 1.19%) were mentioned relatively less frequently. The proportions of tweets mentioning PrEP (327/2251, 14.53%, in 2014, 5067/12,971, 39.1%, in 2019; P≤.001), HIV testing (208/2251, 9.24%, in 2014, 2193/12,971, 16.91% in 2019; P≤.001), and PEP (25/2251, 1.11%, in 2014, 342/12,971, 2.64%, in 2019; P≤.001) were higher in 2019 compared with 2014, whereas the proportions of tweets mentioning abstinence, condom use, circumcision, harm reduction, and gender inequity were lower in 2019 compared with 2014. The top retweeted accounts were mostly UN-affiliated entities; celebrities and HIV advocates were also represented. Geotagged #HIVPrevention tweets in the United States between 2014 and 2019 (n=514) were positively correlated with the number of state-level HIV cases in 2019 (r=0.81, P≤.01). Conclusions: Twitter may be a useful source for identifying HIV prevention trends. During our evaluation period (2014-2019), the most frequently mentioned prevention topics were PrEP and HIV testing in tweets using #HIVPrevention. Strategic responses to these tweets that provide information about where to get tested or how to obtain PrEP may be potential approaches to reduce HIV incidence. %M 35969453 %R 10.2196/35937 %U https://publichealth.jmir.org/2022/8/e35937 %U https://doi.org/10.2196/35937 %U http://www.ncbi.nlm.nih.gov/pubmed/35969453 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e38015 %T Social Media Use for Research Participant Recruitment: Integrative Literature Review %A Darko,Elizabeth Mirekuwaa %A Kleib,Manal %A Olson,Joanne %+ College of Health Sciences, Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 7807826810, darko@ualberta.ca %K advertisement %K recruitment %K research participants %K social media %K mobile phone %D 2022 %7 4.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Social media tools have provided health researchers with the opportunity to engage with communities and groups in a nonconventional manner to recruit participants for health research. Using social media to advertise research opportunities and recruit participants facilitates accessibility to participants from broad geographical areas and diverse populations. However, little guidance is provided by ethics review boards for researchers to effectively use this recruitment method in their research. Objective: This study sought to explore the literature on the use of social media for participant recruitment for research studies and identify the best practices for recruiting participants using this method. Methods: An integrative review approach was used to synthesize the literature. A total of 5 health sciences databases, namely, EMBASE (Ovid), MEDLINE (Ovid and EBSCOhost), PsycINFO (Ovid), Scopus (Elsevier), and CINAHL Plus with Full Text (EBSCOhost), were searched using predefined keywords and inclusion and exclusion criteria. The initial search was conducted in October 2020 and was updated in February 2022. Descriptive and content analyses were applied to synthesize the results, and the findings are presented in a narrative and tabular format. Results: A total of 96 records were included in this review, 83 (86%) from the initial search and 13 (14%) from the updated search. The publication year ranged between 2011 and 2022, with most publications (63/96, 66%) being from the United States. Regarding recruitment strategy, 45% (43/96) of the studies exclusively used social media, whereas 51% (49/96) used social media in conjunction with other strategies. The remaining 4% (4/96) provided guidelines and recommendations for social media recruitment. Notably, 38% (36/96) of these studies involved hard-to-reach populations. The findings also revealed that the use of social media is a cost-effective and efficient strategy for recruiting research participants. Despite the expanded use across different populations, there is limited participation of older adults in social media recruitment. Conclusions: This review provides important insights into the current use of social media for health research participant recruitment. Ethics boards and research support services in academic institutions are encouraged to explicitly provide researchers with guidelines on the use of social media for health research participant recruitment. A preliminary guideline prepared based on the findings of this review is proposed to spark further development in this area. %M 35925655 %R 10.2196/38015 %U https://www.jmir.org/2022/8/e38015 %U https://doi.org/10.2196/38015 %U http://www.ncbi.nlm.nih.gov/pubmed/35925655 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 7 %P e37201 %T Extraction of Explicit and Implicit Cause-Effect Relationships in Patient-Reported Diabetes-Related Tweets From 2017 to 2021: Deep Learning Approach %A Ahne,Adrian %A Khetan,Vivek %A Tannier,Xavier %A Rizvi,Md Imbesat Hassan %A Czernichow,Thomas %A Orchard,Francisco %A Bour,Charline %A Fano,Andrew %A Fagherazzi,Guy %+ Center of Epidemiology and Population Health, Inserm, Hospital Gustave Roussy, Paris-Saclay University, 20 Rue du Dr Pinel, Villejuif, 94800, France, 33 142115386, adrian.ahne@protonmail.com %K causality %K deep learning %K natural language processing %K diabetes %K social media %K causal relation extraction %K social media data %K machine learning %D 2022 %7 19.7.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Intervening in and preventing diabetes distress requires an understanding of its causes and, in particular, from a patient’s perspective. Social media data provide direct access to how patients see and understand their disease and consequently show the causes of diabetes distress. Objective: Leveraging machine learning methods, we aim to extract both explicit and implicit cause-effect relationships in patient-reported diabetes-related tweets and provide a methodology to better understand the opinions, feelings, and observations shared within the diabetes online community from a causality perspective. Methods: More than 30 million diabetes-related tweets in English were collected between April 2017 and January 2021. Deep learning and natural language processing methods were applied to focus on tweets with personal and emotional content. A cause-effect tweet data set was manually labeled and used to train (1) a fine-tuned BERTweet model to detect causal sentences containing a causal relation and (2) a conditional random field model with Bidirectional Encoder Representations from Transformers (BERT)-based features to extract possible cause-effect associations. Causes and effects were clustered in a semisupervised approach and visualized in an interactive cause-effect network. Results: Causal sentences were detected with a recall of 68% in an imbalanced data set. A conditional random field model with BERT-based features outperformed a fine-tuned BERT model for cause-effect detection with a macro recall of 68%. This led to 96,676 sentences with cause-effect relationships. “Diabetes” was identified as the central cluster followed by “death” and “insulin.” Insulin pricing–related causes were frequently associated with death. Conclusions: A novel methodology was developed to detect causal sentences and identify both explicit and implicit, single and multiword cause, and the corresponding effect, as expressed in diabetes-related tweets leveraging BERT-based architectures and visualized as cause-effect network. Extracting causal associations in real life, patient-reported outcomes in social media data provide a useful complementary source of information in diabetes research. %M 35852829 %R 10.2196/37201 %U https://medinform.jmir.org/2022/7/e37201 %U https://doi.org/10.2196/37201 %U http://www.ncbi.nlm.nih.gov/pubmed/35852829 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e34114 %T Investigating the Impact of the New York State Flavor Ban on e-Cigarette–Related Discussions on Twitter: Observational Study %A Gao,Yankun %A Xie,Zidian %A Li,Dongmei %+ University of Rochester Medical Center, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K New York State flavor ban %K e-cigarettes %K twitter %K topic modeling %K sentiment analysis %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: On May 18, 2020, the New York State Department of Health implemented a statewide flavor ban to prohibit the sales of all flavored vapor products, except for tobacco or any other authorized flavor. Objective: This study aims to investigate the discussion changes in e-cigarette–related tweets over time with the implementation of the New York State flavor ban. Methods: Through the Twitter streaming application programming interface, 59,883 e-cigarette–related tweets were collected within the New York State from February 6, 2020, to May 17, 2020 (period 1, before the implementation of the flavor ban), May 18, 2020-June 30, 2020 (period 2, between the implementation of the flavor ban and the online sales ban), July 1, 2020-September 15, 2020 (period 3, the short term after the online sales ban), and September 16, 2020-November 30, 2020 (period 4, the long term after the online sales ban). Sentiment analysis and topic modeling were conducted to investigate the changes in public attitudes and discussions in e-cigarette–related tweets. The popularity of different e-cigarette flavor categories was compared before and after the implementation of the New York State flavor ban. Results: Our results showed that the proportion of e-cigarette–related tweets with negative sentiment significantly decreased (4305/13,246, 32.5% vs 3855/14,455, 26.67%, P<.001), and tweets with positive sentiment significantly increased (5246/13,246, 39.6% vs 7038/14,455, 48.69%, P<.001) in period 4 compared to period 3. “Teens and nicotine products” was the most frequently discussed e-cigarette–related topic in the negative tweets. In contrast, “nicotine products and quitting” was more prevalent in positive tweets. The proportion of tweets mentioning mint and menthol flavors significantly increased right after the flavor ban and decreased to lower levels over time. The proportions of fruit and sweet flavors were most frequently mentioned in period 1, decreased in period 2, and dominated again in period 4. Conclusions: The proportion of e-cigarette–related tweets with different attitudes and frequently discussed flavor categories changed over time after the implementation of the New York State ban of flavored vaping products. This change indicated a potential impact of the flavor ban on public discussions of flavored e-cigarettes. %M 35802417 %R 10.2196/34114 %U https://publichealth.jmir.org/2022/7/e34114 %U https://doi.org/10.2196/34114 %U http://www.ncbi.nlm.nih.gov/pubmed/35802417 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e34285 %T Using Social Media to Predict Food Deserts in the United States: Infodemiology Study of Tweets %A Sigalo,Nekabari %A St Jean,Beth %A Frias-Martinez,Vanessa %+ College of Information Studies, University of Maryland, 4130 Campus Dr, College Park, MD, 20742, United States, 1 301 405 2033, nsigalo@umd.edu %K social media %K Twitter %K food deserts %K food insecurity %D 2022 %7 5.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The issue of food insecurity is becoming increasingly important to public health practitioners because of the adverse health outcomes and underlying racial disparities associated with insufficient access to healthy foods. Prior research has used data sources such as surveys, geographic information systems, and food store assessments to identify regions classified as food deserts but perhaps the individuals in these regions unknowingly provide their own accounts of food consumption and food insecurity through social media. Social media data have proved useful in answering questions related to public health; therefore, these data are a rich source for identifying food deserts in the United States. Objective: The aim of this study was to develop, from geotagged Twitter data, a predictive model for the identification of food deserts in the United States using the linguistic constructs found in food-related tweets. Methods: Twitter’s streaming application programming interface was used to collect a random 1% sample of public geolocated tweets across 25 major cities from March 2020 to December 2020. A total of 60,174 geolocated food-related tweets were collected across the 25 cities. Each geolocated tweet was mapped to its respective census tract using point-to-polygon mapping, which allowed us to develop census tract–level features derived from the linguistic constructs found in food-related tweets, such as tweet sentiment and average nutritional value of foods mentioned in the tweets. These features were then used to examine the associations between food desert status and the food ingestion language and sentiment of tweets in a census tract and to determine whether food-related tweets can be used to infer census tract–level food desert status. Results: We found associations between a census tract being classified as a food desert and an increase in the number of tweets in a census tract that mentioned unhealthy foods (P=.03), including foods high in cholesterol (P=.02) or low in key nutrients such as potassium (P=.01). We also found an association between a census tract being classified as a food desert and an increase in the proportion of tweets that mentioned healthy foods (P=.03) and fast-food restaurants (P=.01) with positive sentiment. In addition, we found that including food ingestion language derived from tweets in classification models that predict food desert status improves model performance compared with baseline models that only include socioeconomic characteristics. Conclusions: Social media data have been increasingly used to answer questions related to health and well-being. Using Twitter data, we found that food-related tweets can be used to develop models for predicting census tract food desert status with high accuracy and improve over baseline models. Food ingestion language found in tweets, such as census tract–level measures of food sentiment and healthiness, are associated with census tract–level food desert status. %M 35788108 %R 10.2196/34285 %U https://publichealth.jmir.org/2022/7/e34285 %U https://doi.org/10.2196/34285 %U http://www.ncbi.nlm.nih.gov/pubmed/35788108 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e35663 %T Strengthening the Merci Mon Héros Campaign Through Adaptive Management: Application of Social Listening Methodology %A Silva,Martha %A Walker,Jonathan %A Portillo,Erin %A Dougherty,Leanne %+ Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA, 70112, United States, 1 2023082374, msilva3@tulane.edu %K social media %K health communication %K young people %K reproductive health %D 2022 %7 28.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Between 2014 and 2018, the penetration of smartphones in sub-Saharan Africa increased from 10% to 30%, enabling increased access to the internet, Facebook, Twitter, Pinterest, and YouTube. These platforms engage users in multidirectional communication and provide public health programs with the tools to inform and engage diverse audiences on a range of public health issues, as well as monitor opinions and behaviors on health topics. Objective: This paper details the process used by the U.S. Agency for International Development–funded Breakthrough RESEARCH to apply social media monitoring and social listening techniques in Burkina Faso, Côte d’Ivoire, Niger, and Togo for the adaptive management of the Merci Mon Héros campaign. We documented how these approaches were applied and how the lessons learned can be used to support future public health communication campaigns. Methods: The process involved 6 steps: (1) ensure there is a sufficient volume of topic-specific web-based conversation in the target countries; (2) develop measures to monitor the campaign’s social media strategy; (3) identify search terms to assess campaign and related conversations; (4) quantitatively assess campaign audience demographics, campaign reach, and engagement through social media monitoring; (5) qualitatively assess audience attitudes, opinions, and behaviors and understand conversation context through social media listening; and (6) adapt campaign content and approach based on the analysis of social media data. Results: We analyzed posts across social media platforms from November 2019 to October 2020 based on identified key search terms related to family planning, reproductive health, menstruation, sexual activity, and gender. Based on the quantitative and qualitative assessments in steps 4 and 5, there were several adaptive shifts in the campaign’s content and approach, of which the following 3 shifts are highlighted. (1) Social media monitoring identified that the Facebook campaign fans were primarily male, which prompted the campaign to target calls to action to the male audience already following the campaign and shift marketing approaches to increase the proportion of female followers. (2) Shorter videos had a higher chance of being viewed in their entirety. In response to this, the campaign shortened video lengths and created screenshot teasers to promote videos. (3) The most negative sentiment related to the campaign videos was associated with beliefs against premarital sex. In response to this finding, the campaign included videos and Facebook Live sessions with religious leaders who promoted talking openly with young people to support intergenerational discussion about reproductive health. Conclusions: Prior to launching health campaigns, programs should test the most relevant social media platforms and their limitations. Inherent biases to internet and social media access are important challenges, and ethical considerations around data privacy must continue to guide the advances in this technology’s use for research. However, social listening and social media monitoring can be powerful monitoring and evaluation tools that can be used to aid the adaptive management of health campaigns that engage populations who have a digital presence. %M 35763319 %R 10.2196/35663 %U https://publichealth.jmir.org/2022/6/e35663 %U https://doi.org/10.2196/35663 %U http://www.ncbi.nlm.nih.gov/pubmed/35763319 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 6 %P e36050 %T Impact of a Long Lockdown on Mental Health and the Role of Media Use: Web-Based Survey Study %A Grygarová,Dominika %A Adámek,Petr %A Juríčková,Veronika %A Horáček,Jiří %A Bakštein,Eduard %A Fajnerová,Iveta %A Kesner,Ladislav %+ Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany, 250 67, Czech Republic, 420 283 088 264, dominika.grygarova@nudz.cz %K mental health %K COVID-19 %K lockdown %K media use %K anxiety %K depression %K nationally representative data %K survey %K longitudinal study %K pandemic %K social isolation %K social media %K psychological trauma %K mental stress %K media news %D 2022 %7 28.6.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Due to the COVID-19 pandemic, the Czech population experienced a second lockdown lasting for about half a year, restricting free movement and imposing social isolation. However, it is not known whether the impact of this long lockdown resulted in habituation to the adverse situation or in the traumatization of the Czech population, and whether the media and specific media use contributed to these effects. Objective: The aim of this study was to elucidate the effect of the long lockdown on the mental health of the Czech population, and the role of exposure to COVID-19 news reports and specific forms of media news use in mental health. Methods: We conducted two consecutive surveys in the early (November 2020) and late (March/April 2021) phases of the nationwide lockdown on the same nationally representative group of Czech adults (N=1777) participating in a longitudinal panel study. Results: Our findings showed that the self-reported symptoms of anxiety and depression increased in the second observation period, confirming the negative effect of the pandemic lockdown as it unfolded, suggesting that restrictive measures and continuous exposure to a collective stressor did not result in the strengthening of resilience but rather in ongoing traumatization. The results also suggest a negative role of the media’s coverage of the COVID-19 pandemic in mental health during the early, and particularly late, phases of the lockdown. Furthermore, we found several risk and protective factors of specific media news use. The media practice in news consumption connected to social media use was the strongest predictor of exacerbated mental health symptoms, particularly in the late phase of the lockdown. Moreover, news media use characterized by internalization of information learned from the news, as well as negative attitudes toward media news, were associated with higher levels of anxiety and depression. Conversely, the use of infotainment, together with an in-depth and contextual style of reading news articles, were related to improvement of mental health. Conclusions: Our study showed that the long lockdown resulted in traumatization rather than habituation, and in more pronounced effects (both negative and positive) of media use in mental health. %M 35605112 %R 10.2196/36050 %U https://mental.jmir.org/2022/6/e36050 %U https://doi.org/10.2196/36050 %U http://www.ncbi.nlm.nih.gov/pubmed/35605112 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e38269 %T Navigating the Credibility of Web-Based Information During the COVID-19 Pandemic: Using Mnemonics to Empower the Public to Spot Red Flags in Health Information on the Internet %A Stokes-Parish,Jessica %+ Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, 4227, Australia, 61 755951468, jstokesp@bond.edu.au %K science communication %K critical appraisal %K social media %K health literacy %K digital literacy %K misinformation %K COVID-19 %K online health %K infodemic %K infodemiology %D 2022 %7 17.6.2022 %9 Viewpoint %J J Med Internet Res %G English %X Misinformation creates challenges for the general public in differentiating truth from fiction in web-based content. During the COVID-19 pandemic, this issue has been amplified due to high volumes of news and changing information. Evidence on misinformation largely focuses on understanding the psychology of misinformation and debunking strategies but neglects to explore critical thinking education for the general public. This viewpoint outlines the science of misinformation and the current resources available to the public. This paper describes the development and theoretical underpinnings of a mnemonic (Conflict of Interest, References, Author, Buzzwords, Scope of Practice [CRABS]) for identifying misinformation in web-based health content. Leveraging evidence-based educational strategies may be a promising approach for empowering the public with the confidence needed to differentiate truth from fiction in an infodemic. %M 35649183 %R 10.2196/38269 %U https://www.jmir.org/2022/6/e38269 %U https://doi.org/10.2196/38269 %U http://www.ncbi.nlm.nih.gov/pubmed/35649183 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e32718 %T User- and Message-Level Correlates of Endorsement and Engagement for HIV-Related Messages on Twitter: Cross-sectional Study %A Oh,Jimin %A Bonett,Stephen %A Kranzler,Elissa C %A Saconi,Bruno %A Stevens,Robin %+ School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, United States, 1 515 231 9890, stepdo@nursing.upenn.edu %K HIV prevention %K social media %K public health %K young adults %K LASSO %K HIV %K Twitter %K digital health %D 2022 %7 17.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Youth and young adults continue to experience high rates of HIV and are also frequent users of social media. Social media platforms such as Twitter can bolster efforts to promote HIV prevention for these individuals, and while HIV-related messages exist on Twitter, little is known about the impact or reach of these messages for this population. Objective: This study aims to address this gap in the literature by identifying user and message characteristics that are associated with tweet endorsement (favorited) and engagement (retweeted) among youth and young men (aged 13-24 years). Methods: In a secondary analysis of data from a study of HIV-related messages posted by young men on Twitter, we used model selection techniques to examine user and tweet-level factors associated with tweet endorsement and engagement. Results: Tweets from personal user accounts garnered greater endorsement and engagement than tweets from institutional users (aOR 3.27, 95% CI 2.75-3.89; P<.001). High follower count was associated with increased endorsement and engagement (aOR 1.05, 95% CI 1.04-1.06; P<.001); tweets that discussed STIs garnered lower endorsement and engagement (aOR 0.59, 95% CI 0.47-1.74; P<.001). Conclusions: Findings suggest practitioners should partner with youth to design and disseminate HIV prevention messages on social media, incorporate content that resonates with youth audiences, and work to challenge stigma and foster social norms conducive to open conversation about sex, sexuality, and health. %M 35713945 %R 10.2196/32718 %U https://publichealth.jmir.org/2022/6/e32718 %U https://doi.org/10.2196/32718 %U http://www.ncbi.nlm.nih.gov/pubmed/35713945 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e35266 %T Enhancing COVID-19 Epidemic Forecasting Accuracy by Combining Real-time and Historical Data From Multiple Internet-Based Sources: Analysis of Social Media Data, Online News Articles, and Search Queries %A Li,Jingwei %A Huang,Wei %A Sia,Choon Ling %A Chen,Zhuo %A Wu,Tailai %A Wang,Qingnan %+ National Center for Applied Mathematics Shenzhen, No. 1088, Xueyuan Avenue, Nanshan District, Shenzhen, 518055, China, 86 15129077179, waynehuangwei@163.com %K SARS-CoV-2 %K COVID 19 %K epidemic forecasting %K disease surveillance %K infectious disease epidemiology %K social medial %K online news %K search query %K autoregression model %D 2022 %7 16.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The SARS-COV-2 virus and its variants pose extraordinary challenges for public health worldwide. Timely and accurate forecasting of the COVID-19 epidemic is key to sustaining interventions and policies and efficient resource allocation. Internet-based data sources have shown great potential to supplement traditional infectious disease surveillance, and the combination of different Internet-based data sources has shown greater power to enhance epidemic forecasting accuracy than using a single Internet-based data source. However, existing methods incorporating multiple Internet-based data sources only used real-time data from these sources as exogenous inputs but did not take all the historical data into account. Moreover, the predictive power of different Internet-based data sources in providing early warning for COVID-19 outbreaks has not been fully explored. Objective: The main aim of our study is to explore whether combining real-time and historical data from multiple Internet-based sources could improve the COVID-19 forecasting accuracy over the existing baseline models. A secondary aim is to explore the COVID-19 forecasting timeliness based on different Internet-based data sources. Methods: We first used core terms and symptom-related keyword-based methods to extract COVID-19–related Internet-based data from December 21, 2019, to February 29, 2020. The Internet-based data we explored included 90,493,912 online news articles, 37,401,900 microblogs, and all the Baidu search query data during that period. We then proposed an autoregressive model with exogenous inputs, incorporating real-time and historical data from multiple Internet-based sources. Our proposed model was compared with baseline models, and all the models were tested during the first wave of COVID-19 epidemics in Hubei province and the rest of mainland China separately. We also used lagged Pearson correlations for COVID-19 forecasting timeliness analysis. Results: Our proposed model achieved the highest accuracy in all 5 accuracy measures, compared with all the baseline models of both Hubei province and the rest of mainland China. In mainland China, except for Hubei, the COVID-19 epidemic forecasting accuracy differences between our proposed model (model i) and all the other baseline models were statistically significant (model 1, t198=–8.722, P<.001; model 2, t198=–5.000, P<.001, model 3, t198=–1.882, P=.06; model 4, t198=–4.644, P<.001; model 5, t198=–4.488, P<.001). In Hubei province, our proposed model's forecasting accuracy improved significantly compared with the baseline model using historical new confirmed COVID-19 case counts only (model 1, t198=–1.732, P=.09). Our results also showed that Internet-based sources could provide a 2- to 6-day earlier warning for COVID-19 outbreaks. Conclusions: Our approach incorporating real-time and historical data from multiple Internet-based sources could improve forecasting accuracy for epidemics of COVID-19 and its variants, which may help improve public health agencies' interventions and resource allocation in mitigating and controlling new waves of COVID-19 or other relevant epidemics. %M 35507921 %R 10.2196/35266 %U https://publichealth.jmir.org/2022/6/e35266 %U https://doi.org/10.2196/35266 %U http://www.ncbi.nlm.nih.gov/pubmed/35507921 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e35930 %T Understanding the Lived Experiences of Patients With Melanoma: Real-World Evidence Generated Through a European Social Media Listening Analysis %A Chauhan,Jyoti %A Aasaithambi,Sathyaraj %A Márquez-Rodas,Iván %A Formisano,Luigi %A Papa,Sophie %A Meyer,Nicolas %A Forschner,Andrea %A Faust,Guy %A Lau,Mike %A Sagkriotis,Alexandros %+ Novartis Healthcare Pvt Ltd, Hyderabad Knowledge City Layout S No 83/1, InOrbit Mall Road, Raidurg, Hyderabad, 500081, India, 91 40 67581000, jyoti.chauhan@novartis.com %K melanoma %K social media %K social media listening %K real-world evidence %K patient journey %K cancer %K mortality rate %K health information %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Cutaneous melanoma is an aggressive malignancy that is proposed to account for 90% of skin cancer–related mortality. Individuals with melanoma experience both physical and psychological impacts associated with their diagnosis and treatment. Health-related information is being increasingly accessed and shared by stakeholders on social media platforms. Objective: This study aimed to assess how individuals living with melanoma across 14 European countries use social media to discuss their needs and provide their perceptions of the disease. Methods: Social media sources including Twitter, forums, and blogs were searched using predefined search strings of keywords relating to melanoma. Manual and automated relevancy approaches filtered the extracted data for content that provided patient-centric insights. This contextualized data was then mined for insightful concepts around the symptoms, diagnosis, treatment, impacts, and lived experiences of melanoma. Results: A total of 182,400 posts related to melanoma were identified between November 2018 and November 2020. Following exclusion of irrelevant posts and using random sampling methodology, 864 posts were identified as relevant to the study objectives. Of the social media channels included, Twitter was the most commonly used, followed by forums and blogs. Most posts originated from the United Kingdom (n=328, 38%) and Spain (n=138, 16%). Of the relevant posts, 62% (n=536) were categorized as originating from individuals with melanoma. The most frequently discussed melanoma-related topics were treatment (436/792, 55%), diagnosis and tests (261/792, 33%), and remission (190/792, 24%). The majority of treatment discussions were about surgery (292/436, 67%), followed by immunotherapy (52/436, 12%). In total, 255 posts discussed the impacts of melanoma, which included emotional burden (n=179, 70%), physical impacts (n=61, 24%), effects on social life (n=43, 17%), and financial impacts (n=10, 4%). Conclusions: Findings from this study highlight how melanoma stakeholders discuss key concepts associated with the condition on social media, adding to the conceptual model of the patient journey. This social media listening approach is a powerful tool for exploring melanoma stakeholder perspectives, providing insights that can be used to corroborate existing data and inform future studies. %M 35699985 %R 10.2196/35930 %U https://cancer.jmir.org/2022/2/e35930 %U https://doi.org/10.2196/35930 %U http://www.ncbi.nlm.nih.gov/pubmed/35699985 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e36239 %T #BingeDrinking—Using Social Media to Understand College Binge Drinking: Qualitative Study %A Cirillo,Madison N %A Halbert,Jennifer P %A Smith,Jessica Gomez %A Alamiri,Nour Sami %A Ingersoll,Karen S %+ Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, 560 Ray C Hunt Dr, Charlottesville, VA, 22903, United States, 1 434 243 0581, KES7A@hscmail.mcc.virginia.edu %K college students %K binge drinking %K social media %K young adults %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Hazardous drinking among college students persists, despite ongoing university alcohol education and alcohol intervention programs. College students often post comments or pictures of drinking episodes on social media platforms. Objective: This study aimed to understand one university’s student attitudes toward alcohol use by examining student posts about drinking on social media platforms and to identify opportunities to reduce alcohol-related harm and inform novel alcohol interventions. Methods: We analyzed social media posts from 7 social media platforms using qualitative inductive coding based on grounded theory to identify the contexts of student drinking and the attitudes and behaviors of students and peers during drinking episodes. We reviewed publicly available social media posts that referenced alcohol, collaborating with undergraduate students to select their most used platforms and develop locally relevant search terms; all posts in our data set were generated by students associated with a specific university. From the codes, we derived themes about student culture regarding alcohol use. Results: In total, 1151 social media posts were included in this study. These included 809 Twitter tweets, 113 Instagram posts, 100 Greekrank posts, 64 Reddit posts, 34 College Confidential posts, 23 Facebook posts, and 8 YouTube posts. Posts included both implicit and explicit portrayals of alcohol use. Across all types of posts reviewed, positive drinking attitudes were most common, followed by negative and then neutral attitudes, but valence varied by platform. Posts that portrayed drinking positively received positive peer feedback and indicate that drinking is viewed by students as an essential and positive part of university student culture. Conclusions: Social media provide a real-time picture of students’ behavior during their own and others’ heavy drinking. Posts portray heavy drinking as a normal part of student culture, reinforced by peers’ positive feedback on posts. Interventions for college drinking should help students manage alcohol intake in real time, provide safety information during alcohol use episodes, and raise student awareness of web-based privacy concerns and reputation management. Additional interventions for students, alumni, and parents are needed to address positive attitudes about and traditions of drinking. %M 35635740 %R 10.2196/36239 %U https://humanfactors.jmir.org/2022/2/e36239 %U https://doi.org/10.2196/36239 %U http://www.ncbi.nlm.nih.gov/pubmed/35635740 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e36966 %T The Mental Health Impact of Daily News Exposure During the COVID-19 Pandemic: Ecological Momentary Assessment Study %A Kellerman,John K %A Hamilton,Jessica L %A Selby,Edward A %A Kleiman,Evan M %+ Department of Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Rd, Piscataway, NJ, 08854, United States, 1 848 445 2576, jk1684@rutgers.edu %K news consumption %K worry %K hopelessness %K ecological momentary assessment %K news media %K COVID-19 %K pandemic %K mental health %K depression %K stress %K psychological distress %K mediation model %K digital health %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Consumption of distressing news media, which substantially increased during the COVID-19 pandemic, has demonstrable negative effects on mental health. Objective: This study examines the proximal impact of daily exposure to news about COVID-19 on mental health in the first year of the pandemic. Methods: A sample of 546 college students completed daily ecological momentary assessments (EMAs) for 8 weeks, measuring exposure to news about COVID-19, worry and optimism specifically related to COVID-19, hopelessness, and general worry. Results: Participants completed >80,000 surveys. Multilevel mediation models indicated that greater daily exposure to news about COVID-19 is associated with higher same-day and next-day worry about the pandemic. Elevations in worry specifically about COVID-19 were in turn associated with greater next-day hopelessness and general worry. Optimism about COVID-19 mediated the relationship between daily exposure to COVID-19 news and next-day general worry but was not related to hopelessness. Conclusions: This study demonstrates the mental health impact of daily exposure to COVID-19 news and highlights how worry about the pandemic contributes over time to hopelessness and general worry. %M 35377320 %R 10.2196/36966 %U https://mental.jmir.org/2022/5/e36966 %U https://doi.org/10.2196/36966 %U http://www.ncbi.nlm.nih.gov/pubmed/35377320 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e36858 %T Social Media and Online Digital Technology Use Among Muslim Young People and Parents: Qualitative Focus Group Study %A Douglass,Caitlin H %A Borthwick,Aidan %A Lim,Megan S C %A Erbas,Bircan %A Eren,Senem %A Higgs,Peter %+ Burnet Institute, 85 Commercial Road, Melbourne, 3004, Australia, 61 (03) 9282 2111, caitlin.douglass@burnet.edu.au %K Muslim %K social media %K young adult %K qualitative research %K social connection %K parenting %K pediatrics %K digital health %K youth %K adolescent %K parent %K digital technology %K user experience %K mental health %K psychological effect %K diverse population %K COVID-19 %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Digital technology and social media use are common among young people in Australia and worldwide. Research suggests that young people have both positive and negative experiences online, but we know little about the experiences of Muslim communities. Objective: This study aims to explore the positive and negative experiences of digital technology and social media use among young people and parents from Muslim backgrounds in Melbourne, Victoria, Australia. Methods: This study involved a partnership between researchers and a not-for-profit organization that work with culturally and linguistically diverse communities. We adopted a participatory and qualitative approach and designed the research in consultation with young people from Muslim backgrounds. Data were collected through in-person and online focus groups with 33 young people aged 16-22 years and 15 parents aged 40-57 years. Data were thematically analyzed. Results: We generated 3 themes: (1) maintaining local and global connections, (2) a paradoxical space: identity, belonging and discrimination, and (3) the digital divide between young Muslims and parents. Results highlighted that social media was an important extension of social and cultural connections, particularly during COVID-19, when people were unable to connect through school or places of worship. Young participants perceived social media as a space where they could establish their identity and feel a sense of belonging. However, participants were also at risk of being exposed to discrimination and unrealistic standards of beauty and success. Although parents and young people shared some similar concerns, there was a large digital divide in online experiences. Both groups implemented strategies to reduce social media use, with young people believing that having short technology-free breaks during prayer and quality family time was beneficial for their mental well-being. Conclusions: Programs that address technology-related harms must acknowledge the benefits of social media for young Muslims across identity, belonging, representation, and social connection. Further research is required to understand how parents and young people can create environments that foster technology-free breaks to support mental well-being. %M 35536616 %R 10.2196/36858 %U https://pediatrics.jmir.org/2022/2/e36858 %U https://doi.org/10.2196/36858 %U http://www.ncbi.nlm.nih.gov/pubmed/35536616 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e31739 %T Developing Reporting Guidelines for Social Media Research (RESOME) by Using a Modified Delphi Method: Protocol for Guideline Development %A Kaushal,Aradhna %A Bravo,Caroline %A Duffy,Stephen %A Lewins,Douglas %A Möhler,Ralph %A Raine,Rosalind %A Vlaev,Ivo %A Waller,Jo %A von Wagner,Christian %+ Research Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 02076705723, aradhnakaushal@gmail.com %K social media %K research design %K web-based social networking %K health behavior %K health promotion %K public health %D 2022 %7 9.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social media platforms, such as Facebook, Twitter, and Instagram, are being increasingly used to deliver public health interventions. Despite the high level of research interest, there is no consensus or guidance on how to report on social media interventions. Reporting guidelines that incorporate elements from behavior change theories and social media engagement frameworks could foster more robust evaluations that capture outcomes that have an impact on behavior change and engagement. Objective: The aim of this project is to develop, publish, and promote a list of items for our Reporting Guidelines for Social Media Research (RESOME) checklist. Methods: RESOME will be developed by using a modified Delphi approach wherein 2 rounds of questionnaires will be sent to experts and stakeholders. The questionnaires will ask them to rate their agreement with a series of statements until a level of consensus is reached. This will be followed by a web-based consensus meeting to finalize the reporting guidelines. After the consensus meeting, the reporting guidelines will be published in the form of a paper outlining the need for the new guidelines and how the guidelines were developed, along with the finalized checklist for reporting. Prior to publication, the guidelines will be piloted to check for understanding and simplify the language used, if necessary. Results: The first draft of RESOME has been developed. Round 1 of the Delphi survey took place between July and December 2021. Round 2 is due to take place in February 2022, and the web-based consensus meeting will be scheduled for the spring of 2022. Conclusions: Developing RESOME has the potential to contribute to improved reporting, and such guidelines will make it easier to assess the effectiveness of social media interventions. Future work will be needed to evaluate our guidelines’ usefulness and practicality. International Registered Report Identifier (IRRID): PRR1-10.2196/31739 %M 35532999 %R 10.2196/31739 %U https://www.researchprotocols.org/2022/5/e31739 %U https://doi.org/10.2196/31739 %U http://www.ncbi.nlm.nih.gov/pubmed/35532999 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e31847 %T The Effects of Internet Exposure on Sexual Risk Behavior Among Sexually Experienced Male College Students in China: Cross-sectional Study %A Xu,Junfang %A Luo,Yan %A Dong,Hengjin %A Zhao,Gang %+ Hangzhou Center for Disease Control and Prevention, 568 Mingshi Road Jianqiaozhen, Hangzhou, 310021, China, 86 13588706065, 13588706065@163.com %K college males %K internet exposure %K sexual partners %K risk behavior %K HIV %K MSM %K social networks %K students %K sexually transmitted infections %K public health %D 2022 %7 2.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As a young subgroup, college students have become the main users of mobile social networks. Considering that people can indiscriminately access explicit sexual content on the internet, coupled with the increase of HIV infections in male college students, the role of the internet in meeting sexual partners and its correlation to risky sexual behavior has become an important topic. Objective: The aim of this study is to explore the effects of internet exposure on sexual partners and sexual risk behavior among sexually experienced male college students. Methods: An institution-based cross-sectional study design was used to collect data through a paper-based questionnaire administered to male college students recruited from colleges and gay organizations in Hangzhou, Zhejiang Province, China. A total of 1045 sexually experienced male students were incorporated in our analysis, with the following information collected: sociodemographic characteristics, sexual intercourse–related behaviors, and sexually transmitted disease (STD) knowledge. Mann-Whitney U and Kruskal-Wallis tests were used to examine differences regarding basic characteristics and sexual risk behaviors between male college students who meet sexual partners via the internet and those who do not. Sequential logistic regression models were employed to examine the influence of meeting sexual partners via the internet on risky sexual behaviors after controlling for other factors. Results: The mean age of the sexually experienced male students was 21.6 (SD 2.0) years. The likelihood of risky sexual behavior was varied, yet it was the highest for those who aim to meet paid sexual partners (145/192, 75.5% to 19/22, 86.4%), followed by those seeking partners for love or romance (258/435, 59.3%). Compared to non-internet partner seekers, internet partner seekers tended to have more casual intercourse (292/542, 53.9% versus 51/503, 10.1%), paid intercourse (32/542, 5.9% versus 12/503, 2.4%), and intercourse with same-sex partners (349/542, 64.4% versus 41/503, 8.2%); they were also more likely to use psychoactive drugs (125/349, 35.8% versus 5/41, 12.2%) and have more than 2 partners. With the increase of HIV and STD knowledge, the probability of having unprotected intercourse decreased for non-internet partner seekers. However, it increased for internet partner seekers with a rising HIV knowledge score. Sequential logistic regression showed that meeting sexual partners on the internet was statistically associated with sexual risk behaviors with multiple sexual partners (odds ratio 4.434; P<.001). Conclusions: Meeting sexual partners via the internet is a common behavior among sexually experienced male college students, and those who meet partners on the internet exhibited higher levels of risky sexual behaviors although they had sufficient HIV and STD knowledge; this is especially true for students who aimed to find partners for sexual intercourse. Thus, more attention should be paid to young adults to address the risky sexual behaviors that may contribute to STD spread among this population. %M 35499864 %R 10.2196/31847 %U https://publichealth.jmir.org/2022/5/e31847 %U https://doi.org/10.2196/31847 %U http://www.ncbi.nlm.nih.gov/pubmed/35499864 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e34321 %T The Mutual Influence of the World Health Organization (WHO) and Twitter Users During COVID-19: Network Agenda-Setting Analysis %A Tahamtan,Iman %A Potnis,Devendra %A Mohammadi,Ehsan %A Singh,Vandana %A Miller,Laura E %+ School of Information Sciences, The University of Tennessee, 1345 Circle Park Drive, 451 Communications Building, Knoxville, TN, 37996-0332, United States, 1 865 974 1000, iman.tahamtan@gmail.com %K COVID-19 %K agenda setting %K network agenda setting %K Twitter %K social media %K public opinion %K content analysis %K public health %K WHO %D 2022 %7 26.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Little is known about the role of the World Health Organization (WHO) in communicating with the public on social media during a global health emergency. More specifically, there is no study about the relationship between the agendas of the WHO and Twitter users during the COVID-19 pandemic. Objective: This study utilizes the network agenda-setting model to investigate the mutual relationship between the agenda of the WHO’s official Twitter account and the agenda of 7.5 million of its Twitter followers regarding COVID-19. Methods: Content analysis was applied to 7090 tweets posted by the WHO on Twitter from January 1, 2020, to July 31, 2020, to identify the topics of tweets. The quadratic assignment procedure (QAP) was used to investigate the relationship between the WHO agenda network and the agenda network of the 6 Twitter user categories, including “health care professionals,” “academics,” “politicians,” “print and electronic media,” “legal professionals,” and the “private sector.” Additionally, 98 Granger causality statistical tests were performed to determine which topic in the WHO agenda had an effect on the corresponding topic in each Twitter user category and vice versa. Results: Content analysis revealed 7 topics that reflect the WHO agenda related to the COVID-19 pandemic, including “prevention,” “solidarity,” “charity,” “teamwork,” “ill-effect,” “surveillance,” and “credibility.” Results of the QAP showed significant and strong correlations between the WHO agenda network and the agenda network of each Twitter user category. These results provide evidence that WHO had an overall effect on different types of Twitter users on the identified topics. For instance, the Granger causality tests indicated that the WHO tweets influenced politicians and print and electronic media about “surveillance.” The WHO tweets also influenced academics and the private sector about “credibility” and print and electronic media about “ill-effect.” Additionally, Twitter users affected some topics in the WHO. For instance, WHO followers affected “charity” and “prevention” in the WHO. Conclusions: This paper extends theorizing on agenda setting by providing empirical evidence that agenda-setting effects vary by topic and types of Twitter users. Although prior studies showed that network agenda setting is a “one-way” model, the novel findings of this research confirm a “2-way” or “multiway” effect of agenda setting on social media due to the interactions between the content creators and audiences. The WHO can determine which topics should be promoted on social media during different phases of a pandemic and collaborate with other public health gatekeepers to collectively make them salient in the public. %M 35275836 %R 10.2196/34321 %U https://www.jmir.org/2022/4/e34321 %U https://doi.org/10.2196/34321 %U http://www.ncbi.nlm.nih.gov/pubmed/35275836 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e36830 %T The Prevalence and Impact of Fake News on COVID-19 Vaccination in Taiwan: Retrospective Study of Digital Media %A Chen,Yen-Pin %A Chen,Yi-Ying %A Yang,Kai-Chou %A Lai,Feipei %A Huang,Chien-Hua %A Chen,Yun-Nung %A Tu,Yi-Chin %+ Department of Computer Science and Information Engineering, National Taiwan University, No 1, Sec 4, Roosevelt Rd, Taipei, 106, Taiwan, 886 2 3366 3366, yvchen@csie.ntu.edu.tw %K misinformation %K vaccine hesitancy %K vaccination %K infodemic %K infodemiology %K COVID-19 %K public immunity %K social media %K fake news %D 2022 %7 26.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccination is an important intervention to prevent the incidence and spread of serious diseases. Many factors including information obtained from the internet influence individuals’ decisions to vaccinate. Misinformation is a critical issue and can be hard to detect, although it can change people's minds, opinions, and decisions. The impact of misinformation on public health and vaccination hesitancy is well documented, but little research has been conducted on the relationship between the size of the population reached by misinformation and the vaccination decisions made by that population. A number of fact-checking services are available on the web, including the Islander news analysis system, a free web service that provides individuals with real-time judgment on web news. In this study, we used such services to estimate the amount of fake news available and used Google Trends levels to model the spread of fake news. We quantified this relationship using official public data on COVID-19 vaccination in Taiwan. Objective: In this study, we aimed to quantify the impact of the magnitude of the propagation of fake news on vaccination decisions. Methods: We collected public data about COVID-19 infections and vaccination from Taiwan's official website and estimated the popularity of searches using Google Trends. We indirectly collected news from 26 digital media sources, using the news database of the Islander system. This system crawls the internet in real time, analyzes the news, and stores it. The incitement and suspicion scores of the Islander system were used to objectively judge news, and a fake news percentage variable was produced. We used multivariable linear regression, chi-square tests, and the Johnson-Neyman procedure to analyze this relationship, using weekly data. Results: A total of 791,183 news items were obtained over 43 weeks in 2021. There was a significant increase in the proportion of fake news in 11 of the 26 media sources during the public vaccination stage. The regression model revealed a positive adjusted coefficient (β=0.98, P=.002) of vaccine availability on the following week's vaccination doses, and a negative adjusted coefficient (β=–3.21, P=.04) of the interaction term on the fake news percentage with the Google Trends level. The Johnson-Neiman plot of the adjusted effect for the interaction term showed that the Google Trends level had a significant negative adjustment effect on vaccination doses for the following week when the proportion of fake news exceeded 39.3%. Conclusions: There was a significant relationship between the amount of fake news to which the population was exposed and the number of vaccination doses administered. Reducing the amount of fake news and increasing public immunity to misinformation will be critical to maintain public health in the internet age. %M 35380546 %R 10.2196/36830 %U https://www.jmir.org/2022/4/e36830 %U https://doi.org/10.2196/36830 %U http://www.ncbi.nlm.nih.gov/pubmed/35380546 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e34070 %T Factors Affecting Human Papillomavirus Vaccination in Men: Systematic Review %A Shin,Hyunjeong %A Jeon,Songi %A Cho,Inhae %A Park,HyunJi %+ College of Nursing, Korea University, 145 Anam-ro, Sungbuk-gu, Seoul, 02841, Republic of Korea, 82 2 3290 4912, inhae05@gmail.com %K health service use %K men %K papillomavirus %K papillomavirus vaccines %K systematic review %K vaccination %K vaccine %K HPV %K review %K gender %D 2022 %7 26.4.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Despite the high risks associated with human papillomavirus (HPV), the HPV vaccination rate of men is far lower than women. Most previous review studies have focused on female vaccination and related affecting factors. However, previous studies have reported that the factors affecting HPV vaccination differ by gender. Objective: The aim of this review was to identify the factors affecting HPV vaccine initiation in men through a systematic review approach. Methods: A literature review was conducted across 3 central electronic databases for relevant articles. A total of 30 articles published between 2013 and 2019 met the inclusion criteria and were reviewed in this study. Results: In total, 50 factors affecting HPV vaccination in men were identified, including 13 sociodemographic factors and social structure factors, 12 belief-related variables, 4 family factors, 4 community factors, 14 variables related to needs, and 3 environmental factors. Conclusions: To increase HPV vaccination rates in men, strategies targeting young males and their families should consider frequent visits to or contact with health care providers so that health care professionals can provide recommendations for HPV vaccination. %M 35471242 %R 10.2196/34070 %U https://publichealth.jmir.org/2022/4/e34070 %U https://doi.org/10.2196/34070 %U http://www.ncbi.nlm.nih.gov/pubmed/35471242 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 2 %P e34111 %T Crowdsourcing Medical Costs in Dermatology: Cross-sectional Study Analyzing Dermatologic GoFundMe Campaigns %A Mark,Erica %A Sridharan,Mira %A Florenzo,Brian %A Schenck,Olivia L %A Noland,Mary-Margaret B %A Barbieri,John S %A Lipoff,Jules B %+ Department of Dermatology, University of Virginia, 775 Walker Square, Charlottesville, VA, 22903, United States, 1 19258189733, ejm5we@virginia.edu %K crowdfunding %K crowdsourcing %K fundraising %K GoFundMe %K social media %K medical expenses %K financial burden %K health equity %D 2022 %7 22.4.2022 %9 Original Paper %J JMIR Dermatol %G English %X Background: Crowdfunding for medical costs is becoming increasingly popular. Few previous studies have described the fundraising characteristics and qualities associated with success. Objective: This study aimed to characterize and investigate the qualities associated with successful dermatological fundraisers. Methods: This cross-sectional study of dermatological GoFundMe campaigns collected data, including demographic variables, thematic variables using an inductive qualitative method, and quantitative information. Linear regression examined the qualities associated with success, which are defined based on funds raised when controlling for campaign goals. Logistic regression was used to examine qualities associated with extremely successful campaigns, defined as those raising >1.5 times the IQR. Statistical significance was set at P<.05. Results: A total of 2008 publicly available campaigns at the time of data collection were evaluated. Nonmodifiable factors associated with greater success included male gender, age 20-40 years, and White race. Modifiable factors associated with success included more updates posted to the campaign page, non–self-identity of the campaign creator, mention of a chronic condition, and smiling in campaign profile photographs. Conclusions: Understanding the modifiable factors of medical crowdfunding may inform future campaigns, and nonmodifiable factors may have policy implications for improving health care equity and financing. Crowdfunding for medical disease treatment may have potential implications for medical privacy and exacerbation of existing health care disparities. This study was limited to publicly available GoFundMe campaigns. Potential limitations for this study include intercoder variability, misclassification bias because of the data abstraction process, and prioritization of campaigns based on the proprietary GoFundMe algorithm. %M 37632862 %R 10.2196/34111 %U https://derma.jmir.org/2022/2/e34111 %U https://doi.org/10.2196/34111 %U http://www.ncbi.nlm.nih.gov/pubmed/37632862 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e30885 %T US Black Maternal Health Advocacy Topics and Trends on Twitter: Temporal Infoveillance Study %A Grigsby-Toussaint,Diana %A Champagne,Ashley %A Uhr,Justin %A Silva,Elizabeth %A Noh,Madeline %A Bradley,Adam %A Rashleigh,Patrick %+ Department of Epidemiology, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, United States, 1 401 863 6164, diana_grigsby-toussaint@brown.edu %K Black maternal health %K disparity %K COVID-19 %K Twitter %K topic modeling %K digital humanities %K infoveillance %K maternal health %K minority %K women %K advocacy %K social media %K model %K trend %K feasibility %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Black women in the United States disproportionately suffer adverse pregnancy and birth outcomes compared to White women. Economic adversity and implicit bias during clinical encounters may lead to physiological responses that place Black women at higher risk for adverse birth outcomes. The novel coronavirus disease of 2019 (COVID-19) further exacerbated this risk, as safety protocols increased social isolation in clinical settings, thereby limiting opportunities to advocate for unbiased care. Twitter, 1 of the most popular social networking sites, has been used to study a variety of issues of public interest, including health care. This study considers whether posts on Twitter accurately reflect public discourse during the COVID-19 pandemic and are being used in infodemiology studies by public health experts. Objective: This study aims to assess the feasibility of Twitter for identifying public discourse related to social determinants of health and advocacy that influence maternal health among Black women across the United States and to examine trends in sentiment between 2019 and 2020 in the context of the COVID-19 pandemic. Methods: Tweets were collected from March 1 to July 13, 2020, from 21 organizations and influencers and from 4 hashtags that focused on Black maternal health. Additionally, tweets from the same organizations and hashtags were collected from the year prior, from March 1 to July 13, 2019. Twint, a Python programming library, was used for data collection and analysis. We gathered the text of approximately 17,000 tweets, as well as all publicly available metadata. Topic modeling and k-means clustering were used to analyze the tweets. Results: A variety of trends were observed when comparing the 2020 data set to the 2019 data set from the same period. The percentages listed for each topic are probabilities of that topic occurring in our corpus. In our topic models, tweets on reproductive justice, maternal mortality crises, and patient care increased by 67.46% in 2020 versus 2019. Topics on community, advocacy, and health equity increased by over 30% in 2020 versus 2019. In contrast, tweet topics that decreased in 2020 versus 2019 were as follows: tweets on Medicaid and medical coverage decreased by 27.73%, and discussions about creating space for Black women decreased by just under 30%. Conclusions: The results indicate that the COVID-19 pandemic may have spurred an increased focus on advocating for improved reproductive health and maternal health outcomes among Black women in the United States. Further analyses are needed to capture a longer time frame that encompasses more of the pandemic, as well as more diverse voices to confirm the robustness of the findings. We also concluded that Twitter is an effective source for providing a snapshot of relevant topics to guide Black maternal health advocacy efforts. %M 35578642 %R 10.2196/30885 %U https://infodemiology.jmir.org/2022/1/e30885 %U https://doi.org/10.2196/30885 %U http://www.ncbi.nlm.nih.gov/pubmed/35578642 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e33450 %T Problematic Social Media Use in Adolescents and Young Adults: Systematic Review and Meta-analysis %A Shannon,Holly %A Bush,Katie %A Villeneuve,Paul J %A Hellemans,Kim GC %A Guimond,Synthia %+ Department of Psychiatry, The Royal's Institute of Mental Health Research, University of Ottawa, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada, 1 6135708402, synthia.guimond@theroyal.ca %K problematic social media use %K depression %K anxiety %K stress %D 2022 %7 14.4.2022 %9 Review %J JMIR Ment Health %G English %X Background: Technology is ever evolving, with more and more diverse activities becoming possible on screen-based devices. However, participating in a heavy screen-based lifestyle may come at a cost. Our hypothesis was that problematic social media use increased the prevalence of mental health outcomes. Objective: This study seeks to systematically examine problematic social media use in youth and its association with symptoms of depression, anxiety, and stress. Methods: A systematic search was conducted to identify studies in adolescents and young adults, using the databases Engineering Village, Psycinfo, Pubmed, and Web of Science. A total of 18 studies were identified, with a total of 9269 participants in our review and included in the meta-analysis. Results: Our metaregression shows moderate but statistically significant correlations between problematic social media use and depression (r=0.273, P<.001), anxiety (r=0.348, P<.001), and stress (r=0.313, P<.001). We did not find evidence of heterogeneity of these summary correlations by age, gender, or year of publication. Conclusions: This study provides further evidence of the association between problematic social media use and negative mental health among adolescents and young adults and supports future research to focus on the underlying mechanisms of problematic use of social media. Trial Registration: PROSPERO CRD42021222309; https://tinyurl.com/2p9y4bjx %M 35436240 %R 10.2196/33450 %U https://mental.jmir.org/2022/4/e33450 %U https://doi.org/10.2196/33450 %U http://www.ncbi.nlm.nih.gov/pubmed/35436240 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e33827 %T Identifying Frames of the COVID-19 Infodemic: Thematic Analysis of Misinformation Stories Across Media %A Mohammadi,Ehsan %A Tahamtan,Iman %A Mansourian,Yazdan %A Overton,Holly %+ School of Information Sciences, University of South Carolina, Davis College, Room 207, 1501 Greene Street, Columbia, SC, 29208, United States, 1 803 777 2324, ehsan2@sc.edu %K COVID-19 %K pandemic %K misinformation %K fake news %K framing theory %K social media %K infodemic %K thematic analysis %K theme %K social media %K pattern %K prevalence %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The word “infodemic” refers to the deluge of false information about an event, and it is a global challenge for today’s society. The sheer volume of misinformation circulating during the COVID-19 pandemic has been harmful to people around the world. Therefore, it is important to study different aspects of misinformation related to the pandemic. Objective: This paper aimed to identify the main subthemes related to COVID-19 misinformation on various platforms, from traditional outlets to social media. This paper aimed to place these subthemes into categories, track the changes, and explore patterns in prevalence, over time, across different platforms and contexts. Methods: From a theoretical perspective, this research was rooted in framing theory; it also employed thematic analysis to identify the main themes and subthemes related to COVID-19 misinformation. The data were collected from 8 fact-checking websites that formed a sample of 127 pieces of false COVID-19 news published from January 1, 2020 to March 30, 2020. Results: The findings revealed 4 main themes (attribution, impact, protection and solutions, and politics) and 19 unique subthemes within those themes related to COVID-19 misinformation. Governmental and political organizations (institutional level) and administrators and politicians (individual level) were the 2 most frequent subthemes, followed by origination and source, home remedies, fake statistics, treatments, drugs, and pseudoscience, among others. Results indicate that the prevalence of misinformation subthemes had altered over time between January 2020 and March 2020. For instance, false stories about the origin and source of the virus were frequent initially (January). Misinformation regarding home remedies became a prominent subtheme in the middle (February), while false information related to government organizations and politicians became popular later (March). Although conspiracy theory web pages and social media outlets were the primary sources of misinformation, surprisingly, results revealed trusted platforms such as official government outlets and news organizations were also avenues for creating COVID-19 misinformation. Conclusions: The identified themes in this study reflect some of the information attitudes and behaviors, such as denial, uncertainty, consequences, and solution-seeking, that provided rich information grounds to create different types of misinformation during the COVID-19 pandemic. Some themes also indicate that the application of effective communication strategies and the creation of timely content were used to persuade human minds with false stories in different phases of the crisis. The findings of this study can be beneficial for communication officers, information professionals, and policy makers to combat misinformation in future global health crises or related events. %M 37113806 %R 10.2196/33827 %U https://infodemiology.jmir.org/2022/1/e33827 %U https://doi.org/10.2196/33827 %U http://www.ncbi.nlm.nih.gov/pubmed/37113806 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e26335 %T Discussions and Misinformation About Electronic Nicotine Delivery Systems and COVID-19: Qualitative Analysis of Twitter Content %A Sidani,Jaime E %A Hoffman,Beth %A Colditz,Jason B %A Wolynn,Riley %A Hsiao,Lily %A Chu,Kar-Hai %A Rose,Jason J %A Shensa,Ariel %A Davis,Esa %A Primack,Brian %+ Center for Social Dynamics and Community Health, Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 130 DeSoto Street, Pittsburgh, PA, 15261, United States, 1 412 383 0733, jaime.sidani@pitt.edu %K COVID-19 %K coronavirus %K e-cigarette %K electronic nicotine delivery systems %K Twitter %K social media %K misinformation %K discussion %K public health %K communication %K concern %K severity %K conspiracy %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Misinformation and conspiracy theories related to COVID-19 and electronic nicotine delivery systems (ENDS) are increasing. Some of this may stem from early reports suggesting a lower risk of severe COVID-19 in nicotine users. Additionally, a common conspiracy is that the e-cigarette or vaping product use–associated lung injury (EVALI) outbreak of 2019 was actually an early presentation of COVID-19. This may have important public health ramifications for both COVID-19 control and ENDS use. Objective: Twitter is an ideal tool for analyzing real-time public discussions related to both ENDS and COVID-19. This study seeks to collect and classify Twitter messages (“tweets”) related to ENDS and COVID-19 to inform public health messaging. Methods: Approximately 2.1 million tweets matching ENDS-related keywords were collected from March 1, 2020, through June 30, 2020, and were then filtered for COVID-19–related keywords, resulting in 67,321 original tweets. A 5% (n=3366) subsample was obtained for human coding using a systematically developed codebook. Tweets were coded for relevance to the topic and four overarching categories. Results: A total of 1930 (57.3%) tweets were coded as relevant to the research topic. Half (n=1008, 52.2%) of these discussed a perceived association between ENDS use and COVID-19 susceptibility or severity, with 42.4% (n=818) suggesting that ENDS use is associated with worse COVID-19 symptoms. One-quarter (n=479, 24.8%) of tweets discussed the perceived similarity/dissimilarity of COVID-19 and EVALI, and 13.8% (n=266) discussed ENDS use behavior. Misinformation and conspiracy theories were present throughout all coding categories. Conclusions: Discussions about ENDS use and COVID-19 on Twitter frequently highlight concerns about the susceptibility and severity of COVID-19 for ENDS users; however, many contain misinformation and conspiracy theories. Public health messaging should capitalize on these concerns and amplify accurate Twitter messaging. %M 35311684 %R 10.2196/26335 %U https://formative.jmir.org/2022/4/e26335 %U https://doi.org/10.2196/26335 %U http://www.ncbi.nlm.nih.gov/pubmed/35311684 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33680 %T The Impact and Applications of Social Media Platforms for Public Health Responses Before and During the COVID-19 Pandemic: Systematic Literature Review %A Gunasekeran,Dinesh Visva %A Chew,Alton %A Chandrasekar,Eeshwar K %A Rajendram,Priyanka %A Kandarpa,Vasundhara %A Rajendram,Mallika %A Chia,Audrey %A Smith,Helen %A Leong,Choon Kit %+ National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore, 65 67723737, dineshvg@hotmail.sg %K digital health %K social media %K big data %K population health %K blockchain %K COVID-19 %K review %K benefit %K challenge %K public health %D 2022 %7 11.4.2022 %9 Review %J J Med Internet Res %G English %X Background:  Social media platforms have numerous potential benefits and drawbacks on public health, which have been described in the literature. The COVID-19 pandemic has exposed our limited knowledge regarding the potential health impact of these platforms, which have been detrimental to public health responses in many regions. Objective: This review aims to highlight a brief history of social media in health care and report its potential negative and positive public health impacts, which have been characterized in the literature. Methods:  We searched electronic bibliographic databases including PubMed, including Medline and Institute of Electrical and Electronics Engineers Xplore, from December 10, 2015, to December 10, 2020. We screened the title and abstracts and selected relevant reports for review of full text and reference lists. These were analyzed thematically and consolidated into applications of social media platforms for public health. Results:  The positive and negative impact of social media platforms on public health are catalogued on the basis of recent research in this report. These findings are discussed in the context of improving future public health responses and incorporating other emerging digital technology domains such as artificial intelligence. However, there is a need for more research with pragmatic methodology that evaluates the impact of specific digital interventions to inform future health policy. Conclusions:  Recent research has highlighted the potential negative impact of social media platforms on population health, as well as potentially useful applications for public health communication, monitoring, and predictions. More research is needed to objectively investigate measures to mitigate against its negative impact while harnessing effective applications for the benefit of public health. %M 35129456 %R 10.2196/33680 %U https://www.jmir.org/2022/4/e33680 %U https://doi.org/10.2196/33680 %U http://www.ncbi.nlm.nih.gov/pubmed/35129456 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e33394 %T Influence of Maternal Exposure to Mass Media on Growth Stunting Among Children Under Five: Mediation Analysis Through the Water, Sanitation, and Hygiene Program %A Huo,Shutong %A Wang,Kai %A Liu,Zongchao %A Yang,Yuao %A Hee,Jia Yi %A He,Qiwei %A Takesue,Rie %A Tang,Kun %+ Vanke School of Public Health, Tsinghua University, 4th Floor Mingli Building, Haidian District, Beijing, 100083, China, 86 010 62781788, tangk@tsinghua.edu.cn %K water, sanitation and hygiene %K mass media %K malnutrition %K Democratic Republic of Congo %K DRC %K mediation analysis %K children %K pediatric %K stunting %K television %K internet %K sanitation %K hygiene %D 2022 %7 6.4.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The issue of malnutrition in the Democratic Republic of Congo is severe. Meanwhile, the Water, Sanitation, and Hygiene program has been demonstrated to be effective in reducing the rates of growth stunting among children. Objective: We aimed to explore the association between maternal exposure to mass media and stunting in children through water, sanitation, and hygiene behaviors. Methods: Mediation analysis was conducted using data from the 2018 Multiple Indicators Cluster Surveys. Results: Mothers’ exposures to television and the internet in the Democratic Republic of Congo significantly decreases the risk of stunting in children by 5% and 10%, respectively, mediated by household water, sanitation, and hygiene facilities and practices. Conclusions: These findings could inform interventions and policies to reduce the rate of stunting rate children by promoting water, sanitation, and hygiene through mass media, especially through the internet and television. %M 35384848 %R 10.2196/33394 %U https://publichealth.jmir.org/2022/4/e33394 %U https://doi.org/10.2196/33394 %U http://www.ncbi.nlm.nih.gov/pubmed/35384848 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e35677 %T Using Twitter to Examine Stigma Against People With Dementia During COVID-19: Infodemiology Study %A Bacsu,Juanita-Dawne %A Fraser,Sarah %A Chasteen,Alison L %A Cammer,Allison %A Grewal,Karl S %A Bechard,Lauren E %A Bethell,Jennifer %A Green,Shoshana %A McGilton,Katherine S %A Morgan,Debra %A O’Rourke,Hannah M %A Poole,Lisa %A Spiteri,Raymond J %A O'Connell,Megan E %+ Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada, 1 306 250 4399, juanita.bacsu@usask.ca %K coronavirus 2019 %K social media %K stigma %K dementia %K ageism %K COVID-19 %K Twitter %K bias %K infodemiology %K attention %K risk %K impact %K misinformation %K belief %K cognition %K cognitive impairment %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: During the pandemic, there has been significant social media attention focused on the increased COVID-19 risks and impacts for people with dementia and their care partners. However, these messages can perpetuate misconceptions, false information, and stigma. Objective: This study used Twitter data to understand stigma against people with dementia propagated during the COVID-19 pandemic. Methods: We collected 1743 stigma-related tweets using the GetOldTweets application in Python from February 15 to September 7, 2020. Thematic analysis was used to analyze the tweets. Results: Based on our analysis, 4 main themes were identified: (1) ageism and devaluing the lives of people with dementia, (2) misinformation and false beliefs about dementia and COVID-19, (3) dementia used as an insult for political ridicule, and (4) challenging stigma against dementia. Social media has been used to spread stigma, but it can also be used to challenge negative beliefs, stereotypes, and false information. Conclusions: Dementia education and awareness campaigns are urgently needed on social media to address COVID-19-related stigma. When stigmatizing discourse on dementia is widely shared and consumed amongst the public, it has public health implications. How we talk about dementia shapes how policymakers, clinicians, and the public value the lives of people with dementia. Stigma perpetuates misinformation, pejorative language, and patronizing attitudes that can lead to discriminatory actions, such as the limited provision of lifesaving supports and health services for people with dementia during the pandemic. COVID-19 policies and public health messages should focus on precautions and preventive measures rather than labeling specific population groups. %M 35290197 %R 10.2196/35677 %U https://aging.jmir.org/2022/1/e35677 %U https://doi.org/10.2196/35677 %U http://www.ncbi.nlm.nih.gov/pubmed/35290197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34050 %T Content Analysis of Nicotine Poisoning (Nic Sick) Videos on TikTok: Retrospective Observational Infodemiology Study %A Purushothaman,Vidya %A McMann,Tiana %A Nali,Matthew %A Li,Zhuoran %A Cuomo,Raphael %A Mackey,Tim K %+ Department of Anthropology, University of California San Diego, 9500 Gilman Drive, Postal Code: 0505, La Jolla, CA, 92093, United States, 1 9514914161, tmackey@ucsd.edu %K nic sick %K vaping %K tobacco %K social media %K TikTok %K content analysis %K smoking %K nicotine %K e-cigarette %K adverse effects %K public health %K infodemiology %D 2022 %7 30.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: TikTok is a microvideo social media platform currently experiencing rapid growth and with 60% of its monthly users between the ages of 16 and 24 years. Increased exposure to e-cigarette content on social media may influence patterns of use, including the risk of overconsumption and possible nicotine poisoning, when users engage in trending challenges online. However, there is limited research assessing the characteristics of nicotine poisoning–related content posted on social media. Objective: We aimed to assess the characteristics of content on TikTok that is associated with a popular nicotine poisoning–related hashtag. Methods: We collected TikTok posts associated with the hashtag #nicsick, using a Python programming package (Selenium) and used an inductive coding approach to analyze video content and characteristics of interest. Videos were manually annotated to generate a codebook of the nicotine sickness–related themes. Statistical analysis was used to compare user engagement characteristics and video length in content with and without active nicotine sickness TikTok topics. Results: A total of 132 TikTok videos associated with the hashtag #nicsick were manually coded, with 52.3% (69/132) identified as discussing firsthand and secondhand reports of suspected nicotine poisoning symptoms and experiences. More than one-third of nicotine poisoning–related content (26/69, 37.68%) portrayed active vaping by users, which included content with vaping behavior such as vaping tricks and overconsumption, and 43% (30/69) of recorded users self-reported experiencing nicotine sickness, poisoning, or adverse events such as vomiting following nicotine consumption. The average follower count of users posting content related to nicotine sickness was significantly higher than that for users posting content unrelated to nicotine sickness (W=2350.5, P=.03). Conclusions: TikTok users openly discuss experiences, both firsthand and secondhand, with nicotine adverse events via the #nicsick hashtag including reports of overconsumption resulting in sickness. These study results suggest that there is a need to assess the utility of digital surveillance on emerging social media platforms for vaping adverse events, particularly on sites popular among youth and young adults. As vaping product use-patterns continue to evolve, digital adverse event detection likely represents an important tool to supplement traditional methods of public health surveillance (such as poison control center prevalence numbers). %M 35353056 %R 10.2196/34050 %U https://www.jmir.org/2022/3/e34050 %U https://doi.org/10.2196/34050 %U http://www.ncbi.nlm.nih.gov/pubmed/35353056 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e33685 %T Quantifying Changes in the Language Used Around Mental Health on Twitter Over 10 Years: Observational Study %A Stupinski,Anne Marie %A Alshaabi,Thayer %A Arnold,Michael V %A Adams,Jane Lydia %A Minot,Joshua R %A Price,Matthew %A Dodds,Peter Sheridan %A Danforth,Christopher M %+ Department of Mathematics and Statistics, University of Vermont, Innovation Hall E220, 82 University Place, Burlington, VT, 05405, United States, 1 802 656 3032, chris.danforth@uvm.edu %K mental health %K stigma %K natural language processing %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health challenges are thought to affect approximately 10% of the global population each year, with many of those affected going untreated because of the stigma and limited access to services. As social media lowers the barrier for joining difficult conversations and finding supportive groups, Twitter is an open source of language data describing the changing experience of a stigmatized group. Objective: By measuring changes in the conversation around mental health on Twitter, we aim to quantify the hypothesized increase in discussions and awareness of the topic as well as the corresponding reduction in stigma around mental health. Methods: We explored trends in words and phrases related to mental health through a collection of 1-, 2-, and 3-grams parsed from a data stream of approximately 10% of all English tweets from 2010 to 2021. We examined temporal dynamics of mental health language and measured levels of positivity of the messages. Finally, we used the ratio of original tweets to retweets to quantify the fraction of appearances of mental health language that was due to social amplification. Results: We found that the popularity of the phrase mental health increased by nearly two orders of magnitude between 2012 and 2018. We observed that mentions of mental health spiked annually and reliably because of mental health awareness campaigns as well as unpredictably in response to mass shootings, celebrities dying by suicide, and popular fictional television stories portraying suicide. We found that the level of positivity of messages containing mental health, while stable through the growth period, has declined recently. Finally, we observed that since 2015, mentions of mental health have become increasingly due to retweets, suggesting that the stigma associated with the discussion of mental health on Twitter has diminished with time. Conclusions: These results provide useful texture regarding the growing conversation around mental health on Twitter and suggest that more awareness and acceptance has been brought to the topic compared with past years. %M 35353049 %R 10.2196/33685 %U https://mental.jmir.org/2022/3/e33685 %U https://doi.org/10.2196/33685 %U http://www.ncbi.nlm.nih.gov/pubmed/35353049 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e34935 %T Patterns of Promotional Content by Dermatology Influencers on TikTok %A Ranpariya,Varun K %A Fathy,Ramie %A Chu,Brian %A Wang,Sonia %A Lipoff,Jules B %+ Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, 3737 Market Street, Suite 1100, Philadelphia, PA, 19104, United States, 1 215 662 8060, Jules.Lipoff@pennmedicine.upenn.edu %K social media %K TikTok %K Instagram %K promotion %K conflicts of interest %K influencer %K dermatology %K dermatologist %D 2022 %7 30.3.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632857 %R 10.2196/34935 %U https://derma.jmir.org/2022/1/e34935 %U https://doi.org/10.2196/34935 %U http://www.ncbi.nlm.nih.gov/pubmed/37632857 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e35016 %T Tracking Public Attitudes Toward COVID-19 Vaccination on Tweets in Canada: Using Aspect-Based Sentiment Analysis %A Jang,Hyeju %A Rempel,Emily %A Roe,Ian %A Adu,Prince %A Carenini,Giuseppe %A Janjua,Naveed Zafar %+ British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada, 1 778 580 9113, hyejuj@cs.ubc.ca %K COVID-19 %K vaccination %K Twitter %K aspect-based sentiment analysis %K Canada %K social media %K pandemic %K content analysis %K vaccine rollout %K sentiment analysis %K public sentiment %K public health %K health promotion %K vaccination promotion %D 2022 %7 29.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The development and approval of COVID-19 vaccines have generated optimism for the end of the COVID-19 pandemic and a return to normalcy. However, vaccine hesitancy, often fueled by misinformation, poses a major barrier to achieving herd immunity. Objective: We aim to investigate Twitter users’ attitudes toward COVID-19 vaccination in Canada after vaccine rollout. Methods: We applied a weakly supervised aspect-based sentiment analysis (ABSA) technique, which involves the human-in-the-loop system, on COVID-19 vaccination–related tweets in Canada. Automatically generated aspect and opinion terms were manually corrected by public health experts to ensure the accuracy of the terms and make them more domain-specific. Then, based on these manually corrected terms, the system inferred sentiments toward the aspects. We observed sentiments toward key aspects related to COVID-19 vaccination, and investigated how sentiments toward “vaccination” changed over time. In addition, we analyzed the most retweeted or liked tweets by observing most frequent nouns and sentiments toward key aspects. Results: After applying the ABSA system, we obtained 170 aspect terms (eg, “immunity” and “pfizer”) and 6775 opinion terms (eg, “trustworthy” for the positive sentiment and “jeopardize” for the negative sentiment). While manually verifying or editing these terms, our public health experts selected 20 key aspects related to COVID-19 vaccination for analysis. The sentiment analysis results for the 20 key aspects revealed negative sentiments related to “vaccine distribution,” “side effects,” “allergy,” “reactions,” and “anti-vaxxer,” and positive sentiments related to “vaccine campaign,” “vaccine candidates,” and “immune response.” These results indicate that the Twitter users express concerns about the safety of vaccines but still consider vaccines as the option to end the pandemic. In addition, compared to the sentiment of the remaining tweets, the most retweeted or liked tweets showed more positive sentiment overall toward key aspects (P<.001), especially vaccines (P<.001) and vaccination (P=.009). Further investigation of the most retweeted or liked tweets revealed two opposing trends in Twitter users who showed negative sentiments toward vaccines: the “anti-vaxxer” population that used negative sentiments as a means to discourage vaccination and the “Covid Zero” population that used negative sentiments to encourage vaccinations while critiquing the public health response. Conclusions: Our study examined public sentiments toward COVID-19 vaccination on tweets over an extended period in Canada. Our findings could inform public health agencies to design and implement interventions to promote vaccination. %M 35275835 %R 10.2196/35016 %U https://www.jmir.org/2022/3/e35016 %U https://doi.org/10.2196/35016 %U http://www.ncbi.nlm.nih.gov/pubmed/35275835 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27894 %T Puff Bars, Tobacco Policy Evasion, and Nicotine Dependence: Content Analysis of Tweets %A Chu,Kar-Hai %A Hershey,Tina B %A Hoffman,Beth L %A Wolynn,Riley %A Colditz,Jason B %A Sidani,Jaime E %A Primack,Brian A %+ Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, United States, 1 4126922578, chuk@pitt.edu %K tobacco %K policy %K social media %K e-cigarette %K twitter %K mHealth %K dependence %K addiction %K nicotine %D 2022 %7 25.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Puff Bars are e-cigarettes that continued marketing flavored products by exploiting the US Food and Drug Administration exemption for disposable devices. Objective: This study aimed to examine discussions related to Puff Bar on Twitter to identify tobacco regulation and policy themes as well as unanticipated outcomes of regulatory loopholes. Methods: Of 8519 original tweets related to Puff Bar collected from July 13, 2020, to August 13, 2020, a random 20% subsample (n=2661) was selected for qualitative coding of topics related to nicotine dependence and tobacco policy. Results: Of the human-coded tweets, 2123 (80.2%) were coded as relevant to Puff Bar as the main topic. Of those tweets, 698 (32.9%) discussed tobacco policy, including flavors (n=320, 45.9%), regulations (n=124, 17.8%), purchases (n=117, 16.8%), and other products (n=110, 15.8%). Approximately 22% (n=480) of the tweets referenced dependence, including lack of access (n=273, 56.9%), appetite suppression (n=59, 12.3%), frequent use (n=47, 9.8%), and self-reported dependence (n=110, 22.9%). Conclusions: This study adds to the growing evidence base that the US Food and Drug Administration ban of e-cigarette flavors did not reduce interest, but rather shifted the discussion to brands utilizing a loophole that allowed flavored products to continue to be sold in disposable devices. Until comprehensive tobacco policy legislation is developed, new products or loopholes will continue to supply nicotine demand. %M 35333188 %R 10.2196/27894 %U https://www.jmir.org/2022/3/e27894 %U https://doi.org/10.2196/27894 %U http://www.ncbi.nlm.nih.gov/pubmed/35333188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34544 %T The Evaluation of a Social Media Campaign to Increase COVID-19 Testing in Migrant Groups: Cluster Randomized Trial %A Elgersma,Ingeborg Hess %A Fretheim,Atle %A Indseth,Thor %A Munch,Anita Thorolvsen %A Johannessen,Live Bøe %A Hansen,Christine Engh %+ Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Postboks 222, Skøyen, Oslo, 0213, Norway, 47 91584782, ingeborghess.elgersma@fhi.no %K COVID-19 %K SARS-CoV-2 %K social media %K campaign %K cluster randomized trial %K nonpharmaceutical interventions %K migrant %K intervention %K testing %K strategy %K public health %K Facebook %K communication %D 2022 %7 24.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: A low test positivity rate is key to keeping the COVID-19 pandemic under control. Throughout the pandemic, several migrant groups in Norway have seen higher rates of confirmed COVID-19 and related hospitalizations, while test positivity has remained high in the same groups. The Norwegian government has used several platforms for communication, and targeted social media advertisements have in particular been an important part of the communication strategy to reach these groups. Objective: In this study, we aimed to investigate whether such a targeted Facebook campaign increased the rate of COVID-19 tests performed in certain migrant groups. Methods: We randomly assigned 386 Norwegian municipalities and city districts to intervention or control groups. Individuals born in Eritrea, Iraq, Pakistan, Poland, Russia, Somalia, Syria, and Turkey residing in intervention areas were targeted with a social media campaign aiming at increasing the COVID-19 test rate. The campaign message was in a simple language and conveyed in the users’ main language or in English. Results: During the 2-week follow-up period, the predicted probability of having a COVID-19 test taken was 4.82% (95% CI 4.47%-5.18%) in the control group, and 5.58% (95% CI 5.20%-5.99%) in the intervention group (P=.004). Conclusions: Our targeted social media intervention led to a modest increase in test rates among certain migrant groups in Norway. Trial Registration: ClinicalTrials.gov NCT04866589; https://clinicaltrials.gov/ct2/show/NCT04866589 %M 35285811 %R 10.2196/34544 %U https://www.jmir.org/2022/3/e34544 %U https://doi.org/10.2196/34544 %U http://www.ncbi.nlm.nih.gov/pubmed/35285811 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e32452 %T COVID-19 and Vitamin D Misinformation on YouTube: Content Analysis %A Quinn,Emma K %A Fenton,Shelby %A Ford-Sahibzada,Chelsea A %A Harper,Andrew %A Marcon,Alessandro R %A Caulfield,Timothy %A Fazel,Sajjad S %A Peters,Cheryl E %+ Department of Occupational and Environmental Hygiene, School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, T2T 1Z3, Canada, 1 403 809 1289, equinn99@student.ubc.ca %K COVID-19 %K vitamin D %K misinformation %K YouTube %K content analysis %K social media %K video %K infodemic %K risk %K prevention %K health information %K immunity %K immune system %K supplements %K natural medicine %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The “infodemic” accompanying the SARS-CoV-2 virus pandemic has the potential to increase avoidable spread as well as engagement in risky health behaviors. Although social media platforms, such as YouTube, can be an inexpensive and effective method of sharing accurate health information, inaccurate and misleading information shared on YouTube can be dangerous for viewers. The confusing nature of data and claims surrounding the benefits of vitamin D, particularly in the prevention or cure of COVID-19, influences both viewers and the general “immune boosting” commercial interest. Objective: The aim of this study was to ascertain how information on vitamin D and COVID-19 was presented on YouTube in 2020. Methods: YouTube video results for the search terms “COVID,” “coronavirus,” and “vitamin D” were collected and analyzed for content themes and deemed useful or misleading based on the accuracy or inaccuracy of the content. Qualitative content analysis and simple statistical analysis were used to determine the prevalence and frequency of concerning content, such as confusing correlation with causation regarding vitamin D benefits. Results: In total, 77 videos with a combined 10,225,763 views (at the time of data collection) were included in the analysis, with over three-quarters of them containing misleading content about COVID-19 and vitamin D. In addition, 45 (58%) of the 77 videos confused the relationship between vitamin D and COVID-19, with 46 (85%) of 54 videos stating that vitamin D has preventative or curative abilities. The major contributors to these videos were medical professionals with YouTube accounts. Vitamin D recommendations that do not align with the current literature were frequently suggested, including taking supplementation higher than the recommended safe dosage or seeking intentional solar UV radiation exposure. Conclusions: The spread of misinformation is particularly alarming when spread by medical professionals, and existing data suggesting vitamin D has immune-boosting abilities can add to viewer confusion or mistrust in health information. Further, the suggestions made in the videos may increase the risks of other poor health outcomes, such as skin cancer from solar UV radiation. %M 35310014 %R 10.2196/32452 %U https://infodemiology.jmir.org/2022/1/e32452 %U https://doi.org/10.2196/32452 %U http://www.ncbi.nlm.nih.gov/pubmed/35310014 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31687 %T The Public Perception of the #GeneEditedBabies Event Across Multiple Social Media Platforms: Observational Study %A Ni,Congning %A Wan,Zhiyu %A Yan,Chao %A Liu,Yongtai %A Clayton,Ellen Wright %A Malin,Bradley %A Yin,Zhijun %+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37232, United States, 1 6159363690, zhijun.yin@vumc.org %K CRISPR/Cas9 %K gene-edited babies %K social media %K stance learning %K text mining %K content analysis %D 2022 %7 11.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In November 2018, a Chinese researcher reported that his team had applied clustered regularly interspaced palindromic repeats or associated protein 9 to delete the gene C-C chemokine receptor type 5 from embryos and claimed that the 2 newborns would have lifetime immunity from HIV infection, an event referred to as #GeneEditedBabies on social media platforms. Although this event stirred a worldwide debate on ethical and legal issues regarding clinical trials with embryonic gene sequences, the focus has mainly been on academics and professionals. However, how the public, especially stratified by geographic region and culture, reacted to these issues is not yet well-understood. Objective: The aim of this study is to examine web-based posts about the #GeneEditedBabies event and characterize and compare the public’s stance across social media platforms with different user bases. Methods: We used a set of relevant keywords to search for web-based posts in 4 worldwide or regional mainstream social media platforms: Sina Weibo (China), Twitter, Reddit, and YouTube. We applied structural topic modeling to analyze the main discussed topics and their temporal trends. On the basis of the topics we found, we designed an annotation codebook to label 2000 randomly sampled posts from each platform on whether a supporting, opposing, or neutral stance toward this event was expressed and what the major considerations of those posts were if a stance was described. The annotated data were used to compare stances and the language used across the 4 web-based platforms. Results: We collected >220,000 posts published by approximately 130,000 users regarding the #GeneEditedBabies event. Our results indicated that users discussed a wide range of topics, some of which had clear temporal trends. Our results further showed that although almost all experts opposed this event, many web-based posts supported this event. In particular, Twitter exhibited the largest number of posts in opposition (701/816, 85.9%), followed by Sina Weibo (968/1140, 84.91%), Reddit (550/898, 61.2%), and YouTube (567/1078, 52.6%). The primary opposing reason was rooted in ethical concerns, whereas the primary supporting reason was based on the expectation that such technology could prevent the occurrence of diseases in the future. Posts from these 4 platforms had different language uses and patterns when they expressed stances on the #GeneEditedBabies event. Conclusions: This research provides evidence that posts on web-based platforms can offer insights into the public’s stance on gene editing techniques. However, these stances vary across web-based platforms and often differ from those raised by academics and policy makers. %M 35275077 %R 10.2196/31687 %U https://www.jmir.org/2022/3/e31687 %U https://doi.org/10.2196/31687 %U http://www.ncbi.nlm.nih.gov/pubmed/35275077 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34275 %T Creating Effective, Evidence-Based Video Communication of Public Health Science (COVCOM Study): Protocol for a Sequential Mixed Methods Effect Study %A Røislien,Jo %A O'Hara,Jane K %A Smeets,Ionica %A Brønnick,Kolbjørn %A Berg,Siv Hilde %A Shortt,Marie Therese %A Lungu,Daniel Adrian %A Thune,Henriette %A Wiig,Siri %+ SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, Stavanger, 4021, Norway, 47 51 83 10 00, jo.roislien@uis.no %K pandemics %K risk %K public health %K science communication %K mixed methods %K evidence-based medicine %K COVID-19 %D 2022 %7 11.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The nonlinear nature of contagious diseases and the potential for exponential growth can be difficult to grasp for the general public. This has strong implications for public health communication, which needs to be both easily accessible and efficient. A pandemic is an extreme situation, and the accompanying strict societal measures are generally easier to accept if one understands the underlying reasoning behind them. Bringing about informed attitude change and achieving compliance to strict restrictions requires explanations of scientific concepts and terminologies that laypersons can understand. Objective: The aim of the project is to develop effective, evidence-based modes of video communication for translating complex, but important, health messages about pandemics to both the general population and decision makers. The study uses COVID-19 as a case to learn and prepare society for handling the ongoing and future pandemics, as well as to provide evidence-based tools for the science communication toolbox. Methods: The project applies a mixed methods design, combining qualitative methods (eg, interviews, observational studies, literature reviews) and quantitative methods (eg, randomized controlled trials [RCTs]). The project brings together researchers from a wide range of academic fields, as well as communication industry professionals. Results: This study has received funding from the Trond Mohn Foundation through the Research Council of Norway’s “COVID-19 Emergency Call for Proposals” March 2020. Recruitment and data collection for the exploratory first phase of the project ran from February 2021 to March 2021. Creative communication work started in May 2021, and the production of videos for use in the RCTs in the final phase of the project started in September 2021. Conclusions: The COVCOM project will take on several grand challenges within the field of communicating science and provide evidence-based tools to the science communication toolbox. A long-term goal of the project is to contribute to the creation of a more resilient health care system by developing communication responses tailormade for different audiences, preparing society for any future pandemic. International Registered Report Identifier (IRRID): DERR1-10.2196/34275 %M 35147500 %R 10.2196/34275 %U https://www.researchprotocols.org/2022/3/e34275 %U https://doi.org/10.2196/34275 %U http://www.ncbi.nlm.nih.gov/pubmed/35147500 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e29891 %T Social Media for ImpLementing Evidence (SMILE): Conceptual Framework %A Zhao,Junqiang %A Harvey,Gillian %A Vandyk,Amanda %A Gifford,Wendy %+ School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada, 1 8192124678, jzhao126@uottawa.ca %K social media %K research use %K knowledge translation %K implementation science %K conceptual framework %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media has become widely used by individual researchers and professional organizations to translate research evidence into health care practice. Despite its increasing popularity, few social media initiatives consider the theoretical perspectives of how social media works as a knowledge translation strategy to affect research use. Objective: The purpose of this paper is to propose a conceptual framework to understand how social media works as a knowledge translation strategy for health care providers, policy makers, and patients to inform their health care decision-making. Methods: We developed this framework using an integrative approach that first involved reviewing 5 long-standing social media initiatives. We then drafted the initial framework using a deductive approach by referring to 5 theories on social media studies and knowledge translation. A total of 58 empirical studies on factors that influenced the use of social media and its messages and strategies for promoting the use of research evidence via social media were further integrated to substantiate and fine-tune our initial framework. Through an iterative process, we developed the Social Media for ImpLementing Evidence (SMILE) framework. Results: The SMILE framework has six key constructs: developers, messages and delivery strategies, recipients, context, triggers, and outcomes. For social media to effectively enable recipients to use research evidence in their decision-making, the framework proposes that social media content developers respond to target recipients’ needs and context and develop relevant messages and appropriate delivery strategies. The recipients’ use of social media messages is influenced by the virtual–technical, individual, organizational, and system contexts and can be activated by three types of triggers: sparks, facilitators, and signals. Conclusions: The SMILE framework maps the factors that are hypothesized to influence the use of social media messages by recipients and offers a heuristic device for social media content developers to create interventions for promoting the use of evidence in health care decision-making. Empirical studies are now needed to test the propositions of this framework. %M 35262488 %R 10.2196/29891 %U https://formative.jmir.org/2022/3/e29891 %U https://doi.org/10.2196/29891 %U http://www.ncbi.nlm.nih.gov/pubmed/35262488 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34040 %T Social-Cyber Maneuvers During the COVID-19 Vaccine Initial Rollout: Content Analysis of Tweets %A Blane,Janice T %A Bellutta,Daniele %A Carley,Kathleen M %+ School of Computer Science, Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA, 15213, United States, 1 412 268 6016, jblane@andrew.cmu.edu %K social cybersecurity %K social-cyber maneuvers %K social network analysis %K disinformation %K BEND maneuvers %K COVID-19 %K coronavirus %K social media %K vaccine %K anti-vaccine %K pro-vaccine %K ORA-PRO %K cybersecurity %K security %K Twitter %K community %K communication %K health information %K manipulation %K belief %D 2022 %7 7.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: During the time surrounding the approval and initial distribution of Pfizer-BioNTech’s COVID-19 vaccine, large numbers of social media users took to using their platforms to voice opinions on the vaccine. They formed pro- and anti-vaccination groups toward the purpose of influencing behaviors to vaccinate or not to vaccinate. The methods of persuasion and manipulation for convincing audiences online can be characterized under a framework for social-cyber maneuvers known as the BEND maneuvers. Previous studies have been conducted on the spread of COVID-19 vaccine disinformation. However, these previous studies lacked comparative analyses over time on both community stances and the competing techniques of manipulating both the narrative and network structure to persuade target audiences. Objective: This study aimed to understand community response to vaccination by dividing Twitter data from the initial Pfizer-BioNTech COVID-19 vaccine rollout into pro-vaccine and anti-vaccine stances, identifying key actors and groups, and evaluating how the different communities use social-cyber maneuvers, or BEND maneuvers, to influence their target audiences and the network as a whole. Methods: COVID-19 Twitter vaccine data were collected using the Twitter application programming interface (API) for 1-week periods before, during, and 6 weeks after the initial Pfizer-BioNTech rollout (December 2020 to January 2021). Bot identifications and linguistic cues were derived for users and tweets, respectively, to use as metrics for evaluating social-cyber maneuvers. Organization Risk Analyzer (ORA)-PRO software was then used to separate the vaccine data into pro-vaccine and anti-vaccine communities and to facilitate identification of key actors, groups, and BEND maneuvers for a comparative analysis between each community and the entire network. Results: Both the pro-vaccine and anti-vaccine communities used combinations of the 16 BEND maneuvers to persuade their target audiences of their particular stances. Our analysis showed how each side attempted to build its own community while simultaneously narrowing and neglecting the opposing community. Pro-vaccine users primarily used positive maneuvers such as excite and explain messages to encourage vaccination and backed leaders within their group. In contrast, anti-vaccine users relied on negative maneuvers to dismay and distort messages with narratives on side effects and death and attempted to neutralize the effectiveness of the leaders within the pro-vaccine community. Furthermore, nuking through platform policies showed to be effective in reducing the size of the anti-vaccine online community and the quantity of anti-vaccine messages. Conclusions: Social media continues to be a domain for manipulating beliefs and ideas. These conversations can ultimately lead to real-world actions such as to vaccinate or not to vaccinate against COVID-19. Moreover, social media policies should be further explored as an effective means for curbing disinformation and misinformation online. %M 35044302 %R 10.2196/34040 %U https://www.jmir.org/2022/3/e34040 %U https://doi.org/10.2196/34040 %U http://www.ncbi.nlm.nih.gov/pubmed/35044302 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e25552 %T Using Social Media to Understand Web-Based Social Factors Concerning Obesity: Systematic Review %A Li,Chuqin %A Ademiluyi,Adesoji %A Ge,Yaorong %A Park,Albert %+ University of North Carolina at Charlotte, Woodward 310H, 9201 University City Blvd, Charlotte, NC, 28223, United States, 1 704 687 8668, al.park@uncc.edu %K obesity %K web-based social factors %K systematic review %K social-ecological model %D 2022 %7 7.3.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Evidence in the literature surrounding obesity suggests that social factors play a substantial role in the spread of obesity. Although social ties with a friend who is obese increase the probability of becoming obese, the role of social media in this dynamic remains underexplored in obesity research. Given the rapid proliferation of social media in recent years, individuals socialize through social media and share their health-related daily routines, including dieting and exercising. Thus, it is timely and imperative to review previous studies focused on social factors in social media and obesity. Objective: This study aims to examine web-based social factors in relation to obesity research. Methods: We conducted a systematic review. We searched PubMed, Association for Computing Machinery, and ScienceDirect for articles published by July 5, 2019. Web-based social factors that are related to obesity behaviors were studied and analyzed. Results: In total, 1608 studies were identified from the selected databases. Of these 1608 studies, 50 (3.11%) studies met the eligibility criteria. In total, 10 types of web-based social factors were identified, and a socioecological model was adopted to explain their potential impact on an individual from varying levels of web-based social structure to social media users’ connection to the real world. Conclusions: We found 4 levels of interaction in social media. Gender was the only factor found at the individual level, and it affects user’s web-based obesity-related behaviors. Social support was the predominant factor identified, which benefits users in their weight loss journey at the interpersonal level. Some factors, such as stigma were also found to be associated with a healthy web-based social environment. Understanding the effectiveness of these factors is essential to help users create and maintain a healthy lifestyle. %M 35254279 %R 10.2196/25552 %U https://publichealth.jmir.org/2022/3/e25552 %U https://doi.org/10.2196/25552 %U http://www.ncbi.nlm.nih.gov/pubmed/35254279 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34831 %T The Challenge of Debunking Health Misinformation in Dynamic Social Media Conversations: Online Randomized Study of Public Masking During COVID-19 %A Mourali,Mehdi %A Drake,Carly %+ Haskayne School of Business, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada, 1 403 220 6684, mehdi.mourali@haskayne.ucalgary.ca %K misinformation %K debunking %K correction %K social media %K truth objectivity %K COVID-19 %K infodemiology %K health information %K digital health %K public health %K health professional %D 2022 %7 2.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The spread of false and misleading health information on social media can cause individual and social harm. Research on debunking has shown that properly designed corrections can mitigate the impact of misinformation, but little is known about the impact of correction in the context of prolonged social media debates. For example, when a social media user takes to Facebook to make a false claim about a health-related practice and a health expert subsequently refutes the claim, the conversation rarely ends there. Often, the social media user proceeds by rebuking the critic and doubling down on the claim. Objective: The aim of this study was to examine the impact of such extended back and forth between false claims and debunking attempts on observers’ dispositions toward behavior that science favors. We tested competing predictions about the effect of extended exposure on people’s attitudes and intentions toward masking in public during the early days of the COVID-19 pandemic and explored several psychological processes potentially underlying this effect. Methods: A total of 500 US residents took part in an online experiment in October 2020. They reported on their attitudes and intentions toward wearing masks in public. They were then randomly assigned to one of four social media exposure conditions (misinformation only vs misinformation+correction vs misinformation+correction+rebuke vs misinformation+correction+rebuke+second correction), and reported their attitudes and intentions for a second time. They also indicated whether they would consider sharing the thread if they were to see it on social media and answered questions on potential mediators and covariates. Results: Exposure to misinformation had a negative impact on attitudes and intentions toward masking (β=–.35, 95% CI –.42 to –.29; P<.001). Moreover, initial debunking of a false claim generally improved attitudes and intentions toward masking (β=.35, 95% CI .16 to .54; P<.001). However, this improvement was washed out by further exposure to false claims and debunking attempts (β=–.53, 95% CI –.72 to –.34; P<.001). The latter result is partially explained by a decrease in the perceived objectivity of truth. That is, extended exposure to false claims and debunking attempts appear to weaken the belief that there is an objectively correct answer to how people ought to behave in this situation, which in turn leads to less positive reactions toward masking as the prescribed behavior. Conclusions: Health professionals and science advocates face an underappreciated challenge in attempting to debunk misinformation on social media. Although engaging in extended debates with science deniers and other purveyors of bunk appears necessary, more research is needed to address the unintended consequences of such engagement. %M 35156933 %R 10.2196/34831 %U https://www.jmir.org/2022/3/e34831 %U https://doi.org/10.2196/34831 %U http://www.ncbi.nlm.nih.gov/pubmed/35156933 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e29422 %T Patient Influencers: The Next Frontier in Direct-to-Consumer Pharmaceutical Marketing %A Willis,Erin %A Delbaere,Marjorie %+ Department of Advertising, Public Relations, and Media Design, University of Colorado Boulder, 478 UCB, 1511 University Ave, Boulder, CO, 80310, United States, 1 3034927161, erin.willis@colorado.edu %K social media %K influencers %K health %K pharmaceutical marketing %K direct-to-consumer advertising %K relationship marketing %K marketing %K advertising %K pharmaceuticals %K ethics %D 2022 %7 1.3.2022 %9 Viewpoint %J J Med Internet Res %G English %X Social media influencers are becoming an increasingly popular strategic communication tactic used across industry verticals, including entertainment, fashion, and beauty, to engage directly with consumers. Pharmaceutical companies have also recently entered the social media marketing arena and—within the bounds of governmental regulations—have found ways to build relationships directly with patients using covert persuasion tactics like partnering with social media influencers. Due to consumers’ negative perceptions of pharmaceutical companies, it makes sense that new marketing tactics are being used to establish and improve relationships with consumers. Previous research well documents the ethical dilemmas of direct-to-consumer advertising, and there is recent burgeoning literature on online covert marketing tactics. The academic and medical literature, however, is behind in regard to social media influencers used in health and medicine. This paper highlights and defines terms used in industry practice, and also calls for more investigation and sets forward a research agenda. As consumers spend more time online and patients continue to consult social media for health information, it is important that this new marketing trend does not go unnoticed. %M 35230241 %R 10.2196/29422 %U https://www.jmir.org/2022/3/e29422 %U https://doi.org/10.2196/29422 %U http://www.ncbi.nlm.nih.gov/pubmed/35230241 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e27244 %T Detecting and Measuring Depression on Social Media Using a Machine Learning Approach: Systematic Review %A Liu,Danxia %A Feng,Xing Lin %A Ahmed,Farooq %A Shahid,Muhammad %A Guo,Jing %+ Department of Health Policy and Management, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China, 86 18086471505, jing624218@bjmu.edu.cn %K depression %K machine learning %K social media %D 2022 %7 1.3.2022 %9 Review %J JMIR Ment Health %G English %X Background: Detection of depression gained prominence soon after this troublesome disease emerged as a serious public health concern worldwide. Objective: This systematic review aims to summarize the findings of previous studies concerning applying machine learning (ML) methods to text data from social media to detect depressive symptoms and to suggest directions for future research in this area. Methods: A bibliographic search was conducted for the period of January 1990 to December 2020 in Google Scholar, PubMed, Medline, ERIC, PsycINFO, and BioMed. Two reviewers retrieved and independently assessed the 418 studies consisting of 322 articles identified through database searching and 96 articles identified through other sources; 17 of the studies met the criteria for inclusion. Results: Of the 17 studies, 10 had identified depression based on researcher-inferred mental status, 5 had identified it based on users’ own descriptions of their mental status, and 2 were identified based on community membership. The ML approaches of 13 of the 17 studies were supervised learning approaches, while 3 used unsupervised learning approaches; the remaining 1 study did not describe its ML approach. Challenges in areas such as sampling, optimization of approaches to prediction and their features, generalizability, privacy, and other ethical issues call for further research. Conclusions: ML approaches applied to text data from users on social media can work effectively in depression detection and could serve as complementary tools in public mental health practice. %M 35230252 %R 10.2196/27244 %U https://mental.jmir.org/2022/3/e27244 %U https://doi.org/10.2196/27244 %U http://www.ncbi.nlm.nih.gov/pubmed/35230252 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e33340 %T An Analysis of Skin of Color Content on TikTok %A Pulsipher,Kayd J %A Concilla,Anthony %A Presley,Colby L %A Laughter,Melissa R %A Anderson,Jaclyn %A Chea,Emily %A Lim,Kristina %A Rundle,Chandler W %A Szeto,Mindy D %A Dellavalle,Robert %+ Dermatology Service, Rocky Mountain Regional Medical Center, US Department of Veteran Affairs, 1700 N Wheeling St, Rm E1-342, Aurora, CO, 80045, United States, 1 720 857 5562, robert.dellavalle@cuanschutz.edu %K internet %K social media %K TikTok %K skin of color %K SoC %K influencer %K user engagement %K hashtag %K dermatologist %D 2022 %7 1.3.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 39499586 %R 10.2196/33340 %U https://derma.jmir.org/2022/1/e33340 %U https://doi.org/10.2196/33340 %U http://www.ncbi.nlm.nih.gov/pubmed/39499586 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e33058 %T Methods and Applications of Social Media Monitoring of Mental Health During Disasters: Scoping Review %A Teague,Samantha J %A Shatte,Adrian B R %A Weller,Emmelyn %A Fuller-Tyszkiewicz,Matthew %A Hutchinson,Delyse M %+ Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 1 Gheringhap St, Geelong, 3220, Australia, 61 3 924 68440, sam.teague@deakin.edu.au %K social media %K SNS %K mental health %K disaster %K big data %K digital psychiatry %D 2022 %7 28.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: With the increasing frequency and magnitude of disasters internationally, there is growing research and clinical interest in the application of social media sites for disaster mental health surveillance. However, important questions remain regarding the extent to which unstructured social media data can be harnessed for clinically meaningful decision-making. Objective: This comprehensive scoping review synthesizes interdisciplinary literature with a particular focus on research methods and applications. Methods: A total of 6 health and computer science databases were searched for studies published before April 20, 2021, resulting in the identification of 47 studies. Included studies were published in peer-reviewed outlets and examined mental health during disasters or crises by using social media data. Results: Applications across 31 mental health issues were identified, which were grouped into the following three broader themes: estimating mental health burden, planning or evaluating interventions and policies, and knowledge discovery. Mental health assessments were completed by primarily using lexical dictionaries and human annotations. The analyses included a range of supervised and unsupervised machine learning, statistical modeling, and qualitative techniques. The overall reporting quality was poor, with key details such as the total number of users and data features often not being reported. Further, biases in sample selection and related limitations in generalizability were often overlooked. Conclusions: The application of social media monitoring has considerable potential for measuring mental health impacts on populations during disasters. Studies have primarily conceptualized mental health in broad terms, such as distress or negative affect, but greater focus is required on validating mental health assessments. There was little evidence for the clinical integration of social media–based disaster mental health monitoring, such as combining surveillance with social media–based interventions or developing and testing real-world disaster management tools. To address issues with study quality, a structured set of reporting guidelines is recommended to improve the methodological quality, replicability, and clinical relevance of future research on the social media monitoring of mental health during disasters. %M 35225815 %R 10.2196/33058 %U https://mental.jmir.org/2022/2/e33058 %U https://doi.org/10.2196/33058 %U http://www.ncbi.nlm.nih.gov/pubmed/35225815 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e31943 %T The Dermatologist on Social Media: When the Pros Outweigh the Cons. Comment on “Risks and Benefits of Using Social Media in Dermatology: Cross-sectional Questionnaire Study” %A Concilla,Anthony %A Laughter,Melissa R %A Presley,Colby L %A Anderson,Jaclyn %A Rundle,Chandler W %+ Department of Dermatology, Duke University, 40 Duke Medicine Circle, Durham, NC, 27705, United States, 1 9196843432, chandler.rundle@duke.edu %K Instagram %K Twitter %K TikTok %K Facebook %K internet %K social media %K dermatologist %K generational differences %K information quality %K patient education %K online content %K risk %K benefit %K dermatology %K cross-sectional %K survey %K online health information %D 2022 %7 25.2.2022 %9 Letter to the Editor %J JMIR Dermatol %G English %X %M 37632875 %R 10.2196/31943 %U https://derma.jmir.org/2022/1/e31943 %U https://doi.org/10.2196/31943 %U http://www.ncbi.nlm.nih.gov/pubmed/37632875 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31793 %T (Mis)Information on Digital Platforms: Quantitative and Qualitative Analysis of Content From Twitter and Sina Weibo in the COVID-19 Pandemic %A Kreps,Sarah %A George,Julie %A Watson,Noah %A Cai,Gloria %A Ding,Keyi %+ Department of Government, Cornell University, 313 White Hall, Ithaca, NY, 14853, United States, 1 703 403 6550, sarah.kreps@cornell.edu %K internet %K social media %K misinformation %K COVID-19 %K Twitter %K Weibo %K prevalence %K discourse %K content %K communication %K public health %K context %K content analysis %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Misinformation about COVID-19 on social media has presented challenges to public health authorities during the pandemic. This paper leverages qualitative and quantitative content analysis on cross-platform, cross-national discourse and misinformation in the context of COVID-19. Specifically, we investigated COVID-19-related content on Twitter and Sina Weibo—the largest microblogging sites in the United States and China, respectively. Objective: Using data from 2 prominent microblogging platform, Twitter, based in the United States, and Sina Weibo, based in China, we compared the content and relative prevalence of misinformation to better understand public discourse of public health issues across social media and cultural contexts. Methods: A total of 3,579,575 posts were scraped from both Sina Weibo and Twitter, focusing on content from January 30, 2020, within 24 hours of when WHO declared COVID-19 a “public health emergency of international concern,” and a week later, on February 6, 2020. We examined how the use and engagement measured by keyword frequencies and hashtags differ across the 2 platforms. A 1% random sample of tweets that contained both the English keywords “coronavirus” and “covid-19” and the equivalent Chinese characters was extracted and analyzed based on changes in the frequencies of keywords and hashtags and the Viterbi algorithm. We manually coded a random selection of 5%-7% of the content to identify misinformation on each platform and compared posts using the WHO fact-check page to adjudicate accuracy of content. Results: Both platforms posted about the outbreak and transmission, but posts on Sina Weibo were less likely to reference topics such as WHO, Hong Kong, and death and more likely to cite themes of resisting, fighting, and cheering against coronavirus. Misinformation constituted 1.1% of Twitter content and 0.3% of Sina Weibo content—almost 4 times as much on Twitter compared to Sina Weibo. Conclusions: Quantitative and qualitative analysis of content on both platforms points to lower degrees of misinformation, more content designed to bolster morale, and less reference to topics such as WHO, death, and Hong Kong on Sina Weibo than on Twitter. %M 36406147 %R 10.2196/31793 %U https://infodemiology.jmir.org/2022/1/e31793 %U https://doi.org/10.2196/31793 %U http://www.ncbi.nlm.nih.gov/pubmed/36406147 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31978 %T Getting a Vaccine, Jab, or Vax Is More Than a Regular Expression. Comment on “COVID-19 Vaccine-Related Discussion on Twitter: Topic Modeling and Sentiment Analysis” %A Cummins,Jack Alexander %+ Manchester Essex Regional High School, 36 Lincoln Street, Manchester, MA, 01944, United States, 1 9788101169, 2jackcummins@gmail.com %K COVID-19 %K vaccine %K vaccination %K Twitter %K infodemiology %K infoveillance %K topic %K sentiment %K opinion %K discussion %K communication %K social media %K perception %K concern %K emotion %K natural language processing %D 2022 %7 23.2.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 35195531 %R 10.2196/31978 %U https://www.jmir.org/2022/2/e31978 %U https://doi.org/10.2196/31978 %U http://www.ncbi.nlm.nih.gov/pubmed/35195531 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31259 %T Understanding the #longCOVID and #longhaulers Conversation on Twitter: Multimethod Study %A Santarossa,Sara %A Rapp,Ashley %A Sardinas,Saily %A Hussein,Janine %A Ramirez,Alex %A Cassidy-Bushrow,Andrea E %A Cheng,Philip %A Yu,Eunice %+ Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, United States, 1 3138747960, ssantar1@hfhs.org %K COVID-19 %K postacute sequela of COVID-19 %K PASC %K patient-centered care %K social media %K social network analysis %K long term %K symptom %K Twitter %K communication %K insight %K perception %K experience %K patient-centered %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The scientific community is just beginning to uncover the potential long-term effects of COVID-19, and one way to start gathering information is by examining the present discourse on the topic. The conversation about long COVID-19 on Twitter provides insight into related public perception and personal experiences. Objective: The aim of this study was to investigate the #longCOVID and #longhaulers conversations on Twitter by examining the combined effects of topic discussion and social network analysis for discovery on long COVID-19. Methods: A multipronged approach was used to analyze data (N=2500 records from Twitter) about long COVID-19 and from people experiencing long COVID-19. A text analysis was performed by both human coders and Netlytic, a cloud-based text and social networks analyzer. The social network analysis generated Name and Chain networks that showed connections and interactions between Twitter users. Results: Among the 2010 tweets about long COVID-19 and 490 tweets by COVID-19 long haulers, 30,923 and 7817 unique words were found, respectively. For both conversation types, “#longcovid” and “covid” were the most frequently mentioned words; however, through visually inspecting the data, words relevant to having long COVID-19 (ie, symptoms, fatigue, pain) were more prominent in tweets by COVID-19 long haulers. When discussing long COVID-19, the most prominent frames were “support” (1090/1931, 56.45%) and “research” (435/1931, 22.53%). In COVID-19 long haulers conversations, “symptoms” (297/483, 61.5%) and “building a community” (152/483, 31.5%) were the most prominent frames. The social network analysis revealed that for both tweets about long COVID-19 and tweets by COVID-19 long haulers, networks are highly decentralized, fragmented, and loosely connected. Conclusions: This study provides a glimpse into the ways long COVID-19 is framed by social network users. Understanding these perspectives may help generate future patient-centered research questions. %M 35229074 %R 10.2196/31259 %U https://infodemiology.jmir.org/2022/1/e31259 %U https://doi.org/10.2196/31259 %U http://www.ncbi.nlm.nih.gov/pubmed/35229074 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29821 %T Using Social Media to Engage Knowledge Users in Health Research Priority Setting: Scoping Review %A Sivaratnam,Surabhi %A Hwang,Kyobin %A Chee-A-Tow,Alyssandra %A Ren,Lily %A Fang,Geoffrey %A Jibb,Lindsay %+ Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada, 1 416 813 7654 ext 309160, lindsay.jibb@sickkids.ca %K social media %K research priority-setting %K knowledge user %K scoping review %D 2022 %7 21.2.2022 %9 Review %J J Med Internet Res %G English %X Background: The need to include individuals with lived experience (ie, patients, family members, caregivers, researchers, and clinicians) in health research priority setting is becoming increasingly recognized. Social media–based methods represent a means to elicit and prioritize the research interests of such individuals, but there remains sparse methodological guidance on how best to conduct these social media efforts and assess their effectiveness. Objective: This review aims to identify social media strategies that enhance participation in priority-setting research, collate metrics assessing the effectiveness of social media campaigns, and summarize the benefits and limitations of social media–based research approaches, as well as recommendations for prospective campaigns. Methods: We searched PubMed, Embase, Cochrane Library, Scopus, and Web of Science from database inception until September 2021. Two reviewers independently screened all titles and abstracts, as well as full texts for studies that implemented and evaluated social media strategies aimed at engaging knowledge users in research priority setting. We subsequently conducted a thematic analysis to aggregate study data by related codes and themes. Results: A total of 23 papers reporting on 22 unique studies were included. These studies used Facebook, Twitter, Reddit, websites, video-calling platforms, emails, blogs, e-newsletters, and web-based forums to engage with health research stakeholders. Priority-setting engagement strategies included paid platform–based advertisements, email-embedded survey links, and question-and-answer forums. Dissemination techniques for priority-setting surveys included snowball sampling and the circulation of participation opportunities via internal members’ and external organizations’ social media platforms. Social media campaign effectiveness was directly assessed as number of clicks and impressions on posts, frequency of viewed posts, volume of comments and replies, number of times individuals searched for a campaign page, and number of times a hashtag was used. Campaign effectiveness was indirectly assessed as numbers of priority-setting survey responses and visits to external survey administration sites. Recommendations to enhance engagement included the use of social media group moderators, opportunities for peer-to-peer interaction, and the establishment of a consistent tone and brand. Conclusions: Social media may increase the speed and reach of priority-setting participation opportunities leading to the development of research agendas informed by patients, family caregivers, clinicians, and researchers. Perceived limitations of the approach include underrepresentation of certain demographic groups and addressing such limitations will enhance the inclusion of diverse research priority opinions in future research agendas. %M 35188476 %R 10.2196/29821 %U https://www.jmir.org/2022/2/e29821 %U https://doi.org/10.2196/29821 %U http://www.ncbi.nlm.nih.gov/pubmed/35188476 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e29246 %T Constituents’ Inferences of Local Governments’ Goals and the Relationship Between Political Party and Belief in COVID-19 Misinformation: Cross-sectional Survey of Twitter Followers of State Public Health Departments %A Stevens,Hannah %A Palomares,Nicholas A %+ Department of Communication, College of Letters and Science, University of California, Davis, One Shields Ave, Davis, CA, 95616, United States, 1 530 752 0966, hrstevens@ucdavis.edu %K COVID-19 %K outbreak %K mass communication %K Twitter %K goal inferences %K political agendas %K misinformation %K infodemic %K partisanship %K health information %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Amid the COVID-19 pandemic, social media have influenced the circulation of health information. Public health agencies often use Twitter to disseminate and amplify the propagation of such information. Still, exposure to local government–endorsed COVID-19 public health information does not make one immune to believing misinformation. Moreover, not all health information on Twitter is accurate, and some users may believe misinformation and disinformation just as much as those who endorse more accurate information. This situation is complicated, given that elected officials may pursue a political agenda of re-election by downplaying the need for COVID-19 restrictions. The politically polarized nature of information and misinformation on social media in the United States has fueled a COVID-19 infodemic. Because pre-existing political beliefs can both facilitate and hinder persuasion, Twitter users’ belief in COVID-19 misinformation is likely a function of their goal inferences about their local government agencies’ motives for addressing the COVID-19 pandemic. Objective: We shed light on the cognitive processes of goal understanding that underlie the relationship between partisanship and belief in health misinformation. We investigate how the valence of Twitter users’ goal inferences of local governments’ COVID-19 efforts predicts their belief in COVID-19 misinformation as a function of their political party affiliation. Methods: We conducted a web-based cross-sectional survey of US Twitter users who followed their state’s official Department of Public Health Twitter account (n=258) between August 10 and December 23, 2020. Inferences about local governments’ goals, demographics, and belief in COVID-19 misinformation were measured. State political affiliation was controlled. Results: Participants from all 50 states were included in the sample. An interaction emerged between political party affiliation and goal inference valence for belief in COVID-19 misinformation (∆R2=0.04; F8,249=4.78; P<.001); positive goal inference valence predicted increased belief in COVID-19 misinformation among Republicans (β=.47; t249=2.59; P=.01) but not among Democrats (β=.07; t249=0.84; P=.40). Conclusions: Our results reveal that favorable inferences about local governments’ COVID-19 efforts can accelerate belief in misinformation among Republican-identifying constituents. In other words, accurate COVID-19 transmission knowledge is a function of constituents' sentiment toward politicians rather than science, which has significant implications on public health efforts for minimizing the spread of the disease, as convincing misinformed constituents to practice safety measures might be a political issue just as much as it is a health one. Our work suggests that goal understanding processes matter for misinformation about COVID-19 among Republicans. Those responsible for future COVID-19 public health messaging aimed at increasing belief in valid information about COVID-19 should recognize the need to test persuasive appeals that address partisans’ pre-existing political views in order to prevent individuals’ goal inferences from interfering with public health messaging. %M 37113808 %R 10.2196/29246 %U https://infodemiology.jmir.org/2022/1/e29246 %U https://doi.org/10.2196/29246 %U http://www.ncbi.nlm.nih.gov/pubmed/37113808 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31473 %T The Evolution of Public Sentiments During the COVID-19 Pandemic: Case Comparisons of India, Singapore, South Korea, the United Kingdom, and the United States %A Lwin,May O %A Sheldenkar,Anita %A Lu,Jiahui %A Schulz,Peter Johannes %A Shin,Wonsun %A Panchapakesan,Chitra %A Gupta,Raj Kumar %A Yang,Yinping %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore, 637718, Singapore, 65 82623610, anitas@ntu.edu.sg %K COVID-19 %K public sentiment %K Twitter %K crisis communication %K cross-country comparison %K sentiment %K social media %K communication %K public health %K health information %K emotion %K perception %K health literacy %K information literacy %K digital literacy %K community health %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Public sentiments are an important indicator of crisis response, with the need to balance exigency without adding to panic or projecting overconfidence. Given the rapid spread of the COVID-19 pandemic, governments have enacted various nationwide measures against the disease with social media platforms providing the previously unparalleled communication space for the global populations. Objective: This research aims to examine and provide a macro-level narrative of the evolution of public sentiments on social media at national levels, by comparing Twitter data from India, Singapore, South Korea, the United Kingdom, and the United States during the current pandemic. Methods: A total of 67,363,091 Twitter posts on COVID-19 from January 28, 2020, to April 28, 2021, were analyzed from the 5 countries with “wuhan,” “corona,” “nCov,” and “covid” as search keywords. Change in sentiments (“very negative,” “negative,” “neutral or mixed,” “positive,” “very positive”) were compared between countries in connection with disease milestones and public health directives. Results: Country-specific assessments show that negative sentiments were predominant across all 5 countries during the initial period of the global pandemic. However, positive sentiments encompassing hope, resilience, and support arose at differing intensities across the 5 countries, particularly in Asian countries. In the next stage of the pandemic, India, Singapore, and South Korea faced escalating waves of COVID-19 cases, resulting in negative sentiments, but positive sentiments appeared simultaneously. In contrast, although negative sentiments in the United Kingdom and the United States increased substantially after the declaration of a national public emergency, strong parallel positive sentiments were slow to surface. Conclusions: Our findings on sentiments across countries facing similar outbreak concerns suggest potential associations between government response actions both in terms of policy and communications, and public sentiment trends. Overall, a more concerted approach to government crisis communication appears to be associated with more stable and less volatile public sentiments over the evolution of the COVID-19 pandemic. %M 37113803 %R 10.2196/31473 %U https://infodemiology.jmir.org/2022/1/e31473 %U https://doi.org/10.2196/31473 %U http://www.ncbi.nlm.nih.gov/pubmed/37113803 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e35164 %T Loss of Weight Gained During the COVID-19 Pandemic: Content Analysis of YouTube Videos %A Tang,Hao %A Kim,Sungwoo %A Laforet,Priscila E %A Tettey,Naa-Solo %A Basch,Corey H %+ Department of Health and Behavior Studies, Teachers College, Columbia University, 528 West 121st Street, New York, NY, 10027, United States, 1 2126783964, ht2489@tc.columbia.edu %K COVID-19 %K quarantine %K weight loss %K weight gain %K social media %K YouTube %D 2022 %7 9.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many people experienced unintended weight gain during the COVID-19 pandemic, which has been discussed widely on social media. Objective: This study aims to describe the content of weight loss videos on YouTube (Google LLC) during the COVID-19 pandemic. Methods: By using the keywords weight loss during quarantine, the 100 most viewed English-language videos were identified and coded for content related to losing weight gained during the COVID-19 pandemic. Results: In total, 9 videos were excluded due to having non-English content or posting data before the COVID-19 pandemic. The 91 videos included in the study sample acquired 407,326 views at the time of study and were roughly 14 minutes long. A total of 48% (44/91) of the sample videos included graphic comparisons to illustrate weight change. Videos that included a graphic comparison were more likely to have content related to trigger warnings (χ21=6.05; P=.01), weight loss (χ21=13.39; P<.001), negative feelings during quarantine (χ21=4.75; P=.03), instructions for losing weight (χ21=9.17; P=.002), self-love (χ21=6.01; P=.01), body shaming (χ21=4.36; P=.04), and special dietary practices (χ21=11.10; P<.001) but were less likely to include food recipes (χ21=5.05; P=.03). Our regression analysis results suggested that mentioning quarantine (P=.05), fat-gaining food (P=.04), self-care and self-love (P=.05), and body shaming (P=.008) and having presenters from both sexes (P<.001) are significant predictors for a higher number of views. Our adjusted regression model suggested that videos with content about routine change have significantly lower view counts (P=.03) than those of videos without such content. Conclusions: The findings of this study indicate the ways in which YouTube is being used to showcase COVID-19–related weight loss in a pre-post fashion. The use of graphic comparisons garnered a great deal of attention. Additional studies are needed to understand the role of graphic comparisons in social media posts. Further studies that focus on people’s attitudes and behaviors toward weight change during the COVID-19 pandemic and the implications of social media on these attitudes and behaviors are warranted. %M 34978534 %R 10.2196/35164 %U https://formative.jmir.org/2022/2/e35164 %U https://doi.org/10.2196/35164 %U http://www.ncbi.nlm.nih.gov/pubmed/34978534 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31726 %T COVID-19 Vaccine Tweets After Vaccine Rollout: Sentiment–Based Topic Modeling %A Huangfu,Luwen %A Mo,Yiwen %A Zhang,Peijie %A Zeng,Daniel Dajun %A He,Saike %+ The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Haidian District, Beijing, 100190, China, 86 (010)82544537, saike.he@ia.ac.cn %K COVID-19 %K COVID-19 vaccine %K sentiment evolution %K topic modeling %K social media %K text mining %D 2022 %7 8.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 vaccines are one of the most effective preventive strategies for containing the pandemic. Having a better understanding of the public’s conceptions of COVID-19 vaccines may aid in the effort to promptly and thoroughly vaccinate the community. However, because no empirical research has yet fully explored the public’s vaccine awareness through sentiment–based topic modeling, little is known about the evolution of public attitude since the rollout of COVID-19 vaccines. Objective: In this study, we specifically focused on tweets about COVID-19 vaccines (Pfizer, Moderna, AstraZeneca, and Johnson & Johnson) after vaccines became publicly available. We aimed to explore the overall sentiments and topics of tweets about COVID-19 vaccines, as well as how such sentiments and main concerns evolved. Methods: We collected 1,122,139 tweets related to COVID-19 vaccines from December 14, 2020, to April 30, 2021, using Twitter’s application programming interface. We removed retweets and duplicate tweets to avoid data redundancy, which resulted in 857,128 tweets. We then applied sentiment–based topic modeling by using the compound score to determine sentiment polarity and the coherence score to determine the optimal topic number for different sentiment polarity categories. Finally, we calculated the topic distribution to illustrate the topic evolution of main concerns. Results: Overall, 398,661 (46.51%) were positive, 204,084 (23.81%) were negative, 245,976 (28.70%) were neutral, 6899 (0.80%) were highly positive, and 1508 (0.18%) were highly negative sentiments. The main topics of positive and highly positive tweets were planning for getting vaccination (251,979/405,560, 62.13%), getting vaccination (76,029/405,560, 18.75%), and vaccine information and knowledge (21,127/405,560, 5.21%). The main concerns in negative and highly negative tweets were vaccine hesitancy (115,206/205,592, 56.04%), extreme side effects of the vaccines (19,690/205,592, 9.58%), and vaccine supply and rollout (17,154/205,592, 8.34%). During the study period, negative sentiment trends were stable, while positive sentiments could be easily influenced. Topic heatmap visualization demonstrated how main concerns changed during the current widespread vaccination campaign. Conclusions: To the best of our knowledge, this is the first study to evaluate public COVID-19 vaccine awareness and awareness trends on social media with automated sentiment–based topic modeling after vaccine rollout. Our results can help policymakers and research communities track public attitudes toward COVID-19 vaccines and help them make decisions to promote the vaccination campaign. %M 34783665 %R 10.2196/31726 %U https://www.jmir.org/2022/2/e31726 %U https://doi.org/10.2196/31726 %U http://www.ncbi.nlm.nih.gov/pubmed/34783665 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31569 %T Authors’ Reply: Understanding the Impact of Social Media Information and Misinformation Producers on Health Information Seeking. Comment on “Health Information Seeking Behaviors on Social Media During the COVID-19 Pandemic Among American Social Networking Site Users: Survey Study” %A Neely,Stephen %A Eldredge,Christina %A Sanders,Ronald %+ School of Public Affairs, University of South Florida, 4202 E Fowler Ave, SOC 107, Tampa, FL, 33620, United States, 1 8139748423, srneely@usf.edu %K social media %K internet %K communication %K public health %K COVID-19 %K usage %K United States %K information seeking %K web-based health information %K online health information %K survey %K mistrust %K vaccination %K misinformation %D 2022 %7 4.2.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X   %M 35119376 %R 10.2196/31569 %U https://www.jmir.org/2022/2/e31569 %U https://doi.org/10.2196/31569 %U http://www.ncbi.nlm.nih.gov/pubmed/35119376 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31415 %T Understanding the Impact of Social Media Information and Misinformation Producers on Health Information Seeking. Comment on “Health Information Seeking Behaviors on Social Media During the COVID-19 Pandemic Among American Social Networking Site Users: Survey Study” %A Boudreau,Hunter %A Singh,Nikhi %A Boyd,Carter J %+ School of Medicine, University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL, 35233, United States, 1 251 545 0115, Hboud@uab.edu %K social media %K internet %K communication %K public health %K COVID-19 %K usage %K United States %K information seeking %K web-based health information %K online health information %K survey %K mistrust %K vaccination %K misinformation %D 2022 %7 4.2.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X   %M 35076408 %R 10.2196/31415 %U https://www.jmir.org/2022/2/e31415 %U https://doi.org/10.2196/31415 %U http://www.ncbi.nlm.nih.gov/pubmed/35076408 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e25216 %T Public Reactions to the New York State Policy on Flavored Electronic Cigarettes on Twitter: Observational Study %A Sun,Li %A Lu,Xinyi %A Xie,Zidian %A Li,Dongmei %+ Department of Clinical & Translational Research, University of Rochester Medical Center, Saunders Research Building 1.303J, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K New York State policy %K flavored e-cigarettes %K Twitter %K social media %K vaping %K e-cigarette %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Flavored electronic cigarettes (e-cigarettes) have become popular in recent years, especially among youth and young adults. To address the epidemic of e-cigarettes, New York State approved a ban on sales of most flavored vaping products other than tobacco and menthol flavors on September 17, 2019. Objective: This study aims to examine the attitude of Twitter users to the policy on flavored e-cigarettes in New York State and the impact of this policy on public perceptions of e-cigarettes. This study also compares the attitudes and topics between New York Twitter users and Twitter users from other states who were not directly affected by this policy. Methods: Tweets related to e-cigarettes and the New York State policy on flavored e-cigarettes were collected using the Twitter streaming application programming interface from June 2019 to December 2019. Tweets from New York State and those from other states that did not have a flavored e-cigarette policy were extracted. Sentiment analysis was applied to analyze the proportion of negative and positive tweets about e-cigarettes or the flavor policy. Topic modeling was applied to e-cigarette–related data sets and New York flavor policy–related data sets to identify the most frequent topics before and after the announcement of the New York State policy. Results: We found that the average number of tweets related to e-cigarettes and the New York State policy on flavored e-cigarettes increased in both New York State and other states after the flavor policy announcement. Sentiment analysis revealed that after the announcement of the New York State flavor policy, in both New York State and other states, the proportion of negative tweets on e-cigarettes increased from 34.07% (4531/13,299) to 44.58% (18,451/41,390) and from 32.48% (14,320/44,090) to 44.40% (64,262/144,734), respectively, while positive tweets decreased significantly from 39.03% (5191/13,299) to 32.86% (13,601/41,390) and from 42.78% (18,863/44,090) to 33.93% (49,105/144,734), respectively. The majority of tweets related to the New York State flavor policy were negative both before and after the announcement of this policy in both New York (87/98, 89% and 3810/4565, 83.46%, respectively) and other states (200/255, 78.4% and 12,695/15,569, 81.54%, respectively), while New York State had a higher proportion of negative tweets than other states. Topic modeling results demonstrated that teenage vaping and health problems were the most discussed topics associated with e-cigarettes. Conclusions: Public attitudes toward e-cigarettes became more negative on Twitter after New York State announced the policy on flavored e-cigarettes. Twitter users in other states that did not have such a policy on flavored e-cigarettes paid close attention to the New York State flavor policy. This study provides some valuable information about the potential impact of the flavored e-cigarettes policy in New York State on public attitudes toward flavored e-cigarettes. %M 35113035 %R 10.2196/25216 %U https://publichealth.jmir.org/2022/2/e25216 %U https://doi.org/10.2196/25216 %U http://www.ncbi.nlm.nih.gov/pubmed/35113035 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e35552 %T A Deadly Infodemic: Social Media and the Power of COVID-19 Misinformation %A Gisondi,Michael A %A Barber,Rachel %A Faust,Jemery Samuel %A Raja,Ali %A Strehlow,Matthew C %A Westafer,Lauren M %A Gottlieb,Michael %+ The Precision Education and Assessment Research Lab, Department of Emergency Medicine, Stanford University, 900 Welch Road - Suite 350, Palo Alto, CA, 94304, United States, 1 650 721 4023, mgisondi@stanford.edu %K COVID-19 %K social media %K misinformation %K disinformation %K infodemic %K ethics %K vaccination %K vaccine hesitancy %K infoveillance %K vaccine %D 2022 %7 1.2.2022 %9 Editorial %J J Med Internet Res %G English %X COVID-19 is currently the third leading cause of death in the United States, and unvaccinated people continue to die in high numbers. Vaccine hesitancy and vaccine refusal are fueled by COVID-19 misinformation and disinformation on social media platforms. This online COVID-19 infodemic has deadly consequences. In this editorial, the authors examine the roles that social media companies play in the COVID-19 infodemic and their obligations to end it. They describe how fake news about the virus developed on social media and acknowledge the initially muted response by the scientific community to counteract misinformation. The authors then challenge social media companies to better mitigate the COVID-19 infodemic, describing legal and ethical imperatives to do so. They close with recommendations for better partnerships with community influencers and implementation scientists, and they provide the next steps for all readers to consider. This guest editorial accompanies the Journal of Medical Internet Research special theme issue, “Social Media, Ethics, and COVID-19 Misinformation.” %M 35007204 %R 10.2196/35552 %U https://www.jmir.org/2022/2/e35552 %U https://doi.org/10.2196/35552 %U http://www.ncbi.nlm.nih.gov/pubmed/35007204 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e31911 %T Elements That Underpin the Design, Development, and Evaluation of Social Media Health Interventions: Protocol for a Scoping Review %A Nizam,Mohammed Zayan %A Powell,Leigh %A Zary,Nabil %+ Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, PO Box 505055, Dubai, 800 MBRU, United Arab Emirates, 971 585960762, Nabil.Zary@mbru.ac.ae %K social media %K health intervention %K behavior change models %K health improvement %K intervention design %K models of design %K evaluating interventions %D 2022 %7 1.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social media use has grown tremendously over the years. Given the volume and diversity of people on social media and the amount of information being exchanged, it is perhaps unsurprising that social media is being used as an avenue to disseminate and deliver health interventions. There exists an opportunity for social media health interventions to make a positive impact on health. However, there is a need to understand more about the ways in which these interventions are designed, developed, and evaluated. This scoping protocol will review the current state of this field by charting the elements that drive the design, development, and evaluation of these interventions. This includes charting models, frameworks, and rationales for the interventions, as well as the platforms being used, and the health behaviors being targeted. This intention of this scoping review is to help inform those who wish to develop effective social media health interventions. Objective: The objective of this review is to map the elements that drive the design, development, and evaluation of social media health interventions. We define “social media health intervention” as interventions that make use of social media platforms to disseminate or deliver health-related information and educational initiatives to the public. We will seek to chart the elements that drive the design, development, and delivery of such interventions, including their platforms and targeted health behaviors. Methods: The methodological framework for this review is guided by Arksey and O’Malley and enhancements by later studies. We will search relevant literature from 9 databases: (1) PubMed, (2) PsycINFO, (3) EMBASE, (4) Web of Science, (5) Scopus, (6) CINAHL, (7) ERIC, (8) MEDLINE, and (9) Google Scholar. The literature will be screened by at least two reviewers in 2 stages: (1) title/abstract screening against the eligibility criteria; and (2) eligible articles will then undergo a full-text screening. Data will be charted using the data charting tool developed by the authors. Results: The results of this study will be presented in a final scoping review paper, divided into 2 sections. The first section will describe the search strategy and study selection process and will contain the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. The second section will provide key details pertaining to the review objective and question. Conclusions: This review will help guide scholars looking to build social media health interventions toward evidence-based practices in design and evaluation. International Registered Report Identifier (IRRID): PRR1-10.2196/31911 %M 34848388 %R 10.2196/31911 %U https://www.researchprotocols.org/2022/2/e31911 %U https://doi.org/10.2196/31911 %U http://www.ncbi.nlm.nih.gov/pubmed/34848388 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e35286 %T Using Social Media in Health Care Research Should Proceed With Caution. Comment on “The Use of Social Media for Health Research Purposes: Scoping Review” %A Girardi,Abdias %A Singh,Nikhi Paul %A Boyd,Carter Joseph %+ Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL, 35233, United States, 1 2055633208, nsingh@uab.edu %K public health %K epidemiology %K research %K health %K medical %K social networking %K infodemiology %K eHealth %K text mining %K medical education %K social media %K information technology %K health care %K HIPAA %K education %D 2022 %7 28.1.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X   %M 35089149 %R 10.2196/35286 %U https://www.jmir.org/2022/1/e35286 %U https://doi.org/10.2196/35286 %U http://www.ncbi.nlm.nih.gov/pubmed/35089149 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e30679 %T An Exploration of e-Cigarette–Related Search Items on YouTube: Network Analysis %A Dashtian,Hassan %A Murthy,Dhiraj %A Kong,Grace %+ The Computational Media Lab and School of Journalism and Media, The University of Texas at Austin, 300 W. Dean Keeton (A0900), Austin, TX, 78712-1069, United States, 1 512 471 5775, Dhiraj.Murthy@austin.utexas.edu %K electronic nicotine delivery systems %K vaping %K social media %K search engine %K natural language processing %K social network analysis %D 2022 %7 27.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: e-Cigarette use among youth is high, which may be due in part to pro–e-cigarette content on social media such as YouTube. YouTube is also a valuable resource for learning about e-cigarette use, trends, marketing, and e-cigarette user perceptions. However, there is a lack of understanding on how similar e-cigarette–related search items result in similar or relatively mutually exclusive search results. This study uses novel methods to evaluate the relationship between e-cigarette–related search items and results. Objective: The aim of this study is to apply network modeling and rule-based classification to characterize the relationships between e-cigarette–related search items on YouTube and gauge the level of importance of each search item as part of an e-cigarette information network on YouTube. Methods: We used 16 fictitious YouTube profiles to retrieve 4201 distinct videos from 18 keywords related to e-cigarettes. We used network modeling to represent the relationships between the search items. Moreover, we developed a rule-based classification approach to classify videos. We used betweenness centrality (BC) and correlations between nodes (ie, search items) to help us gain knowledge of the underlying structure of the information network. Results: By modeling search items and videos as a network, we observed that broad search items such as e-cig had the most connections to other search items, and specific search items such as cigalike had the least connections. Search items with similar words (eg, vape and vaping) and search items with similar meaning (eg, e-liquid and e-juice) yielded a high degree of connectedness. We also found that each node had 18 (SD 34.8) connections (common videos) on average. BC indicated that general search items such as electronic cigarette and vaping had high importance in the network (BC=0.00836). Our rule-based classification sorted videos into four categories: e-cigarette devices (34%-57%), cannabis vaping (16%-28%), e-liquid (14%-37%), and other (8%-22%). Conclusions: Our findings indicate that search items on YouTube have unique relationships that vary in strength and importance. Our methods can not only be used to successfully identify the important, overlapping, and unique e-cigarette–related search items but also help determine which search items are more likely to act as a gateway to e-cigarette–related content. %M 35084353 %R 10.2196/30679 %U https://www.jmir.org/2022/1/e30679 %U https://doi.org/10.2196/30679 %U http://www.ncbi.nlm.nih.gov/pubmed/35084353 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e27719 %T Measuring Problematic Internet Use, Internet Gaming Disorder, and Social Media Addiction in Young Adults: Cross-sectional Survey Study %A Moreno,Megan %A Riddle,Karyn %A Jenkins,Marina C %A Singh,Ajay Paul %A Zhao,Qianqian %A Eickhoff,Jens %+ Department of Pediatrics, University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, United States, 1 6082632846, mamoreno@pediatrics.wisc.edu %K technology %K young adults %K addiction %K social media %K internet %K video games %K screening %K surveillance %K cross-sectional %K survey %K mobile phone %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital technology use is nearly ubiquitous among young adults; this use provides both benefits and risks. The risks of technology use include maladaptive technology use or technology addiction. Several conceptualizations of these addictions have emerged, each with its own assessment tools. These conditions include problematic internet use (PIU), internet gaming disorder (IGD), and social media addiction (SMA). These conditions have been associated with health outcomes such as problematic alcohol use, sleep disorders, and mental illness. These maladaptive technology conditions have been most commonly studied in isolation from each other. Objective: The aim of this study is to examine PIU, IGD, and SMA together to better inform future research approaches and provider screening practices for young adults. Methods: This cross-sectional survey study was conducted using Qualtrics panel-based recruitment and survey hosting. We recruited US young adults aged 18-25 years. The survey assessed PIU, IGD, and SMA. Survey measures also included assessments of problematic alcohol use, sleep, depression, and anxiety. We evaluated the frequency of and overlap in positive screening scores among PIU, IGD, and SMA and modeled each condition using multivariate logistic regression. Finally, we calculated sensitivity and specificity, as well as the positive predictive value and negative predictive value of the screening tools using the most prevalent maladaptive technology type. Results: Our 6000 participants had an average age of 21.7 (SD 2.5) years. Of these 6000 participants, 3062 (51.03%) were female, 3431 (57.18%) were Caucasian, 1686 (28.1%) were in a 4-year college program, and 2319 (38.65%) worked full time. The mean PIU score was 3.5 (SD 3.1), and 53.58% (3215/6000) of participants met the criteria for PIU. The mean IGD score was 2.7 (SD 2.6), and 24.33% (1460/6000) of participants met the criteria for IGD. The mean SMA score was 7.5 (SD 5.7), and 3.42% (205/6000) met the criteria for SMA. Across all 3 maladaptive technology use diagnoses, there were varied associations with demographic variables and similar overlap with health outcomes. The sensitivity of PIU screening to detect IGD was 82% and to detect SMA was 93%, whereas the specificity and positive predictive value were much lower (37%-54% specificity; 6%-37% positive predictive value). Conclusions: This cross-sectional survey screened a large national sample of adolescents and young adults for PIU, IGD, and SMA to determine prevalence and overlap, demographic associations with each, and associations between these technology-related conditions and health outcomes. There was overlap across PIU, IGD, and SMA in some associated demographic variables and health outcomes. However, the patterns in the associated variables demonstrated unique qualities of each of these conditions. %M 34081596 %R 10.2196/27719 %U https://publichealth.jmir.org/2022/1/e27719 %U https://doi.org/10.2196/27719 %U http://www.ncbi.nlm.nih.gov/pubmed/34081596 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28152 %T Medical and Health-Related Misinformation on Social Media: Bibliometric Study of the Scientific Literature %A Yeung,Andy Wai Kan %A Tosevska,Anela %A Klager,Elisabeth %A Eibensteiner,Fabian %A Tsagkaris,Christos %A Parvanov,Emil D %A Nawaz,Faisal A %A Völkl-Kernstock,Sabine %A Schaden,Eva %A Kletecka-Pulker,Maria %A Willschke,Harald %A Atanasov,Atanas G %+ Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria, 43 664 1929 852, Atanas.Atanasov@dhps.lbg.ac.at %K COVID-19 %K Twitter %K health %K social media %K bibliometric %K dissemination %K knowledge exchange %D 2022 %7 25.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media has been extensively used for the communication of health-related information and consecutively for the potential spread of medical misinformation. Conventional systematic reviews have been published on this topic to identify original articles and to summarize their methodological approaches and themes. A bibliometric study could complement their findings, for instance, by evaluating the geographical distribution of the publications and determining if they were well cited and disseminated in high-impact journals. Objective: The aim of this study was to perform a bibliometric analysis of the current literature to discover the prevalent trends and topics related to medical misinformation on social media. Methods: The Web of Science Core Collection electronic database was accessed to identify relevant papers with the following search string: ALL=(misinformati* OR “wrong informati*” OR disinformati* OR “misleading informati*” OR “fake news*”) AND ALL=(medic* OR illness* OR disease* OR health* OR pharma* OR drug* OR therap*) AND ALL=(“social media*” OR Facebook* OR Twitter* OR Instagram* OR YouTube* OR Weibo* OR Whatsapp* OR Reddit* OR TikTok* OR WeChat*). Full records were exported to a bibliometric software, VOSviewer, to link bibliographic information with citation data. Term and keyword maps were created to illustrate recurring terms and keywords. Results: Based on an analysis of 529 papers on medical and health-related misinformation on social media, we found that the most popularly investigated social media platforms were Twitter (n=90), YouTube (n=67), and Facebook (n=57). Articles targeting these 3 platforms had higher citations per paper (>13.7) than articles covering other social media platforms (Instagram, Weibo, WhatsApp, Reddit, and WeChat; citations per paper <8.7). Moreover, social media platform–specific papers accounted for 44.1% (233/529) of all identified publications. Investigations on these platforms had different foci. Twitter-based research explored cyberchondria and hypochondriasis, YouTube-based research explored tobacco smoking, and Facebook-based research studied vaccine hesitancy related to autism. COVID-19 was a common topic investigated across all platforms. Overall, the United States contributed to half of all identified papers, and 80% of the top 10 most productive institutions were based in this country. The identified papers were mostly published in journals of the categories public environmental and occupational health, communication, health care sciences services, medical informatics, and medicine general internal, with the top journal being the Journal of Medical Internet Research. Conclusions: There is a significant platform-specific topic preference for social media investigations on medical misinformation. With a large population of internet users from China, it may be reasonably expected that Weibo, WeChat, and TikTok (and its Chinese version Douyin) would be more investigated in future studies. Currently, these platforms present research gaps that leave their usage and information dissemination warranting further evaluation. Future studies should also include social platforms targeting non-English users to provide a wider global perspective. %M 34951864 %R 10.2196/28152 %U https://www.jmir.org/2022/1/e28152 %U https://doi.org/10.2196/28152 %U http://www.ncbi.nlm.nih.gov/pubmed/34951864 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e30388 %T Investigation of Carers’ Perspectives of Dementia Misconceptions on Twitter: Focus Group Study %A Hudson,Georgie %A Jansli,Sonja M %A Erturk,Sinan %A Morris,Daniel %A Odoi,Clarissa M %A Clayton-Turner,Angela %A Bray,Vanessa %A Yourston,Gill %A Clouden,Doreen %A Proudfoot,David %A Cornwall,Andrew %A Waldron,Claire %A Wykes,Til %A Jilka,Sagar %+ Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 2.13 Henry Wellcome Building, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 7708715627, sagar.jilka@kcl.ac.uk %K patient and public involvement %K dementia %K co-production %K misconceptions %K stigma %K Twitter %K social media %K Alzheimer’s Disease %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Dementia misconceptions on social media are common, with negative effects on people with the condition, their carers, and those who know them. This study codeveloped a thematic framework with carers to understand the forms these misconceptions take on Twitter. Objective: The aim of this study is to identify and analyze types of dementia conversations on Twitter using participatory methods. Methods: A total of 3 focus groups with dementia carers were held to develop a framework of dementia misconceptions based on their experiences. Dementia-related tweets were collected from Twitter’s official application programming interface using neutral and negative search terms defined by the literature and by carers (N=48,211). A sample of these tweets was selected with equal numbers of neutral and negative words (n=1497), which was validated in individual ratings by carers. We then used the framework to analyze, in detail, a sample of carer-rated negative tweets (n=863). Results: A total of 25.94% (12,507/48,211) of our tweet corpus contained negative search terms about dementia. The carers’ framework had 3 negative and 3 neutral categories. Our thematic analysis of carer-rated negative tweets found 9 themes, including the use of weaponizing language to insult politicians (469/863, 54.3%), using dehumanizing or outdated words or statements about members of the public (n=143, 16.6%), unfounded claims about the cures or causes of dementia (n=11, 1.3%), or providing armchair diagnoses of dementia (n=21, 2.4%). Conclusions: This is the first study to use participatory methods to develop a framework that identifies dementia misconceptions on Twitter. We show that misconceptions and stigmatizing language are not rare. They manifest through minimizing and underestimating language. Web-based campaigns aiming to reduce discrimination and stigma about dementia could target those who use negative vocabulary and reduce the misconceptions that are being propagated, thus improving general awareness. %M 35072637 %R 10.2196/30388 %U https://aging.jmir.org/2022/1/e30388 %U https://doi.org/10.2196/30388 %U http://www.ncbi.nlm.nih.gov/pubmed/35072637 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32394 %T The Evolution and Disparities of Online Attitudes Toward COVID-19 Vaccines: Year-long Longitudinal and Cross-sectional Study %A Zhang,Chunyan %A Xu,Songhua %A Li,Zongfang %A Liu,Ge %A Dai,Duwei %A Dong,Caixia %+ Institute of Medical Artificial Intelligence, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, 710004, China, 86 18710823698, songhua_xu1@163.com %K COVID-19 %K vaccine %K attitude %K Twitter %K data mining %K pandemic %K population group %K evolution %K disparity %D 2022 %7 21.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to the urgency caused by the COVID-19 pandemic worldwide, vaccine manufacturers have to shorten and parallel the development steps to accelerate COVID-19 vaccine production. Although all usual safety and efficacy monitoring mechanisms remain in place, varied attitudes toward the new vaccines have arisen among different population groups. Objective: This study aimed to discern the evolution and disparities of attitudes toward COVID-19 vaccines among various population groups through the study of large-scale tweets spanning over a whole year. Methods: We collected over 1.4 billion tweets from June 2020 to July 2021, which cover some critical phases concerning the development and inoculation of COVID-19 vaccines worldwide. We first developed a data mining model that incorporates a series of deep learning algorithms for inferring a range of individual characteristics, both in reality and in cyberspace, as well as sentiments and emotions expressed in tweets. We further conducted an observational study, including an overall analysis, a longitudinal study, and a cross-sectional study, to collectively explore the attitudes of major population groups. Results: Our study derived 3 main findings. First, the whole population’s attentiveness toward vaccines was strongly correlated (Pearson r=0.9512) with official COVID-19 statistics, including confirmed cases and deaths. Such attentiveness was also noticeably influenced by major vaccine-related events. Second, after the beginning of large-scale vaccine inoculation, the sentiments of all population groups stabilized, followed by a considerably pessimistic trend after June 2021. Third, attitude disparities toward vaccines existed among population groups defined by 8 different demographic characteristics. By crossing the 2 dimensions of attitude, we found that among population groups carrying low sentiments, some had high attentiveness ratios, such as males and individuals aged ≥40 years, while some had low attentiveness ratios, such as individuals aged ≤18 years, those with occupations of the 3rd category, those with account age <5 years, and those with follower number <500. These findings can be used as a guide in deciding who should be given more attention and what kinds of help to give to alleviate the concerns about vaccines. Conclusions: This study tracked the year-long evolution of attitudes toward COVID-19 vaccines among various population groups defined by 8 demographic characteristics, through which significant disparities in attitudes along multiple dimensions were revealed. According to these findings, it is suggested that governments and public health organizations should provide targeted interventions to address different concerns, especially among males, older people, and other individuals with low levels of education, low awareness of news, low income, and light use of social media. Moreover, public health authorities may consider cooperating with Twitter users having high levels of social influence to promote the acceptance of COVID-19 vaccines among all population groups. %M 34878410 %R 10.2196/32394 %U https://www.jmir.org/2022/1/e32394 %U https://doi.org/10.2196/32394 %U http://www.ncbi.nlm.nih.gov/pubmed/34878410 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e26868 %T COVID-19 Mask Usage and Social Distancing in Social Media Images: Large-scale Deep Learning Analysis %A Singh,Asmit Kumar %A Mehan,Paras %A Sharma,Divyanshu %A Pandey,Rohan %A Sethi,Tavpritesh %A Kumaraguru,Ponnurangam %+ Indraprastha Institute of Information Technology Delhi, Okhla Industrial Estate, Phase III, New Delhi, 110020, India, 91 11 26907533, tavpriteshsethi@iiitd.ac.in %K COVID-19 %K mask detection %K deep learning %K classification %K segmentation %K social media analysis %D 2022 %7 18.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The adoption of nonpharmaceutical interventions and their surveillance are critical for detecting and stopping possible transmission routes of COVID-19. A study of the effects of these interventions can help shape public health decisions. The efficacy of nonpharmaceutical interventions can be affected by public behaviors in events, such as protests. We examined mask use and mask fit in the United States, from social media images, especially during the Black Lives Matter (BLM) protests, representing the first large-scale public gatherings in the pandemic. Objective: This study assessed the use and fit of face masks and social distancing in the United States and events of large physical gatherings through public social media images from 6 cities and BLM protests. Methods: We collected and analyzed 2.04 million public social media images from New York City, Dallas, Seattle, New Orleans, Boston, and Minneapolis between February 1, 2020, and May 31, 2020. We evaluated correlations between online mask usage trends and COVID-19 cases. We looked for significant changes in mask use patterns and group posting around important policy decisions. For BLM protests, we analyzed 195,452 posts from New York and Minneapolis from May 25, 2020, to July 15, 2020. We looked at differences in adopting the preventive measures in the BLM protests through the mask fit score. Results: The average percentage of group pictures dropped from 8.05% to 4.65% after the lockdown week. New York City, Dallas, Seattle, New Orleans, Boston, and Minneapolis observed increases of 5.0%, 7.4%, 7.4%, 6.5%, 5.6%, and 7.1%, respectively, in mask use between February 2020 and May 2020. Boston and Minneapolis observed significant increases of 3.0% and 7.4%, respectively, in mask use after the mask mandates. Differences of 6.2% and 8.3% were found in group pictures between BLM posts and non-BLM posts for New York City and Minneapolis, respectively. In contrast, the differences in the percentage of masked faces in group pictures between BLM and non-BLM posts were 29.0% and 20.1% for New York City and Minneapolis, respectively. Across protests, 35% of individuals wore a mask with a fit score greater than 80%. Conclusions: The study found a significant drop in group posting when the stay-at-home laws were applied and a significant increase in mask use for 2 of 3 cities where masks were mandated. Although a positive trend toward mask use and social distancing was observed, a high percentage of posts showed disregard for the guidelines. BLM-related posts captured the lack of seriousness to safety measures, with a high percentage of group pictures and low mask fit scores. Thus, the methodology provides a directional indication of how government policies can be indirectly monitored through social media. %M 34479183 %R 10.2196/26868 %U https://publichealth.jmir.org/2022/1/e26868 %U https://doi.org/10.2196/26868 %U http://www.ncbi.nlm.nih.gov/pubmed/34479183 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28858 %T Harnessing Artificial Intelligence for Health Message Generation: The Folic Acid Message Engine %A Schmälzle,Ralf %A Wilcox,Shelby %+ Department of Communication, Michigan State University, 404 Wilson Rd, East Lansing, MI, 48824, United States, 1 (517) 353 ext 6629, schmaelz@msu.edu %K human-centered AI %K campaigns %K health communication %K NLP %K health promotion %D 2022 %7 18.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Communication campaigns using social media can raise public awareness; however, they are difficult to sustain. A barrier is the need to generate and constantly post novel but on-topic messages, which creates a resource-intensive bottleneck. Objective: In this study, we aim to harness the latest advances in artificial intelligence (AI) to build a pilot system that can generate many candidate messages, which could be used for a campaign to suggest novel, on-topic candidate messages. The issue of folic acid, a B-vitamin that helps prevent major birth defects, serves as an example; however, the system can work with other issues that could benefit from higher levels of public awareness. Methods: We used the Generative Pretrained Transformer-2 architecture, a machine learning model trained on a large natural language corpus, and fine-tuned it using a data set of autodownloaded tweets about #folicacid. The fine-tuned model was then used as a message engine, that is, to create new messages about this topic. We conducted a web-based study to gauge how human raters evaluate AI-generated tweet messages compared with original, human-crafted messages. Results: We found that the Folic Acid Message Engine can easily create several hundreds of new messages that appear natural to humans. Web-based raters evaluated the clarity and quality of a human-curated sample of AI-generated messages as on par with human-generated ones. Overall, these results showed that it is feasible to use such a message engine to suggest messages for web-based campaigns that focus on promoting awareness. Conclusions: The message engine can serve as a starting point for more sophisticated AI-guided message creation systems for health communication. Beyond the practical potential of such systems for campaigns in the age of social media, they also hold great scientific potential for the quantitative analysis of message characteristics that promote successful communication. We discuss future developments and obvious ethical challenges that need to be addressed as AI technologies for health persuasion enter the stage. %M 35040800 %R 10.2196/28858 %U https://www.jmir.org/2022/1/e28858 %U https://doi.org/10.2196/28858 %U http://www.ncbi.nlm.nih.gov/pubmed/35040800 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e23656 %T Young Adults’ Use of Different Social Media Platforms for Health Information: Insights From Web-Based Conversations %A Lim,Megan S C %A Molenaar,Annika %A Brennan,Linda %A Reid,Mike %A McCaffrey,Tracy %+ Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia, 61 85062403, megan.lim@burnet.edu.au %K social media %K Facebook %K Instagram %K YouTube %K health information %K health communication %K young adults %D 2022 %7 18.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media–delivered health promotion has demonstrated limited uptake and effectiveness among young adults. Understanding how young adults interact with existing social media platforms for health might provide insight for future health promotion interventions. Objective: The aim of this study is to describe how young adults interact with different social media platforms for health and health information. Methods: We used a web-based conversation methodology to collect data from 165 young adults aged 18 to 24 years. Participants participated in an extended conversation with moderators and other participants about health and social media. They were prompted to discuss how they find health information, how they use different social media platforms, and how they evaluate the trustworthiness of information. A thematic qualitative analysis was applied to the data. Results: Young adults spent a lot of time scrolling through Facebook newsfeeds, which often resulted in seeing health-related content either from their friends, news sources, or advertisements. Some actively sought out information about specific health areas by joining groups or following relevant pages. YouTube was considered a useful source for learning about everything and was often the go-to when searching for information or advice (after Google). Young adults found the video format easy to learn from. They stated that they could identify accurate YouTube health content by cross-checking multiple videos, by feeling that the presenter was real and relatable, or just through instinctively judging a video’s credibility. Instagram was a source of inspiration for health and wellness from those whose lives were dedicated to healthy lifestyles and fitness. Twitter, Tumblr, and Snapchat were rarely used for health information. Conclusions: Most young adults obtain health information from social media, both actively and through passive exposure. Participants indicated looking to social media influencers for health and lifestyle inspiration and judged the credibility of sources by appearance and instinct. Health experts should try to use the channels in the way that young adults already use them; use relatable role models on Instagram and YouTube, eye-catching headlines and support groups on Facebook, and easy to follow instruction videos via YouTube. International Registered Report Identifier (IRRID): RR2-10.1111/1747-0080.12448 %M 35040796 %R 10.2196/23656 %U https://www.jmir.org/2022/1/e23656 %U https://doi.org/10.2196/23656 %U http://www.ncbi.nlm.nih.gov/pubmed/35040796 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e32140 %T Patterns of Suicide Ideation Across Eight Countries in Four Continents During the COVID-19 Pandemic Era: Repeated Cross-sectional Study %A Schluter,Philip J %A Généreux,Mélissa %A Hung,Kevin KC %A Landaverde,Elsa %A Law,Ronald P %A Mok,Catherine Pui Yin %A Murray,Virginia %A O'Sullivan,Tracey %A Qadar,Zeeshan %A Roy,Mathieu %+ School of Health Sciences, University of Canterbury - Te Whare Wananga o Waitaha, Private Bag 4800, Christchurch, 8140, New Zealand, 64 275106239, philip.schluter@canterbury.ac.nz %K pandemic %K infodemic %K psychosocial impacts %K sense of coherence %K suicide ideation %K epidemiology %K suicide %K pattern %K COVID-19 %K cross-sectional %K mental health %K misinformation %K risk %K prevalence %K gender %K age %K sociodemographic %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and countries’ response measures have had a globally significant mental health impact. This mental health burden has also been fueled by an infodemic: an information overload that includes misinformation and disinformation. Suicide, the worst mental health outcome, is a serious public health problem that can be prevented with timely, evidence-based, and often low-cost interventions. Suicide ideation, one important risk factor for suicide, is thus important to measure and monitor, as are the factors that may impact on it. Objective: This investigation had 2 primary aims: (1) to estimate and compare country-specific prevalence of suicide ideation at 2 different time points, overall and by gender and age groups, and (2) to investigate the influence of sociodemographic and infodemic variables on suicide ideation. Methods: A repeated, online, 8-country (Canada, the United States, England, Switzerland, Belgium, Hong Kong, Philippines, and New Zealand), cross-sectional study was undertaken with adults aged ≥18 years, with measurement wave 1 conducted from May 29, 2020 to June 12, 2020 and measurement wave 2 conducted November 6-18, 2021. Self-reported suicide ideation was derived from item 9 of the Patient Health Questionnaire-9 (PHQ-9). Age-standardized suicide ideation rates were reported, a binomial regression model was used to estimate suicide ideation indication rates for each country and measurement wave, and logistic regression models were then employed to relate sociodemographic, pandemic, and infodemic variables to suicide ideation. Results: The final sample totaled 17,833 adults: 8806 (49.4%) from measurement wave 1 and 9027 (50.6%) from wave 2. Overall, 24.2% (2131/8806) and 27.5% (2486/9027) of participants reported suicide ideation at measurement waves 1 and 2, respectively, a difference that was significant (P<.001). Considerable variability was observed in suicide ideation age-standardized rates between countries, ranging from 15.6% in Belgium (wave 1) to 42.9% in Hong Kong (wave 2). Frequent social media usage was associated with increased suicide ideation at wave 2 (adjusted odds ratio [AOR] 1.47, 95% CI 1.25-1.72; P<.001) but not wave 1 (AOR 1.11, 95% CI 0.96-1.23; P=.16). However, having a weaker sense of coherence (SOC; AOR 3.80, 95% CI 3.18-4.55 at wave 1 and AOR 4.39, 95% CI 3.66-5.27 at wave 2; both P<.001) had the largest overall effect size. Conclusions: Suicide ideation is prevalent and significantly increasing over time in this COVID-19 pandemic era, with considerable variability between countries. Younger adults and those residing in Hong Kong carried disproportionately higher rates. Social media appears to have an increasingly detrimental association with suicide ideation, although having a stronger SOC had a larger protective effect. Policies and promotion of SOC, together with disseminating health information that explicitly tackles the infodemic’s misinformation and disinformation, may importantly reduce the rising mental health morbidity and mortality triggered by this pandemic. %M 34727524 %R 10.2196/32140 %U https://publichealth.jmir.org/2022/1/e32140 %U https://doi.org/10.2196/32140 %U http://www.ncbi.nlm.nih.gov/pubmed/34727524 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e35274 %T Investigating #covidnurse Messages on TikTok: Descriptive Study %A Yalamanchili,Bhavya %A Donelle,Lorie %A Jurado,Leo-Felix %A Fera,Joseph %A Basch,Corey H %+ William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 9737202603, baschc@wpunj.edu %K COVID-19 pandemic %K nurse %K burnout %K social media %K stress %K TikTok %K nursing %K COVID-19 %K pandemic %K social support %K digital peer support %K health communication %K peer support %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: During a time of high stress and decreased social interaction, nurses have turned to social media platforms like TikTok as an outlet for expression, entertainment, and communication. Objective: The purpose of this cross-sectional content analysis study is to describe the content of videos with the hashtag #covidnurse on TikTok, which included 100 videos in the English language. Methods: At the time of the study, this hashtag had 116.9 million views. Each video was coded for content-related to what nurses encountered and were feeling during the COVID-19 pandemic. Results: Combined, the 100 videos sampled received 47,056,700 views; 76,856 comments; and 5,996,676 likes. There were 4 content categories that appeared in a majority (>50) of the videos: 83 showed the individual as a nurse, 72 showed the individual in professional attire, 58 mentioned/suggested stress, 55 used music, and 53 mentioned/suggested frustration. Those that mentioned stress and those that mentioned frustration received less than 50% of the total views (n=21,726,800, 46.17% and n=16,326,300, 34.69%, respectively). Although not a majority, 49 of the 100 videos mentioned the importance of nursing. These videos garnered 37.41% (n=17,606,000) of the total views, 34.82% (n=26,759) of the total comments, and 23.85% (n=1,430,213) of the total likes. So, despite nearly half of the total videos mentioning how important nurses are, these videos received less than half of the total views, comments, and likes. Conclusions: Social media and increasingly video-related online messaging such as TikTok are important platforms for social networking, social support, entertainment, and education on diverse topics, including health in general and COVID-19 specifically. This presents an opportunity for future research to assess the utility of the TikTok platform for meaningful engagement and health communication on important public health issues. %M 35029536 %R 10.2196/35274 %U https://nursing.jmir.org/2022/1/e35274 %U https://doi.org/10.2196/35274 %U http://www.ncbi.nlm.nih.gov/pubmed/35029536 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e24086 %T The Digital Divide and Seeking Health Information on Smartphones in Asia: Survey Study of Ten Countries %A Wang,Xiaohui %A Shi,Jingyuan %A Lee,Kwan Min %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, Room 03-44, WKWSCI Building, 31 Nanyang Link, Singapore, 637718, Singapore, 65 63168816, kwanminlee@ntu.edu.sg %K smartphone %K health information seeking %K Asia %K user profile %K digital divide %D 2022 %7 13.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Although recent developments in mobile health have elevated the importance of how smartphones empower individuals to seek health information, research investigating this phenomenon in Asian countries has been rare. Objective: The goal of our study was to provide a comprehensive profile of mobile health information seekers and to examine the individual- and country-level digital divide in Asia. Methods: With survey data from 10 Asian countries (N=9086), we ran multilevel regression models to assess the effect of sociodemographic factors, technological factors, and country-level disparities on using smartphones to seek health information. Results: Respondents who were women (β=.13, P<.001), parents (β=.16, P<.001), employed (β=.08, P=.002), of higher social status (β=.08, P<.001), and/or from countries with low health expenditures (β=.19, P=.02) were more likely to use smartphones to seek health information. In terms of technological factors, technology innovativeness (β=.10, P<.001) and frequency of smartphone use (β=.42, P<.001) were important factors of health information seeking, whereas the effect of online information quality was marginal (β=–.04, P<.001). Conclusions: Among smartphone users in Asia, health information seeking varies according to individuals’ socioeconomic status, their innovativeness toward technology, and their frequency of smartphone use. Although smartphones widen the digital divide among individuals with different socioeconomic status, they also bridge the divide between countries with varying health expenditures. Smartphones appear to be a particularly useful complement to manage health in developing countries. %M 35023845 %R 10.2196/24086 %U https://www.jmir.org/2022/1/e24086 %U https://doi.org/10.2196/24086 %U http://www.ncbi.nlm.nih.gov/pubmed/35023845 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e34429 %T Assessment of Social Support and Quitting Smoking in an Online Community Forum: Study Involving Content Analysis %A Struik,Laura %A Khan,Shaheer %A Assoiants,Artem %A Sharma,Ramona H %+ School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 2508079972, laura.struik@ubc.ca %K qualitative research %K smoking cessation %K social media %K social support %K smoking %K tobacco use %K tobacco %K online forum %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A key factor in successfully reducing and quitting smoking, as well as preventing smoking relapse is access to and engagement with social support. Recent technological advances have made it possible for smokers to access social support via online community forums. While community forums associated with smoking cessation interventions are now common practice, there is a gap in understanding how and when the different types of social support identified by Cutrona and Suhr (1992) (emotional, esteem, informational, tangible, and network) are exchanged on such forums. Community forums that entail “superusers” (a key marker of a successful forum), like QuitNow, are ripe for exploring and leveraging promising social support exchanges on these platforms. Objective: The purpose of this study was to characterize the posts made on the QuitNow community forum at different stages in the quit journey, and determine when and how the social support constructs are present within the posts. Methods: A total of 506 posts (including original and response posts) were collected. Using conventional content analysis, the original posts were coded inductively to generate categories and subcategories, and the responses were coded deductively according to the 5 types of social support. Data were analyzed using Microsoft Excel software. Results: Overall, individuals were most heavily engaged on the forum during the first month of quitting, which then tapered off in the subsequent months. In relation to the original posts, the majority of them fit into the categories of sharing quit successes, quit struggles, updates, quit strategies, and desires to quit. Asking for advice and describing smoke-free benefits were the least represented categories. In relation to the responses, encouragement (emotional), compliment (esteem), and suggestion/advice (informational) consistently remained the most prominent types of support throughout all quit stages. Companionship (network) maintained a steady downward trajectory over time. Conclusions: The findings of this study highlight the complexity of how and when different types of social support are exchanged on the QuitNow community forum. These findings provide directions for how social support can be more strategically employed and leveraged in these online contexts to support smoking cessation. %M 35023834 %R 10.2196/34429 %U https://formative.jmir.org/2022/1/e34429 %U https://doi.org/10.2196/34429 %U http://www.ncbi.nlm.nih.gov/pubmed/35023834 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e33525 %T Exploring Empathy and Compassion Using Digital Narratives (the Learning to Care Project): Protocol for a Multiphase Mixed Methods Study %A Ferrari,Manuela %A Fazeli,Sahar %A Mitchell,Claudia %A Shah,Jai %A Iyer,Srividya N %+ Department of Psychiatry, McGill University, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada, 1 5147616131 ext 3445, manuela.ferrari@mcgill.ca %K digital narratives %K fundraising campaigns %K mixed methods %K randomized controlled trial %K stigma and discrimination %D 2022 %7 13.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital stories—first-person, self-made, 2- to 3-minute videos—generate awareness, impart knowledge, and promote understanding on topics such as mental illness. Digital stories are a narrative-based art form often created by individuals without formal training in filmmaking to relate personal experiences. Somewhat like digital narratives, video testimonies created within the social marketing or fundraising campaigns of government agencies and private or public corporations aim to reduce the stigma of mental illness while supporting research and services. In video testimonies, personal stories are captured on camera by professional filmmakers. Sharing critical life events greatly benefits tellers and listeners alike, supporting catharsis, healing, connectiveness, and citizenship. Objective: This study explores digital stories and video testimonies featuring mental illness and recovery in their ability to elicit empathy and compassion while reducing stigma among viewers. Methods: Using mixed methods, phase 1 will involve a search of Canadian social marketing activities and fundraising campaigns concerning mental illness and recovery. Phase 2 will involve the organization of digital storytelling workshops in which participants will create digital stories about their own experiences of mental illness and recovery. In phase 3, a pilot randomized controlled trial will be undertaken to compare marketing and fundraising campaigns with digital stories for their impact on viewers, whereas phase 4 will focus on knowledge dissemination. Results: Ethics approval for this study was received in March 2021. Data on the feasibility of the study design and the results of the controlled trial will be generated. This study will produce new knowledge on effective ways of promoting mental health awareness and decreasing stigma, with practical importance for future social marketing and fundraising campaigns. The anticipated time for completion within the 2-year study period includes 9 months for phase 1 (knowledge synthesis activities identifying social marketing and fundraising campaigns) and phase 2 (storytelling workshops), 11 months for phase 3 (feasibility assessment and data collection: randomized controlled trial), and 2 months for phase 4 (knowledge dissemination). Conclusions: The knowledge generated will have practical implications for the public and for future social marketing and fundraising campaigns promoted by government agencies as well as nonprofit and for-profit organizations by enhancing our understanding of how individuals and societies respond to stories of mental distress and what prompts citizens to help others. Trial Registration: ClinicalTrials.gov NCT04881084; https://clinicaltrials.gov/ct2/show/NCT04881084 International Registered Report Identifier (IRRID): PRR1-10.2196/33525 %M 35023844 %R 10.2196/33525 %U https://www.researchprotocols.org/2022/1/e33525 %U https://doi.org/10.2196/33525 %U http://www.ncbi.nlm.nih.gov/pubmed/35023844 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31759 %T Using Facebook Advertisements for Women’s Health Research: Methodology and Outcomes of an Observational Study %A Farr,Deeonna E %A Battle,Darian A %A Hall,Marla B %+ Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 2307 Carol G Belk Building, Mail Stop 529, Greenville, NC, 27858, United States, 1 2527375392, farrd17@ecu.edu %K social media %K surveys %K questionnaires %K advertising %K patient selection %K methodology %K ethnic groups %K health research %K healthcare %K health care %K women’s health %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Recruitment of diverse populations for health research studies remains a challenge. The COVID-19 pandemic has exacerbated these challenges by limiting in-person recruitment efforts and placing additional demands on potential participants. Social media, through the use of Facebook advertisements, has the potential to address recruitment challenges. However, existing reports are inconsistent with regard to the success of this strategy. Additionally, limited information is available about processes that can be used to increase the diversity of study participants. Objective: A Qualtrics survey was fielded to ascertain women’s knowledge of and health care experiences related to breast density. This paper describes the process of using Facebook advertisements for recruitment and the effectiveness of various advertisement strategies. Methods: Facebook advertisements were placed in 2 rounds between June and July 2020. During round 1, multiple combinations of headlines and interest terms were tested to determine the most cost-effective advertisement. The best performing advertisement was used in round 2 in combination with various strategies to enhance the diversity of the survey sample. Advertisement performance, cost, and survey respondent data were collected and examined. Results: In round 1, a total of 45 advertisements with 5 different headlines were placed, and the average cost per link click for each headline ranged from US $0.12 to US $0.79. Of the 164 women recruited in round 1, in total 91.62% were eligible to complete the survey. Advertisements used during recruitment in round 2 resulted in an average cost per link click of US $0.11. During the second round, 478 women attempted the survey, and 87.44% were eligible to participate. The majority of survey respondents were White (80.41%), over the age of 55 years (63.94%), and highly educated (63.71%). Conclusions: Facebook advertisements can be used to recruit respondents for health research quickly, but this strategy may yield participants who are less racially diverse, more educated, and older than the general population. Researchers should consider recruiting participants through other methods in addition to creating Facebook advertisements targeting underrepresented populations. %M 35019843 %R 10.2196/31759 %U https://formative.jmir.org/2022/1/e31759 %U https://doi.org/10.2196/31759 %U http://www.ncbi.nlm.nih.gov/pubmed/35019843 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31175 %T Examining Tweet Content and Engagement of Users With Tweets About Hikikomori in Japanese: Mixed Methods Study of Social Withdrawal %A Pereira-Sanchez,Victor %A Alvarez-Mon,Miguel Angel %A Horinouchi,Toru %A Kawagishi,Ryo %A Tan,Marcus P J %A Hooker,Elizabeth R %A Alvarez-Mon,Melchor %A Teo,Alan R %+ Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Campus Universitario – C/ 19, Av, de Madrid, Km 33,600, Alcala de Henares, Spain, 34 91 885 4505, maalvarezdemon@icloud.com %K hikikomori %K loneliness %K social isolation %K social withdrawal %K Twitter %K hidden youth %K mobile phone %D 2022 %7 11.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Hikikomori is a form of severe social withdrawal that is particularly prevalent in Japan. Social media posts offer insight into public perceptions of mental health conditions and may also inform strategies to identify, engage, and support hard-to-reach patient populations such as individuals affected by hikikomori. Objective: In this study, we seek to identify the types of content on Twitter related to hikikomori in the Japanese language and to assess Twitter users’ engagement with that content. Methods: We conducted a mixed methods analysis of a random sample of 4940 Japanese tweets from February to August 2018 using a hashtag (#hikikomori). Qualitative content analysis included examination of the text of each tweet, development of a codebook, and categorization of tweets into relevant codes. For quantitative analysis (n=4859 tweets), we used bivariate and multivariate logistic regression models, adjusted for multiple comparisons, and estimated the predicted probabilities of tweets receiving engagement (likes or retweets). Results: Our content analysis identified 9 codes relevant to tweets about hikikomori: personal anecdotes, social support, marketing, advice, stigma, educational opportunities, refuge (ibasho), employment opportunities, and medicine and science. Tweets about personal anecdotes were the most common (present in 2747/4859, 56.53% of the tweets), followed by social support (902/4859, 18.56%) and marketing (624/4859, 12.84%). In the adjusted models, tweets coded as stigma had a lower predicted probability of likes (−33 percentage points, 95% CI −42 to −23 percentage points; P<.001) and retweets (−11 percentage points, 95% CI −18 to −4 percentage points; P<.001), personal anecdotes had a lower predicted probability of retweets (−8 percentage points, 95% CI −14 to −3 percentage points; P=.002), marketing had a lower predicted probability of likes (−13 percentage points, 95% CI −21 to −6 percentage points; P<.001), and social support had a higher predicted probability of retweets (+15 percentage points, 95% CI 6-24 percentage points; P=.001), compared with all tweets without each of these codes. Conclusions: Japanese tweets about hikikomori reflect a unique array of topics, many of which have not been identified in prior research and vary in their likelihood of receiving engagement. Tweets often contain personal stories of hikikomori, suggesting the potential to identify individuals with hikikomori through Twitter. %M 35014971 %R 10.2196/31175 %U https://www.jmir.org/2022/1/e31175 %U https://doi.org/10.2196/31175 %U http://www.ncbi.nlm.nih.gov/pubmed/35014971 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e27000 %T Heterogeneity of Prevalence of Social Media Addiction Across Multiple Classification Schemes: Latent Profile Analysis %A Cheng,Cecilia %A Ebrahimi,Omid V %A Luk,Jeremy W %+ Social and Health Psychology Lab, Department of Psychology, The University of Hong Kong, Pokfulam, China (Hong Kong), 852 39174224, ceci-cheng@hku.hk %K behavioral addiction %K compulsive social media use %K information technology addiction %K mental health %K psychological assessment %K sensitivity %K social network site %K social networking %K well-being %D 2022 %7 10.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: As social media is a major channel of interpersonal communication in the digital age, social media addiction has emerged as a novel mental health issue that has raised considerable concerns among researchers, health professionals, policy makers, mass media, and the general public. Objective: The aim of this study is to examine the prevalence of social media addiction derived from 4 major classification schemes (strict monothetic, strict polythetic, monothetic, and polythetic), with latent profiles embedded in the empirical data adopted as the benchmark for comparison. The extent of matching between the classification of each scheme and the actual data pattern was evaluated using sensitivity and specificity analyses. The associations between social media addiction and 2 comorbid mental health conditions—depression and anxiety—were investigated. Methods: A cross-sectional web-based survey was conducted, and the replicability of findings was assessed in 2 independent samples comprising 573 adults from the United Kingdom (261/573, 45.6% men; mean age 43.62 years, SD 12.24 years) and 474 adults from the United States (224/474, 47.4% men; mean age 44.67 years, SD 12.99 years). The demographic characteristics of both samples were similar to those of their respective populations. Results: The prevalence estimates of social media addiction varied across the classification schemes, ranging from 1% to 15% for the UK sample and 0% to 11% for the US sample. The latent profile analysis identified 3 latent groups for both samples: low-risk, at-risk, and high-risk. The sensitivity, specificity, and negative predictive values were high (83%-100%) for all classification schemes, except for the relatively lower sensitivity (73%-74%) for the polythetic scheme. However, the polythetic scheme had high positive predictive values (88%-94%), whereas such values were low (2%-43%) for the other 3 classification schemes. The group membership yielded by the polythetic scheme was largely consistent (95%-96%) with that of the benchmark. Conclusions: Among the classification schemes, the polythetic scheme is more well-balanced across all 4 indices. %M 35006084 %R 10.2196/27000 %U https://www.jmir.org/2022/1/e27000 %U https://doi.org/10.2196/27000 %U http://www.ncbi.nlm.nih.gov/pubmed/35006084 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e30379 %T Social Media and Health Care (Part II): Narrative Review of Social Media Use by Patients %A Farsi,Deema %A Martinez-Menchaca,Hector R %A Ahmed,Mohammad %A Farsi,Nada %+ Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, PO Box 80200, Jeddah, 21589, Saudi Arabia, 966 16402000 ext 20388, dfarsi@kau.edu.sa %K social media %K social networking %K internet %K health care %K COVID-19 %K patient %K telemedicine %K mobile phone %D 2022 %7 7.1.2022 %9 Review %J J Med Internet Res %G English %X Background: People are now connected in a borderless web-based world. The modern public, especially the younger generation, relies heavily on the internet as the main source of health-related information. In health care, patients can use social media for more tailored uses such as telemedicine, finding a provider, and for peer support. Objective: The aim of this narrative review is to discuss how social media has been used in the health care industry from the perspective of patients and describe the main issues surrounding its use in health care. Methods: Between March and June 2020, a review of the literature was conducted on PubMed, Google Scholar, and Web of Science for English studies that were published since 2007 and discussed the use of social media in health care. In addition to only English publications that discussed the use of social media by patients, publications pertaining to ethical and legal considerations in the use of social media were included. The studies were then categorized as health information, telemedicine, finding a health care provider, peer support and sharing experiences, and influencing positive health behavior. In addition, two more sections were added to the review: issues pertaining to social media use in health care and ethical considerations. Results: Initially, 75 studies were included. As the study proceeded, more studies were included, and a total of 91 studies were reviewed, complemented by 1 textbook chapter and 13 web references. Approximately half of the studies were reviews. The first study was published in 2009, and the last was published in 2021, with more than half of the studies published in the last 5 years. The studies were mostly from the United States (n=40), followed by Europe (n=13), and the least from India (n=1). WhatsApp or WeChat was the most investigated social media platform. Conclusions: Social media can be used by the public and patients to improve their health and knowledge. However, due diligence must be practiced to assess the credibility of the information obtained and its source. Health care providers, patients, and the public need not forget the risks associated with the use of social media. The limitations and shortcomings of the use of social media by patients should be understood. %M 34994706 %R 10.2196/30379 %U https://www.jmir.org/2022/1/e30379 %U https://doi.org/10.2196/30379 %U http://www.ncbi.nlm.nih.gov/pubmed/34994706 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32329 %T Direct and Indirect Associations of Media Use With COVID-19 Vaccine Hesitancy in South Korea: Cross-sectional Web-Based Survey %A Lee,Minjung %A You,Myoungsoon %+ Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 02 880 2773, msyou@snu.ac.kr %K COVID-19 %K coronavirus %K vaccination %K vaccine hesitancy %K media use %K social media %K public health %K pandemic %K epidemiology %K online information %K health information %D 2022 %7 6.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The battle against the 2019 novel coronavirus (COVID-19) has not concluded. Despite the availability of vaccines, the high prevalence of vaccine hesitancy represents a significant challenge to public health, and raising vaccine acceptance among the public is critical. Although media has become an increasingly popular source of COVID-19 vaccine-related information, the question of whether and how media use is related to the public’s vaccine hesitancy warrants exploration. Objective: This study aimed to (1) examine the level of COVID-19 vaccine hesitancy, (2) identify factors associated with COVID-19 vaccine hesitancy, and (3) explore the direct and indirect relationship between media use and vaccine hesitancy through psychological factors. Methods: A month before COVID-19 vaccination was initiated in South Korea, we conducted a cross-sectional web-based survey over 6 days (January 20-25, 2021). This study included 1016 participants, and a logit model for regression analyzed associations between sociodemographic factors, health-related factors, psychological factors, and media use toward one’s COVID-19 vaccine hesitancy. Additionally, we conducted a path analysis to examine the indirect effects of media use on vaccine hesitancy by using psychological factors (ie, perceived risk of COVID-19 infection, perceived benefits, and perceived barriers of COVID-19 vaccination). Results: Among the participants (N=1016), 53.3% (541/1016) hesitated to take the COVID-19 vaccine, while 46.7% (475/1016) agreed to accept the vaccine. Of the sociodemographic factors, female gender (odds ratio [OR] 1.967, 95% CI 1.36-2.86; P<.001), age in 50s (OR 0.47, 95% CI 0.23-0.96; P=.004), and age over 60s (OR 0.49, 95% CI 0.24-0.99; P=.04) were significant individual predictors of COVID-19 vaccine hesitancy. Perceived susceptibility of infection (OR 0.69, 95% CI 0.52-0.91; P=.01) and perceived benefits of vaccination (OR 0.69, 95% CI 0.52-0.91; P=.01) were associated with lower vaccine hesitancy. Perceived barriers of vaccination (OR 1.63, 95% CI 1.29-2.07; P<.001) and lower trust in government (OR 0.72, 95% CI 0.53-0.98; P=.04) were related to vaccine hesitancy. The use of offline and online media as sources for the perceived benefits of vaccination was associated with vaccine hesitancy, resulting in lower vaccine hesitancy. Moreover, perceived susceptibility of the disease and perceived barriers of vaccination mediated the association between social media use and vaccine hesitancy. Conclusions: Our findings revealed a considerable level of COVID-19 vaccine hesitancy in South Korea. Gender-based and generation-based public health policies and communication are recommended. Efforts to lower the perceived risk of vaccine side effects and heighten perceived benefits of the vaccine are required. Although the use of media has a positive and negative effect on the population’s vaccine hesitancy, efforts should be made to disseminate reliable and timely information on media while confronting misinformation or disinformation for successive implementation of vaccine programs during pandemics. %M 34870605 %R 10.2196/32329 %U https://www.jmir.org/2022/1/e32329 %U https://doi.org/10.2196/32329 %U http://www.ncbi.nlm.nih.gov/pubmed/34870605 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e33311 %T Comparison of Online Patient Reviews and National Pharmacovigilance Data for Tramadol-Related Adverse Events: Comparative Observational Study %A Park,Susan %A Choi,So Hyun %A Song,Yun-Kyoung %A Kwon,Jin-Won %+ BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea, 82 53 950 8580, jwkwon@knu.ac.kr %K drug safety %K pharmacovigilance %K tramadol %K social media %K adverse effect %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Tramadol is known to cause fewer adverse events (AEs) than other opioids. However, recent research has raised concerns about various safety issues. Objective: We aimed to explore these new AEs related to tramadol using social media and conventional pharmacovigilance data. Methods: This study used 2 data sets, 1 from patients’ drug reviews on WebMD (January 2007 to January 2021) and 1 from the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS; January 2016 to December 2020). We analyzed 2062 and 29,350 patient reports from WebMD and FAERS, respectively. Patient posts on WebMD were manually assigned the preferred terms of the Medical Dictionary for Regulatory Activities. To analyze AEs from FAERS, a disproportionality analysis was performed with 3 measures: proportional reporting ratio, reporting odds ratio, and information component. Results: From the 869 AEs reported, we identified 125 new signals related to tramadol use not listed on the drug label that satisfied all 3 signal detection criteria. In addition, 20 serious AEs were selected from new signals. Among new serious AEs, vascular disorders had the largest signal detection criteria value. Based on the disproportionality analysis and patients’ symptom descriptions, tramadol-induced pain might also be an unexpected AE. Conclusions: This study detected several novel signals related to tramadol use, suggesting newly identified possible AEs. Additionally, this study indicates that unexpected AEs can be detected using social media analysis alongside traditional pharmacovigilance data. %M 34982723 %R 10.2196/33311 %U https://publichealth.jmir.org/2022/1/e33311 %U https://doi.org/10.2196/33311 %U http://www.ncbi.nlm.nih.gov/pubmed/34982723 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e31671 %T Temporal Variations and Spatial Disparities in Public Sentiment Toward COVID-19 and Preventive Practices in the United States: Infodemiology Study of Tweets %A Kahanek,Alexander %A Yu,Xinchen %A Hong,Lingzi %A Cleveland,Ana %A Philbrick,Jodi %+ College of Information, University of North Texas, E292, 3940 N Elm St, Denton, TX, 76203, United States, 1 9192607578, lingzi.hong@unt.edu %K COVID-19 %K preventive practices %K temporal variations %K spatial disparities %K Twitter %K public sentiment %K socioeconomic factors %D 2021 %7 30.12.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the COVID-19 pandemic, US public health authorities and county, state, and federal governments recommended or ordered certain preventative practices, such as wearing masks, to reduce the spread of the disease. However, individuals had divergent reactions to these preventive practices. Objective: The purpose of this study was to understand the variations in public sentiment toward COVID-19 and the recommended or ordered preventive practices from the temporal and spatial perspectives, as well as how the variations in public sentiment are related to geographical and socioeconomic factors. Methods: The authors leveraged machine learning methods to investigate public sentiment polarity in COVID-19–related tweets from January 21, 2020 to June 12, 2020. The study measured the temporal variations and spatial disparities in public sentiment toward both general COVID-19 topics and preventive practices in the United States. Results: In the temporal analysis, we found a 4-stage pattern from high negative sentiment in the initial stage to decreasing and low negative sentiment in the second and third stages, to the rebound and increase in negative sentiment in the last stage. We also identified that public sentiment to preventive practices was significantly different in urban and rural areas, while poverty rate and unemployment rate were positively associated with negative sentiment to COVID-19 issues. Conclusions: The differences between public sentiment toward COVID-19 and the preventive practices imply that actions need to be taken to manage the initial and rebound stages in future pandemics. The urban and rural differences should be considered in terms of the communication strategies and decision making during a pandemic. This research also presents a framework to investigate time-sensitive public sentiment at the county and state levels, which could guide local and state governments and regional communities in making decisions and developing policies in crises. %M 35013722 %R 10.2196/31671 %U https://infodemiology.jmir.org/2021/1/e31671 %U https://doi.org/10.2196/31671 %U http://www.ncbi.nlm.nih.gov/pubmed/35013722 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28042 %T Examining Twitter Discourse on Electronic Cigarette and Tobacco Consumption During National Cancer Prevention Month in 2018: Topic Modeling and Geospatial Analysis %A Lu,Jiahui %A Lee,Edmund W J %+ School of New Media and Communication, Tianjin University, No 92 Weijin Road, Tianjin, 300072, China, 86 18222418810, lujiahui@tju.edu.cn %K electronic cigarette %K smoking %K lung cancer %K Twitter %K national cancer prevention month %K policy %K topic modeling %K cessation %K e-cigarette %K cancer %K social media %K eHealth %K cancer prevention %K tweets %K public health %D 2021 %7 29.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Examining public perception of tobacco products is critical for effective tobacco policy making and public education outreach. While the link between traditional tobacco products and lung cancer is well established, it is not known how the public perceives the association between electronic cigarettes (e-cigarettes) and lung cancer. In addition, it is unclear how members of the public interact with official messages during cancer campaigns on tobacco consumption and lung cancer. Objective: In this study, we aimed to analyze e-cigarette and smoking tweets in the context of lung cancer during National Cancer Prevention Month in 2018 and examine how e-cigarette and traditional tobacco product discussions relate to implementation of tobacco control policies across different states in the United States. Methods: We mined tweets that contained the term “lung cancer” on Twitter from February to March 2018. The data set contained 13,946 publicly available tweets that occurred during National Cancer Prevention Month (February 2018), and 10,153 tweets that occurred during March 2018. E-cigarette–related and smoking-related tweets were retrieved, using topic modeling and geospatial analysis. Results: Debates on harmfulness (454/915, 49.7%), personal experiences (316/915, 34.5%), and e-cigarette risks (145/915, 15.8%) were the major themes of e-cigarette tweets related to lung cancer. Policy discussions (2251/3870, 58.1%), smoking risks (843/3870, 21.8%), and personal experiences (776/3870, 20.1%) were the major themes of smoking tweets related to lung cancer. Geospatial analysis showed that discussion on e-cigarette risks was positively correlated with the number of state-level smoke-free policies enacted for e-cigarettes. In particular, the number of indoor and on campus smoke-free policies was related to the number of tweets on e-cigarette risks (smoke-free indoor, r49=0.33, P=.02; smoke-free campus, r49=0.32, P=.02). The total number of e-cigarette policies was also positively related to the number of tweets on e-cigarette risks (r49=0.32, P=.02). In contrast, the number of smoking policies was not significantly associated with any of the smoking themes in the lung cancer discourse (P>.13). Conclusions: Though people recognized the importance of traditional tobacco control policies in reducing lung cancer incidences, their views on e-cigarette risks were divided, and discussions on the importance of e-cigarette policy control were missing from public discourse. Findings suggest the need for health organizations to continuously engage the public in discussions on the potential health risks of e-cigarettes and raise awareness of the insidious lobbying efforts from the tobacco industry. %M 34964716 %R 10.2196/28042 %U https://www.jmir.org/2021/12/e28042 %U https://doi.org/10.2196/28042 %U http://www.ncbi.nlm.nih.gov/pubmed/34964716 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25230 %T Social Media and the Transformation of the Physician-Patient Relationship: Viewpoint %A Forgie,Ella M E %A Lai,Hollis %A Cao,Bo %A Stroulia,Eleni %A Greenshaw,Andrew J %A Goez,Helly %+ Department of Pediatrics, University of Alberta, Rm 19 Glenrose Rehabilitation Hospital, 10230 111 Ave NW, Edmonton, AB, T5G 0B7, Canada, 1 780 492 4119, goez@ualberta.camd %K social media %K social determinants of health %K precision medicine %K patient care %D 2021 %7 24.12.2021 %9 Viewpoint %J J Med Internet Res %G English %X As many as 80% of internet users seek health information online. The social determinants of health (SDoH) are intimately related to who has access to the internet and health care as a whole. Those who face more barriers to care are more likely to benefit from accessing health information online, assuming the information they are retrieving is accurate. Virtual communities on social media platforms are beginning to serve as venues for seeking health information online because peers have been shown to influence health behavior more than almost anything else. As a positive mediator of health, social media can be used as a direct or indirect mode of communication between physicians and patients, a venue for health promotion and health information, and a community support network. However, false or misleading content, social contagion, confirmation bias, and security and privacy concerns must be mitigated to realize the full potential of social media as a positive mediator of health. This paper presents the shifting dynamics of how such communities are affecting physician-patient relationships. With the intersections between the SDoH, social media, and health evolving, physicians must take into consideration these factors when establishing their relationships with patients. We argue a paradigm shift in the physician-patient relationship is warranted, one where physicians acknowledge the impacts of the SDoH on information-seeking behavior, recognize the positive and negative roles of social media as a mediator of health through the lens of the SDoH, and use social media to catalyze positive changes in the physician-patient relationship. We discuss how the physician-patient relationship must evolve to accommodate for the ever-increasing role of social media in health and to best use social media as a tool to improve health outcomes. Finally, we present a fluid and multicomponent diagram that we believe will assist in framing future research in this area. We conclude that it is ineffective and even counterproductive for physicians to ignore the relationship between social media, the SDoH and health, their impact on one another, and the effect it has on designing the medical encounter and the delivery of care under the definition of precision medicine. %M 34951596 %R 10.2196/25230 %U https://www.jmir.org/2021/12/e25230 %U https://doi.org/10.2196/25230 %U http://www.ncbi.nlm.nih.gov/pubmed/34951596 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e31540 %T Infoveillance of the Croatian Online Media During the COVID-19 Pandemic: One-Year Longitudinal Study Using Natural Language Processing %A Beliga,Slobodan %A Martinčić-Ipšić,Sanda %A Matešić,Mihaela %A Petrijevčanin Vuksanović,Irena %A Meštrović,Ana %+ Department of Informatics, University of Rijeka, Radmile Matejčić 2, Rijeka, 51000, Croatia, 385 51584726, sbeliga@inf.uniri.hr %K COVID-19 %K pandemic %K online media %K news coverage %K infoveillance %K infodemic %K infodemiology %K natural language processing %K name entity recognition %K longitudinal study %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Online media play an important role in public health emergencies and serve as essential communication platforms. Infoveillance of online media during the COVID-19 pandemic is an important step toward gaining a better understanding of crisis communication. Objective: The goal of this study was to perform a longitudinal analysis of the COVID-19–related content on online media based on natural language processing. Methods: We collected a data set of news articles published by Croatian online media during the first 13 months of the pandemic. First, we tested the correlations between the number of articles and the number of new daily COVID-19 cases. Second, we analyzed the content by extracting the most frequent terms and applied the Jaccard similarity coefficient. Third, we compared the occurrence of the pandemic-related terms during the two waves of the pandemic. Finally, we applied named entity recognition to extract the most frequent entities and tracked the dynamics of changes during the observation period. Results: The results showed no significant correlation between the number of articles and the number of new daily COVID-19 cases. Furthermore, there were high overlaps in the terminology used in all articles published during the pandemic with a slight shift in the pandemic-related terms between the first and the second waves. Finally, the findings indicate that the most influential entities have lower overlaps for the identified people and higher overlaps for locations and institutions. Conclusions: Our study shows that online media have a prompt response to the pandemic with a large number of COVID-19–related articles. There was a high overlap in the frequently used terms across the first 13 months, which may indicate the narrow focus of reporting in certain periods. However, the pandemic-related terminology is well-covered. %M 34739388 %R 10.2196/31540 %U https://publichealth.jmir.org/2021/12/e31540 %U https://doi.org/10.2196/31540 %U http://www.ncbi.nlm.nih.gov/pubmed/34739388 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e33331 %T Campus Smoking Policies and Smoking-Related Twitter Posts Originating From California Public Universities: Retrospective Study %A Yang,Joshua S %A Cuomo,Raphael E %A Purushothaman,Vidya %A Nali,Matthew %A Shah,Neal %A Bardier,Cortni %A Obradovich,Nick %A Mackey,Tim %+ Global Health Program, Department of Anthropology, University of California, San Diego, 9500 Gilman Drive, Mail Code 0505, La Jolla, CA, 92093, United States, 1 9514914161, tkmackey@ucsd.edu %K tobacco-free policies %K social media %K colleges and universities %K smoking %K smoking %K smoking policy %K campus policy %K tobacco use %K Twitter analysis %K smoke-free %K tobacco-free %K Twitter %K college students %K students %K campus %K health policy %D 2021 %7 24.12.2021 %9 Short Paper %J JMIR Form Res %G English %X Background: The number of colleges and universities with smoke- or tobacco-free campus policies has been increasing. The effects of campus smoking policies on overall sentiment, particularly among young adult populations, are more difficult to assess owing to the changing tobacco and e-cigarette product landscape and differential attitudes toward policy implementation and enforcement. Objective: The goal of the study was to retrospectively assess the campus climate toward tobacco use by comparing tweets from California universities with and those without smoke- or tobacco-free campus policies. Methods: Geolocated Twitter posts from 2015 were collected using the Twitter public application programming interface in combination with cloud computing services on Amazon Web Services. Posts were filtered for tobacco products and behavior-related keywords. A total of 42,877,339 posts were collected from 2015, with 2837 originating from a University of California or California State University system campus, and 758 of these manually verified as being about smoking. Chi-square tests were conducted to determine if there were significant differences in tweet user sentiments between campuses that were smoke- or tobacco-free (all University of California campuses and California State University, Fullerton) compared to those that were not. A separate content analysis of tweets included in chi-square tests was conducted to identify major themes by campus smoking policy status. Results: The percentage of positive sentiment tweets toward tobacco use was higher on campuses without a smoke- or tobacco-free campus policy than on campuses with a smoke- or tobacco-free campus policy (76.7% vs 66.4%, P=.03). Higher positive sentiment on campuses without a smoke- or tobacco-free campus policy may have been driven by general comments about one’s own smoking behavior and comments about smoking as a general behavior. Positive sentiment tweets originating from campuses without a smoke- or tobacco-free policy had greater variation in tweet type, which may have also contributed to differences in sentiment among universities. Conclusions: Our study introduces preliminary data suggesting that campus smoke- and tobacco-free policies are associated with a reduction in positive sentiment toward smoking. However, continued expressions and intentions to smoke and reports of one’s own smoking among Twitter users suggest a need for more research to better understand the dynamics between implementation of smoke- and tobacco-free policies and resulting tobacco behavioral sentiment. %M 34951597 %R 10.2196/33331 %U https://formative.jmir.org/2021/12/e33331 %U https://doi.org/10.2196/33331 %U http://www.ncbi.nlm.nih.gov/pubmed/34951597 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27339 %T COVID-19–Related Rumor Content, Transmission, and Clarification Strategies in China: Descriptive Study %A Ning,Peishan %A Cheng,Peixia %A Li,Jie %A Zheng,Ming %A Schwebel,David C %A Yang,Yang %A Lu,Peng %A Mengdi,Li %A Zhang,Zhuo %A Hu,Guoqing %+ Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, China, 86 731 84805414, huguoqing009@gmail.com %K COVID-19 %K rumor %K strategy %K China %K social media %D 2021 %7 23.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the permeation of social media throughout society, rumors spread faster than ever before, which significantly complicates government responses to public health emergencies such as the COVID-19 pandemic. Objective: We aimed to examine the characteristics and propagation of rumors during the early months of the COVID-19 pandemic in China and evaluated the effectiveness of health authorities’ release of correction announcements. Methods: We retrieved rumors widely circulating on social media in China during the early stages of the COVID-19 pandemic and assessed the effectiveness of official government clarifications and popular science articles refuting those rumors. Results: We show that the number of rumors related to the COVID-19 pandemic fluctuated widely in China between December 1, 2019 and April 15, 2020. Rumors mainly occurred in 3 provinces: Hubei, Zhejiang, and Guangxi. Personal social media accounts constituted the major source of media reports of the 4 most widely distributed rumors (the novel coronavirus can be prevented with “Shuanghuanglian”: 7648/10,664, 71.7%; the novel coronavirus is the SARS coronavirus: 14,696/15,902, 92.4%; medical supplies intended for assisting Hubei were detained by the local government: 3911/3943, 99.2%; asymptomatically infected persons were regarded as diagnosed COVID-19 patients with symptoms in official counts: 322/323, 99.7%). The number of rumors circulating was positively associated with the severity of the COVID-19 epidemic (ρ=0.88, 95% CI 0.81-0.93). The release of correction articles was associated with a substantial decrease in the proportion of rumor reports compared to accurate reports. The proportions of negative sentiments appearing among comments by citizens in response to media articles disseminating rumors and disseminating correct information differ insignificantly (both correct reports: χ12=0.315, P=.58; both rumors: χ12=0.025, P=.88; first rumor and last correct report: χ12=1.287, P=.26; first correct report and last rumor: χ12=0.033, P=.86). Conclusions: Our results highlight the importance and urgency of monitoring and correcting false or misleading reports on websites and personal social media accounts. The circulation of rumors can influence public health, and government bodies should establish guidelines to monitor and mitigate the negative impact of such rumors. %M 34806992 %R 10.2196/27339 %U https://www.jmir.org/2021/12/e27339 %U https://doi.org/10.2196/27339 %U http://www.ncbi.nlm.nih.gov/pubmed/34806992 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e34218 %T Tracking Private WhatsApp Discourse About COVID-19 in Singapore: Longitudinal Infodemiology Study %A Tan,Edina YQ %A Wee,Russell RE %A Saw,Young Ern %A Heng,Kylie JQ %A Chin,Joseph WE %A Tong,Eddie MW %A Liu,Jean CJ %+ Division of Social Sciences, Yale-NUS College, 28 College Ave West, Singapore, 138527, Singapore, 65 66013694, jeanliu@yale-nus.edu.sg %K social media %K WhatsApp %K infodemiology %K misinformation %K COVID-19 %K tracking %K surveillance %K app %K longitudinal %K Singapore %K characteristic %K usage %K pattern %K well-being %K communication %K risk %D 2021 %7 23.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Worldwide, social media traffic increased following the onset of the COVID-19 pandemic. Although the spread of COVID-19 content has been described for several social media platforms (eg, Twitter and Facebook), little is known about how such content is spread via private messaging platforms, such as WhatsApp (WhatsApp LLC). Objective: In this study, we documented (1) how WhatsApp is used to transmit COVID-19 content, (2) the characteristics of WhatsApp users based on their usage patterns, and (3) how usage patterns link to COVID-19 concerns. Methods: We used the experience sampling method to track day-to-day WhatsApp usage during the COVID-19 pandemic. For 1 week, participants reported each day the extent to which they had received, forwarded, or discussed COVID-19 content. The final data set comprised 924 data points, which were collected from 151 participants. Results: During the weeklong monitoring process, most participants (143/151, 94.7%) reported at least 1 COVID-19–related use of WhatsApp. When a taxonomy was generated based on usage patterns, around 1 in 10 participants (21/151, 13.9%) were found to have received and shared a high volume of forwarded COVID-19 content, akin to super-spreaders identified on other social media platforms. Finally, those who engaged with more COVID-19 content in their personal chats were more likely to report having COVID-19–related thoughts throughout the day. Conclusions: Our findings provide a rare window into discourse on private messaging platforms. Such data can be used to inform risk communication strategies during the pandemic. Trial Registration: ClinicalTrials.gov NCT04367363; https://clinicaltrials.gov/ct2/show/NCT04367363 %M 34881720 %R 10.2196/34218 %U https://www.jmir.org/2021/12/e34218 %U https://doi.org/10.2196/34218 %U http://www.ncbi.nlm.nih.gov/pubmed/34881720 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e30753 %T Characterizing and Identifying the Prevalence of Web-Based Misinformation Relating to Medication for Opioid Use Disorder: Machine Learning Approach %A ElSherief,Mai %A Sumner,Steven A %A Jones,Christopher M %A Law,Royal K %A Kacha-Ochana,Akadia %A Shieber,Lyna %A Cordier,LeShaundra %A Holton,Kelly %A De Choudhury,Munmun %+ School of Interactive Computing, Georgia Institute of Technology, 756 W Peachtree St NW, Atlanta, GA, 30308, United States, 1 4043858603, munmund@gatech.edu %K opioid use disorder %K substance use %K addiction treatment %K misinformation %K social media %K machine learning %K natural language processing %D 2021 %7 22.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Expanding access to and use of medication for opioid use disorder (MOUD) is a key component of overdose prevention. An important barrier to the uptake of MOUD is exposure to inaccurate and potentially harmful health misinformation on social media or web-based forums where individuals commonly seek information. There is a significant need to devise computational techniques to describe the prevalence of web-based health misinformation related to MOUD to facilitate mitigation efforts. Objective: By adopting a multidisciplinary, mixed methods strategy, this paper aims to present machine learning and natural language analysis approaches to identify the characteristics and prevalence of web-based misinformation related to MOUD to inform future prevention, treatment, and response efforts. Methods: The team harnessed public social media posts and comments in the English language from Twitter (6,365,245 posts), YouTube (99,386 posts), Reddit (13,483,419 posts), and Drugs-Forum (5549 posts). Leveraging public health expert annotations on a sample of 2400 of these social media posts that were found to be semantically most similar to a variety of prevailing opioid use disorder–related myths based on representational learning, the team developed a supervised machine learning classifier. This classifier identified whether a post’s language promoted one of the leading myths challenging addiction treatment: that the use of agonist therapy for MOUD is simply replacing one drug with another. Platform-level prevalence was calculated thereafter by machine labeling all unannotated posts with the classifier and noting the proportion of myth-indicative posts over all posts. Results: Our results demonstrate promise in identifying social media postings that center on treatment myths about opioid use disorder with an accuracy of 91% and an area under the curve of 0.9, including how these discussions vary across platforms in terms of prevalence and linguistic characteristics, with the lowest prevalence on web-based health communities such as Reddit and Drugs-Forum and the highest on Twitter. Specifically, the prevalence of the stated MOUD myth ranged from 0.4% on web-based health communities to 0.9% on Twitter. Conclusions: This work provides one of the first large-scale assessments of a key MOUD-related myth across multiple social media platforms and highlights the feasibility and importance of ongoing assessment of health misinformation related to addiction treatment. %M 34941555 %R 10.2196/30753 %U https://www.jmir.org/2021/12/e30753 %U https://doi.org/10.2196/30753 %U http://www.ncbi.nlm.nih.gov/pubmed/34941555 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e31834 %T The Spread of COVID-19 Crisis Communication by German Public Authorities and Experts on Twitter: Quantitative Content Analysis %A Drescher,Larissa S %A Roosen,Jutta %A Aue,Katja %A Dressel,Kerstin %A Schär,Wiebke %A Götz,Anne %+ C³ team GbR, Zennerstraße 13, Munich, 81379, Germany, 49 1726099031, larissa.drescher@c3team.de %K COVID-19 %K crisis communication %K content analysis %K Twitter %K experts %K authorities %K Germany %K negative binomial regression %K social media %K communication %K crisis %K information %K development %D 2021 %7 22.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic led to the necessity of immediate crisis communication by public health authorities. In Germany, as in many other countries, people choose social media, including Twitter, to obtain real-time information and understanding of the pandemic and its consequences. Next to authorities, experts such as virologists and science communicators were very prominent at the beginning of German Twitter COVID-19 crisis communication. Objective: The aim of this study was to detect similarities and differences between public authorities and individual experts in COVID-19 crisis communication on Twitter during the first year of the pandemic. Methods: Descriptive analysis and quantitative content analysis were carried out on 8251 original tweets posted from January 1, 2020, to January 15, 2021. COVID-19–related tweets of 21 authorities and 18 experts were categorized into structural, content, and style components. Negative binomial regressions were performed to evaluate tweet spread measured by the retweet and like counts of COVID-19–related tweets. Results: Descriptive statistics revealed that authorities and experts increasingly tweeted about COVID-19 over the period under study. Two experts and one authority were responsible for 70.26% (544,418/774,865) of all retweets, thus representing COVID-19 influencers. Altogether, COVID-19 tweets by experts reached a 7-fold higher rate of retweeting (t8,249=26.94, P<.001) and 13.9 times the like rate (t8,249=31.27, P<.001) compared with those of authorities. Tweets by authorities were much more designed than those by experts, with more structural and content components; for example, 91.99% (4997/5432) of tweets by authorities used hashtags in contrast to only 19.01% (536/2819) of experts’ COVID-19 tweets. Multivariate analysis revealed that such structural elements reduce the spread of the tweets, and the incidence rate of retweets for authorities’ tweets using hashtags was approximately 0.64 that of tweets without hashtags (Z=–6.92, P<.001). For experts, the effect of hashtags on retweets was insignificant (Z=1.56, P=.12). Conclusions: Twitter data are a powerful information source and suitable for crisis communication in Germany. COVID-19 tweet activity mirrors the development of COVID-19 cases in Germany. Twitter users retweet and like communications regarding COVID-19 by experts more than those delivered by authorities. Tweets have higher coverage for both authorities and experts when they are plain and for authorities when they directly address people. For authorities, it appears that it was difficult to win recognition during COVID-19. For all stakeholders studied, the association between number of followers and number of retweets was highly significantly positive (authorities Z=28.74, P<.001; experts Z=25.99, P<.001). Updated standards might be required for successful crisis communication by authorities. %M 34710054 %R 10.2196/31834 %U https://publichealth.jmir.org/2021/12/e31834 %U https://doi.org/10.2196/31834 %U http://www.ncbi.nlm.nih.gov/pubmed/34710054 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e26644 %T Understanding Health Communication Through Google Trends and News Coverage for COVID-19: Multinational Study in Eight Countries %A Ming,Wai-kit %A Huang,Fengqiu %A Chen,Qiuyi %A Liang,Beiting %A Jiao,Aoao %A Liu,Taoran %A Wu,Huailiang %A Akinwunmi,Babatunde %A Li,Jia %A Liu,Guan %A Zhang,Casper J P %A Huang,Jian %A Liu,Qian %+ School of Journalism and Communication, National Media Experimental Teaching Demonstration Center, Jinan University, 601 Huangpu Dadao West, Guangzhou, 510632, China, 86 13302292599, tsusanliu@jnu.edu.cn %K COVID-19 %K Google Trends %K search peaks %K news coverage %K public concerns %D 2021 %7 21.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Due to the COVID-19 pandemic, health information related to COVID-19 has spread across news media worldwide. Google is among the most used internet search engines, and the Google Trends tool can reflect how the public seeks COVID-19–related health information during the pandemic. Objective: The aim of this study was to understand health communication through Google Trends and news coverage and to explore their relationship with prevention and control of COVID-19 at the early epidemic stage. Methods: To achieve the study objectives, we analyzed the public’s information-seeking behaviors on Google and news media coverage on COVID-19. We collected data on COVID-19 news coverage and Google search queries from eight countries (ie, the United States, the United Kingdom, Canada, Singapore, Ireland, Australia, South Africa, and New Zealand) between January 1 and April 29, 2020. We depicted the characteristics of the COVID-19 news coverage trends over time, as well as the search query trends for the topics of COVID-19–related “diseases,” “treatments and medical resources,” “symptoms and signs,” and “public measures.” The search query trends provided the relative search volume (RSV) as an indicator to represent the popularity of a specific search term in a specific geographic area over time. Also, time-lag correlation analysis was used to further explore the relationship between search terms trends and the number of new daily cases, as well as the relationship between search terms trends and news coverage. Results: Across all search trends in eight countries, almost all search peaks appeared between March and April 2020, and declined in April 2020. Regarding COVID-19–related “diseases,” in most countries, the RSV of the term “coronavirus” increased earlier than that of “covid-19”; however, around April 2020, the search volume of the term “covid-19” surpassed that of “coronavirus.” Regarding the topic “treatments and medical resources,” the most and least searched terms were “mask” and “ventilator,” respectively. Regarding the topic “symptoms and signs,” “fever” and “cough” were the most searched terms. The RSV for the term “lockdown” was significantly higher than that for “social distancing” under the topic “public health measures.” In addition, when combining search trends with news coverage, there were three main patterns: (1) the pattern for Singapore, (2) the pattern for the United States, and (3) the pattern for the other countries. In the time-lag correlation analysis between the RSV for the topic “treatments and medical resources” and the number of new daily cases, the RSV for all countries except Singapore was positively correlated with new daily cases, with a maximum correlation of 0.8 for the United States. In addition, in the time-lag correlation analysis between the overall RSV for the topic “diseases” and the number of daily news items, the overall RSV was positively correlated with the number of daily news items, the maximum correlation coefficient was more than 0.8, and the search behavior occurred 0 to 17 days earlier than the news coverage. Conclusions: Our findings revealed public interest in masks, disease control, and public measures, and revealed the potential value of Google Trends in the face of the emergence of new infectious diseases. Also, Google Trends combined with news media can achieve more efficient health communication. Therefore, both news media and Google Trends can contribute to the early prevention and control of epidemics. %M 34591781 %R 10.2196/26644 %U https://publichealth.jmir.org/2021/12/e26644 %U https://doi.org/10.2196/26644 %U http://www.ncbi.nlm.nih.gov/pubmed/34591781 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e27183 %T Smokers’ Likelihood to Engage With Information and Misinformation on Twitter About the Relative Harms of e-Cigarette Use: Results From a Randomized Controlled Trial %A Liu,Jessica %A Wright,Caroline %A Williams,Philippa %A Elizarova,Olga %A Dahne,Jennifer %A Bian,Jiang %A Zhao,Yunpeng %A Tan,Andy S L %+ Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States, 1 7149289866, jessica_liu@g.harvard.edu %K e-cigarettes %K misinformation %K Twitter %K social media %D 2021 %7 21.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Information and misinformation on the internet about e-cigarette harms may increase smokers’ misperceptions of e-cigarettes. There is limited research on smokers’ engagement with information and misinformation about e-cigarettes on social media. Objective: This study assessed smokers’ likelihood to engage with—defined as replying, retweeting, liking, and sharing—tweets that contain information and misinformation and uncertainty about the harms of e-cigarettes. Methods: We conducted a web-based randomized controlled trial among 2400 UK and US adult smokers who did not vape in the past 30 days. Participants were randomly assigned to view four tweets in one of four conditions: (1) e-cigarettes are as harmful or more harmful than smoking, (2) e-cigarettes are completely harmless, (3) uncertainty about e-cigarette harms, or (4) control (physical activity). The outcome measure was participants’ likelihood of engaging with tweets, which comprised the sum of whether they would reply, retweet, like, and share each tweet. We fitted Poisson regression models to predict the likelihood of engagement with tweets among 974 Twitter users and 1287 non-Twitter social media users, adjusting for covariates and stratified by UK and US participants. Results: Among Twitter users, participants were more likely to engage with tweets in condition 1 (e-cigarettes are as harmful or more harmful than smoking) than in condition 2 (e-cigarettes are completely harmless). Among other social media users, participants were more likely to likely to engage with tweets in condition 1 than in conditions 2 and 3 (e-cigarettes are completely harmless and uncertainty about e-cigarette harms). Conclusions: Tweets stating information and misinformation that e-cigarettes were as harmful or more harmful than smoking regular cigarettes may receive higher engagement than tweets indicating e-cigarettes were completely harmless. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 16082420; https://doi.org/10.1186/ISRCTN16082420 %M 34931999 %R 10.2196/27183 %U https://publichealth.jmir.org/2021/12/e27183 %U https://doi.org/10.2196/27183 %U http://www.ncbi.nlm.nih.gov/pubmed/34931999 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27307 %T Infodemiological Examination of Personal and Commercial Tweets About Cannabidiol: Term and Sentiment Analysis %A Turner,Jason %A Kantardzic,Mehmed %A Vickers-Smith,Rachel %+ Data Mining Lab, Department of Computer Science and Engineering, University of Louisville, 222 Eastern Pkwy, Louisville, KY, 40292, United States, 1 502 852 6304, jason.turner@louisville.edu %K social media %K social networks %K text mining %K CBD %K cannabidiol %K cannabis %K public health %K drug regulation %K Twitter %K sentiment analysis %K unregulated substances %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In the absence of official clinical trial information, data from social networks can be used by public health and medical researchers to assess public claims about loosely regulated substances such as cannabidiol (CBD). For example, this can be achieved by comparing the medical conditions targeted by those selling CBD against the medical conditions patients commonly treat with CBD. Objective: The objective of this study was to provide a framework for public health and medical researchers to use for identifying and analyzing the consumption and marketing of unregulated substances. Specifically, we examined CBD, which is a substance that is often presented to the public as medication despite complete evidence of efficacy and safety. Methods: We collected 567,850 tweets by searching Twitter with the Tweepy Python package using the terms “CBD” and “cannabidiol.” We trained two binary text classifiers to create two corpora of 167,755 personal use and 143,322 commercial/sales tweets. Using medical, standard, and slang dictionaries, we identified and compared the most frequently occurring medical conditions, symptoms, side effects, body parts, and other substances referenced in both corpora. In addition, to assess popular claims about the efficacy of CBD as a medical treatment circulating on Twitter, we performed sentiment analysis via the VADER (Valence Aware Dictionary for Sentiment Reasoning) model on the personal CBD tweets. Results: We found references to medically relevant terms that were unique to either personal or commercial CBD tweet classes, as well as medically relevant terms that were common to both classes. When we calculated the average sentiment scores for both personal and commercial CBD tweets referencing at least one of 17 medical conditions/symptoms terms, an overall positive sentiment was observed in both personal and commercial CBD tweets. We observed instances of negative sentiment conveyed in personal CBD tweets referencing autism, whereas CBD was also marketed multiple times as a treatment for autism within commercial tweets. Conclusions: Our proposed framework provides a tool for public health and medical researchers to analyze the consumption and marketing of unregulated substances on social networks. Our analysis showed that most users of CBD are satisfied with it in regard to the condition that it is being advertised for, with the exception of autism. %M 34932014 %R 10.2196/27307 %U https://www.jmir.org/2021/12/e27307 %U https://doi.org/10.2196/27307 %U http://www.ncbi.nlm.nih.gov/pubmed/34932014 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e33617 %T Utility of Facebook’s Social Connectedness Index in Modeling COVID-19 Spread: Exponential Random Graph Modeling Study %A Prusaczyk,Beth %A Pietka,Kathryn %A Landman,Joshua M %A Luke,Douglas A %+ Center for Population Health Informatics, Institute for Informatics, Washington University School of Medicine in St. Louis, 660 S. Euclid Avenue, Saint Louis, MO, 63110, United States, 1 314 330 0537, beth.prusaczyk@wustl.edu %K COVID-19 %K social media %K social networks %K network analysis %K public health %K utility %K Facebook %K connection %K modeling %K spread %K United States %K belief %D 2021 %7 15.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 (the disease caused by the SARS-CoV-2 virus) pandemic has underscored the need for additional data, tools, and methods that can be used to combat emerging and existing public health concerns. Since March 2020, there has been substantial interest in using social media data to both understand and intervene in the pandemic. Researchers from many disciplines have recently found a relationship between COVID-19 and a new data set from Facebook called the Social Connectedness Index (SCI). Objective: Building off this work, we seek to use the SCI to examine how social similarity of Missouri counties could explain similarities of COVID-19 cases over time. Additionally, we aim to add to the body of literature on the utility of the SCI by using a novel modeling technique. Methods: In September 2020, we conducted this cross-sectional study using publicly available data to test the association between the SCI and COVID-19 spread in Missouri using exponential random graph models, which model relational data, and the outcome variable must be binary, representing the presence or absence of a relationship. In our model, this was the presence or absence of a highly correlated COVID-19 case count trajectory between two given counties in Missouri. Covariates included each county’s total population, percent rurality, and distance between each county pair. Results: We found that all covariates were significantly associated with two counties having highly correlated COVID-19 case count trajectories. As the log of a county’s total population increased, the odds of two counties having highly correlated COVID-19 case count trajectories increased by 66% (odds ratio [OR] 1.66, 95% CI 1.43-1.92). As the percent of a county classified as rural increased, the odds of two counties having highly correlated COVID-19 case count trajectories increased by 1% (OR 1.01, 95% CI 1.00-1.01). As the distance (in miles) between two counties increased, the odds of two counties having highly correlated COVID-19 case count trajectories decreased by 43% (OR 0.57, 95% CI 0.43-0.77). Lastly, as the log of the SCI between two Missouri counties increased, the odds of those two counties having highly correlated COVID-19 case count trajectories significantly increased by 17% (OR 1.17, 95% CI 1.09-1.26). Conclusions: These results could suggest that two counties with a greater likelihood of sharing Facebook friendships means residents of those counties have a higher likelihood of sharing similar belief systems, in particular as they relate to COVID-19 and public health practices. Another possibility is that the SCI is picking up travel or movement data among county residents. This suggests the SCI is capturing a unique phenomenon relevant to COVID-19 and that it may be worth adding to other COVID-19 models. Additional research is needed to better understand what the SCI is capturing practically and what it means for public health policies and prevention practices. %M 34797775 %R 10.2196/33617 %U https://publichealth.jmir.org/2021/12/e33617 %U https://doi.org/10.2196/33617 %U http://www.ncbi.nlm.nih.gov/pubmed/34797775 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e30315 %T Examining TikTok’s Potential for Community-Engaged Digital Knowledge Mobilization With Equity-Seeking Groups %A MacKinnon,Kinnon Ross %A Kia,Hannah %A Lacombe-Duncan,Ashley %+ School of Social Work, York University, 4700 Keele Avenue, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 66333, kinnonmk@yorku.ca %K trans %K nonbinary %K marginalized communities %K gender-affirming care %K digital health %K community-engaged research %K knowledge mobilization %K mobile phone %D 2021 %7 9.12.2021 %9 Viewpoint %J J Med Internet Res %G English %X Social media is increasingly being leveraged by researchers to engage in public debates and rapidly disseminate research results to health care providers, health care users, policy makers, educators, and the general public. This paper contributes to the growing literature on the use of social media for digital knowledge mobilization, drawing particular attention to TikTok and its unique potential for collaborative knowledge mobilization with underserved communities who experience barriers to health care and health inequities (eg, equity-seeking groups). Setting the TikTok platform apart from other social media are the unique audiovisual video editing tools, together with an impactful algorithm, that make knowledge dissemination and exchange with large global audiences possible. As an example, we will discuss digital knowledge mobilization with trans and nonbinary (trans) communities, a population that experiences barriers to health care and is engaged in significant peer-to-peer health information sharing on the web. To demonstrate, analytics data from 13 selected TikTok videos on the topic of research on gender-affirming medicine (eg, hormonal therapy and surgeries) are presented to illustrate how knowledge is disseminated within the trans community via TikTok. Considerations for researchers planning to use TikTok for digital knowledge mobilization and other related community engagement with equity-seeking groups are also discussed. These include the limitations of TikTok analytics data for measuring knowledge mobilization, population-specific concerns related to community safety on social media, the spread of disinformation, barriers to internet access, and commercialization and intellectual property issues. This paper concludes that TikTok is an innovative social media platform that presents possibilities for achieving transformative, community-engaged knowledge mobilization among researchers, underserved health care users, and their health care providers, all of whom are necessary to achieve better health care and population health outcomes. %M 34889739 %R 10.2196/30315 %U https://www.jmir.org/2021/12/e30315 %U https://doi.org/10.2196/30315 %U http://www.ncbi.nlm.nih.gov/pubmed/34889739 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27613 %T Identifying Insomnia From Social Media Posts: Psycholinguistic Analyses of User Tweets %A Sakib,Ahmed Shahriar %A Mukta,Md Saddam Hossain %A Huda,Fariha Rowshan %A Islam,A K M Najmul %A Islam,Tohedul %A Ali,Mohammed Eunus %+ United International University, Madani Ave, Natun Bazar, Dhaka, 1216, Bangladesh, 880 1712 095216, saddam@cse.uiu.ac.bd %K insomnia %K Twitter %K word embedding %K Big 5 personality traits %K classification %K social media %K prediction model %K psycholinguistics %D 2021 %7 9.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many people suffer from insomnia, a sleep disorder characterized by difficulty falling and staying asleep during the night. As social media have become a ubiquitous platform to share users’ thoughts, opinions, activities, and preferences with their friends and acquaintances, the shared content across these platforms can be used to diagnose different health problems, including insomnia. Only a few recent studies have examined the prediction of insomnia from Twitter data, and we found research gaps in predicting insomnia from word usage patterns and correlations between users’ insomnia and their Big 5 personality traits as derived from social media interactions. Objective: The purpose of this study is to build an insomnia prediction model from users’ psycholinguistic patterns, including the elements of word usage, semantics, and their Big 5 personality traits as derived from tweets. Methods: In this paper, we exploited both psycholinguistic and personality traits derived from tweets to identify insomnia patients. First, we built psycholinguistic profiles of the users from their word choices and the semantic relationships between the words of their tweets. We then determined the relationship between a users’ personality traits and insomnia. Finally, we built a double-weighted ensemble classification model to predict insomnia from both psycholinguistic and personality traits as derived from user tweets. Results: Our classification model showed strong prediction potential (78.8%) to predict insomnia from tweets. As insomniacs are generally ill-tempered and feel more stress and mental exhaustion, we observed significant correlations of certain word usage patterns among them. They tend to use negative words (eg, “no,” “not,” “never”). Some people frequently use swear words (eg, “damn,” “piss,” “fuck”) with strong temperament. They also use anxious (eg, “worried,” “fearful,” “nervous”) and sad (eg, “crying,” “grief,” “sad”) words in their tweets. We also found that the users with high neuroticism and conscientiousness scores for the Big 5 personality traits likely have strong correlations with insomnia. Additionally, we observed that users with high conscientiousness scores have strong correlations with insomnia patterns, while negative correlation between extraversion and insomnia was also found. Conclusions: Our model can help predict insomnia from users’ social media interactions. Thus, incorporating our model into a software system can help family members detect insomnia problems in individuals before they become worse. The software system can also help doctors to diagnose possible insomnia in patients. %M 34889758 %R 10.2196/27613 %U https://www.jmir.org/2021/12/e27613 %U https://doi.org/10.2196/27613 %U http://www.ncbi.nlm.nih.gov/pubmed/34889758 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28305 %T Anti-Asian Sentiments During the COVID-19 Pandemic Across 20 Countries: Analysis of a 12-Billion-Word News Media Database %A Ng,Reuben %+ Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Rd, Singapore, 259772, Singapore, 65 66015229, spprng@nus.edu.sg %K racism %K COVID-19 %K anti-Asian sentiments %K psychomics %K quantitative social science %K culture %K text as data %K xenophobia %K digital humanities %D 2021 %7 8.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: US president Joe Biden signed an executive action directing federal agencies to combat hate crimes and racism against Asians, which have percolated during the COVID-19 pandemic. This is one of the first known empirical studies to dynamically test whether global societal sentiments toward Asians have become more negative during the COVID-19 pandemic. Objective: This study aimed to investigate whether global societal sentiments toward Asians across 20 countries have become more negative, month by month, from before the pandemic (October 2019) to May 2020, along with the pandemic (incidence and mortality rates) and cultural (Hofstede’s cultural dimensions) predictors of this trend. Methods: We leveraged a 12-billion-word web-based media database, with over 30 million newspaper and magazine articles taken from over 7000 sites across 20 countries, and identified 6 synonyms of “Asian” that are related to the coronavirus. We compiled their most frequently used descriptors (collocates) from October 2019 to May 2020 across 20 countries, culminating in 85,827 collocates that were rated by 2 independent researchers to provide a Cumulative Asian Sentiment Score (CASS) per month. This allowed us to track significant shifts in societal sentiments toward Asians from a baseline period (October to December 2019) to the onset of the pandemic (January to May 2020). We tested the competing predictors of this trend: pandemic variables of incidence and mortality rates measured monthly for all 20 countries taken from the Oxford COVID-19 Government Response Tracker, and Hofstede’s Cultural Dimensions of Individualism, Power Distance, Uncertainty Avoidance, and Masculinity for the 20 countries. Results: Before the pandemic in December 2019, Jamaica and New Zealand evidenced the most negative societal sentiments toward Asians; when news about the coronavirus was released in January 2020, the United States and Nigeria evidenced the most negative sentiments toward Asians among 20 countries. Globally, sentiments of Asians became more negative—a significant linear decline during the COVID-19 pandemic. CASS trended neutral before the pandemic during the baseline period of October to November 2019 and then plummeted in February 2020. CASS were, ironically, not predicted by COVID-19’s incidence and mortality rates, but rather by Hofstede’s cultural dimensions: individualism, power distance, and uncertainty avoidance—as shown by mixed models (N=28,494). Specifically, higher power distance, individualism, and uncertainty avoidance were associated with negative societal sentiments toward Asians. Conclusions: Racism, in the form of Anti-Asian sentiments, are deep-seated, and predicated on structural undercurrents of culture. The COVID-19 pandemic may have indirectly and inadvertently exacerbated societal tendencies for racism. Our study lays the important groundwork to design interventions and policy communications to ameliorate Anti-Asian racism, which are culturally nuanced and contextually appropriate. %M 34678754 %R 10.2196/28305 %U https://www.jmir.org/2021/12/e28305 %U https://doi.org/10.2196/28305 %U http://www.ncbi.nlm.nih.gov/pubmed/34678754 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e25654 %T Audience of Academic Otolaryngology on Twitter: Cross-sectional Study %A Xie,Deborah X %A Boss,Emily F %A Stewart,C Matthew %+ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N Caroline Street, Baltimore, MD, 21231, United States, 1 410 955 3492, cstewa16@jhmi.edu %K Twitter %K otolaryngology %K residency %K medical education %K social media %K internet %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Despite the ubiquity of social media, the utilization and audience reach of this communication method by otolaryngology-head and neck surgery (OHNS) residency programs has not been investigated. Objective: The purpose of this study was to evaluate the content posted to a popular social media platform (Twitter) by OHNS residency programs. Methods: In this cross-sectional study, we identified Twitter accounts for accredited academic OHNS residency programs. Tweets published over a 6-month period (March to August 2019) were extracted. Tweets were categorized and analyzed for source (original versus retweet) and target audience (medical versus layman). A random sample of 100 tweets was used to identify patterns of content, which were then used to categorize additional tweets. We quantified the total number of likes or retweets by health care professionals. Results: Of the 121 accredited programs, 35 (28.9%) had Twitter accounts. Of the 2526 tweets in the 6-month period, 1695 (67.10%) were original-content tweets. The majority of tweets (1283/1695, 75.69%) were targeted toward health care workers, most of which did not directly contain medical information (954/1283, 74.36%). These tweets contained information about the department’s trainees and education (349/954, 36.6%), participation at conferences (263/954, 27.6%), and research publications (112/954, 11.7%). Two-thirds of all tweets did not contain medical information. Medical professionals accounted for 1249/1362 (91.70%) of retweets and 5616/6372 (88.14%) of likes on original-content tweets. Conclusions: The majority of Twitter usage by OHNS residency programs is for intra and interprofessional communication, and only a minority of tweets contain information geared toward the public. Communication and information sharing with patients is not the focus of OHNS departments on Twitter. %M 34889748 %R 10.2196/25654 %U https://mededu.jmir.org/2021/4/e25654 %U https://doi.org/10.2196/25654 %U http://www.ncbi.nlm.nih.gov/pubmed/34889748 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e29011 %T Difficulty Regulating Social Media Content of Age-Restricted Products: Comparing JUUL’s Official Twitter Timeline and Social Media Content About JUUL %A Valdez,Danny %A Unger,Jennifer B %+ Department of Applied Health Science, Indiana University School of Public Health, 1025 E 7th Street, #111, Bloomington, IN, 47405, United States, 1 8128551561, danvald@iu.edu %K social media %K JUUL %K underage marketing %K LDA %K Latent Dirichlet Allocation %K topic models %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: In 2018, JUUL Labs Inc, a popular e-cigarette manufacturer, announced it would substantially limit its social media presence in compliance with the Food and Drug Administration’s (FDA) call to curb underage e-cigarette use. However, shortly after the announcement, a series of JUUL-related hashtags emerged on various social media platforms, calling the effectiveness of the FDA’s regulations into question. Objective: The purpose of this study is to determine whether hashtags remain a common venue to market age-restricted products on social media. Methods: We used Twitter’s standard application programming interface to download the 3200 most-recent tweets originating from JUUL Labs Inc’s official Twitter Account (@JUULVapor), and a series of tweets (n=28,989) from other Twitter users containing either #JUUL or mentioned JUUL in the tweet text. We ran exploratory (10×10) and iterative Latent Dirichlet Allocation (LDA) topic models to compare @JUULVapor’s content versus our hashtag corpus. We qualitatively deliberated topic meanings and substantiated our interpretations with tweets from either corpus. Results: The topic models generated for @JUULVapor’s timeline seemingly alluded to compliance with the FDA’s call to prohibit marketing of age-restricted products on social media. However, the topic models generated for the hashtag corpus of tweets from other Twitter users contained several references to flavors, vaping paraphernalia, and illicit drugs, which may be appealing to younger audiences. Conclusions: Our findings underscore the complicated nature of social media regulation. Although JUUL Labs Inc seemingly complied with the FDA to limit its social media presence, JUUL and other e-cigarette manufacturers are still discussed openly in social media spaces. Much discourse about JUUL and e-cigarettes is spread via hashtags, which allow messages to reach a wide audience quickly. This suggests that social media regulations on manufacturers cannot prevent e-cigarette users, influencers, or marketers from spreading information about e-cigarette attributes that appeal to the youth, such as flavors. Stricter protocols are needed to regulate discourse about age-restricted products on social media. %M 37114198 %R 10.2196/29011 %U https://infodemiology.jmir.org/2021/1/e29011 %U https://doi.org/10.2196/29011 %U http://www.ncbi.nlm.nih.gov/pubmed/37114198 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e32814 %T Factors Driving the Popularity and Virality of COVID-19 Vaccine Discourse on Twitter: Text Mining and Data Visualization Study %A Zhang,Jueman %A Wang,Yi %A Shi,Molu %A Wang,Xiuli %+ School of New Media, Peking University, 5 Yiheyuan Road, Haidian District, Beijing, 100871, China, 86 10 6276 6689, xiuli.wang@pku.edu.cn %K COVID-19 %K vaccine %K topic modeling %K LDA %K valence %K share %K viral %K Twitter %K social media %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 vaccination is considered a critical prevention measure to help end the pandemic. Social media platforms such as Twitter have played an important role in the public discussion about COVID-19 vaccines. Objective: The aim of this study was to investigate message-level drivers of the popularity and virality of tweets about COVID-19 vaccines using machine-based text-mining techniques. We further aimed to examine the topic communities of the most liked and most retweeted tweets using network analysis and visualization. Methods: We collected US-based English-language public tweets about COVID-19 vaccines from January 1, 2020, to April 30, 2021 (N=501,531). Topic modeling and sentiment analysis were used to identify latent topics and valence, which together with autoextracted information about media presence, linguistic features, and account verification were used in regression models to predict likes and retweets. Among the 2500 most liked tweets and 2500 most retweeted tweets, network analysis and visualization were used to detect topic communities and present the relationship between the topics and the tweets. Results: Topic modeling yielded 12 topics. The regression analyses showed that 8 topics positively predicted likes and 7 topics positively predicted retweets, among which the topic of vaccine development and people’s views and that of vaccine efficacy and rollout had relatively larger effects. Network analysis and visualization revealed that the 2500 most liked and most retweeted retweets clustered around the topics of vaccine access, vaccine efficacy and rollout, vaccine development and people’s views, and vaccination status. The overall valence of the tweets was positive. Positive valence increased likes, but valence did not affect retweets. Media (photo, video, gif) presence and account verification increased likes and retweets. Linguistic features had mixed effects on likes and retweets. Conclusions: This study suggests the public interest in and demand for information about vaccine development and people’s views, and about vaccine efficacy and rollout. These topics, along with the use of media and verified accounts, have enhanced the popularity and virality of tweets. These topics could be addressed in vaccine campaigns to help the diffusion of content on Twitter. %M 34665761 %R 10.2196/32814 %U https://publichealth.jmir.org/2021/12/e32814 %U https://doi.org/10.2196/32814 %U http://www.ncbi.nlm.nih.gov/pubmed/34665761 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e27385 %T Using Google Trends to Inform the Population Size Estimation and Spatial Distribution of Gay, Bisexual, and Other Men Who Have Sex With Men: Proof-of-concept Study %A Card,Kiffer G %A Lachowsky,Nathan J %A Hogg,Robert S %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada, 1 2502131743, kiffercard@gmail.com %K gay, bisexual, and other men who have sex with men %K spatial distribution %K population size estimation %K pornography %K technology-aided surveillance %D 2021 %7 29.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: We must triangulate data sources to understand best the spatial distribution and population size of marginalized populations to empower public health leaders to address population-specific needs. Existing population size estimation techniques are difficult and limited. Objective: We sought to identify a passive surveillance strategy that utilizes internet and social media to enhance, validate, and triangulate population size estimates of gay, bisexual, and other men who have sex with men (gbMSM). Methods: We explored the Google Trends platform to approximate an estimate of the spatial heterogeneity of the population distribution of gbMSM. This was done by comparing the prevalence of the search term “gay porn” with that of the search term “porn.” Results: Our results suggested that most cities have a gbMSM population size between 2% and 4% of their total population, with large urban centers having higher estimates relative to rural or suburban areas. This represents nearly a double up of population size estimates compared to that found by other methods, which typically find that between 1% and 2% of the total population are gbMSM. We noted that our method was limited by unequal coverage in internet usage across Canada and differences in the frequency of porn use by gender and sexual orientation. Conclusions: We argue that Google Trends estimates may provide, for many public health planning purposes, adequate city-level estimates of gbMSM population size in regions with a high prevalence of internet access and for purposes in which a precise or narrow estimate of the population size is not required. Furthermore, the Google Trends platform does so in less than a minute at no cost, making it extremely timely and cost-effective relative to more precise (and complex) estimates. We also discuss future steps for further validation of this approach. %M 34618679 %R 10.2196/27385 %U https://publichealth.jmir.org/2021/11/e27385 %U https://doi.org/10.2196/27385 %U http://www.ncbi.nlm.nih.gov/pubmed/34618679 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30761 %T Limited Interaction Targeted Epidemiology of HIV in Sexual and Gender Minority American Adolescents and Adults: Feasibility of the Keeping it LITE Study %A Gleason,Neil %A Serrano,Pedro A %A Muñoz,Alejandro %A French,Audrey %A Hosek,Sybil %+ Ruth M Rothstein CORE Center, Cook County Health, 2020 W Harrison St,, Chicago, IL, 60612, United States, 1 (312) 572 4500, pserrano@cookcountyhhs.org %K social epidemiology %K adolescents and young adults %K sexual and gender minorities %K HIV testing %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV infection rates among sexual minority men and transgender individuals, particularly adolescents and young adults, remain elevated in the United States despite continued improvement in the HIV public health response. However, there remains a knowledge gap in understanding the barriers faced by this community in receiving HIV care and prevention resources. To address this, the Keeping it LITE study was conducted to assess HIV risk factors and barriers to preventive treatment in a large national cohort of young sexual minority men and transgender individuals at high risk of HIV infection. Objective: This study aims to evaluate the feasibility of enrolling a large remote cohort, challenges encountered in recruitment, and adjustments made to address these challenges. Methods: A large national cohort (n=3444) of young sexual minority men and transgender individuals were recruited. Participants were recruited via advertisements on social media; social apps for lesbian, gay, bisexual, transgender, and queer individuals; print advertising; and word-of-mouth. Before enrolling, participants verified their HIV status using an at-home HIV test or by providing their own testing documentation. Descriptive statistics were generated, and a series of logistic regressions were conducted to evaluate demographic differences between recruitment methods, HIV testing methods, and enrollment status. Results: The Keeping it LITE study was particularly successful in recruiting participants via social media, with over half of the participants recruited from advertisements on social media platforms such as Facebook, Instagram, and Snapchat. Participants were also recruited via word-of-mouth; lesbian, gay, bisexual, transgender, and queer apps (ie, Grindr, Scruff); and print advertisements, and participants recruited from these sources tended to be older and have a higher risk profile. The study was also successful in recruiting a large sample of transgender youth, particularly transgender men and nonbinary individuals. At-home HIV testing was acceptable and more heavily used by younger participants, although several barriers were encountered and overcome in the implementation of this testing. The study had more limited success in recruiting participants aged 13-17 years because of lower enrollment rates and barriers to advertising on social media platforms. The implications of these findings for the future development of HIV research and intervention protocols among sexual minorities and trans youth are discussed. Conclusions: The methods used in the Keeping it LITE study, particularly recruitment via social media, were found to be feasible and acceptable to participants. %M 34346403 %R 10.2196/30761 %U https://formative.jmir.org/2021/11/e30761 %U https://doi.org/10.2196/30761 %U http://www.ncbi.nlm.nih.gov/pubmed/34346403 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e29487 %T Studies of Depression and Anxiety Using Reddit as a Data Source: Scoping Review %A Boettcher,Nick %+ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada, 1 (403) 220 4286, nkboettc@ucalgary.ca %K depression %K anxiety %K mental health %K Reddit %K social media %K review %D 2021 %7 25.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: The study of depression and anxiety using publicly available social media data is a research activity that has grown considerably over the past decade. The discussion platform Reddit has become a popular social media data source in this nascent area of study, in part because of the unique ways in which the platform is facilitative of research. To date, no work has been done to synthesize existing studies on depression and anxiety using Reddit. Objective: The objective of this review is to understand the scope and nature of research using Reddit as a primary data source for studying depression and anxiety. Methods: A scoping review was conducted using the Arksey and O’Malley framework. MEDLINE, Embase, CINAHL, PsycINFO, PsycARTICLES, Scopus, ScienceDirect, IEEE Xplore, and ACM academic databases were searched. Inclusion criteria were developed using the participants, concept, and context framework outlined by the Joanna Briggs Institute Scoping Review Methodology Group. Eligible studies featured an analytic focus on depression or anxiety and used naturalistic written expressions from Reddit users as a primary data source. Results: A total of 54 studies were included in the review. Tables and corresponding analyses delineate the key methodological features, including a comparatively larger focus on depression versus anxiety, an even split of original and premade data sets, a widespread analytic focus on classifying the mental health states of Reddit users, and practical implications that often recommend new methods of professionally delivered monitoring and outreach for Reddit users. Conclusions: Studies of depression and anxiety using Reddit data are currently driven by a prevailing methodology that favors a technical, solution-based orientation. Researchers interested in advancing this research area will benefit from further consideration of conceptual issues surrounding the interpretation of Reddit data with the medical model of mental health. Further efforts are also needed to locate accountability and autonomy within practice implications, suggesting new forms of engagement with Reddit users. %M 34842560 %R 10.2196/29487 %U https://mental.jmir.org/2021/11/e29487 %U https://doi.org/10.2196/29487 %U http://www.ncbi.nlm.nih.gov/pubmed/34842560 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29600 %T Characteristics of and User Engagement With Antivaping Posts on Instagram: Observational Study %A Gao,Yankun %A Xie,Zidian %A Sun,Li %A Xu,Chenliang %A Li,Dongmei %+ Department of Clinical & Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 585 276 7285, Dongmei_Li@urmc.rochester.edu %K anti-vaping %K Instagram %K user engagement %K e-cigarettes %K vaping %K social media %K content analysis %K public health %K lung health %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although government agencies acknowledge that messages about the adverse health effects of e-cigarette use should be promoted on social media, effectively delivering those health messages is challenging. Instagram is one of the most popular social media platforms among US youth and young adults, and it has been used to educate the public about the potential harm of vaping through antivaping posts. Objective: We aim to analyze the characteristics of and user engagement with antivaping posts on Instagram to inform future message development and information delivery. Methods: A total of 11,322 Instagram posts were collected from November 18, 2019, to January 2, 2020, by using antivaping hashtags including #novape, #novaping, #stopvaping, #dontvape, #antivaping, #quitvaping, #antivape, #stopjuuling, #dontvapeonthepizza, and #escapethevape. Among those posts, 1025 posts were randomly selected and 500 antivaping posts were further identified by hand coding. The image type, image content, and account type of antivaping posts were hand coded, the text information in the caption was explored by topic modeling, and the user engagement of each category was compared. Results: Analyses found that antivaping images of the educational/warning type were the most common (253/500; 50.6%). The average likes of the educational/warning type (15 likes/post) were significantly lower than the catchphrase image type (these emphasized a slogan such as “athletesdontvape” in the image; 32.5 likes/post; P<.001). The majority of the antivaping posts contained the image content element text (n=332, 66.4%), followed by the image content element people/person (n=110, 22%). The images containing people/person elements (32.8 likes/post) had more likes than the images containing other elements (13.8-21.1 likes/post). The captions of the antivaping Instagram posts covered topics including “lung health,” “teen vaping,” “stop vaping,” and “vaping death cases.” Among the 500 antivaping Instagram posts, while most posts were from the antivaping community (n=177, 35.4%) and personal account types (n=182, 36.4%), the antivaping community account type had the highest average number of posts (1.69 posts/account). However, there was no difference in the number of likes among different account types. Conclusions: Multiple features of antivaping Instagram posts may be related to user engagement and perception. This study identified the critical elements associated with high user engagement, which could be used to design antivaping posts to deliver health-related information more efficiently. %M 34842553 %R 10.2196/29600 %U https://publichealth.jmir.org/2021/11/e29600 %U https://doi.org/10.2196/29600 %U http://www.ncbi.nlm.nih.gov/pubmed/34842553 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e25618 %T Mobile Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Randomized Trial of Project Debunk %A Prokhorov,Alexander V %A Calabro,Karen Sue %A Arya,Ashish %A Russell,Sophia %A Czerniak,Katarzyna W %A Botello,Gabrielle C %A Chen,Minxing %A Yuan,Ying %A Perez,Adriana %A Vidrine,Damon J %A Perry,Cheryl L %A Khalil,Georges Elias %+ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Clinical and Translational Science Building, 2004 Mowry Road Office 2252, Gainesville, FL, 32610, United States, 1 3522948415, gkhalil@ufl.edu %K tobacco use %K risk communication %K text messaging %K message framing %K regulatory science %K young adults %K vaping %K mobile phone %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% of YAs own mobile phones, SMS text messaging may be an effective strategy for tobacco risk communication. Objective: Project Debunk is a community-based randomized trial aiming to identify specific types of messages that effectively improve perceived NETP and CTP risk among YAs in community colleges. Methods: With YAs recruited offline from 3 campuses at the Houston Community College (September 2016 to July 2017), we conducted a 6-month randomized trial with 8 arms based on the combination of 3 message categories: framing (gain-framed vs loss-framed), depth (simple vs complex), and appeal (emotional vs rational). Participants received fully automated web-based SMS text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Owing to multiple testing with 7 models, an association was deemed significant for P<.007 (.05 divided by 7). Results: A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received messages from both campaigns. By the 2-month post campaign 2 assessment point, 70.1% (446/636) completed all outcome measures. By the end of both campaigns, participants had a significant increase in perceived NETP risk over time (P<.001); however, participants had a marginal increase in perceived CTP risk (P=.008). Separately for each group, there was a significant increase in perceived NETP risk among participants who received rational messages (P=.005), those who received emotional messages (P=.006), those who received simple messages (P=.003), and those who received gain-framed messages (P=.003). Conclusions: In this trial, YAs had an increase in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally had an increase in perceived CTP risk and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health programs may take advantage of our tailored messages through larger technology-based programs such as smartphone apps and social media campaigns. Trial Registration: ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480 International Registered Report Identifier (IRRID): RR2-10.2196/10977 %M 34822339 %R 10.2196/25618 %U https://mhealth.jmir.org/2021/11/e25618 %U https://doi.org/10.2196/25618 %U http://www.ncbi.nlm.nih.gov/pubmed/34822339 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e25287 %T Understanding the Relationship Between Official and Social Information About Infectious Disease: Experimental Analysis %A Assaf,Elias %A Bond,Robert M %A Cranmer,Skyler J %A Kaizar,Eloise E %A Ratliff Santoro,Lauren %A Shikano,Susumu %A Sivakoff,David J %+ The University of Texas at Dallas, 800 W Campbell Rd., Richardson, TX, 75080, United States, 1 9728836241, laurenratliffsantoro@utdallas.edu %K disease %K social information %K official information %K network experiments %D 2021 %7 23.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Communicating official public health information about infectious diseases is complicated by the fact that individuals receive much of their information from their social contacts, either via interpersonal interaction or social media, which can be prone to bias and misconception. Objective: This study aims to evaluate the effect of public health campaigns and the effect of socially communicated health information on learning about diseases simultaneously. Although extant literature addresses the effect of one source of information (official or social) or the other, it has not addressed the simultaneous interaction of official information (OI) and social information (SI) in an experimental setting. Methods: We used a series of experiments that exposed participants to both OI and structured SI about the symptoms and spread of hepatitis C over a series of 10 rounds of computer-based interactions. Participants were randomly assigned to receive a high, low, or control intensity of OI and to receive accurate or inaccurate SI about the disease. Results: A total of 195 participants consented to participate in the study. Of these respondents, 186 had complete responses across all ten experimental rounds, which corresponds to a 4.6% (9/195) nonresponse rate. The OI high intensity treatment increases learning over the control condition for all symptom and contagion questions when individuals have lower levels of baseline knowledge (all P values ≤.04). The accurate SI condition increased learning across experimental rounds over the inaccurate condition (all P values ≤.01). We find limited evidence of an interaction between official and SI about infectious diseases. Conclusions: This project demonstrates that exposure to official public health information increases individuals’ knowledge of the spread and symptoms of a disease. Socially shared information also facilitates the learning of accurate and inaccurate information, though to a lesser extent than exposure to OI. Although the effect of OI persists, preliminary results suggest that it can be degraded by persistent contradictory SI over time. %M 34817389 %R 10.2196/25287 %U https://www.jmir.org/2021/11/e25287 %U https://doi.org/10.2196/25287 %U http://www.ncbi.nlm.nih.gov/pubmed/34817389 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e30467 %T The Evolution of Rumors on a Closed Social Networking Platform During COVID-19: Algorithm Development and Content Study %A Wang,Andrea W %A Lan,Jo-Yu %A Wang,Ming-Hung %A Yu,Chihhao %+ Information Operations Research Group, 7F-13, No. 103, Sec. 1, Fuxing S. Rd., Da’an Dist., Taipei, 106, Taiwan, 886 933 263 989, chihhao@iorg.tw %K COVID-19 %K rumors %K rumor diffusion %K rumor propagation %K social listening %K infodemic %K social media %K closed platform %K natural language processing %K machine learning %K unsupervised learning %K computers and society %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: In 2020, the COVID-19 pandemic put the world in a crisis regarding both physical and psychological health. Simultaneously, a myriad of unverified information flowed on social media and online outlets. The situation was so severe that the World Health Organization identified it as an infodemic in February 2020. Objective: The aim of this study was to examine the propagation patterns and textual transformation of COVID-19–related rumors on a closed social media platform. Methods: We obtained a data set of suspicious text messages collected on Taiwan’s most popular instant messaging platform, LINE, between January and July 2020. We proposed a classification-based clustering algorithm that could efficiently cluster messages into groups, with each group representing a rumor. For ease of understanding, a group is referred to as a “rumor group.” Messages in a rumor group could be identical or could have limited textual differences between them. Therefore, each message in a rumor group is a form of the rumor. Results: A total of 936 rumor groups with at least 10 messages each were discovered among 114,124 text messages collected from LINE. Among 936 rumors, 396 (42.3%) were related to COVID-19. Of the 396 COVID-19–related rumors, 134 (33.8%) had been fact-checked by the International Fact-Checking Network–certified agencies in Taiwan and determined to be false or misleading. By studying the prevalence of simplified Chinese characters or phrases in the messages that originated in China, we found that COVID-19–related messages, compared to non–COVID-19–related messages, were more likely to have been written by non-Taiwanese users. The association was statistically significant, with P<.001, as determined by the chi-square independence test. The qualitative investigations of the three most popular COVID-19 rumors revealed that key authoritative figures, mostly medical personnel, were often misquoted in the messages. In addition, these rumors resurfaced multiple times after being fact-checked, usually preceded by major societal events or textual transformations. Conclusions: To fight the infodemic, it is crucial that we first understand why and how a rumor becomes popular. While social media has given rise to an unprecedented number of unverified rumors, it also provides a unique opportunity for us to study the propagation of rumors and their interactions with society. Therefore, we must put more effort into these areas. %M 34623954 %R 10.2196/30467 %U https://medinform.jmir.org/2021/11/e30467 %U https://doi.org/10.2196/30467 %U http://www.ncbi.nlm.nih.gov/pubmed/34623954 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e26660 %T Obesity-Related Communication in Digital Chinese News From Mainland China, Hong Kong, and Taiwan: Automated Content Analysis %A Chang,Angela %A Schulz,Peter Johannes %A Jiao,Wen %A Liu,Matthew Tingchi %+ Faculty of Social Sciences, University of Macau, E21 FSS Bldg, 2nd Fl., Taipa, 100, Macao, 853 88228991, wychang@um.edu.mo %K public health %K computational content %K digital research methods %K obesity discourse %K gene disorders %K noncommunicable disease %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The fact that the number of individuals with obesity has increased worldwide calls into question media efforts for informing the public. This study attempts to determine the ways in which the mainstream digital news covers the etiology of obesity and diseases associated with the burden of obesity. Objective: The dual objectives of this study are to obtain an understanding of what the news reports on obesity and to explore meaning in data by extending the preconceived grounded theory. Methods: The 10 years of news text from 2010 to 2019 compared the development of obesity-related coverage and its potential impact on its perception in Mainland China, Hong Kong, and Taiwan. Digital news stories on obesity along with affliction and inferences in 9 Chinese mainstream newspapers were sampled. An automatic content analysis tool, DiVoMiner was proposed. This computer-aided platform is designed to organize and filter large sets of data on the basis of the patterns of word occurrence and term discovery. Another programming language, Python 3, was used to explore connections and patterns created by the aggregated interactions. Results: A total of 30,968 news stories were identified with increasing attention since 2016. The highest intensity of newspaper coverage of obesity communication was observed in Taiwan. Overall, a stronger focus on 2 shared causative attributes of obesity is on stress (n=4483, 33.0%) and tobacco use (n=3148, 23.2%). The burdens of obesity and cardiovascular diseases are implied to be the most, despite the aggregated interaction of edge centrality showing the highest link between the “cancer” and obesity. This study goes beyond traditional journalism studies by extending the framework of computational and customizable web-based text analysis. This could set a norm for researchers and practitioners who work on data projects largely for an innovative attempt. Conclusions: Similar to previous studies, the discourse between the obesity epidemic and personal afflictions is the most emphasized approach. Our study also indicates that the inclination of blaming personal attributes for health afflictions potentially limits social and governmental responsibility for addressing this issue. %M 34817383 %R 10.2196/26660 %U https://publichealth.jmir.org/2021/11/e26660 %U https://doi.org/10.2196/26660 %U http://www.ncbi.nlm.nih.gov/pubmed/34817383 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e30642 %T COVID-19 Vaccine Hesitancy on Social Media: Building a Public Twitter Data Set of Antivaccine Content, Vaccine Misinformation, and Conspiracies %A Muric,Goran %A Wu,Yusong %A Ferrara,Emilio %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way, Suite 1001, Marina del Rey, CA, 90292, United States, 1 213 740 2467, gmuric@isi.edu %K vaccine hesitancy %K COVID-19 vaccines %K dataset %K COVID-19 %K SARS-CoV-2 %K social media %K network analysis %K hesitancy %K vaccine %K Twitter %K misinformation %K conspiracy %K trust %K public health %K utilization %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: False claims about COVID-19 vaccines can undermine public trust in ongoing vaccination campaigns, posing a threat to global public health. Misinformation originating from various sources has been spreading on the web since the beginning of the COVID-19 pandemic. Antivaccine activists have also begun to use platforms such as Twitter to promote their views. To properly understand the phenomenon of vaccine hesitancy through the lens of social media, it is of great importance to gather the relevant data. Objective: In this paper, we describe a data set of Twitter posts and Twitter accounts that publicly exhibit a strong antivaccine stance. The data set is made available to the research community via our AvaxTweets data set GitHub repository. We characterize the collected accounts in terms of prominent hashtags, shared news sources, and most likely political leaning. Methods: We started the ongoing data collection on October 18, 2020, leveraging the Twitter streaming application programming interface (API) to follow a set of specific antivaccine-related keywords. Then, we collected the historical tweets of the set of accounts that engaged in spreading antivaccination narratives between October 2020 and December 2020, leveraging the Academic Track Twitter API. The political leaning of the accounts was estimated by measuring the political bias of the media outlets they shared. Results: We gathered two curated Twitter data collections and made them publicly available: (1) a streaming keyword–centered data collection with more than 1.8 million tweets, and (2) a historical account–level data collection with more than 135 million tweets. The accounts engaged in the antivaccination narratives lean to the right (conservative) direction of the political spectrum. The vaccine hesitancy is fueled by misinformation originating from websites with already questionable credibility. Conclusions: The vaccine-related misinformation on social media may exacerbate the levels of vaccine hesitancy, hampering progress toward vaccine-induced herd immunity, and could potentially increase the number of infections related to new COVID-19 variants. For these reasons, understanding vaccine hesitancy through the lens of social media is of paramount importance. Because data access is the first obstacle to attain this goal, we published a data set that can be used in studying antivaccine misinformation on social media and enable a better understanding of vaccine hesitancy. %M 34653016 %R 10.2196/30642 %U https://publichealth.jmir.org/2021/11/e30642 %U https://doi.org/10.2196/30642 %U http://www.ncbi.nlm.nih.gov/pubmed/34653016 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e32707 %T Patients’ and Health Care Workers’ Perception of Migraine Images on the Internet: Cross-sectional Survey Study %A Raffaelli,Bianca %A Kull,Pia %A Mecklenburg,Jasper %A Overeem,Lucas Hendrik %A Storch,Elisabeth %A Terhart,Maria %A Neeb,Lars %A Reuter,Uwe %+ Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30450660888, bianca.raffaelli@charite.de %K migraine %K stigma %K mass media %K stock photos %K advocacy %K internet %K perception %K headache %K pain %K cross-sectional %K survey %K stereotype %K media %K awareness %D 2021 %7 12.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The representation of migraine in the media is stereotypical. Standard images of migraine attacks display stylish young women holding their head in a pain pose. This representation may contribute to the social stigmatization of patients with migraine. Objective: We aimed to analyze how patients with migraine and health care workers perceive online images of migraine. Methods: The study consisted of an anonymous web-based survey of patients with migraine at the Headache Center of Charité – Universitätsmedizin Berlin (migraine group) and employees and students at our university (health care group). A total of 10 frequently used Adobe Stock photos of migraine attacks were presented to the participants. Each photo was rated on a scale of 0% to 100% based on how closely it resembled a realistic migraine attack (realism score). Patients with migraine also indicated how much each photo corresponded to their own experience of migraine as a percentage (representation score). We calculated the mean realism and representation scores for all photos and conducted further analyses using the categories male or female models, younger or older models, and unilateral or bilateral pain pose. Results: A total of 367 patients with migraine and 331 health care employees and students completed the survey. In both groups, the mean realism score was <50% (migraine group: 47.8%, SD 18.3%; health care group: 46.0%, SD 16.2%). Patients with migraine identified their own migraine experience in these photos to a lesser degree (mean representation score 44.4%, SD 19.8%; P<.001 when compared to the realism score). Patients and health care workers considered photos with male models to be more realistic than photos with females (P<.001) and photos with older models to be more realistic than those with younger people (P<.001). In the health care group only, a bilateral pain posture was deemed more realistic than a unilateral pose (P<.001). Conclusions: Standard images of migraine attacks are considered only slightly or moderately realistic by patients and health care workers. Some characteristics perceived as more realistic such as male sex or older age are in contrast with migraine epidemiology. A more accurate representation of migraine in the media could help to raise awareness for migraine and reduce the associated stigma. %M 34766918 %R 10.2196/32707 %U https://www.jmir.org/2021/11/e32707 %U https://doi.org/10.2196/32707 %U http://www.ncbi.nlm.nih.gov/pubmed/34766918 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e21142 %T Recruiting Participants for Population Health Intervention Research: Effectiveness and Costs of Recruitment Methods for a Cohort Study %A Wasfi,Rania %A Poirier Stephens,Zoe %A Sones,Meridith %A Laberee,Karen %A Pugh,Caitlin %A Fuller,Daniel %A Winters,Meghan %A Kestens,Yan %+ Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada, 1 3435537356, rania.wasfi@phac-aspc.gc.ca %K recruitment methods %K Facebook recruitment %K cost-effectiveness %K built environment %K intervention research %K natural experiment %K mobile phone %D 2021 %7 12.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Public health research studies often rely on population-based participation and draw on various recruitment methods to establish samples. Increasingly, researchers are turning to web-based recruitment tools. However, few studies detail traditional and web-based recruitment efforts in terms of costs and potential biases. Objective: This study aims to report on and evaluate the cost-effectiveness, time effectiveness, and sociodemographic representation of diverse recruitment methods used to enroll participants in 3 cities of the Interventions, Research, and Action in Cities Team (INTERACT) study, a cohort study conducted in Canadian cities. Methods: Over 2017 and 2018 in Vancouver, Saskatoon, and Montreal, the INTERACT study used the following recruitment methods: mailed letters, social media (including sponsored Facebook advertisements), news media, partner communications, snowball recruitment, in-person recruitment, and posters. Participation in the study involved answering web-based questionnaires (at minimum), activating a smartphone app to share sensor data, and wearing a device for mobility and physical activity monitoring. We describe sociodemographic characteristics by the recruitment method and analyze performance indicators, including cost, completion rate, and time effectiveness. Effectiveness included calculating cost per completer (ie, a participant who completed at least one questionnaire), the completion rate of a health questionnaire, and the delay between completion of eligibility and health questionnaires. Cost included producing materials (ie, printing costs), transmitting recruitment messages (ie, mailing list rental, postage, and sponsored Facebook posts charges), and staff time. In Montreal, the largest INTERACT sample, we modeled the number of daily recruits through generalized linear models accounting for the distributed lagged effects of recruitment campaigns. Results: Overall, 1791 participants were recruited from 3 cities and completed at least one questionnaire: 318 in Vancouver, 315 in Saskatoon, and 1158 in Montreal. In all cities, most participants chose to participate fully (questionnaires, apps, and devices). The costs associated with a completed participant varied across recruitment methods and by city. Facebook advertisements generated the most recruits (n=687), at a cost of CAD $15.04 (US $11.57; including staff time) per completer. Mailed letters were the costliest, at CAD $108.30 (US $83.3) per completer but served to reach older participants. All methods resulted in a gender imbalance, with women participating more, specifically with social media. Partner newsletters resulted in the participation of younger adults and were cost-efficient (CAD $5.16 [US $3.97] per completer). A generalized linear model for daily Montreal recruitment identified 2-day lag effects on most recruitment methods, except for the snowball campaign (4 days), letters (15 days), and reminder cards (5 days). Conclusions: This study presents comprehensive data on the costs, effectiveness, and bias of population recruitment in a cohort study in 3 Canadian cities. More comprehensive documentation and reporting of recruitment efforts across studies are needed to improve our capacity to conduct inclusive intervention research. %M 34587586 %R 10.2196/21142 %U https://www.jmir.org/2021/11/e21142 %U https://doi.org/10.2196/21142 %U http://www.ncbi.nlm.nih.gov/pubmed/34587586 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e25897 %T Online Newspaper Reports on Ambulance Accidents in Austria, Germany, and Switzerland: Retrospective Cross-sectional Review %A Boldt,Johanna %A Steinfort,Femke %A Müller,Martin %A Exadaktylos,Aristomenis K %A Klukowska-Roetzler,Jolanta %+ Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University, Freiburgerstrasse 16C, Berne, 3010, Switzerland, 41 31 632 33 96, jolanta.klukowska-roetzler@insel.ch %K ambulance accidents %K ambulance collisions %K ambulance crashes %K media-based %K media-based review %K newspaper review %K Austria %K Germany %K Switzerland %K German-speaking European countries %K retrospective %K cross-sectional %K review %K ambulance %K accident %K data %K media %K newspaper %D 2021 %7 12.11.2021 %9 Review %J JMIR Public Health Surveill %G English %X Background: Ambulance accidents are an unfortunate indirect result of ambulance emergency calls, which create hazardous environments for personnel, patients, and bystanders. However, in European German-speaking countries, factors contributing to ambulance accidents have not been optimally researched and analyzed. Objective: The objective of this study was to extract, analyze, and compare data from online newspaper articles on ambulance accidents for Austria, Germany, and Switzerland. We hope to highlight future strategies to offset the deficit in research data and official registers for prevention of ambulance and emergency vehicle accidents. Methods: Ambulance accident data were collected from Austrian, German, and Swiss free web-based daily newspapers, as listed in Wikipedia, for the period between January 2014 and January 2019. All included newspapers were searched for articles reporting ambulance accidents using German terms representing “ambulance” and “ambulance accident.” Characteristics of the accidents were compiled and analyzed. Only ground ambulance accidents were covered. Results: In Germany, a total of 597 ambulance accidents were recorded, corresponding to 0.719 (95% CI 0.663-0.779) per 100,000 inhabitants; 453 of these accidents left 1170 people injured, corresponding to 1.409 (95% CI 1.330-1.492) per 100,000 inhabitants, and 28 of these accidents caused 31 fatalities, corresponding to 0.037 (95% CI 0.025-0.053) per 100,000 inhabitants. In Austria, a total of 62 ambulance accidents were recorded, corresponding to 0.698 (95% CI 0.535-0.894) per 100,000 inhabitants; 47 of these accidents left 115 people injured, corresponding to 1.294 (95% CI 1.068-1.553) per 100,000 inhabitants, and 6 of these accidents caused 7 fatalities, corresponding to 0.079 (95% CI 0.032-0.162) per 100,000 inhabitants. In Switzerland, a total of 25 ambulance accidents were recorded, corresponding to 0.293 (95% CI 0.189-0.432) per 100,000 inhabitants; 11 of these accidents left 18 people injured, corresponding to 0.211(95% CI 0.113-0.308) per 100,000 inhabitants. There were no fatalities. In each of the three countries, the majority of the accidents involved another car (77%-81%). In Germany and Switzerland, most accidents occurred at an intersection. In Germany, Austria, and Switzerland, 38.7%, 26%, and 4%, respectively, of ambulance accidents occurred at intersections for which the ambulance had a red light (P<.001). In all three countries, most of the casualties were staff and not uncommonly a third party. Most accidents took place on weekdays and during the daytime. Ambulance accidents were evenly distributed across the four seasons. The direction of travel was reported in 28%-37% of the accidents and the patient was in the ambulance approximately 50% of the time in all countries. The cause of the ambulance accidents was reported to be the ambulance itself in 125 (48.1% of accidents where the cause was reported), 22 (42%), and 8 (40%) accidents in Germany, Austria, and Switzerland, respectively (P=.02), and another vehicle in 118 (45.4%), 29 (56%), and 9 (45%) accidents, respectively (P<.001). A total of 292 accidents occurred while blue lights and sirens were used, which caused 3 deaths and 577 injuries. Conclusions: This study draws attention to much needed auxiliary sources of data that may allow for creation of a contemporary registry of all ambulance accidents in Austria, Germany, and Switzerland. To improve risk management and set European standards, it should be mandatory to collect standardized goal-directed and representative information using various sources (including the wide range presented by the press and social media), which should then be made available for audit, analysis, and research. %M 34766915 %R 10.2196/25897 %U https://publichealth.jmir.org/2021/11/e25897 %U https://doi.org/10.2196/25897 %U http://www.ncbi.nlm.nih.gov/pubmed/34766915 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28237 %T Causal Effects of Alcohol-Related Facebook Posts on Drinking Behavior: Longitudinal Experimental Study %A Hendriks,Hanneke %A de Nooy,Wouter %A Gebhardt,Winifred A %A van den Putte,Bas %+ Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, Nijmegen, 6525 GD, Netherlands, 31 24 3612372, hanneke.hendriks@ru.nl %K social media %K social networking site (SNS) %K alcohol-related posts %K alcoholposts %K alcohol consumption %D 2021 %7 11.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescents and young adults frequently post alcohol-related content (ie, alcoholposts) on social media. This is problematic because both social norms theory and social learning theory suggest that viewing alcoholposts of peers could increase drinking behavior. It is therefore paramount to understand the effects of exposure to alcoholposts on viewers. Objective: This study aimed to investigate the causal effects of exposure to alcoholposts on alcohol consumption by using a rigorous design. Methods: We conducted a 6-week longitudinal study during which alcoholposts were measured by a newly developed app that copied Facebook posts shared by participants (n=281) to a new social media environment. In addition, daily questionnaires assessed alcohol use. Effects of natural alcoholposts (ie, posted by the participants) were assessed in phase 1, and effects of experimental posts (ie, posted by fake participants) were explored in phase 2. Results: Results showed that natural alcoholposts increased the occurrence and quantity of drinking the following day. That is, exposure to a single additional alcoholpost increased the log odds of drinking the next day by 0.27 (b=.27, credible interval [CI] .18 to .35). Furthermore, the number of natural alcoholposts had a positive (predictive) effect on the number of glasses drunk the next day (b=.21, CI .14 to .29). In phase 2 when experimental posts were also present, these effects decreased. Experimental posts themselves had hardly any effects. Conclusions: This study illustrates clear and direct effects of exposure to alcoholposts on next-day alcohol consumption and suggests that alcoholposts represent an important societal problem that interventions need to address. %M 34762061 %R 10.2196/28237 %U https://www.jmir.org/2021/11/e28237 %U https://doi.org/10.2196/28237 %U http://www.ncbi.nlm.nih.gov/pubmed/34762061 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e26310 %T Cancer Communication and User Engagement on Chinese Social Media: Content Analysis and Topic Modeling Study %A Chen,Liang %A Wang,Pianpian %A Ma,Xin %A Wang,Xiaohui %+ School of Media and Communication, Shenzhen University, #3883 Baishi Road, Nanshan District, Shenzhen, 518000, China, 86 15013528703, pian.wang@szu.edu.cn %K cancer-related information %K social media %K topic modeling %K user engagement %K Weibo %K cancer %D 2021 %7 10.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Cancer ranks among the most serious public health challenges worldwide. In China—the world’s most populous country—about one-quarter of the population consists of people with cancer. Social media has become an important platform that the Chinese public uses to express opinions. Objective: We investigated cancer-related discussions on the Chinese social media platform Weibo (Sina Corporation) to identify cancer topics that generate the highest levels of user engagement. Methods: We conducted topic modeling and regression analyses to analyze and visualize cancer-related messages on Weibo and to examine the relationships between different cancer topics and user engagement (ie, the number of retweets, comments, and likes). Results: Our results revealed that cancer communication on Weibo has generally focused on the following six topics: social support, cancer treatment, cancer prevention, women’s cancers, smoking and skin cancer, and other topics. Discussions about social support and cancer treatment attracted the highest number of users and received the greatest numbers of retweets, comments, and likes. Conclusions: Our investigation of cancer-related communication on Weibo provides valuable insights into public concerns about cancer and can help guide the development of health campaigns in social media. %M 34757320 %R 10.2196/26310 %U https://www.jmir.org/2021/11/e26310 %U https://doi.org/10.2196/26310 %U http://www.ncbi.nlm.nih.gov/pubmed/34757320 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e32936 %T The Impact of Public Health Events on COVID-19 Vaccine Hesitancy on Chinese Social Media: National Infoveillance Study %A Zhang,Zizheng %A Feng,Guanrui %A Xu,Jiahong %A Zhang,Yimin %A Li,Jinhui %A Huang,Jian %A Akinwunmi,Babatunde %A Zhang,Casper J P %A Ming,Wai-kit %+ Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, To Yuen Building, 31 To Yuen Street, Hong Kong, China (Hong Kong), 852 34426956, wkming2@cityu.edu.hk %K COVID-19 %K vaccine %K hesitancy %K social media %K China %K sentiment analysis %K infoveillance %K public health %K surveillance %K Weibo %K data mining %K sentiment %K attitude %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The ongoing COVID-19 pandemic has brought unprecedented challenges to every country worldwide. A call for global vaccination for COVID-19 plays a pivotal role in the fight against this virus. With the development of COVID-19 vaccines, public willingness to get vaccinated has become an important public health concern, considering the vaccine hesitancy observed worldwide. Social media is powerful in monitoring public attitudes and assess the dissemination, which would provide valuable information for policy makers. Objective: This study aimed to investigate the responses of vaccine positivity on social media when major public events (major outbreaks) or major adverse events related to vaccination (COVID-19 or other similar vaccines) were reported. Methods: A total of 340,783 vaccine-related posts were captured with the poster’s information on Weibo, the largest social platform in China. After data cleaning, 156,223 posts were included in the subsequent analysis. Using pandas and SnowNLP Python libraries, posts were classified into 2 categories, positive and negative. After model training and sentiment analysis, the proportion of positive posts was computed to measure the public positivity toward the COVID-19 vaccine. Results: The positivity toward COVID-19 vaccines in China tends to fluctuate over time in the range of 45.7% to 77.0% and is intuitively correlated with public health events. In terms of gender, males were more positive (70.0% of the time) than females. In terms of region, when regional epidemics arose, not only the region with the epidemic and surrounding regions but also the whole country showed more positive attitudes to varying degrees. When the epidemic subsided temporarily, positivity decreased with varying degrees in each region. Conclusions: In China, public positivity toward COVID-19 vaccines fluctuates over time and a regional epidemic or news on social media may cause significant variations in willingness to accept a vaccine. Furthermore, public attitudes toward COVID-19 vaccination vary from gender and region. It is crucial for policy makers to adjust their policies through the use of positive incentives with prompt responses to pandemic-related news to promote vaccination acceptance. %M 34591782 %R 10.2196/32936 %U https://publichealth.jmir.org/2021/11/e32936 %U https://doi.org/10.2196/32936 %U http://www.ncbi.nlm.nih.gov/pubmed/34591782 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e31707 %T Multilevel Determinants of COVID-19 Vaccine Uptake Among South Asian Ethnic Minorities in Hong Kong: Cross-sectional Web-Based Survey %A Singh,Akansha %A Lai,Angel Hor Yan %A Wang,Jingxuan %A Asim,Saba %A Chan,Paul Shing-Fong %A Wang,Zixin %A Yeoh,Eng Kiong %+ Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, N.T., Hong Kong, 666888, China (Hong Kong), 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K South Asian ethnic minorities %K COVID-19 vaccination %K uptake %K cultural and religious reasons for vaccine hesitancy %K perceptions %K information exposure on social media %K influence of peers %K socioecological model %K Hong Kong %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic continues to have a disproportionate effect on ethnic minorities. Across countries, greater vaccine hesitancy has been observed among ethnic minorities. After excluding foreign domestic helpers, South Asians make up the largest proportion of ethnic minorities in Hong Kong. It is necessary to plan for COVID-19 vaccination promotional strategies that cater to the unique needs of South Asians in Hong Kong. Objective: This study investigated the prevalence of COVID-19 vaccine uptake among a sample of South Asians in Hong Kong. We examined the effects of sociodemographic data and factors at individual level (perceptions), interpersonal level (information exposure on social media), and sociostructural level (cultural) based on the socioecological model. Methods: A cross-sectional web-based survey was conducted on May 1-31, 2021. Participants were South Asian people aged 18 years or older living in Hong Kong; able to comprehend English, Hindi, Nepali, or Urdu; and having access to a smartphone. Three community-based organizations providing services to South Asians in Hong Kong facilitated the data collection. The staff of the community-based organizations posted the study information in WhatsApp groups involving South Asian clients and invited them to participate in a web-based survey. Logistic regression models were fit for data analysis. Results: Among 245 participants, 81 (33.1%) had taken at least one dose of the COVID-19 vaccine (one dose, 62/245, 25.2%; and both doses, 19/245, 7.9%). After adjusting for significant background characteristics, cultural and religious reasons for COVID-19 vaccine hesitancy were associated with lower COVID-19 vaccine uptake (adjusted odds ratio [AOR] 0.83, 95% CI 0.71-0.97; P=.02). At the individual level, having more positive attitudes toward COVID-19 vaccination (AOR 1.31, 95% CI 1.10-1.55; P=.002), perceived support from significant others (AOR 1.29, 95% CI 1.03-1.60; P=.03), and perceived higher behavioral control to receive COVID-19 vaccination (AOR 2.63, 95% CI 1.65-4.19; P<.001) were associated with higher COVID-19 vaccine uptake, while a negative association was found between negative attitudes and the dependent variable (AOR 0.73, 95% CI 0.62-0.85; P<.001). Knowing more peers who had taken the COVID-19 vaccine was also associated with higher uptake (AOR 1.39, 95% CI 1.11-1.74; P=.01). At the interpersonal level, higher exposure to information about deaths and other serious conditions caused by COVID-19 vaccination was associated with lower uptake (AOR 0.54, 95% CI 0.33-0.86; P=.01). Conclusions: In this study, one-third (81/245) of our participants received at least one dose of the COVID-19 vaccine. Cultural or religious reasons, perceptions, information exposure on social media, and influence of peers were found to be the determinants of COVID-19 vaccine uptake among South Asians. Future programs should engage community groups, champions, and faith leaders, and develop culturally competent interventions. %M 34653014 %R 10.2196/31707 %U https://publichealth.jmir.org/2021/11/e31707 %U https://doi.org/10.2196/31707 %U http://www.ncbi.nlm.nih.gov/pubmed/34653014 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e24471 %T Suicide Risk and Protective Factors in Online Support Forum Posts: Annotation Scheme Development and Validation Study %A Chancellor,Stevie %A Sumner,Steven A %A David-Ferdon,Corinne %A Ahmad,Tahirah %A De Choudhury,Munmun %+ Department of Computer Science & Engineering, University of Minnesota - Twin Cities, 200 Union Street SE, 4-189 Keller Hall, Minneapolis, MN, 55455, United States, 1 612 625 4002, steviec@umn.edu %K online communities %K suicide crisis %K construct validity %K annotation scheme %K Reddit %K annotation %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Online communities provide support for individuals looking for help with suicidal ideation and crisis. As community data are increasingly used to devise machine learning models to infer who might be at risk, there have been limited efforts to identify both risk and protective factors in web-based posts. These annotations can enrich and augment computational assessment approaches to identify appropriate intervention points, which are useful to public health professionals and suicide prevention researchers. Objective: This qualitative study aims to develop a valid and reliable annotation scheme for evaluating risk and protective factors for suicidal ideation in posts in suicide crisis forums. Methods: We designed a valid, reliable, and clinically grounded process for identifying risk and protective markers in social media data. This scheme draws on prior work on construct validity and the social sciences of measurement. We then applied the scheme to annotate 200 posts from r/SuicideWatch—a Reddit community focused on suicide crisis. Results: We documented our results on producing an annotation scheme that is consistent with leading public health information coding schemes for suicide and advances attention to protective factors. Our study showed high internal validity, and we have presented results that indicate that our approach is consistent with findings from prior work. Conclusions: Our work formalizes a framework that incorporates construct validity into the development of annotation schemes for suicide risk on social media. This study furthers the understanding of risk and protective factors expressed in social media data. This may help public health programming to prevent suicide and computational social science research and investigations that rely on the quality of labels for downstream machine learning tasks. %M 34747705 %R 10.2196/24471 %U https://mental.jmir.org/2021/11/e24471 %U https://doi.org/10.2196/24471 %U http://www.ncbi.nlm.nih.gov/pubmed/34747705 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e24448 %T Twitter Use by Academic Nuclear Medicine Programs: Pilot Content Analysis Study %A Panda,Ananya %A Sharma,Akash %A Dundar,Ayca %A Packard,Ann %A Aase,Lee %A Kotsenas,Amy %A Kendi,Ayse Tuba %+ Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, United States, 1 612 408 9737, kendi.ayse@mayo.edu %K social media %K Twitter %K radiology %K nuclear medicine %K nuclear radiology %K social network %K medical education %K networking %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is scant insight into the presence of nuclear medicine (NM) and nuclear radiology (NR) programs on social media. Objective: Our purpose was to assess Twitter engagement by academic NM/NR programs in the United States. Methods: We measured Twitter engagement by the academic NM/NR community, accounting for various NM/NR certification pathways. The Twitter presence of NM/NR programs at both the department and program director level was identified. Tweets by programs were cross-referenced against potential high-yield NM- or NR-related hashtags, and tabulated at a binary level. A brief survey was done to identify obstacles and benefits to Twitter use by academic NM/NR faculty. Results: For 2019-2020, 88 unique programs in the United States offered NM/NR certification pathways. Of these, 52% (46/88) had Twitter accounts and 24% (21/88) had at least one post related to NM/NR. Only three radiology departments had unique Twitter accounts for the NM/molecular imaging division. Of the other 103 diagnostic radiology residency programs, only 16% (16/103) had a presence on Twitter and 5% (5/103) had tweets about NM/NR. Only 9% (8/88) of NM/NR program directors were on Twitter, and three program directors tweeted about NM/NR. The survey revealed a lack of clarity and resources around using Twitter, although respondents acknowledged the perceived value of Twitter engagement for attracting younger trainees. Conclusions: Currently, there is minimal Twitter engagement by the academic NM/NR community. The perceived value of Twitter engagement is counterbalanced by identifiable obstacles. Given radiologists’ overall positive views of social media’s usefulness, scant social media engagement by the NM community may represent a missed opportunity. More Twitter engagement and further research by trainees and colleagues should be encouraged, as well as the streamlined use of unique hashtags. %M 34747708 %R 10.2196/24448 %U https://formative.jmir.org/2021/11/e24448 %U https://doi.org/10.2196/24448 %U http://www.ncbi.nlm.nih.gov/pubmed/34747708 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29789 %T Examining the Utility of Social Media in COVID-19 Vaccination: Unsupervised Learning of 672,133 Twitter Posts %A Liew,Tau Ming %A Lee,Cia Sin %+ Department of Psychiatry, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore, 65 62223322, liew.tau.ming@singhealth.com.sg %K social media %K COVID-19 %K vaccine hesitancy %K natural language processing %K machine learning %K infodemiology %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although COVID-19 vaccines have recently become available, efforts in global mass vaccination can be hampered by the widespread issue of vaccine hesitancy. Objective: The aim of this study was to use social media data to capture close-to-real-time public perspectives and sentiments regarding COVID-19 vaccines, with the intention to understand the key issues that have captured public attention, as well as the barriers and facilitators to successful COVID-19 vaccination. Methods: Twitter was searched for tweets related to “COVID-19” and “vaccine” over an 11-week period after November 18, 2020, following a press release regarding the first effective vaccine. An unsupervised machine learning approach (ie, structural topic modeling) was used to identify topics from tweets, with each topic further grouped into themes using manually conducted thematic analysis as well as guided by the theoretical framework of the COM-B (capability, opportunity, and motivation components of behavior) model. Sentiment analysis of the tweets was also performed using the rule-based machine learning model VADER (Valence Aware Dictionary and Sentiment Reasoner). Results: Tweets related to COVID-19 vaccines were posted by individuals around the world (N=672,133). Six overarching themes were identified: (1) emotional reactions related to COVID-19 vaccines (19.3%), (2) public concerns related to COVID-19 vaccines (19.6%), (3) discussions about news items related to COVID-19 vaccines (13.3%), (4) public health communications about COVID-19 vaccines (10.3%), (5) discussions about approaches to COVID-19 vaccination drives (17.1%), and (6) discussions about the distribution of COVID-19 vaccines (20.3%). Tweets with negative sentiments largely fell within the themes of emotional reactions and public concerns related to COVID-19 vaccines. Tweets related to facilitators of vaccination showed temporal variations over time, while tweets related to barriers remained largely constant throughout the study period. Conclusions: The findings from this study may facilitate the formulation of comprehensive strategies to improve COVID-19 vaccine uptake; they highlight the key processes that require attention in the planning of COVID-19 vaccination and provide feedback on evolving barriers and facilitators in ongoing vaccination drives to allow for further policy tweaks. The findings also illustrate three key roles of social media in COVID-19 vaccination, as follows: surveillance and monitoring, a communication platform, and evaluation of government responses. %M 34583316 %R 10.2196/29789 %U https://publichealth.jmir.org/2021/11/e29789 %U https://doi.org/10.2196/29789 %U http://www.ncbi.nlm.nih.gov/pubmed/34583316 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e29390 %T Discussion of Weight Loss Surgery in Instagram Posts: Successive Sampling Study %A Meleo-Erwin,Zoe C %A Basch,Corey H %A Fera,Joseph %A Smith,Bonnie %+ Department of Public Health, William Paterson University of New Jersey, 300 Pompton Rd, University Hall, Suite 359 – Office 370, Wayne, NJ, 07470, United States, 1 9737202394, erwinz@wpunj.edu %K bariatric surgery %K social media %K Instagram %K health promotion %K post-operative medicine %K Instagram %K online health information %K information accuracy %K surgery %K information quality %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The majority of American adults search for health and illness information on the internet. However, the quality and accuracy of this information are notoriously variable. With the advent of social media, US individuals have increasingly shared their own health and illness experiences, including those related to bariatric surgery, on social media platforms. Previous research has found that peer-to-peer requesting and giving of advice related to bariatric surgery on social media is common, that such advice is often presented in stark terms, and that the advice may not reflect patient standards of care. These previous investigations have helped to map bariatric surgery content on Facebook and YouTube. Objective: This objective of this study was to document and compare weight loss surgery (WLS)–related content on Instagram in the months leading up to the COVID-19 pandemic and 1 year later. Methods: We analyzed a total of 300 Instagram posts (50 posts per week for 3 consecutive weeks in late February and early March in both 2020 and 2021) uploaded using the hashtag #wls. Descriptive statistics were reported, and independent 1-tailed chi-square tests were used to determine if a post’s publication year statistically affected its inclusion of a particular type of content. Results: Overall, advice giving and personal responsibility for outcomes were emphasized by WLS posters on Instagram. However, social support was less emphasized. The safety, challenges, and risks associated with WLS were rarely discussed. The majority of posts did not contain references to facts from reputable medical sources. Posts published in 2021 were more likely to mention stress/hardships of living with WLS (45/150, 30%, vs 29/150, 19.3%; P=.03); however, those published in 2020 more often identified the importance of ongoing support for WLS success (35/150, 23.3%, vs 16/150, 10.7%; P=.004). Conclusions: Given that bariatric patients have low rates of postoperative follow-up, yet post-operative care and yet support are associated with improved health and weight loss outcomes, and given that health content on the web is of mixed accuracy, bariatric professionals may wish to consider including an online support forum moderated by a professional as a routine part of postoperative care. Doing so may not only improve follow-up rates but may offer providers the opportunity to counter inaccuracies encountered on social media. %M 34723828 %R 10.2196/29390 %U https://periop.jmir.org/2021/2/e29390 %U https://doi.org/10.2196/29390 %U http://www.ncbi.nlm.nih.gov/pubmed/34723828 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28069 %T Characterizing Vaping Industry Political Influence and Mobilization on Facebook: Social Network Analysis %A Haupt,Michael Robert %A Xu,Qing %A Yang,Joshua %A Cai,Mingxiang %A Mackey,Tim K %+ Global Health Program, Department of Anthropology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 951 491 4161, tmackey@ucsd.edu %K vaping %K alternative tobacco industry %K e-cigarettes %K Facebook %K social network analysis %K social networks %K ehealth %K health policy %D 2021 %7 29.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In response to recent policy efforts to regulate tobacco and vaping products, the vaping industry has been aggressive in mobilizing opposition by using a network of manufacturers, trade associations, and tobacco user communities, and by appealing to the general public. One strategy the alternative tobacco industry uses to mobilize political action is coordinating on social media platforms, such as the social networking site Facebook. However, few studies have specifically assessed how platforms such as Facebook are used to influence public sentiment and attitudes towards tobacco control policy. Objective: This study used social network analysis to examine how the alternative tobacco industry uses Facebook to mobilize online users to influence tobacco control policy outcomes with a focus on the state of California. Methods: Data were collected from local and national alternative tobacco Facebook groups that had affiliations with activities in the state of California. Network ties were constructed based on users’ reactions to posts (eg, “like” and “love”) and comments to characterize political mobilization networks. Results: Findings show that alternative tobacco industry employees were more likely to engage within these networks and that these employees were also more likely to be influential members (ie, be more active) in the network. Comparisons between subnetworks show that communication within the local alternative tobacco advocacy group network was less dense and more centralized in contrast to a national advocacy group that had overall higher levels of engagement among members. A timeline analysis found that a higher number of influential posts that disseminated widely across networks occurred during e-cigarette–related legislative events, suggesting strategic online engagement and increased mobilization of online activity for the purposes of influencing policy outcomes. Conclusions: Results from this study provide important insights into how tobacco industry–related advocacy groups leverage the Facebook platform to mobilize their online constituents in an effort to influence public perceptions and coordinate to defeat tobacco control efforts at the local, state, and federal level. Study results reveal one part of a vast network of socially enabled alternative tobacco industry actors and constituents that use Facebook as a mobilization point to support goals of the alternative tobacco industry. %M 34714245 %R 10.2196/28069 %U https://www.jmir.org/2021/10/e28069 %U https://doi.org/10.2196/28069 %U http://www.ncbi.nlm.nih.gov/pubmed/34714245 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e30449 %T Young Adults’ Responses to an African and US-Based COVID-19 Edutainment Miniseries: Real-Time Qualitative Analysis of Online Social Media Engagement %A Baker,Venetia %A Arnold,Georgia %A Piot,Sara %A Thwala,Lesedi %A Glynn,Judith %A Hargreaves,James %A Birdthistle,Isolde %+ Department of Population Health, Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 20 7636 8636, venetia.baker1@lshtm.ac.uk %K COVID-19 %K adolescents %K young people %K social media %K edutainment %D 2021 %7 29.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In April 2020, as cases of the novel COVID-19 spread across the globe, MTV Staying Alive Foundation created the educational entertainment miniseries MTV Shuga: Alone Together. In 70 short episodes released daily on YouTube, Alone Together aimed to disseminate timely and accurate information to increase young people’s knowledge, motivation, and actions to prevent COVID-19. Objective: We sought to identify Alone Together viewer’s perspectives on the global COVID-19 pandemic and national lockdowns by examining the words, conversations, experiences, and emotions expressed on social media in response to the Alone Together episodes. We also assessed how viewers used the series and its online community as a source of support during the global pandemic. Methods: A total of 3982 comments and 70 live chat conversations were extracted from YouTube between April and October 2020 and analyzed through a data-led inductive thematic approach. Aggregated demographic and geographical data were collected using YouTube Analytics. Results: The miniseries had a global reach across 5 continents, with a total of 7.7 million views across MTV Shuga platforms. The series had over 1 million views over 70 episodes on YouTube and an average of 5683 unique viewers per episode on YouTube. The dominant audience was adults under the age of 35 years and women. Across diverse countries such as Nigeria, Ghana, the United States, and the UK, viewers believed that COVID-19 was serious and expressed that it was socially responsible to follow public health measures. Storylines of the series about the impact of self-isolation on mental health, exposure to violence in lockdowns, and restricted employment opportunities due to the pandemic resonated with young viewers. Tuning in to the miniseries provided viewers with reliable information, entertainment, and an online community during an isolating, confusing, and worrying time. Conclusions: During the first wave of COVID-19, viewers from at least 53 countries connected on social media via the MTV miniseries. The analysis showed how digitally connected people under the age of 35 years, predominantly women, felt compelled to follow COVID-19 safety measures despite the pandemic’s impact on their social, educational, and financial needs. Viewers used social media to reach out to fellow viewers for advice, solace, support, and resources. Organizations, governments, and individuals have been forced to innovate during the pandemic to ensure people can access services safely and remotely. This analysis showed that women under 35 years of age were especially receptive to receiving support from online communities and media services. Peer influence and support online can be a powerful public health tool as people have a great capacity to influence each other and shape norms around public health. However, online services are not accessible to everyone, and COVID-19 has increased disparities between digitally connected and unconnected younger adults. %M 34596568 %R 10.2196/30449 %U https://formative.jmir.org/2021/10/e30449 %U https://doi.org/10.2196/30449 %U http://www.ncbi.nlm.nih.gov/pubmed/34596568 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e32856 %T Impact of the World Inflammatory Bowel Disease Day and Crohn’s and Colitis Awareness Week on Population Interest Between 2016 and 2020: Google Trends Analysis %A Silangcruz,Krixie %A Nishimura,Yoshito %A Czech,Torrey %A Kimura,Nobuhiko %A Hagiya,Hideharu %A Koyama,Toshihiro %A Otsuka,Fumio %+ University of Hawaii, 1356 Lusitana St, Honolulu, HI, United States, 1 808 586 2910, nishimura-yoshito@okayama-u.ac.jp %K inflammatory bowel disease %K ulcerative colitis %K Crohn disease %K google trends %K trend analysis %K online health information %K awareness %K chronic disease %K gastrointestinal %K trend %K impact %K public health %K United States %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: More than 6 million people are affected by inflammatory bowel disease (IBD) globally. The World IBD Day (WID, May 19) and Crohn’s and Colitis Awareness Week (CCAW, December 1-7) occur yearly as national health observances to raise public awareness of IBD, but their effects are unclear. Objective: The aim of this study was to analyze the relationship between WID or CCAW and the public health awareness on IBD represented by the Google search engine query data. Methods: This study evaluates the impact of WID and CCAW on the public awareness of IBD in the United States and worldwide from 2016 to 2020 by using the relative search volume of “IBD,” “ulcerative colitis,” and “Crohn’s disease” in Google Trends. To identify significant time points of trend changes (joinpoints), we performed joinpoint regression analysis. Results: No joinpoints were noted around the time of WID or CCAW during the study period in the search results of the United States. Worldwide, joinpoints were noted around WID in 2020 with the search for “IBD” and around CCAW in 2017 and 2019 with the search for “ulcerative colitis.” However, the extents of trend changes were modest without statistically significant increases. Conclusions: These results posed a question that WID and CCAW might not have worked as expected to raise public awareness of IBD. Additional studies are needed to precisely estimate the impact of health observances to raise the awareness of IBD. %M 37114197 %R 10.2196/32856 %U https://infodemiology.jmir.org/2021/1/e32856 %U https://doi.org/10.2196/32856 %U http://www.ncbi.nlm.nih.gov/pubmed/37114197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28508 %T Feasibility of Indirect Secondary Distribution of HIV Self-test Kits via WeChat Among Men Who Have Sex With Men: National Cross-sectional Study in China %A Li,Shangcao %A Zhang,Jing %A Mao,Xiang %A Lu,Tianyi %A Gao,Yangyang %A Zhang,Wenran %A Wang,Hongyi %A Chu,Zhenxing %A Hu,Qinghai %A Jiang,Yongjun %A Geng,Wenqing %A Shang,Hong %A Xu,Junjie %+ NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, 110001, China, 86 8328 2634, xjjcmu@163.com %K secondary distribution %K HIV %K men who have sex with men %K WeChat %K HIV self-testing %D 2021 %7 26.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: HIV self-testing (HIVST) kits are common in key sexually active populations. Direct secondary distribution of HIVST kits (DSDHK) is effective in improving the uptake of HIVST. However, there are concerns about the various limitations of DSDHK, including limited geographic reach, payment problems, and need for face-to-face interactions. Objective: In this study, we aim to evaluate the feasibility and characteristics of indirect secondary distribution of HIVST kits (ISDHK) via WeChat (distributing HIVST application links and follow-up HIVST kits to partners) among men who have sex with men (MSM). Methods: From October 2017 to September 2019, an HIVST recruitment advertisement was disseminated on the WeChat social media platform to invite MSM to apply for the HIVST kits (referred to as index participants [IPs]). All MSM participants were encouraged to distribute the HIVST application link to their friends and sexual partners (referred to as alters) through their social networks. All the alters were further encouraged to continue distributing the HIVST application link. All participants paid a deposit (US $7), which was refundable upon completion of the questionnaire, and uploaded the test results via a web-based survey system. Results: A total of 2263 MSM met the criteria and successfully applied for HIVST. Of these, 1816 participants returned their HIVST results, including 1422 (88.3%) IPs and 394 (21.7%) alters. More alters had condomless anal intercourse, a higher proportion of them had never previously tested for HIV, and they showed a greater willingness to distribute HIVST kits to their sexual partners (P=.002) than the IPs. After controlling for age, education, and income, the alters had a greater proportion of MSM who had never tested for HIV before (adjusted odds ratio [aOR] 1.29, 95% CI 1.00-1.68), were more willing to distribute the HIVST application link (aOR 1.71, 95% CI 1.21-2.40), had a lower number of sexual partners (aOR 0.71, 95% CI 0.57-0.90), and were less likely to search for sexual partners on the web (aOR 0.78, 95% CI 0.60-1.02) than IPs. In comparison, the rates of reactive HIVST results, conducting HIV confirmatory tests, HIV seropositivity, and initiation of HIV antiretroviral therapy were similar for IPs and alters. Conclusions: The ISDHK model of distributing HIVST application links among the MSM population via social media is feasible. The ISDHK model should be used to supplement the DSDHK model to enable a greater proportion of the MSM population to know their HIV infection status. %M 34698651 %R 10.2196/28508 %U https://www.jmir.org/2021/10/e28508 %U https://doi.org/10.2196/28508 %U http://www.ncbi.nlm.nih.gov/pubmed/34698651 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e24336 %T Areas of Interest and Attitudes Toward Antiobesity Drugs: Thematic and Quantitative Analysis Using Twitter %A Alvarez-Mon,Miguel Angel %A Llavero-Valero,Maria %A Asunsolo del Barco,Angel %A Zaragozá,Cristina %A Ortega,Miguel A %A Lahera,Guillermo %A Quintero,Javier %A Alvarez-Mon,Melchor %+ Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid, 28031, Spain, 34 911 91 80 00, maalvarezdemon@icloud.com %K obesity %K social media %K Twitter %K drug therapy %K pharmacotherapy %K attitude %K thematic analysis %K quantitative analysis %K drug %D 2021 %7 26.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Antiobesity drugs are prescribed for the treatment of obesity in conjunction with healthy eating, physical activity, and behavior modification. However, poor adherence rates have been reported. Attitudes or beliefs toward medications are important to ascertain because they may be associated with patient behavior. The analysis of tweets has become a tool for health research. Objective: The aim of this study is to investigate the content and key metrics of tweets referring to antiobesity drugs. Methods: In this observational quantitative and qualitative study, we focused on tweets containing hashtags related to antiobesity drugs between September 20, 2019, and October 31, 2019. Tweets were first classified according to whether they described medical issues or not. Tweets with medical content were classified according to the topic they referred to: side effects, efficacy, or adherence. We additionally rated it as positive or negative. Furthermore, we classified any links included within a tweet as either scientific or nonscientific. Finally, the number of retweets generated as well as the dissemination and sentiment score obtained by the antiobesity drugs analyzed were also measured. Results: We analyzed a total of 2045 tweets, 945 of which were excluded according to the criteria of the study. Finally, 320 out of the 1,100 remaining tweets were also excluded because their content, although related to drugs for obesity treatment, did not address the efficacy, side effects, or adherence to medication. Liraglutide and semaglutide accumulated the majority of tweets (682/780, 87.4%). Notably, the content that generated the highest frequency of tweets was related to treatment efficacy, with liraglutide-, semaglutide-, and lorcaserin-related tweets accumulating the highest proportion of positive consideration. We found the highest percentages of tweets with scientific links in those posts related to liraglutide and semaglutide. Semaglutide-related tweets obtained the highest probability of likes and were the most disseminated within the Twitter community. Conclusions: This analysis of posted tweets related to antiobesity drugs shows that the interest, beliefs, and experiences regarding these pharmacological treatments are heterogeneous. The efficacy of the treatment accounts for the majority of interest among Twitter users. %M 34698653 %R 10.2196/24336 %U https://www.jmir.org/2021/10/e24336 %U https://doi.org/10.2196/24336 %U http://www.ncbi.nlm.nih.gov/pubmed/34698653 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e31101 %T Using Twitter Comments to Understand People’s Experiences of UK Health Care During the COVID-19 Pandemic: Thematic and Sentiment Analysis %A Ainley,Esther %A Witwicki,Cara %A Tallett,Amy %A Graham,Chris %+ Picker Institute Europe, Buxton Court, 3 West Way, Oxford, OX2 0JB, United Kingdom, 44 01865208168, esther.ainley@pickereurope.ac.uk %K patient experience %K COVID-19 %K remote health care %K phone consultation %K video consultation %K Twitter %K sentiment analysis %K social media %K digital health %K public health %K public opinion %D 2021 %7 25.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to changes in health service utilization patterns and a rapid rise in care being delivered remotely. However, there has been little published research examining patients’ experiences of accessing remote consultations since COVID-19. Such research is important as remote methods for delivering some care may be maintained in the future. Objective: The aim of this study was to use content from Twitter to understand discourse around health and care delivery in the United Kingdom as a result of COVID-19, focusing on Twitter users’ views on and attitudes toward care being delivered remotely. Methods: Tweets posted from the United Kingdom between January 2018 and October 2020 were extracted using the Twitter application programming interface. A total of 1408 tweets across three search terms were extracted into Excel; 161 tweets were removed following deduplication and 610 were identified as irrelevant to the research question. The remaining relevant tweets (N=637) were coded into categories using NVivo software, and assigned a positive, neutral, or negative sentiment. To examine views of remote care over time, the coded data were imported back into Excel so that each tweet was associated with both a theme and sentiment. Results: The volume of tweets on remote care delivery increased markedly following the COVID-19 outbreak. Five main themes were identified in the tweets: access to remote care (n=267), quality of remote care (n=130), anticipation of remote care (n=39), online booking and asynchronous communication (n=85), and publicizing changes to services or care delivery (n=160). Mixed public attitudes and experiences to the changes in service delivery were found. The proportion of positive tweets regarding access to, and quality of, remote care was higher in the immediate period following the COVID-19 outbreak (March-May 2020) when compared to the time before COVID-19 onset and the time when restrictions from the first lockdown eased (June-October 2020). Conclusions: Using Twitter data to address our research questions proved beneficial for providing rapid access to Twitter users’ attitudes to remote care delivery at a time when it would have been difficult to conduct primary research due to COVID-19. This approach allowed us to examine the discourse on remote care over a relatively long period and to explore shifting attitudes of Twitter users at a time of rapid changes in care delivery. The mixed attitudes toward remote care highlight the importance for patients to have a choice over the type of consultation that best suits their needs, and to ensure that the increased use of technology for delivering care does not become a barrier for some. The finding that overall sentiment about remote care was more positive in the early stages of the pandemic but has since declined emphasizes the need for a continued examination of people’s preference, particularly if remote appointments are likely to remain central to health care delivery. %M 34469327 %R 10.2196/31101 %U https://www.jmir.org/2021/10/e31101 %U https://doi.org/10.2196/31101 %U http://www.ncbi.nlm.nih.gov/pubmed/34469327 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30681 %T Videos With the Hashtag #vaping on TikTok and Implications for Informed Decision-making by Adolescents: Descriptive Study %A Basch,Corey H %A Fera,Joseph %A Pellicane,Alessia %A Basch,Charles E %+ William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 973 720 2603, baschc@wpunj.edu %K vaping %K TikTok %K social media %K misinformation %K decision-making %K adolescents %K young adults %K e-cigarettes %K public health %K informed decision-making %D 2021 %7 25.10.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite the public health importance of vaping and the widespread use of TikTok by adolescents and young adults, research is lacking on the nature and scope of vaping content on this networking service. Objective: The purpose of this study is to describe the content of TikTok videos related to vaping. Methods: By searching the hashtag #vaping in the discover feature, ~478.4 million views were seen during the time of data collection. The first 100 relevant videos under that hashtag were used in this study. Relevance was determined by simply noting if the video was related in any way to vaping. Coding consisted of several categories directly related to vaping and additional categories, including the number of likes, comments, and views, and if the video involved music, humor, or dance. Results: The 100 videos included in the sample garnered 156,331,347 views; 20,335,800 likes; and 296,460 comments. The majority of the videos (n=59) used music and over one-third (n=37) used humor. The only content category observed in the majority of the videos sampled was the promotion of vaping, which was included in 57 videos that garnered over 74 million views (47.5% of cumulative views). A total of 42% (n=42) of the 100 videos sampled featured someone vaping or in the presence of vape pens, and these videos garnered over 22% (>35 million) of the total views. Conclusions: It is necessary for public health agencies to improve understanding of the nature and content of videos that attract viewers’ attention and harness the strength of this communication channel to promote informed decision-making about vaping. %M 34694231 %R 10.2196/30681 %U https://pediatrics.jmir.org/2021/4/e30681 %U https://doi.org/10.2196/30681 %U http://www.ncbi.nlm.nih.gov/pubmed/34694231 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28689 %T How Food Marketing on Instagram Shapes Adolescents’ Food Preferences: Online Randomized Trial %A Bragg,Marie %A Lutfeali,Samina %A Greene,Tenay %A Osterman,Jessica %A Dalton,Madeline %+ Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, 3rd Floor, New York City, NY, 10016, United States, 1 646 501 2717, Marie.Bragg@nyulangone.org %K food marketing %K traditional media %K social media %K adolescents %K Instagram %D 2021 %7 22.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Worldwide obesity rates have prompted 16 countries to enact policies to reduce children’s exposure to unhealthy food marketing, but few policies address online advertising practices or protect adolescents from being targeted. Given adolescents spend so much time online, it is critical to understand how persuasive Instagram food advertisements (ads) are compared with traditional food ads. To strengthen online food marketing policies, more evidence is needed on whether social media ads are more persuasive than other types of ads in shaping adolescents’ preferences. Objective: This study examined whether adolescents could identify food companies’ Instagram posts as ads, and the extent to which Instagram versus traditional food ads shape adolescents’ preferences. Methods: In Part 1, participants aged 13-17 years (N=832) viewed 8 pairs of ads and were asked to identify which ads originated from Instagram. One ad in each pair was selected from traditional sources (eg, print; online banner ad), and the other ad was selected from Instagram, but we removed the Instagram frame—which includes the logo, comments, and “likes.” In Part 2, participants were randomized to rate food ads that ostensibly originated from (1) Instagram (ie, we photoshopped the Instagram frame onto ads); or (2) traditional sources. Unbeknownst to participants, half of the ads in their condition originated from Instagram and half originated from traditional sources. Results: In Part 1, adolescents performed worse than chance when asked to identify Instagram ads (P<.001). In Part 2, there were no differences on 4 of 5 outcomes in the “labeled ad condition.” In the “unlabeled ad condition,” however, they preferred Instagram ads to traditional ads on 3 of 5 outcomes (ie, trendiness, P=.001; artistic appeal, P=.001; likeability, P=.001). Conclusions: Adolescents incorrectly identified traditional ads as Instagram posts, suggesting the artistic appearance of social media ads may not be perceived as marketing. Further, the mere presence of Instagram features caused adolescents to rate food ads more positively than ads without Instagram features. %M 34677136 %R 10.2196/28689 %U https://www.jmir.org/2021/10/e28689 %U https://doi.org/10.2196/28689 %U http://www.ncbi.nlm.nih.gov/pubmed/34677136 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30765 %T Topics and Sentiments of Public Concerns Regarding COVID-19 Vaccines: Social Media Trend Analysis %A Monselise,Michal %A Chang,Chia-Hsuan %A Ferreira,Gustavo %A Yang,Rita %A Yang,Christopher C %+ College of Computing and Informatics, Drexel University, 3675 Market St, 10th Floor, Philadelphia, PA, 19104, United States, 1 215 895 1631, chris.yang@drexel.edu %K health care informatics %K topic detection %K unsupervised sentiment analysis %K COVID-19 %K vaccine hesitancy %K sentiment %K concern %K vaccine %K social media %K trend %K trust %K health information %K Twitter %K discussion %K communication %K hesitancy %K emotion %K fear %D 2021 %7 21.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As a number of vaccines for COVID-19 are given emergency use authorization by local health agencies and are being administered in multiple countries, it is crucial to gain public trust in these vaccines to ensure herd immunity through vaccination. One way to gauge public sentiment regarding vaccines for the goal of increasing vaccination rates is by analyzing social media such as Twitter. Objective: The goal of this research was to understand public sentiment toward COVID-19 vaccines by analyzing discussions about the vaccines on social media for a period of 60 days when the vaccines were started in the United States. Using the combination of topic detection and sentiment analysis, we identified different types of concerns regarding vaccines that were expressed by different groups of the public on social media. Methods: To better understand public sentiment, we collected tweets for exactly 60 days starting from December 16, 2020 that contained hashtags or keywords related to COVID-19 vaccines. We detected and analyzed different topics of discussion of these tweets as well as their emotional content. Vaccine topics were identified by nonnegative matrix factorization, and emotional content was identified using the Valence Aware Dictionary and sEntiment Reasoner sentiment analysis library as well as by using sentence bidirectional encoder representations from transformer embeddings and comparing the embedding to different emotions using cosine similarity. Results: After removing all duplicates and retweets, 7,948,886 tweets were collected during the 60-day time period. Topic modeling resulted in 50 topics; of those, we selected 12 topics with the highest volume of tweets for analysis. Administration and access to vaccines were some of the major concerns of the public. Additionally, we classified the tweets in each topic into 1 of the 5 emotions and found fear to be the leading emotion in the tweets, followed by joy. Conclusions: This research focused not only on negative emotions that may have led to vaccine hesitancy but also on positive emotions toward the vaccine. By identifying both positive and negative emotions, we were able to identify the public's response to the vaccines overall and to news events related to the vaccines. These results are useful for developing plans for disseminating authoritative health information and for better communication to build understanding and trust. %M 34581682 %R 10.2196/30765 %U https://www.jmir.org/2021/10/e30765 %U https://doi.org/10.2196/30765 %U http://www.ncbi.nlm.nih.gov/pubmed/34581682 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e31125 %T Willingness to Receive COVID-19 Vaccination Among People Living With HIV and AIDS in China: Nationwide Cross-sectional Online Survey %A Huang,Xiaojie %A Yu,Maohe %A Fu,Gengfeng %A Lan,Guanghua %A Li,Linghua %A Yang,Jianzhou %A Qiao,Ying %A Zhao,Jin %A Qian,Han-Zhu %A Zhang,Xiangjun %A Liu,Xinchao %A Jin,Xia %A Chen,Guohong %A Jiang,Hui %A Tang,Weiming %A Wang,Zixin %A Xu,Junjie %+ Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong, 666888, China, 852 22528740, wangzx@cuhk.edu.hk %K people living with HIV and AIDS %K COVID-19 vaccination %K willingness %K perceptions %K internet and social media influences %K interpersonal communication %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: HIV infection is a significant independent risk factor for both severe COVID-19 presentation at hospital admission and in-hospital mortality. Available information has suggested that people living with HIV and AIDS (PLWHA) could benefit from COVID-19 vaccination. However, there is a dearth of evidence on willingness to receive COVID-19 vaccination among PLWHA. Objective: The aim of this study was to investigate willingness to receive COVID-19 vaccination among a national sample of PLWHA in China. Methods: This cross-sectional online survey investigated factors associated with willingness to receive COVID-19 vaccination among PLWHA aged 18 to 65 years living in eight conveniently selected Chinese metropolitan cities between January and February 2021. Eight community-based organizations (CBOs) providing services to PLWHA facilitated the recruitment. Eligible PLWHA completed an online survey developed using a widely used encrypted web-based survey platform in China. We fitted a single logistic regression model to obtain adjusted odds ratios (aORs), which involved one of the independent variables of interest and all significant background variables. Path analysis was also used in the data analysis. Results: Out of 10,845 PLWHA approached by the CBOs, 2740 completed the survey, and 170 had received at least one dose of the COVID-19 vaccine. This analysis was performed among 2570 participants who had never received COVID-19 vaccination. Over half of the participants reported willingness to receive COVID-19 vaccination (1470/2570, 57.2%). Perceptions related to COVID-19 vaccination were significantly associated with willingness to receive COVID-19 vaccination, including positive attitudes (aOR 1.11, 95% CI 1.09-1.12; P<.001), negative attitudes (aOR 0.96, 95% CI 0.94-0.97; P<.001), perceived support from significant others (perceived subjective norm; aOR 1.53, 95% CI 1.46-1.61; P<.001), and perceived behavioral control (aOR 1.13, 95% CI 1.11-1.14; P<.001). At the interpersonal level, receiving advice supportive of COVID-19 vaccination from doctors (aOR 1.99, 95% CI 1.65-2.40; P<.001), CBO staff (aOR 1.89, 95% CI 1.51-2.36; P<.001), friends and/or family members (aOR 3.22, 95% CI 1.93-5.35; P<.001), and PLWHA peers (aOR 2.38, 95% CI 1.85-3.08; P<.001) was associated with higher willingness to receive COVID-19 vaccination. The overall opinion supporting COVID-19 vaccination for PLWHA on the internet or social media was also positively associated with willingness to receive COVID-19 vaccination (aOR 1.59, 95% CI 1.31-1.94; P<.001). Path analysis indicated that interpersonal-level variables were indirectly associated with willingness to receive COVID-19 vaccination through perceptions (β=.43, 95% CI .37-.51; P<.001). Conclusions: As compared to PLWHA in other countries and the general population in most parts of the world, PLWHA in China reported a relatively low willingness to receive COVID-19 vaccination. The internet and social media as well as interpersonal communications may be major sources of influence on PLWHA’s perceptions and willingness to receive COVID-19 vaccination. %M 34543223 %R 10.2196/31125 %U https://publichealth.jmir.org/2021/10/e31125 %U https://doi.org/10.2196/31125 %U http://www.ncbi.nlm.nih.gov/pubmed/34543223 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e30311 %T Social Semiotics of Gangstalking Evidence Videos on YouTube: Multimodal Discourse Analysis of a Novel Persecutory Belief System %A Lustig,Andrew %A Brookes,Gavin %A Hunt,Daniel %+ Department of Psychiatry, Faculty of Medicine, University of Toronto, 1051 Queen Street West, Crisis and Critical Care Building, Toronto, ON, M6J1H3, Canada, 1 4165185878, andrew.lustig@camh.ca %K internet %K discourse analysis %K psychosis %K delusion %K semiotics %K linguistics %K computer-mediated communication %K schizophrenia %K eHealth %K video %K communication %K YouTube %K social media %K discourse %K mental health %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Gangstalking refers to a novel persecutory belief system wherein sufferers believe that they are being followed, watched, and harassed by a vast network of people in their community who have been recruited as complicit perpetrators. They are frequently diagnosed as mentally ill, although they reject this formulation. Those affected by this belief system self-identify as targeted individuals (TIs). They seek to prove the veracity of their persecution and dispute the notion that they are mentally ill by posting videos online that purport to provide evidence of their claims. Objective: The objective of the study was to characterize the multimodal social semiotic practices used in gangstalking evidence videos. Methods: We assembled a group of 50 evidence videos posted on YouTube by self-identified TIs and performed a multimodal social semiotic discourse analysis using a grounded theory approach to data analysis. Results: TIs accomplished several social and interpersonal tasks in the videos. They constructed their own identity as subjects of persecution and refuted the notion that they suffered from mental illness. They also cultivated positive ambient affiliation with viewers of the videos but manifested hostility toward people who appeared in the videos. They made extensive use of multimodal deixis to generate salience and construe the gangstalking belief system. The act of filming itself was a source of conflict and served as a self-fulfilling prophecy; filming was undertaken to neutrally record hostility directed toward video bloggers (vloggers). However, the act of filming precipitated the very behaviors that they set out to document. Finally, the act of filming was also regarded as an act of resistance and empowerment by vloggers. Conclusions: These data provide insight into a novel persecutory belief system. Interpersonal concerns are important for people affected, and they construe others as either sympathetic or hostile. They create positive ambient affiliation with viewers. We found that vloggers use multimodal deixis to illustrate the salience of the belief system. The videos highlighted the Derridean concept of différance, wherein the meaning of polysemous signifiers is deferred without definitive resolution. This may be important in communicating with people and patients with persecutory belief systems. Clinicians may consider stepping away from the traditional true/false dichotomy endorsed by psychiatric classification systems and focus on the ambiguity in semiotic systems generally and in persecutory belief systems specifically. %M 34673523 %R 10.2196/30311 %U https://mental.jmir.org/2021/10/e30311 %U https://doi.org/10.2196/30311 %U http://www.ncbi.nlm.nih.gov/pubmed/34673523 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e29375 %T Health Communication About Hospice Care in Chinese Media: Digital Topic Modeling Study %A Liu,Qian %A Zheng,Zequan %A Chen,Jingsen %A Tsang,Winghei %A Jin,Shan %A Zhang,Yimin %A Akinwunmi,Babatunde %A Zhang,Casper JP %A Ming,Wai-kit %+ Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, 5/F, Block 1, To Yuen Building, 31 To Yuen Street, Tat Chee Avenue, Kowloon, Hong Kong, China, 852 3442 6956, wkming@connect.hku.hk %K health communication %K hospice care %K mass media %K China %K topic modeling %K communication %K media %K model %K hospice %K end-of-life %K misconception %K health information %K news %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hospice care, a type of end-of-life care provided for dying patients and their families, has been rooted in China since the 1980s. It can improve receivers’ quality of life as well as ease their economic burden. The Chinese mass media have continued to actively dispel misconceptions surrounding hospice care and deliver the latest information to citizens. Objective: This study aims to retrieve and analyze news reports on hospice care in order to gain insight into whether any differences existed in heath information delivered over time and to evaluate the role of mass media in health communication in recent years. Methods: We searched the Huike (WiseSearch) news database for relevant news reports from Chinese mass media released between 2014 and 2019. We defined two time periods for this study: (1) January 1, 2014, to December 31, 2016, and (2) January 1, 2017, to December 31, 2019. The data cleaning process was completed using Python. We determined appropriate topic numbers for these two periods based on the coherence score and applied latent Dirichlet allocation topic modeling. Keywords for each topic and corresponding topics’ names were then generated. The topics were plotted into different circles, and their distances on the 2D plane was represented by multidimensional scaling. Results: After removing duplicated and irrelevant news articles, we obtained a total of 2227 articles. We chose 8 as the suitable topic number for both study periods and generated topic names and associated keywords. The top 3 most reported topics in the first period were patient treatment, hospice care stories, and development of health care services and health insurance, accounting for 18.68% (178/953), 16.58% (158/953), and 14.17% (135/953) of the collected reports, respectively. The top 3 most reported topics in the second period were hospice care stories, patient treatment, and development of health care services, accounting for 15.62% (199/953), 15.38% (15.38/953), and 14.27% (182/953), respectively. Conclusions: Topic modeling of news reports gives us a better understanding of the patterns of health communication about hospice care by mass media. Chinese mass media frequently reported on hospice care in April of every year on account of a traditional Chinese festival. Moreover, an increase in coverage was observed in the second period. The two periods shared 6 similar topics, of which patient treatment outstrips hospice care stories was the most reported topic in the second period, implying the humanistic spirit behind the reports. Based on the findings of this study, we suggest stakeholders cooperate with the mass media when planning to update policies. %M 34673530 %R 10.2196/29375 %U https://publichealth.jmir.org/2021/10/e29375 %U https://doi.org/10.2196/29375 %U http://www.ncbi.nlm.nih.gov/pubmed/34673530 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28923 %T General Practice and Digital Methods to Recruit Stroke Survivors to a Clinical Mobility Study: Comparative Analysis %A Reuter,Katja %A Liu,Chang %A Le,NamQuyen %A Angyan,Praveen %A Finley,James M %+ Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, Weiskotten Hall Rm. 2263, 766 Irving Avenue, Syracuse, NY, 13210, United States, 1 315 464 5540, reuterk@upstate.edu %K clinical trial %K stroke %K falls %K digital media %K social media %K advertising %K participant recruitment %K Facebook %K Google %K clinical research %K research methods %K recruitment practices %K enrollment %D 2021 %7 13.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Participant recruitment remains a barrier to conducting clinical research. The disabling nature of a stroke, which often includes functional and cognitive impairments, and the acute stage of illness at which patients are appropriate for many trials make recruiting patients particularly complex and challenging. In addition, people aged 65 years and older, which includes most stroke survivors, have been identified as a group that is difficult to reach and is commonly underrepresented in health research, particularly clinical trials. Digital media may provide effective tools to support enrollment efforts of stroke survivors in clinical trials. Objective: The objective of this study was to compare the effectiveness of general practice (traditional) and digital (online) methods of recruiting stroke survivors to a clinical mobility study. Methods: Recruitment for a clinical mobility study began in July 2018. Eligible study participants included individuals 18 years and older who had a single stroke and were currently ambulatory in the community. General recruiting practice included calling individuals listed in a stroke registry, contacting local physical therapists, and placing study flyers throughout a university campus. Between May 21, 2019, and June 26, 2019, the study was also promoted digitally using the social network Facebook and the search engine marketing tool Google AdWords. The recruitment advertisements (ads) included a link to the study page to which users who clicked were referred. Primary outcomes of interest for both general practice and digital methods included recruitment speed (enrollment rate) and sample characteristics. The data were analyzed using the Lilliefors test, the Welch two-sample t test, and the Mann-Whitney test. Significance was set at P=.05. All statistical analyses were performed in MATLAB 2019b. Results: Our results indicate that digital recruitment methods can address recruitment challenges regarding stroke survivors. Digital recruitment methods allowed us to enroll study participants at a faster rate (1.8 participants/week) compared to using general practice methods (0.57 participants/week). Our findings also demonstrate that digital and general recruitment practices can achieve an equivalent level of sample representativeness. The characteristics of the enrolled stroke survivors did not differ significantly by age (P=.95) or clinical scores (P=.22; P=.82). Comparing the cost-effectiveness of Facebook and Google, we found that the use of Facebook resulted in a lower cost per click and cost per enrollee per ad. Conclusions: Digital recruitment can be used to expedite participant recruitment of stroke survivors compared to more traditional recruitment practices, while also achieving equivalent sample representativeness. Both general practice and digital recruitment methods will be important to the successful recruitment of stroke survivors. Future studies could focus on testing the effectiveness of additional general practice and digital media approaches and include robust cost-effectiveness analyses. Examining the effectiveness of different messaging and visual approaches tailored to culturally diverse and underrepresented target subgroups could provide further data to move toward evidence-based recruitment strategies. %M 34643544 %R 10.2196/28923 %U https://www.jmir.org/2021/10/e28923 %U https://doi.org/10.2196/28923 %U http://www.ncbi.nlm.nih.gov/pubmed/34643544 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e23312 %T Engaging Institutional Stakeholders to Develop and Implement Guidelines for Recruiting Participants in Research Studies Using Social Media: Mixed Methods, Multi-Phase Process %A Flood-Grady,Elizabeth %A Solberg,Lauren B %A Baralt,Claire %A Meyer,Meghan %A Stevens,Jeff %A Krieger,Janice L %+ STEM Translational Communication Center, College of Journalism and Communications, University of Florida, PO Box 118400, Gainesville, FL, 32611, United States, 1 352 273 0240, efloodgrady@ufl.edu %K social media %K research recruitment %K stakeholder engagement %K health communication %D 2021 %7 8.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Limited regulatory guidance surrounding the use of social media channels for participant recruitment is an interdisciplinary challenge. Establishing stakeholder-informed procedures is essential for ethical and effective use of social media for participant recruitment. Objective: This study aims to provide replicable procedures for developing and implementing guidelines for using social media to recruit participants in research studies. Methods: Social media use cases at the university were used to identify institutional stakeholders for the initiative. After establishing workflow procedures, a scoping review of web-based materials about recruitment and research on the internet and social media from 19 peer institutions and 2 federal agencies was conducted to inform the structure of the policies and procedures. End users (investigators and study coordinators; N=14) also provided feedback on the policies and procedures and implementation. Results: Representatives (n=7) from 5 institutional offices and 15 subject-matter experts from 5 areas were identified as stakeholders in the development of policies and procedures. Peers with web-based materials (n=16) identified in the scoping review revealed 4 themes that served as a basis for developing our policies and procedures. End user feedback further informed the policies and procedures and implementation. A centrally managed social media account for communicating with participants and hosting advertising campaigns on social media was also established and, when combined with the policies and procedures, resulted in 39 advertising campaigns, and 2846 participants were enrolled in health and clinical research studies. Conclusions: Our policies and procedures allow research teams to harness the potential of social media to increase study recruitment and participation; the transparent, stakeholder-informed process can be replicated by institutional administrators to establish policies and procedures that meet the interests and needs of their research community. %M 34623319 %R 10.2196/23312 %U https://www.jmir.org/2021/10/e23312 %U https://doi.org/10.2196/23312 %U http://www.ncbi.nlm.nih.gov/pubmed/34623319 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e27417 %T Smoking Protective and Risk Factors Among Transgender and Gender-Expansive Individuals (Project SPRING): Qualitative Study Using Digital Photovoice %A Tan,Andy SL %A Gazarian,Priscilla K %A Darwish,Sabreen %A Hanby,Elaine %A Farnham,Bethany C %A Koroma-Coker,Faith A %A Potter,Jennifer %A Ballout,Suha %+ Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Annenberg School at UPenn, Philadelphia, PA, 19104, United States, 1 4436161129, andy.tan@asc.upenn.edu %K transgender and gender expansive populations %K tobacco-related health disparities %K United States %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Transgender and gender-expansive (TGE) adults are twice as likely to smoke cigarettes than cisgender individuals. There is a critical gap in research on effective and culturally sensitive approaches to reduce smoking prevalence among TGE adults. Objective: This study aims to qualitatively examine the risk and protective factors of cigarette smoking among TGE adults through real-world exemplars. Methods: We conducted a digital photovoice study among a purposeful sample of 47 TGE adults aged ≥18 years and currently smoking in the United States (March 2019-April 2020). Participants uploaded photos daily that depicted smoking risk and protective factors they experienced over 21 days on either private Facebook or Instagram groups. Next, we conducted separate focus group discussions to explore the experiences of these factors among a subset of participants from each group. We analyzed participants’ photos, captions, and focus group transcripts and generated themes associated with smoking risk and protective factors. Results: We identified 6 major themes of risk and protective factors of smoking among TGE individuals: experience of stress, gender affirmation, health consciousness, social influences, routine behaviors, and environmental cues. We describe and illustrate each theme using exemplar photos and quotes. Conclusions: The findings of this study will inform future community-engaged research to develop culturally tailored interventions to reduce smoking prevalence among TGE individuals. %M 34612842 %R 10.2196/27417 %U https://publichealth.jmir.org/2021/10/e27417 %U https://doi.org/10.2196/27417 %U http://www.ncbi.nlm.nih.gov/pubmed/34612842 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e23465 %T Understanding University Students’ Experiences, Perceptions, and Attitudes Toward Peers Displaying Mental Health–Related Problems on Social Networking Sites: Online Survey and Interview Study %A Kim,Taewan %A Hong,Hwajung %+ Department of Industrial Design, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea, 82 42 350 4502, hwajung@kaist.ac.kr %K mental health %K social media %K social support %K peers %K peer support %K self-disclosure %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: College students’ mental health is at an all-time low. Students are increasingly disclosing their vulnerable, stigmatizing experiences on online social networking sites (SNSs). Peer support facilitated by SNSs can play a crucial role for the students in coping with mental health–related problems. Thus, it is imperative to understand how university students form perceptions, attitudes, and behaviors toward their peers who are dealing with mental health problems. Objective: This study aimed to provide a better understanding of how college students recognize, perceive, and react to signs of mental health problems in their peers on SNSs. Our ultimate goal in this study was to inform the design of SNSs that can facilitate online peer support. Methods: We conducted surveys with 226 students as well as semistructured interviews with 20 students at six universities in South Korea. Results: Of the 226 survey respondents, 150 (66.4%) reported that they recognized signs of a mental health problem on their friends’ SNS posts. However, a considerable number of respondents (62/150, 41.3%) were reluctant to offer support, even when they had identified friends who were at risk; this reluctance was due to a lack of knowledge or confidence and their desire to maintain a distance from at-risk peers to save their identity from stigmatization and to avoid emotional contagion online. Conclusions: Drawing on these results, we provide implications that could explain the construction of students’ perceptions regarding their peers’ mental health problems. We also provide design proposals for SNSs to serve as platforms that facilitate just-in-time and adaptive support exchanges among peers while mitigating stigma-related concerns. %M 34609315 %R 10.2196/23465 %U https://mental.jmir.org/2021/10/e23465 %U https://doi.org/10.2196/23465 %U http://www.ncbi.nlm.nih.gov/pubmed/34609315 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e29486 %T Evaluating Applicant Perceptions of the Impact of Social Media on the 2020-2021 Residency Application Cycle Occurring During the COVID-19 Pandemic: Survey Study %A Naaseh,Ariana %A Thompson,Sean %A Tohmasi,Steven %A Wiechmann,Warren %A Toohey,Shannon %A Wray,Alisa %A Boysen-Osborn,Megan %+ University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA, 92617, United States, 1 (949) 824 4285, mbo@hs.uci.edu %K residency application %K social media %K medical education %K resident %K medical student %K perspective %K residency recruitment %K virtual application %K virtual residency %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Due to challenges related to the COVID-19 pandemic, residency programs in the United States conducted virtual interviews during the 2020-2021 application season. As a result, programs and applicants may have relied more heavily on social media–based communication and dissemination of information. Objective: We sought to determine social media’s impact on residency applicants during an entirely virtual application cycle. Methods: An anonymous electronic survey was distributed to 465 eligible 2021 Match applicants at 4 University of California Schools of Medicine in the United States. Results: A total of 72 participants (15.5% of eligible respondents), applying to 16 specialties, responded. Of those who responded, 53% (n=38) reported following prospective residency accounts on social media, and 89% (n=34) of those respondents were positively or negatively influenced by these accounts. The top three digital methods by which applicants sought information about residency programs included the program website, digital conversations with residents and fellows of that program, and Instagram. Among respondents, 53% (n=38) attended virtual information sessions for prospective programs. A minority of applicants (n=19, 26%) adjusted the number of programs they applied to based on information found on social media, with most (n=14, 74%) increasing the number of programs to which they applied. Survey respondents ranked social media’s effectiveness in allowing applicants to learn about programs at 6.7 (SD 2.1) on a visual analogue scale from 1-10. Most applicants (n=61, 86%) felt that programs should use social media in future application cycles even if they are nonvirtual. Conclusions: Social media appears to be an important tool for resident recruitment. Future studies should seek more information on its effect on later parts of the application cycle and the Match. %M 34591779 %R 10.2196/29486 %U https://mededu.jmir.org/2021/4/e29486 %U https://doi.org/10.2196/29486 %U http://www.ncbi.nlm.nih.gov/pubmed/34591779 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e29413 %T Tracking Self-reported Symptoms and Medical Conditions on Social Media During the COVID-19 Pandemic: Infodemiological Study %A Ding,Qinglan %A Massey,Daisy %A Huang,Chenxi %A Grady,Connor B %A Lu,Yuan %A Cohen,Alina %A Matzner,Pini %A Mahajan,Shiwani %A Caraballo,César %A Kumar,Navin %A Xue,Yuchen %A Dreyer,Rachel %A Roy,Brita %A Krumholz,Harlan M %+ Center for Outcomes Research and Evaluation, Yale New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT, 06510, United States, 1 203 764 5885, harlan.krumholz@yale.edu %K health conditions %K symptoms %K mental health %K social media %K infoveillance %K public health surveillance %K COVID-19 %K pandemic %K natural language processing %D 2021 %7 28.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Harnessing health-related data posted on social media in real time can offer insights into how the pandemic impacts the mental health and general well-being of individuals and populations over time. Objective: This study aimed to obtain information on symptoms and medical conditions self-reported by non-Twitter social media users during the COVID-19 pandemic, to determine how discussion of these symptoms and medical conditions changed over time, and to identify correlations between frequency of the top 5 commonly mentioned symptoms post and daily COVID-19 statistics (new cases, new deaths, new active cases, and new recovered cases) in the United States. Methods: We used natural language processing (NLP) algorithms to identify symptom- and medical condition–related topics being discussed on social media between June 14 and December 13, 2020. The sample posts were geotagged by NetBase, a third-party data provider. We calculated the positive predictive value and sensitivity to validate the classification of posts. We also assessed the frequency of health-related discussions on social media over time during the study period, and used Pearson correlation coefficients to identify statistically significant correlations between the frequency of the 5 most commonly mentioned symptoms and fluctuation of daily US COVID-19 statistics. Results: Within a total of 9,807,813 posts (nearly 70% were sourced from the United States), we identified a discussion of 120 symptom-related topics and 1542 medical condition–related topics. Our classification of the health-related posts had a positive predictive value of over 80% and an average classification rate of 92% sensitivity. The 5 most commonly mentioned symptoms on social media during the study period were anxiety (in 201,303 posts or 12.2% of the total posts mentioning symptoms), generalized pain (189,673, 11.5%), weight loss (95,793, 5.8%), fatigue (91,252, 5.5%), and coughing (86,235, 5.2%). The 5 most discussed medical conditions were COVID-19 (in 5,420,276 posts or 66.4% of the total posts mentioning medical conditions), unspecified infectious disease (469,356, 5.8%), influenza (270,166, 3.3%), unspecified disorders of the central nervous system (253,407, 3.1%), and depression (151,752, 1.9%). Changes in posts in the frequency of anxiety, generalized pain, and weight loss were significant but negatively correlated with daily new COVID-19 cases in the United States (r=-0.49, r=-0.46, and r=-0.39, respectively; P<.05). Posts on the frequency of anxiety, generalized pain, weight loss, fatigue, and the changes in fatigue positively and significantly correlated with daily changes in both new deaths and new active cases in the United States (r ranged=0.39-0.48; P<.05). Conclusions: COVID-19 and symptoms of anxiety were the 2 most commonly discussed health-related topics on social media from June 14 to December 13, 2020. Real-time monitoring of social media posts on symptoms and medical conditions may help assess the population’s mental health status and enhance public health surveillance for infectious disease. %M 34517338 %R 10.2196/29413 %U https://publichealth.jmir.org/2021/9/e29413 %U https://doi.org/10.2196/29413 %U http://www.ncbi.nlm.nih.gov/pubmed/34517338 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e32685 %T Comparing Public Sentiment Toward COVID-19 Vaccines Across Canadian Cities: Analysis of Comments on Reddit %A Yan,Cathy %A Law,Melanie %A Nguyen,Stephanie %A Cheung,Janelle %A Kong,Jude %+ Department of Mathematics & Statistics, York University, Ross 533N, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 66093, jdkong@yorku.ca %K COVID-19 %K public sentiment %K social media %K Reddit %K Canada %K communication %K sentiment %K opinion %K emotion %K concern %K pandemic %K vaccine %K hesitancy %D 2021 %7 24.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media enables the rapid consumption of news related to COVID-19 and serves as a platform for discussions. Its richness in text-based data in the form of posts and comments allows researchers to identify popular topics and assess public sentiment. Nonetheless, the vast majority of topic extraction and sentiment analysis based on social media is performed on the platform or country level and does not account for local culture and policies. Objective: The aim of this study is to use location-based subreddits on Reddit to study city-level variations in sentiments toward vaccine-related topics. Methods: Comments on posts providing regular updates on COVID-19 statistics in the Vancouver (r/vancouver, n=49,291), Toronto (r/toronto, n=20,764), and Calgary (r/calgary, n=21,277) subreddits between July 13, 2020, and June 14, 2021, were extracted. Latent Dirichlet allocation was used to identify frequently discussed topics. Sentiment (joy, sadness, fear, and anger) scores were assigned to comments through random forest regression. Results: The number of comments on the 250 posts from the Vancouver subreddit positively correlated with the number of new daily COVID-19 cases in British Columbia (R=0.51, 95% CI for slope 0.18-0.29; P<.001). From the comments, 13 topics were identified. Two were related to vaccines, 1 regarding vaccine uptake and the other about vaccine supply. The levels of discussion for both topics were linked to the total number of vaccines administered (Granger test for causality, P<.001). Comments pertaining to either topic displayed higher scores for joy than for other topics (P<.001). Calgary and Toronto also discussed vaccine uptake. Sentiment scores for this topic differed across the 3 cities (P<.001). Conclusions: Our work demonstrates that data from city-specific subreddits can be used to better understand concerns and sentiments around COVID-19 vaccines at the local level. This can potentially lead to more targeted and publicly acceptable policies based on content on social media. %M 34519654 %R 10.2196/32685 %U https://www.jmir.org/2021/9/e32685 %U https://doi.org/10.2196/32685 %U http://www.ncbi.nlm.nih.gov/pubmed/34519654 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e22313 %T Precision Public Health Campaign: Delivering Persuasive Messages to Relevant Segments Through Targeted Advertisements on Social Media %A An,Jisun %A Kwak,Haewoon %A Qureshi,Hanya M %A Weber,Ingmar %+ School of Computing and Information Systems, Singapore Management University, 80 Stamford Road, Singapore, 178902, Singapore, 65 6826 4809, jisun.an@acm.org %K precision public health %K tailored health communication %K social media advertising %K Facebook advertising %K public health campaigns %K effectiveness of campaigns %K public health %K advertising %D 2021 %7 24.9.2021 %9 Viewpoint %J JMIR Form Res %G English %X Although established marketing techniques have been applied to design more effective health campaigns, more often than not, the same message is broadcasted to large populations, irrespective of unique characteristics. As individual digital device use has increased, so have individual digital footprints, creating potential opportunities for targeted digital health interventions. We propose a novel precision public health campaign framework to structure and standardize the process of designing and delivering tailored health messages to target particular population segments using social media–targeted advertising tools. Our framework consists of five stages: defining a campaign goal, priority audience, and evaluation metrics; splitting the target audience into smaller segments; tailoring the message for each segment and conducting a pilot test; running the health campaign formally; and evaluating the performance of the campaigns. We have demonstrated how the framework works through 2 case studies. The precision public health campaign framework has the potential to support higher population uptake and engagement rates by encouraging a more standardized, concise, efficient, and targeted approach to public health campaign development. %M 34559055 %R 10.2196/22313 %U https://formative.jmir.org/2021/9/e22313 %U https://doi.org/10.2196/22313 %U http://www.ncbi.nlm.nih.gov/pubmed/34559055 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e25621 %T Analysis of Population Differences in Digital Conversations About Cancer Clinical Trials: Advanced Data Mining and Extraction Study %A Perez,Edith A %A Jaffee,Elizabeth M %A Whyte,John %A Boyce,Cheryl A %A Carpten,John D %A Lozano,Guillermina %A Williams,Raymond M %A Winkfield,Karen M %A Bernstein,David %A Poblete,Sung %+ Stand Up To Cancer, 10880 Wilshire Blvd, Los Angeles, CA, 90024, United States, 1 929 253 6728, dbernstein@su2c.org %K cancer %K clinical trials %K data mining %K text extraction %K social media %K race and ethnicity %K health communication %K health care disparities %K natural language processing %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Racial and ethnic diversity in clinical trials for cancer treatment is essential for the development of treatments that are effective for all patients and for identifying potential differences in toxicity between different demographics. Mining of social media discussions about clinical trials has been used previously to identify patient barriers to enrollment in clinical trials; however, a comprehensive breakdown of sentiments and barriers by various racial and ethnic groups is lacking. Objective: The aim of this study is to use an innovative methodology to analyze web-based conversations about cancer clinical trials and to identify and compare conversation topics, barriers, and sentiments between different racial and ethnic populations. Methods: We analyzed 372,283 web-based conversations about cancer clinical trials, of which 179,339 (48.17%) of the discussions had identifiable race information about the individual posting the conversations. Using sophisticated machine learning software and analyses, we were able to identify key sentiments and feelings, topics of interest, and barriers to clinical trials across racial groups. The stage of treatment could also be identified in many of the discussions, allowing for a unique insight into how the sentiments and challenges of patients change throughout the treatment process for each racial group. Results: We observed that only 4.01% (372,283/9,284,284) of cancer-related discussions referenced clinical trials. Within these discussions, topics of interest and identified clinical trial barriers discussed by all racial and ethnic groups throughout the treatment process included health care professional interactions, cost of care, fear, anxiety and lack of awareness, risks, treatment experiences, and the clinical trial enrollment process. Health care professional interactions, cost of care, and enrollment processes were notably discussed more frequently in minority populations. Other minor variations in the frequency of discussion topics between ethnic and racial groups throughout the treatment process were identified. Conclusions: This study demonstrates the power of digital search technology in health care research. The results are also valuable for identifying the ideal content and timing for the delivery of clinical trial information and resources for different racial and ethnic groups. %M 34554099 %R 10.2196/25621 %U https://cancer.jmir.org/2021/3/e25621 %U https://doi.org/10.2196/25621 %U http://www.ncbi.nlm.nih.gov/pubmed/34554099 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e27063 %T Gaps in Public Awareness About BRCA and Genetic Testing in Prostate Cancer: Social Media Landscape Analysis %A Loeb,Stacy %A Massey,Philip %A Leader,Amy E %A Thakker,Sameer %A Falge,Emily %A Taneja,Sabina %A Byrne,Nataliya %A Rose,Meredith %A Joy,Matthew %A Walter,Dawn %A Katz,Matthew S %A Wong,Risa L %A Selvan,Preethi %A Keith,Scott W %A Giri,Veda N %+ Department of Urology and Population Health, New York University School of Medicine, 227 E 30th Street #612, New York, NY, 10016, United States, 1 7182619100, stacyloeb@gmail.com %K genetic testing %K BRCA %K prostate cancer %K breast cancer %K social media %K infodemiology %D 2021 %7 20.9.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Genetic testing, particularly for BRCA1/2, is increasingly important in prostate cancer (PCa) care, with impact on PCa management and hereditary cancer risk. However, the extent of public awareness and online discourse on social media is unknown, and presents opportunities to identify gaps and enhance population awareness and uptake of advances in PCa precision medicine. Objective: The objective of this study was to characterize activity and engagement across multiple social media platforms (Twitter, Facebook, and YouTube) regarding BRCA and genetic testing for PCa compared with breast cancer, which has a long history of public awareness, advocacy, and prominent social media presence. Methods: The Symplur Signals online analytics platform was used to obtain metrics for tweets about (1) #BRCA and #breastcancer, (2) #BRCA and #prostatecancer, (3) #genetictesting and #breastcancer, and (4) #genetictesting and #prostatecancer from 2016 to 2020. We examined the total number of tweets, users, and reach for each hashtag, and performed content analysis for a subset of tweets. Facebook and YouTube were queried using analogous search terms, and engagement metrics were calculated. Results: During a 5-year period, there were 10,005 tweets for #BRCA and #breastcancer, versus 1008 tweets about #BRCA and #prostatecancer. There were also more tweets about #genetictesting and #breastcancer (n=1748), compared with #genetic testing and #prostatecancer (n=328). Tweets about genetic testing (12,921,954) and BRCA (75,724,795) in breast cancer also had substantially greater reach than those about PCa (1,463,777 and 4,849,905, respectively). Facebook groups and pages regarding PCa and BRCA/genetic testing had fewer average members, new members, and new posts, as well as fewer likes and followers, compared with breast cancer. Facebook videos had more engagement than YouTube videos across both PCa and breast cancer content. Conclusions: There is substantially less social media engagement about BRCA and genetic testing in PCa compared with breast cancer. This landscape analysis provides insights into strategies for leveraging social media platforms to increase public awareness about PCa germline testing, including use of Facebook to share video content and Twitter for discussions with health professionals. %M 34542414 %R 10.2196/27063 %U https://cancer.jmir.org/2021/3/e27063 %U https://doi.org/10.2196/27063 %U http://www.ncbi.nlm.nih.gov/pubmed/34542414 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26273 %T Associations Between Social Media, Bedtime Technology Use Rules, and Daytime Sleepiness Among Adolescents: Cross-sectional Findings From a Nationally Representative Sample %A Hamilton,Jessica Leigh %A Lee,Woanjun %+ Department of Psychology, Rutgers University, 50 Joyce Kilmer Ave, Piscataway, NJ, 08854, United States, 1 (848) 445 2576, jessica.hamilton@rutgers.edu %K adolescents %K social media %K daytime sleepiness %K parenting %K bedtime %K mental health %K mobile phone %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Social media use is associated with poor sleep among adolescents, including daytime sleepiness, which affects adolescents’ mental health. Few studies have examined the associations among specific aspects of social media, such as frequency of checking and posting, perceived importance of social media for social belonging, and daytime sleepiness. Identifying whether certain adolescents are more at risk or protected from the effects of social media on sleepiness may inform future interventions for social media, sleep, and mental health. Objective: This study aims to examine the association between social media use frequency and importance, daytime sleepiness, and whether the perceived importance of social media for social interactions and parental rules around bedtime technology moderated these relationships. Methods: This cross-sectional survey study was conducted with a sample of 4153 adolescents from across the United States. Qualtrics was used to collect data via panel recruitment from a national sample representing the US demographics of teens aged 12 to 17 years. Participants completed measures of daytime sleepiness, frequency of social media checking and posting, and the importance of social media for social interactions. Parents reported whether they had a household rule around bedtime media and screen use. Hierarchical regressions and moderation analyses were conducted, covarying for age, gender, and age at first smartphone use. Results: Participants had a mean age of 14.64 (SD 1.66) years in grades 6 to 12, 46.45% (1929/4153) identified as female, and 67.93% (2821/4153) identified as White. The results indicated that adolescents who posted (B=0.70, SE 0.04; P<.001) or checked (B=0.76, SE 0.04; P<.001) social media more frequently or who perceived social media to be more important for social belonging (B=0.36, SE 0.02; P<.001) had higher levels of daytime sleepiness. Moderation analyses indicated that the relationship between social media use frequency and daytime sleepiness was exacerbated by higher levels of perceived social media importance (B=0.04, SE 0.01; P<.001). Adolescents without household rules around bedtime technology use were more likely to be affected by social media checking (B=−0.34, SE 0.09; P<.001) and importance (B=−0.16, SE 0.04; P<.001) on daytime sleepiness. Conclusions: The findings suggest that social media use frequency and perceived importance of social interactions are associated with daytime sleepiness among adolescents. It is important to consider youth’s perceptions of social media when assessing the potential effects of social media use frequency on youth well-being. Furthermore, youth who did not have parental rules around bedtime technology use were most likely to be affected by social media use and perceived importance. The findings may extend to other mental health outcomes and may guide future prevention and intervention programs designed to improve social media use, sleep, and mental health. %M 34524967 %R 10.2196/26273 %U https://mental.jmir.org/2021/9/e26273 %U https://doi.org/10.2196/26273 %U http://www.ncbi.nlm.nih.gov/pubmed/34524967 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26204 %T The Roles of Social Comparison Orientation and Regulatory Focus in College Students’ Responses to Fitspiration Posts on Social Media: Cross-sectional Study %A Pasko,Kristen %A Arigo,Danielle %+ Department of Psychology, Rowan University, 201 Mullica Hill Drive, Robinson Hall 116G, Glassboro, NJ, 08028, United States, 1 (856)256 4500 ext 53775, arigo@rowan.edu %K social media %K college %K fitspiration %K subjective well-being %K social comparison %K regulatory focus %K perception %K well-being %K young adult %K college student %K cross-sectional %K motivation %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Information shared via social media influences college students’ self-perceptions and behavior, particularly, “fitspiration” posts (ie, images of healthy food, people exercising, or fitness quotations). There are mixed findings regarding the mental health implications of fitspiration and its potential to motivate healthy behavior. Individual differences such as social comparison orientation and regulatory focus could aid in determining for whom fitspiration may be helpful versus harmful, though these characteristics have received limited attention in terms of students’ fitspiration perceptions. Objective: This cross-sectional study examined associations between students’ fitspiration use (ie, intentional versus unintentional exposure while using social media), response tendencies (ie, feelings about the self and motivation to be physically active), social comparison orientation, and regulatory focus. Methods: College students (N=344; 239/344, 69.5% women) completed an electronic survey in which they self-reported demographic information, the frequency of their social media use, exposure to fitspiration posts, typical feelings in response to fitspiration posts, and typical motivation for physical activity after viewing fitspiration posts. They also completed validated self-report measures of social comparison orientation and regulatory focus. Results: College students reported frequent exposure to fitspiration posts on social media and that they experienced negative feelings in response to these posts more often than positive feelings. Average motivation for physical activity was rated as feeling motivated “some of the time.” However, students who reported more negative feelings after viewing fitspiration also reported greater motivation to be physically active after exposure. Associations between the frequency of intentional fitspiration use and motivation for physical activity after viewing fitspiration posts were moderated by social comparison orientation (b=−0.01, P=.03) but not by regulatory focus (b=−0.002, P=.67). Conclusions: Negative feelings about the self may be motivating for students with weak social comparison orientation, as fitspiration may highlight a discrepancy between one’s real and ideal self that does not prompt dejection or disengagement. However, negative feelings for prevention-focused students might not be as motivating because there are no salient negative models to avoid. Further research into these associations is warranted and could inform future efforts to promote student health and well-being during college. %M 34524965 %R 10.2196/26204 %U https://mental.jmir.org/2021/9/e26204 %U https://doi.org/10.2196/26204 %U http://www.ncbi.nlm.nih.gov/pubmed/34524965 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e30833 %T Shift in Social Media App Usage During COVID-19 Lockdown and Clinical Anxiety Symptoms: Machine Learning–Based Ecological Momentary Assessment Study %A Ryu,Jihan %A Sükei,Emese %A Norbury,Agnes %A H Liu,Shelley %A Campaña-Montes,Juan José %A Baca-Garcia,Enrique %A Artés,Antonio %A Perez-Rodriguez,M Mercedes %+ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Icahn (East) Bldg, 4th Floor, L4-53, 1425 Madison Ave, New York, NY, 10029, United States, 1 241 9775, mercedes.perez@mssm.edu %K anxiety disorder %K COVID-19 %K social media %K public health %K digital phenotype %K ecological momentary assessment %K smartphone %K machine learning %K hidden Markov model %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Anxiety symptoms during public health crises are associated with adverse psychiatric outcomes and impaired health decision-making. The interaction between real-time social media use patterns and clinical anxiety during infectious disease outbreaks is underexplored. Objective: We aimed to evaluate the usage pattern of 2 types of social media apps (communication and social networking) among patients in outpatient psychiatric treatment during the COVID-19 surge and lockdown in Madrid, Spain and their short-term anxiety symptoms (7-item General Anxiety Disorder scale) at clinical follow-up. Methods: The individual-level shifts in median social media usage behavior from February 1 through May 3, 2020 were summarized using repeated measures analysis of variance that accounted for the fixed effects of the lockdown (prelockdown versus postlockdown), group (clinical anxiety group versus nonclinical anxiety group), the interaction of lockdown and group, and random effects of users. A machine learning–based approach that combined a hidden Markov model and logistic regression was applied to predict clinical anxiety (n=44) and nonclinical anxiety (n=51), based on longitudinal time-series data that comprised communication and social networking app usage (in seconds) as well as anxiety-associated clinical survey variables, including the presence of an essential worker in the household, worries about life instability, changes in social interaction frequency during the lockdown, cohabitation status, and health status. Results: Individual-level analysis of daily social media usage showed that the increase in communication app usage from prelockdown to lockdown period was significantly smaller in the clinical anxiety group than that in the nonclinical anxiety group (F1,72=3.84, P=.05). The machine learning model achieved a mean accuracy of 62.30% (SD 16%) and area under the receiver operating curve 0.70 (SD 0.19) in 10-fold cross-validation in identifying the clinical anxiety group. Conclusions: Patients who reported severe anxiety symptoms were less active in communication apps after the mandated lockdown and more engaged in social networking apps in the overall period, which suggested that there was a different pattern of digital social behavior for adapting to the crisis. Predictive modeling using digital biomarkers—passive-sensing of shifts in category-based social media app usage during the lockdown—can identify individuals at risk for psychiatric sequelae. %M 34524091 %R 10.2196/30833 %U https://mental.jmir.org/2021/9/e30833 %U https://doi.org/10.2196/30833 %U http://www.ncbi.nlm.nih.gov/pubmed/34524091 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27314 %T Deep Learning for Identification of Alcohol-Related Content on Social Media (Reddit and Twitter): Exploratory Analysis of Alcohol-Related Outcomes %A Ricard,Benjamin Joseph %A Hassanpour,Saeed %+ Department of Biomedical Data Science, Dartmouth College, Williamson Translational Research Building, One Medical Center Drive HB 7261, Lebanon, NH, 03756, United States, 1 603 650 1983, saeed.hassanpour@dartmouth.edu %K social media %K natural language processing %K alcohol abuse %K machine learning %D 2021 %7 15.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many social media studies have explored the ability of thematic structures, such as hashtags and subreddits, to identify information related to a wide variety of mental health disorders. However, studies and models trained on specific themed communities are often difficult to apply to different social media platforms and related outcomes. A deep learning framework using thematic structures from Reddit and Twitter can have distinct advantages for studying alcohol abuse, particularly among the youth in the United States. Objective: This study proposes a new deep learning pipeline that uses thematic structures to identify alcohol-related content across different platforms. We apply our method on Twitter to determine the association of the prevalence of alcohol-related tweets with alcohol-related outcomes reported from the National Institute of Alcoholism and Alcohol Abuse, Centers for Disease Control Behavioral Risk Factor Surveillance System, county health rankings, and the National Industry Classification System. Methods: The Bidirectional Encoder Representations From Transformers neural network learned to classify 1,302,524 Reddit posts as either alcohol-related or control subreddits. The trained model identified 24 alcohol-related hashtags from an unlabeled data set of 843,769 random tweets. Querying alcohol-related hashtags identified 25,558,846 alcohol-related tweets, including 790,544 location-specific (geotagged) tweets. We calculated the correlation between the prevalence of alcohol-related tweets and alcohol-related outcomes, controlling for confounding effects of age, sex, income, education, and self-reported race, as recorded by the 2013-2018 American Community Survey. Results: Significant associations were observed: between alcohol-hashtagged tweets and alcohol consumption (P=.01) and heavy drinking (P=.005) but not binge drinking (P=.37), self-reported at the metropolitan-micropolitan statistical area level; between alcohol-hashtagged tweets and self-reported excessive drinking behavior (P=.03) but not motor vehicle fatalities involving alcohol (P=.21); between alcohol-hashtagged tweets and the number of breweries (P<.001), wineries (P<.001), and beer, wine, and liquor stores (P<.001) but not drinking places (P=.23), per capita at the US county and county-equivalent level; and between alcohol-hashtagged tweets and all gallons of ethanol consumed (P<.001), as well as ethanol consumed from wine (P<.001) and liquor (P=.01) sources but not beer (P=.63), at the US state level. Conclusions: Here, we present a novel natural language processing pipeline developed using Reddit’s alcohol-related subreddits that identify highly specific alcohol-related Twitter hashtags. The prevalence of identified hashtags contains interpretable information about alcohol consumption at both coarse (eg, US state) and fine-grained (eg, metropolitan-micropolitan statistical area level and county) geographical designations. This approach can expand research and deep learning interventions on alcohol abuse and other behavioral health outcomes. %M 34524095 %R 10.2196/27314 %U https://www.jmir.org/2021/9/e27314 %U https://doi.org/10.2196/27314 %U http://www.ncbi.nlm.nih.gov/pubmed/34524095 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26176 %T Seeking Help From Trusted Adults in Response to Peers’ Social Media Posts About Mental Health Struggles: Qualitative Interview Study Among Latinx Adolescents %A Campos-Castillo,Celeste %A Thomas,Brian Jason %A Reyes,Felipe %A Laestadius,Linnea Irina %+ Department of Sociology, University of Wisconsin-Milwaukee, 3210 N Maryland Ave, Milwaukee, WI, 53201, United States, 1 414 229 1113, camposca@uwm.edu %K adolescents %K confidants %K ethnicity %K gender %K network resources %K privacy %K race %K social media %K social support %K tie activation %K trust %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Rather than confiding in adults about their mental health struggles, adolescents may use social media to disclose them to peers. Disclosure recipients are tasked with deciding whether to alert an adult and, if so, whom to alert. Few studies have examined how adolescents decide on a trusted adult to help a friend who posts on social media about his/her mental health struggles. Moreover, Latinx adolescents are underrepresented in research on social media use, which creates gaps in understanding how social media may influence their well-being. Objective: This qualitative study presents findings from semistructured interviews with Latinx adolescents to investigate how they seek out trusted adults when a friend posts on social media about their mental health struggles. Specifically, we sought to determine which adult ties they activated, the resources they believed the adult could provide, and the support they expected the adult to provide. Methods: We recruited participants through a nonprofit organization serving the Latinx community (primarily of Mexican origin) located in Milwaukee, Wisconsin. We conducted 43 semistructured interviews, each lasting 60-90 minutes, with Latinx adolescents (25 females, 18 males) aged 13-17 years. All interviews were conducted in English, at the adolescents’ request. Using a grounded theory approach, we identified the nature of the relationship between the trusted adult and either the disclosure recipient or distressed friend, and the resources and support the trusted adult is expected to provide. Results: Participants nominated adults who were emotionally or physically proximate to either the disclosure recipient or distressed friend, particularly parents (of the recipient and friend) and school staff. However, some felt that not all parents and school staff were emotionally proximate. Adolescents sought trusted adults with access to two resources: experiential knowledge and authority. Some, particularly males, avoided adults with authority because of the risk of punishment and others thought their immigrant parents did not have relevant experiential knowledge to assist them. Interviewees felt that trusted adults with either resource could provide emotional and instrumental support either directly or indirectly, while those with experiential knowledge could provide informational support. Notably, interviews did not problematize the fact that the disclosure occurred on social media when deliberating about adults. Conclusions: To assist a distressed friend posting on social media, Latinx adolescents look not only for trusted adults who are emotionally and physically proximate but also those who have key resources that facilitate support. Efforts should focus on connecting adolescents with trusted adults and training adults who hold positions of authority or experiential knowledge to offer both direct and indirect support. Additionally, efforts should consider how immigrant experiences shape parent-child relations and address the potential long-term consequences of oversurveillance of Latinx youth, particularly males, by school staff for their access to social support. %M 34524088 %R 10.2196/26176 %U https://mental.jmir.org/2021/9/e26176 %U https://doi.org/10.2196/26176 %U http://www.ncbi.nlm.nih.gov/pubmed/34524088 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26154 %T How Our Technology Use Changed in 2020: Perspectives From Three Youths %A Fadiran,Babayosimi %A Lee,Jessica %A Lemminger,Jared %A Jolliff,Anna %+ Department of Pediatrics, University of Wisconsin - Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, United States, 1 5035539361, ajolliff@wisc.edu %K mental health %K social media %K digital technology %K youth %K adolescent %K commentary %K technology %K wellness %D 2021 %7 15.9.2021 %9 Commentary %J JMIR Ment Health %G English %X The Technology and Adolescent Mental Wellness program (TAM) is a research program with the primary goals of promoting research on the topic of adolescent technology use and mental wellness, creatively disseminating that research, and fostering community among stakeholders. Our foundational question is this: How can technology support adolescent mental wellness? Youth are key stakeholders in pursuit of this foundational question. In this commentary, we invited 3 members of TAM’s youth advisory board to respond to the following question: “How did your technology use change in 2020?” Jessica, Jared, and Babayosimi describe their technology use during COVID-19 as dynamic, and neither uniformly positive nor negative. Further, these 3 youths differ in their perceptions of the same technologies—social media and online school, for example—as well as their perceived ability to self-regulate use of those technologies. We invite you to weigh these perspectives just as we do at TAM—not as empirical findings in themselves, but as examples of youth ideas for future empirical investigation. %M 34524108 %R 10.2196/26154 %U https://mental.jmir.org/2021/9/e26154 %U https://doi.org/10.2196/26154 %U http://www.ncbi.nlm.nih.gov/pubmed/34524108 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26029 %T A Cyberbullying Media-Based Prevention Intervention for Adolescents on Instagram: Pilot Randomized Controlled Trial %A Kutok,Emily R %A Dunsiger,Shira %A Patena,John V %A Nugent,Nicole R %A Riese,Alison %A Rosen,Rochelle K %A Ranney,Megan L %+ Brown-Lifespan Center for Digital Health, 139 Point Street, Providence, RI, 02903, United States, 1 (401) 444 2557, megan_ranney@brown.edu %K cyberbullying %K adolescents %K mobile application %K messaging %K brief interventions %K social media %K recruitment %K mobile phone %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Between 15% and 70% of adolescents report experiencing cybervictimization. Cybervictimization is associated with multiple negative consequences, including depressed mood. Few validated, easily disseminated interventions exist to prevent cybervictimization and its consequences. With over 97% of adolescents using social media (such as YouTube, Facebook, Instagram, or Snapchat), recruiting and delivering a prevention intervention through social media and apps may improve accessibility of prevention tools for at-risk youth. Objective: This study aims to evaluate the feasibility and acceptability of and obtain preliminary outcome data on IMPACT (Intervention Media to Prevent Adolescent Cyber-Conflict Through Technology), a brief, remote app-based intervention to prevent and reduce the effect of cyberbullying. Methods: From January 30, 2020, to May 3, 2020, a national sample of 80 adolescents with a history of past-year cybervictimization was recruited through Instagram for a randomized control trial of IMPACT, a brief, remote research assistant–led intervention and a fully automated app-based program, versus enhanced web-based resources (control). Feasibility and acceptability were measured by consent, daily use, and validated surveys. Although not powered for efficacy, outcomes (victimization, bystander self-efficacy, and well-being) were measured using validated measures at 8 and 16 weeks and evaluated using a series of longitudinal mixed models. Results: Regarding feasibility, 24.5% (121/494) of eligible participants provided contact information; of these, 69.4% (84/121) completed full enrollment procedures. Of the participants enrolled, 45% (36/80) were randomized into the IMPACT intervention and 55% (44/80) into the enhanced web-based resources groups. All participants randomized to the intervention condition completed the remote intervention session, and 89% (77/80) of the daily prompts were answered. The retention rate was 99% (79/80) at 8 weeks and 96% (77/80) at 16 weeks for all participants. Regarding acceptability, 100% (36/36) of the intervention participants were at least moderately satisfied with IMPACT overall, and 92% (33/36) of the participants were at least moderately satisfied with the app. At both 8 and 16 weeks, well-being was significantly higher (β=1.17, SE 0.87, P=.02 at 8 weeks and β=3.24, SE 0.95, P<.001 at 16 weeks) and psychological stress was lower (β=−.66, SE 0.08, P=.04 at 8 weeks and β=−.89, SE 0.09, P<.001 at 16 weeks) among IMPACT users than among control group users. Participants in the intervention group attempted significantly more bystander interventions than those in the control group at 8 weeks (β=.82, SE 0.42; P=.02). Conclusions: This remote app-based intervention for victims of cyberbullying was feasible and acceptable, increased overall well-being and bystander interventions, and decreased psychological stress. Our findings are especially noteworthy given that the trial took place during the COVID-19 pandemic. The use of Instagram to recruit adolescents can be a successful strategy for identifying and intervening with those at the highest risk of cybervictimization. Trial Registration: ClinicalTrials.gov NCT04259216; http://clinicaltrials.gov/ct2/show/NCT04259216. %M 34524103 %R 10.2196/26029 %U https://mental.jmir.org/2021/9/e26029 %U https://doi.org/10.2196/26029 %U http://www.ncbi.nlm.nih.gov/pubmed/34524103 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e25636 %T Characterization of Vaccine Tweets During the Early Stage of the COVID-19 Outbreak in the United States: Topic Modeling Analysis %A Jiang,Li Crystal %A Chu,Tsz Hang %A Sun,Mengru %+ Department of Media and Communication, City University of Hong Kong, M5082, Run Run Shaw Creative Media Centre, 18 Tat Hong Avenue, Kowloon, Hong Kong, China (Hong Kong), 852 034429332, crystal.jiang@cityu.edu.hk %K topic modeling %K social media %K infoveillance %K vaccine %K coronavirus %K COVID-19 %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the early stages of the COVID-19 pandemic, developing safe and effective coronavirus vaccines was considered critical to arresting the spread of the disease. News and social media discussions have extensively covered the issue of coronavirus vaccines, with a mixture of vaccine advocacies, concerns, and oppositions. Objective: This study aimed to uncover the emerging themes in Twitter users’ perceptions and attitudes toward vaccines during the early stages of the COVID-19 outbreak. Methods: This study employed topic modeling to analyze tweets related to coronavirus vaccines at the start of the COVID-19 outbreak in the United States (February 21 to March 20, 2020). We created a predefined query (eg, “COVID” AND “vaccine”) to extract the tweet text and metadata (number of followers of the Twitter account and engagement metrics based on likes, comments, and retweeting) from the Meltwater database. After preprocessing the data, we tested Latent Dirichlet Allocation models to identify topics associated with these tweets. The model specifying 20 topics provided the best overall coherence, and each topic was interpreted based on its top associated terms. Results: In total, we analyzed 100,209 tweets containing keywords related to coronavirus and vaccines. The 20 topics were further collapsed based on shared similarities, thereby generating 7 major themes. Our analysis characterized 26.3% (26,234/100,209) of the tweets as News Related to Coronavirus and Vaccine Development, 25.4% (25,425/100,209) as General Discussion and Seeking of Information on Coronavirus, 12.9% (12,882/100,209) as Financial Concerns, 12.7% (12,696/100,209) as Venting Negative Emotions, 9.9% (9908/100,209) as Prayers and Calls for Positivity, 8.1% (8155/100,209) as Efficacy of Vaccine and Treatment, and 4.9% (4909/100,209) as Conspiracies about Coronavirus and Its Vaccines. Different themes demonstrated some changes over time, mostly in close association with news or events related to vaccine developments. Twitter users who discussed conspiracy theories, the efficacy of vaccines and treatments, and financial concerns had more followers than those focused on other vaccine themes. The engagement level—the extent to which a tweet being retweeted, quoted, liked, or replied by other users—was similar among different themes, but tweets venting negative emotions yielded the lowest engagement. Conclusions: This study enriches our understanding of public concerns over new vaccines or vaccine development at early stages of the outbreak, bearing implications for influencing vaccine attitudes and guiding public health efforts to cope with infectious disease outbreaks in the future. This study concluded that public concerns centered on general policy issues related to coronavirus vaccines and that the discussions were considerably mixed with political views when vaccines were not made available. Only a small proportion of tweets focused on conspiracy theories, but these tweets demonstrated high engagement levels and were often contributed by Twitter users with more influence. %M 34604707 %R 10.2196/25636 %U https://infodemiology.jmir.org/2021/1/e25636 %U https://doi.org/10.2196/25636 %U http://www.ncbi.nlm.nih.gov/pubmed/34604707 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30854 %T Revealing Public Opinion Towards COVID-19 Vaccines With Twitter Data in the United States: Spatiotemporal Perspective %A Hu,Tao %A Wang,Siqin %A Luo,Wei %A Zhang,Mengxi %A Huang,Xiao %A Yan,Yingwei %A Liu,Regina %A Ly,Kelly %A Kacker,Viraj %A She,Bing %A Li,Zhenlong %+ Department of Geography, National University of Singapore, 1 Arts Link, #04-32 Block AS2, Singapore, 117570, Singapore, 65 65163851, geowl@nus.edu.sg %K Twitter %K public opinion %K COVID-19 vaccines %K sentiment analysis %K emotion analysis %K topic modeling %K COVID-19 %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has imposed a large, initially uncontrollable, public health crisis both in the United States and across the world, with experts looking to vaccines as the ultimate mechanism of defense. The development and deployment of COVID-19 vaccines have been rapidly advancing via global efforts. Hence, it is crucial for governments, public health officials, and policy makers to understand public attitudes and opinions towards vaccines, such that effective interventions and educational campaigns can be designed to promote vaccine acceptance. Objective: The aim of this study was to investigate public opinion and perception on COVID-19 vaccines in the United States. We investigated the spatiotemporal trends of public sentiment and emotion towards COVID-19 vaccines and analyzed how such trends relate to popular topics found on Twitter. Methods: We collected over 300,000 geotagged tweets in the United States from March 1, 2020 to February 28, 2021. We examined the spatiotemporal patterns of public sentiment and emotion over time at both national and state scales and identified 3 phases along the pandemic timeline with sharp changes in public sentiment and emotion. Using sentiment analysis, emotion analysis (with cloud mapping of keywords), and topic modeling, we further identified 11 key events and major topics as the potential drivers to such changes. Results: An increasing trend in positive sentiment in conjunction with a decrease in negative sentiment were generally observed in most states, reflecting the rising confidence and anticipation of the public towards vaccines. The overall tendency of the 8 types of emotion implies that the public trusts and anticipates the vaccine. This is accompanied by a mixture of fear, sadness, and anger. Critical social or international events or announcements by political leaders and authorities may have potential impacts on public opinion towards vaccines. These factors help identify underlying themes and validate insights from the analysis. Conclusions: The analyses of near real-time social media big data benefit public health authorities by enabling them to monitor public attitudes and opinions towards vaccine-related information in a geo-aware manner, address the concerns of vaccine skeptics, and promote the confidence that individuals within a certain region or community have towards vaccines. %M 34346888 %R 10.2196/30854 %U https://www.jmir.org/2021/9/e30854 %U https://doi.org/10.2196/30854 %U http://www.ncbi.nlm.nih.gov/pubmed/34346888 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30800 %T Framing of and Attention to COVID-19 on Twitter: Thematic Analysis of Hashtags %A Tahamtan,Iman %A Potnis,Devendra %A Mohammadi,Ehsan %A Miller,Laura E %A Singh,Vandana %+ School of Information Sciences, The University of Tennessee, 1345 Circle Park Drive 451 Communications Building, Knoxville, TN, 37996-0332, United States, 1 865 974 2148, iman.tahamtan@gmail.com %K COVID-19 %K framing %K Twitter %K social media %K public opinion %K engagement %K public attention %K thematic analysis %K public health %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although past research has focused on COVID-19–related frames in the news media, such research may not accurately capture and represent the perspectives of people from diverse backgrounds. Additionally, research on the public attention to COVID-19 as reflected through frames on social media is scarce. Objective: This study identified the frames about the COVID-19 pandemic in the public discourse on Twitter, which voices diverse opinions. This study also investigated the amount of public attention to those frames on Twitter. Methods: We collected 22 trending hashtags related to COVID-19 in the United States and 694,582 tweets written in English containing these hashtags in March 2020 and analyzed them via thematic analysis. Public attention to these frames was measured by evaluating the amount of public engagement with frames and public adoption of those frames. Results: We identified 9 frames including “public health guidelines,” “quarantine life,” “solidarity,” “evidence and facts,” “call for action,” “politics,” “post-pandemic life,” “shortage panic,” and “conflict.” Results showed that some frames such as “call for action” are more appealing than others during a global pandemic, receiving greater public adoption and engagement. The “call for action” frame had the highest engagement score, followed by “conflict” and “evidence and facts.” Additionally, “post-pandemic life” had the highest adoption score, followed by “call for action” and “shortage panic.” The findings indicated that the frequency of a frame on social media does not necessarily mean greater public adoption of or engagement with the frame. Conclusions: This study contributes to framing theory and research by demonstrating how trending hashtags can be used as new user-generated data to identify frames on social media. This study concludes that the identified frames such as “quarantine life” and “conflict” and themes such as “isolation” and “toilet paper panic” represent the consequences of the COVID-19 pandemic. The consequences could be (1) exclusively related to COVID-19, such as hand hygiene or isolation; (2) related to any health crisis such as social support of vulnerable groups; and (3) generic that are irrespective of COVID-19, such as homeschooling or remote working. %M 34406961 %R 10.2196/30800 %U https://www.jmir.org/2021/9/e30800 %U https://doi.org/10.2196/30800 %U http://www.ncbi.nlm.nih.gov/pubmed/34406961 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30451 %T Identifying False Human Papillomavirus (HPV) Vaccine Information and Corresponding Risk Perceptions From Twitter: Advanced Predictive Models %A Tomaszewski,Tre %A Morales,Alex %A Lourentzou,Ismini %A Caskey,Rachel %A Liu,Bing %A Schwartz,Alan %A Chin,Jessie %+ School of Information Sciences, University of Illinois at Urbana-Champaign, 501 E Daniel St, Champaign, IL, 61820, United States, 1 217 333 0125, chin5@illinois.edu %K misinformation %K disinformation %K social media %K HPV %K human papillomavirus vaccination %K vaccination %K causality mining %K cause %K effect %K risk perceptions %K vaccine %K perception %K risk %K Twitter %K machine learning %K natural language processing %K cervical cancer %D 2021 %7 9.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The vaccination uptake rates of the human papillomavirus (HPV) vaccine remain low despite the fact that the effectiveness of HPV vaccines has been established for more than a decade. Vaccine hesitancy is in part due to false information about HPV vaccines on social media. Combating false HPV vaccine information is a reasonable step to addressing vaccine hesitancy. Objective: Given the substantial harm of false HPV vaccine information, there is an urgent need to identify false social media messages before it goes viral. The goal of the study is to develop a systematic and generalizable approach to identifying false HPV vaccine information on social media. Methods: This study used machine learning and natural language processing to develop a series of classification models and causality mining methods to identify and examine true and false HPV vaccine–related information on Twitter. Results: We found that the convolutional neural network model outperformed all other models in identifying tweets containing false HPV vaccine–related information (F score=91.95). We also developed completely unsupervised causality mining models to identify HPV vaccine candidate effects for capturing risk perceptions of HPV vaccines. Furthermore, we found that false information contained mostly loss-framed messages focusing on the potential risk of vaccines covering a variety of topics using more diverse vocabulary, while true information contained both gain- and loss-framed messages focusing on the effectiveness of vaccines covering fewer topics using relatively limited vocabulary. Conclusions: Our research demonstrated the feasibility and effectiveness of using predictive models to identify false HPV vaccine information and its risk perceptions on social media. %M 34499043 %R 10.2196/30451 %U https://www.jmir.org/2021/9/e30451 %U https://doi.org/10.2196/30451 %U http://www.ncbi.nlm.nih.gov/pubmed/34499043 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e31409 %T COVID-19 Vaccine Perception in South Korea: Web Crawling Approach %A Lee,Hocheol %A Noh,Eun Bi %A Park,Sung Jong %A Nam,Hae Kweun %A Lee,Tae Ho %A Lee,Ga Ram %A Nam,Eun Woo %+ Department of Health Administration, Yonsei University Graduate School, Unit 412, Chang-jo gwan, 1 Yonseidae-gil, Wonju, 26493, Republic of Korea, 82 33 760 2413, ewnam@yonsei.ac.kr %K COVID-19 vaccine %K COVID-19 %K instagram %K social media %K infodemiology %K sentiment analysis %K vaccine perception %K South Korea %K web crawling %K AstraZeneca %K Pfizer %D 2021 %7 8.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The US Centers for Disease Control and Prevention and the World Health Organization emphasized vaccination against COVID-19 because physical distancing proved inadequate to mitigate death, illness, and massive economic loss. Objective: This study aimed to investigate Korean citizens’ perceptions of vaccines by examining their views on COVID-19 vaccines, their positive and negative perceptions of each vaccine, and ways to enhance policies to increase vaccine acceptance. Methods: This cross-sectional study analyzed posts on NAVER and Instagram to examine Korean citizens’ perception of COVID-19 vaccines. The keywords searched were “vaccine,” “AstraZeneca,” and “Pfizer.” In total 8100 posts in NAVER and 5291 posts in Instagram were sampled through web crawling. Morphology analysis was performed, overlapping or meaningless words were removed, sentiment analysis was implemented, and 3 public health professionals reviewed the results. Results: The findings revealed a negative perception of COVID-19 vaccines; of the words crawled, the proportion of negative words for AstraZeneca was 71.0% (476/670) and for Pfizer was 56.3% (498/885). Among words crawled with “vaccine,” “good” ranked first, with a frequency of 13.43% (312/2323). Meanwhile, “side effect” ranked highest, with a frequency of 29.2% (163/559) for “AstraZeneca,” but 0.6% (4/673) for “Pfizer.” With “vaccine,” positive words were more frequently used, whereas with “AstraZeneca” and “Pfizer” negative words were prevalent. Conclusions: There is a negative perception of AstraZeneca and Pfizer vaccines in Korea, with 1 in 4 people refusing vaccination. To address this, accurate information needs to be shared about vaccines including AstraZeneca, and the experiences of those vaccinated. Furthermore, government communication about risk management is required to increase the AstraZeneca vaccination rate for herd immunity before the vaccine expires. %M 34348890 %R 10.2196/31409 %U https://publichealth.jmir.org/2021/9/e31409 %U https://doi.org/10.2196/31409 %U http://www.ncbi.nlm.nih.gov/pubmed/34348890 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28975 %T Association Between What People Learned About COVID-19 Using Web Searches and Their Behavior Toward Public Health Guidelines: Empirical Infodemiology Study %A Akpan,Ikpe Justice %A Aguolu,Obianuju Genevieve %A Kobara,Yawo Mamoua %A Razavi,Rouzbeh %A Akpan,Asuama A %A Shanker,Murali %+ Department of Management & Information Systems, Kent State University, 330 University Drive Northeast, New Philadelphia, OH, 44663, United States, 1 3303393391 ext 7572, iakpan@kent.edu %K internet %K novel coronavirus %K SARS-CoV-2 %K COVID-19 %K infodemiology %K misinformation %K conspiracy theories %K public health %D 2021 %7 2.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of the internet and web-based platforms to obtain public health information and manage health-related issues has become widespread in this digital age. The practice is so pervasive that the first reaction to obtaining health information is to “Google it.” As SARS-CoV-2 broke out in Wuhan, China, in December 2019 and quickly spread worldwide, people flocked to the internet to learn about the novel coronavirus and the disease, COVID-19. Lagging responses by governments and public health agencies to prioritize the dissemination of information about the coronavirus outbreak through the internet and the World Wide Web and to build trust gave room for others to quickly populate social media, online blogs, news outlets, and websites with misinformation and conspiracy theories about the COVID-19 pandemic, resulting in people’s deviant behaviors toward public health safety measures. Objective: The goals of this study were to determine what people learned about the COVID-19 pandemic through web searches, examine any association between what people learned about COVID-19 and behavior toward public health guidelines, and analyze the impact of misinformation and conspiracy theories about the COVID-19 pandemic on people’s behavior toward public health measures. Methods: This infodemiology study used Google Trends’ worldwide search index, covering the first 6 months after the SARS-CoV-2 outbreak (January 1 to June 30, 2020) when the public scrambled for information about the pandemic. Data analysis employed statistical trends, correlation and regression, principal component analysis (PCA), and predictive models. Results: The PCA identified two latent variables comprising past coronavirus epidemics (pastCoVepidemics: keywords that address previous epidemics) and the ongoing COVID-19 pandemic (presCoVpandemic: keywords that explain the ongoing pandemic). Both principal components were used significantly to learn about SARS-CoV-2 and COVID-19 and explained 88.78% of the variability. Three principal components fuelled misinformation about COVID-19: misinformation (keywords “biological weapon,” “virus hoax,” “common cold,” “COVID-19 hoax,” and “China virus”), conspiracy theory 1 (ConspTheory1; keyword “5G” or “@5G”), and conspiracy theory 2 (ConspTheory2; keyword “ingest bleach”). These principal components explained 84.85% of the variability. The principal components represent two measurements of public health safety guidelines—public health measures 1 (PubHealthMes1; keywords “social distancing,” “wash hands,” “isolation,” and “quarantine”) and public health measures 2 (PubHealthMes2; keyword “wear mask”)—which explained 84.7% of the variability. Based on the PCA results and the log-linear and predictive models, ConspTheory1 (keyword “@5G”) was identified as a predictor of people’s behavior toward public health measures (PubHealthMes2). Although correlations of misinformation (keywords “COVID-19,” “hoax,” “virus hoax,” “common cold,” and more) and ConspTheory2 (keyword “ingest bleach”) with PubHealthMes1 (keywords “social distancing,” “hand wash,” “isolation,” and more) were r=0.83 and r=–0.11, respectively, neither was statistically significant (P=.27 and P=.13, respectively). Conclusions: Several studies focused on the impacts of social media and related platforms on the spreading of misinformation and conspiracy theories. This study provides the first empirical evidence to the mainly anecdotal discourse on the use of web searches to learn about SARS-CoV-2 and COVID-19. %M 34280117 %R 10.2196/28975 %U https://www.jmir.org/2021/9/e28975 %U https://doi.org/10.2196/28975 %U http://www.ncbi.nlm.nih.gov/pubmed/34280117 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e27715 %T US Physicians’ and Nurses’ Motivations, Barriers, and Recommendations for Correcting Health Misinformation on Social Media: Qualitative Interview Study %A Bautista,John Robert %A Zhang,Yan %A Gwizdka,Jacek %+ School of Information, The University of Texas at Austin, 1616 Guadalupe Street, Austin, TX, 78701, United States, 1 3462048410, jrbautista@utexas.edu %K correction %K COVID-19 %K physicians %K misinformation %K infodemic %K infodemiology %K nurses %K social media %D 2021 %7 1.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Health misinformation is a public health concern. Various stakeholders have called on health care professionals, such as nurses and physicians, to be more proactive in correcting health misinformation on social media. Objective: This study aims to identify US physicians’ and nurses’ motivations for correcting health misinformation on social media, the barriers they face in doing so, and their recommendations for overcoming such barriers. Methods: In-depth interviews were conducted with 30 participants, which comprised 15 (50%) registered nurses and 15 (50%) physicians. Qualitative data were analyzed by using thematic analysis. Results: Participants were personally (eg, personal choice) and professionally (eg, to fulfill the responsibility of a health care professional) motivated to correct health misinformation on social media. However, they also faced intrapersonal (eg, a lack of positive outcomes and time), interpersonal (eg, harassment and bullying), and institutional (eg, a lack of institutional support and social media training) barriers to correcting health misinformation on social media. To overcome these barriers, participants recommended that health care professionals should receive misinformation and social media training, including building their social media presence. Conclusions: US physicians and nurses are willing to correct health misinformation on social media despite several barriers. Nonetheless, this study provides recommendations that can be used to overcome such barriers. Overall, the findings can be used by health authorities and organizations to guide policies and activities aimed at encouraging more health care professionals to be present on social media to counteract health misinformation. %M 34468331 %R 10.2196/27715 %U https://publichealth.jmir.org/2021/9/e27715 %U https://doi.org/10.2196/27715 %U http://www.ncbi.nlm.nih.gov/pubmed/34468331 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30715 %T Exploring the Expression Differences Between Professionals and Laypeople Toward the COVID-19 Vaccine: Text Mining Approach %A Luo,Chen %A Ji,Kaiyuan %A Tang,Yulong %A Du,Zhiyuan %+ Institute of Communication Studies, Communication University of China, No 1 Dingfuzhuang East Street, Chaoyang District, Beijing, 100024, China, 86 13217810927, longbao0927@163.com %K COVID-19 %K vaccine %K Zhihu %K structural topic modeling %K medical professional %K laypeople %K adverse reactions %K vaccination %K vaccine effectiveness %K vaccine development %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is still rampant all over the world. Until now, the COVID-19 vaccine is the most promising measure to subdue contagion and achieve herd immunity. However, public vaccination intention is suboptimal. A clear division lies between medical professionals and laypeople. While most professionals eagerly promote the vaccination campaign, some laypeople exude suspicion, hesitancy, and even opposition toward COVID-19 vaccines. Objective: This study aims to employ a text mining approach to examine expression differences and thematic disparities between the professionals and laypeople within the COVID-19 vaccine context. Methods: We collected 3196 answers under 65 filtered questions concerning the COVID-19 vaccine from the China-based question and answer forum Zhihu. The questions were classified into 5 categories depending on their contents and description: adverse reactions, vaccination, vaccine effectiveness, social implications of vaccine, and vaccine development. Respondents were also manually coded into two groups: professional and laypeople. Automated text analysis was performed to calculate fundamental expression characteristics of the 2 groups, including answer length, attitude distribution, and high-frequency words. Furthermore, structural topic modeling (STM), as a cutting-edge branch in the topic modeling family, was used to extract topics under each question category, and thematic disparities were evaluated between the 2 groups. Results: Laypeople are more prevailing in the COVID-19 vaccine–related discussion. Regarding differences in expression characteristics, the professionals posted longer answers and showed a conservative stance toward vaccine effectiveness than did laypeople. Laypeople mentioned countries more frequently, while professionals were inclined to raise medical jargon. STM discloses prominent topics under each question category. Statistical analysis revealed that laypeople preferred the “safety of Chinese-made vaccine” topic and other vaccine-related issues in other countries. However, the professionals paid more attention to medical principles and professional standards underlying the COVID-19 vaccine. With respect to topics associated with the social implications of vaccines, the 2 groups showed no significant difference. Conclusions: Our findings indicate that laypeople and professionals share some common grounds but also hold divergent focuses toward the COVID-19 vaccine issue. These incongruities can be summarized as “qualitatively different” in perspective rather than “quantitatively different” in scientific knowledge. Among those questions closely associated with medical expertise, the “qualitatively different” characteristic is quite conspicuous. This study boosts the current understanding of how the public perceives the COVID-19 vaccine, in a more nuanced way. Web-based question and answer forums are a bonanza for examining perception discrepancies among various identities. STM further exhibits unique strengths over the traditional topic modeling method in statistically testing the topic preference of diverse groups. Public health practitioners should be keenly aware of the cognitive differences between professionals and laypeople, and pay special attention to the topics with significant inconsistency across groups to build consensus and promote vaccination effectively. %M 34346885 %R 10.2196/30715 %U https://www.jmir.org/2021/8/e30715 %U https://doi.org/10.2196/30715 %U http://www.ncbi.nlm.nih.gov/pubmed/34346885 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e26395 %T Association Between Social Media Use and Cancer Screening Awareness and Behavior for People Without a Cancer Diagnosis: Matched Cohort Study %A Qin,Lei %A Zhang,Xiaomei %A Wu,Anlin %A Miser,James S %A Liu,Yen-Lin %A Hsu,Jason C %A Shia,Ben-Chang %A Ye,Linglong %+ School of Public Affairs, Xiamen University, No.422, Siming South Road, Xiamen, 361005, China, 86 5922182783, leyloria@gmail.com %K social media %K cancer screening awareness %K cancer screening behavior %K gender-specific effects %K propensity-score matching %K general population %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of social media in communications regarding cancer prevention is rapidly growing. However, less is known about the general population’s social media use related to cancer screening awareness and behavior for different cancers. Objective: We aimed to examine the relationship between social media use and cancer screening awareness and behavior among people without a cancer diagnosis. Methods: Data were collected from the Health Information National Trends Survey 5 Cycle 1 to 3 in the United States (n=12,227). Our study included 10,124 participants without a cancer diagnosis and 3 measures of screening awareness (those who had heard of hepatitis C virus [HCV], human papillomavirus [HPV], and the HPV vaccine) and 4 measures of behavior (those who had prostate-specific antigen tests, Papanicolaou tests for cervical cancer, as well as breast cancer and colon cancer tests). Propensity-score matching was conducted to adjust for the sociodemographic variables between the social media user and nonuser participants. Multivariable logistic regression was used to assess the association of social media use by gender. Jackknife replicate weights were incorporated into the analyses. Results: Of the 3794 matched participants, 1861 (57.6% weighted) were male, and the mean age was 55.5 (SD 0.42) years. Compared to social media nonusers, users were more likely to have heard of HCV (adjusted odds ratio [aOR]=2.27, 95% CI, 1.29-3.98 and aOR=2.86, 95% CI, 1.51-5.40, for male and female users, respectively) and HPV (aOR=1.82, 95% CI, 1.29-2.58 and aOR=2.35, 95% CI, 1.65-3.33, for male and female users, respectively). In addition, female users were more likely to have heard of the HPV vaccine (aOR=2.06, 95% CI, 1.41-3.00). No significant associations were found between social media use and prostate-specific antigen tests in males, Papanicolaou tests and breast cancer tests in females, or colon cancer tests in both male and female users. Conclusions: While social media services can potentially promote cancer screening awareness in the general population, but they did not improve screening behavior after adjusting for socioeconomic status. These findings strengthened our understanding of social media use in targeting health communications for different cancers. %M 34448708 %R 10.2196/26395 %U https://www.jmir.org/2021/8/e26395 %U https://doi.org/10.2196/26395 %U http://www.ncbi.nlm.nih.gov/pubmed/34448708 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e24523 %T Online News Coverage of the Sugar-Sweetened Beverages Tax in Malaysia: Content Analysis %A Mohd Hanim,Muhammad Faiz %A Md Sabri,Budi Aslinie %A Yusof,Norashikin %+ Centre of Population Oral Health and Clinical Prevention Studies, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), UiTM Sg. Buloh Campus, Sungai Buloh, 47000, Malaysia, 60 3 6126 6621, nyshikin@gmail.com %K sugar-sweetened beverages %K obesity %K taxes %K media content analysis %K public health policy %K media content %K public health %K netnography %K malaysia %K budget %D 2021 %7 18.8.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In Malaysia, the Sugar-Sweetened Beverages (SSBs) tax was announced during the parliament's 2019 Budget Speech. The tax was slated to be enforced by April 2019 but was later postponed to July 2019. The announcement has since generated significant media coverage and public feedback. Objective: This study presents a qualitative and quantitative cross-sectional study using netnography to examine how Malaysian online news articles responded to the SSBs tax after the announcement and postimplementation. Methods: Online news articles published on popular online news platforms from November 2018 to August 2019 were downloaded using NCapture and imported into NVivo for analysis using the inductive approach and thematic content analysis following the initial SSBs implementation announcement. Results: A total of 62 news articles were analyzed. Most of the articles positively portrayed the SSBs tax (46.8%) and highlighted its health impacts (76%). There were 7 key framing arguments identified in the articles. The positive arguments revolved around incentivizing manufacturers to introduce healthier products voluntarily, positive health consequences, the tax’s impact on government revenue, and the use of the generated revenue toward beneficial social programs. The opposing arguments included increased operating costs to the manufacturer, the increased retail price of drinks, and how the SSBs tax is not a robust solution to obesity. The top priority sector considered in introducing the tax was the health perspective, followed by economic purposes and creating policies such as regulating the food and drinks industry. Conclusions: The majority of online news articles positively reported the implementation of the SSBs tax in Malaysia. This suggests media played a role in garnering support for the health policy. As such, relevant bodies can use negative findings to anticipate and reframe counteracting arguments opposing the SSBs tax. %M 34406125 %R 10.2196/24523 %U https://publichealth.jmir.org/2021/8/e24523 %U https://doi.org/10.2196/24523 %U http://www.ncbi.nlm.nih.gov/pubmed/34406125 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e29029 %T Natural Language Processing Insight into LGBTQ+ Youth Mental Health During the COVID-19 Pandemic: Longitudinal Content Analysis of Anxiety-Provoking Topics and Trends in Emotion in LGBTeens Microcommunity Subreddit %A Stevens,Hannah R %A Acic,Irena %A Rhea,Sofia %+ Department of Communication, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, United States, 1 530 752 0966, hrstevens@ucdavis.edu %K COVID-19 %K natural language processing %K LGBTQ+ %K mental health %K anxiety %K emotion %K coronavirus %K outbreak %D 2021 %7 17.8.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Widespread fear surrounding COVID-19, coupled with physical and social distancing orders, has caused severe adverse mental health outcomes. Little is known, however, about how the COVID-19 crisis has impacted LGBTQ+ youth, who disproportionately experienced a high rate of adverse mental health outcomes before the COVID-19 pandemic. Objective: We aimed to address this knowledge gap by harnessing natural language processing methodologies to investigate the evolution of conversation topics in the most popular subreddit for LGBTQ+ youth. Methods: We generated a data set of all r/LGBTeens subreddit posts (n=39,389) between January 1, 2020 and February 1, 2021 and analyzed meaningful trends in anxiety, anger, and sadness in the posts. Because the distribution of anxiety before widespread social distancing orders was meaningfully different from the distribution after (P<.001), we employed latent Dirichlet allocation to examine topics that provoked this shift in anxiety. Results: We did not find any differences in LGBTQ+ youth anger and sadness before and after government-mandated social distancing; however, anxiety increased significantly (P<.001). Further analysis revealed a list of 10 anxiety-provoking topics discussed during the pandemic: attraction to a friend, coming out, coming out to family, discrimination, education, exploring sexuality, gender pronouns, love and relationship advice, starting a new relationship, and struggling with mental health. Conclusions: During the COVID-19 pandemic, LGBTQ+ teens increased their reliance on anonymous discussion forums when discussing anxiety-provoking topics. LGBTQ+ teens likely perceived anonymous forums as safe spaces for discussing lifestyle stressors during COVID-19 disruptions (eg, school closures). The list of prevalent anxiety-provoking topics in LGBTQ+ teens’ anonymous discussions can inform future mental health interventions in LGBTQ+ youth. %M 34402803 %R 10.2196/29029 %U https://publichealth.jmir.org/2021/8/e29029 %U https://doi.org/10.2196/29029 %U http://www.ncbi.nlm.nih.gov/pubmed/34402803 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e32475 %T Acceptability of Using Social Media Content in Mental Health Research: A Reflection. Comment on “Twitter Users’ Views on Mental Health Crisis Resolution Team Care Compared With Stakeholder Interviews and Focus Groups: Qualitative Analysis” %A Morant,Nicola %A Chilman,Natasha %A Lloyd-Evans,Brynmor %A Wackett,Jane %A Johnson,Sonia %+ Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7NF, United Kingdom, 44 7969688554, n.morant@ucl.ac.uk %K Twitter %K social media %K qualitative %K crisis resolution team %K home treatment team %K mental health %K acute care %K severe mental illness %D 2021 %7 17.8.2021 %9 Letter to the Editor %J JMIR Ment Health %G English %X %M 34402799 %R 10.2196/32475 %U https://mental.jmir.org/2021/8/e32475 %U https://doi.org/10.2196/32475 %U http://www.ncbi.nlm.nih.gov/pubmed/34402799 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e28800 %T Analyzing Social Media to Explore the Attitudes and Behaviors Following the Announcement of Successful COVID-19 Vaccine Trials: Infodemiology Study %A Boucher,Jean-Christophe %A Cornelson,Kirsten %A Benham,Jamie L %A Fullerton,Madison M %A Tang,Theresa %A Constantinescu,Cora %A Mourali,Mehdi %A Oxoby,Robert J %A Marshall,Deborah A %A Hemmati,Hadi %A Badami,Abbas %A Hu,Jia %A Lang,Raynell %+ School of Public Policy and Department of Political Science, University of Calgary, 906 8 Ave SW 5th Floor, Calgary, AB, Canada, 1 403 220 8565, jc.boucher@ucalgary.ca %K coronavirus %K COVID-19 %K public health %K social media %K Twitter %K behavior %K risk reduction %K attitudes %K social network analysis %K machine learning %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The rollout of COVID-19 vaccines has brought vaccine hesitancy to the forefront in managing this pandemic. COVID-19 vaccine hesitancy is fundamentally different from that of other vaccines due to the new technologies being used, rapid development, and widespread global distribution. Attitudes on vaccines are largely driven by online information, particularly information on social media. The first step toward influencing attitudes about immunization is understanding the current patterns of communication that characterize the immunization debate on social media platforms. Objective: We aimed to evaluate societal attitudes, communication trends, and barriers to COVID-19 vaccine uptake through social media content analysis to inform communication strategies promoting vaccine acceptance. Methods: Social network analysis (SNA) and unsupervised machine learning were used to characterize COVID-19 vaccine content on Twitter globally. Tweets published in English and French were collected through the Twitter application programming interface between November 19 and 26, 2020, just following the announcement of initial COVID-19 vaccine trials. SNA was used to identify social media clusters expressing mistrustful opinions on COVID-19 vaccination. Based on the SNA results, an unsupervised machine learning approach to natural language processing using a sentence-level algorithm transfer function to detect semantic textual similarity was performed in order to identify the main themes of vaccine hesitancy. Results: The tweets (n=636,516) identified that the main themes driving the vaccine hesitancy conversation were concerns of safety, efficacy, and freedom, and mistrust in institutions (either the government or multinational corporations). A main theme was the safety and efficacy of mRNA technology and side effects. The conversation around efficacy was that vaccines were unlikely to completely rid the population of COVID-19, polymerase chain reaction testing is flawed, and there is no indication of long-term T-cell immunity for COVID-19. Nearly one-third (45,628/146,191, 31.2%) of the conversations on COVID-19 vaccine hesitancy clusters expressed concerns for freedom or mistrust of institutions (either the government or multinational corporations) and nearly a quarter (34,756/146,191, 23.8%) expressed criticism toward the government’s handling of the pandemic. Conclusions: Social media content analysis combined with social network analysis provides insights into the themes of the vaccination conversation on Twitter. The themes of safety, efficacy, and trust in institutions will need to be considered, as targeted outreach programs and intervention strategies are deployed on Twitter to improve the uptake of COVID-19 vaccination. %M 34447924 %R 10.2196/28800 %U https://infodemiology.jmir.org/2021/1/e28800 %U https://doi.org/10.2196/28800 %U http://www.ncbi.nlm.nih.gov/pubmed/34447924 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28931 %T Perceptions of Alerts Issued by Social Media Platforms in Response to Self-injury Posts Among Latinx Adolescents: Qualitative Analysis %A Laestadius,Linnea I %A Craig,Katherine A %A Campos-Castillo,Celeste %+ Zilber School of Public Health, University of Wisconsin-Milwaukee, P O Box 413, Milwaukee, WI, 53201, United States, 1 414 251 5607, llaestad@uwm.edu %K adolescents %K social media %K mental health %K NSSI %K race and ethnicity %K mobile phone %D 2021 %7 10.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is growing interest in using social media data to detect and address nonsuicidal self-injury (NSSI) among adolescents. Adolescents often do not seek clinical help for NSSI and may adopt strategies to obscure detection; therefore, social media platforms may be able to facilitate early detection and treatment by using machine learning models to screen posts for harmful content and subsequently alert adults. However, such efforts have raised privacy and ethical concerns among health researchers. Little is currently known about how adolescents perceive these efforts. Objective: The aim of this study is to examine perceptions of automated alerts for NSSI posts on social media among Latinx adolescents, who are at risk for NSSI yet are underrepresented in both NSSI and health informatics research. In addition, we considered their perspectives on preferred recipients of automated alerts. Methods: We conducted semistructured, qualitative interviews with 42 Latinx adolescents between the ages of 13 and 17 years who were recruited from a nonprofit organization serving the Latinx community in Milwaukee, Wisconsin. The Latinx population in Milwaukee is largely of Mexican descent. All interviews were conducted between June and July 2019. Transcripts were analyzed using framework analysis to discern their perceptions of automated alerts sent by social media platforms and potential alert recipients. Results: Participants felt that automated alerts would make adolescents safer and expedite aid before the situation escalated. However, some worried that hyperbolic statements would generate false alerts and instigate conflicts. Interviews revealed strong opinions about ideal alert recipients. Parents were most commonly endorsed, but support was conditional on perceptions that the parent would respond appropriately. Emergency services were judged as safer but inappropriate for situations considered lower risk. Alerts sent to school staff generated the strongest privacy concerns. Altogether, the preferred alert recipients varied by individual adolescents and perceived risks in the situation. None raised ethical concerns about the collection, analysis, or storage of personal information regarding their mental health status. Conclusions: Overall, Latinx adolescents expressed broad support for automated alerts for NSSI on social media, which indicates opportunities to address NSSI. However, these efforts should be co-constructed with adolescents to ensure that preferences and needs are met, as well as embedded within broader approaches for addressing structural and cultural barriers to care. %M 34383683 %R 10.2196/28931 %U https://www.jmir.org/2021/8/e28931 %U https://doi.org/10.2196/28931 %U http://www.ncbi.nlm.nih.gov/pubmed/34383683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28249 %T Mining of Opinions on COVID-19 Large-Scale Social Restrictions in Indonesia: Public Sentiment and Emotion Analysis on Online Media %A Tri Sakti,Andi Muhammad %A Mohamad,Emma %A Azlan,Arina Anis %+ Centre for Research in Media and Communication, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, UKM Bangi, Bangi, 43600, Malaysia, 60 0123065261, arina@ukm.edu.my %K large-scale social restrictions %K social media %K public sentiment %K Twitter %K COVID-19 %K infodemiology %K infoveillance %D 2021 %7 9.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the successful measures to curb COVID-19 spread in large populations is the implementation of a movement restriction order. Globally, it was observed that countries implementing strict movement control were more successful in controlling the spread of the virus as compared with those with less stringent measures. Society’s adherence to the movement control order has helped expedite the process to flatten the pandemic curve as seen in countries such as China and Malaysia. At the same time, there are countries facing challenges with society’s nonconformity toward movement restriction orders due to various claims such as human rights violations as well as sociocultural and economic issues. In Indonesia, society’s adherence to its large-scale social restrictions (LSSRs) order is also a challenge to achieve. Indonesia is regarded as among the worst in Southeast Asian countries in terms of managing the spread of COVID-19. It is proven by the increased number of daily confirmed cases and the total number of deaths, which was more than 6.21% (1351/21,745) of total active cases as of May 2020. Objective: The aim of this study was to explore public sentiments and emotions toward the LSSR and identify issues, fear, and reluctance to observe this restriction among the Indonesian public. Methods: This study adopts a sentiment analysis method with a supervised machine learning approach on COVID-19-related posts on selected media platforms (Twitter, Facebook, Instagram, and YouTube). The analysis was also performed on COVID-19-related news contained in more than 500 online news platforms recognized by the Indonesian Press Council. Social media posts and news originating from Indonesian online media between March 31 and May 31, 2020, were analyzed. Emotion analysis on Twitter platform was also performed to identify collective public emotions toward the LSSR. Results: The study found that positive sentiment surpasses other sentiment categories by 51.84% (n=1,002,947) of the total data (N=1,934,596) collected via the search engine. Negative sentiment was recorded at 35.51% (686,892/1,934,596) and neutral sentiment at 12.65% (244,757/1,934,596). The analysis of Twitter posts also showed that the majority of public have the emotion of “trust” toward the LSSR. Conclusions: Public sentiment toward the LSSR appeared to be positive despite doubts on government consistency in executing the LSSR. The emotion analysis also concluded that the majority of people believe in LSSR as the best method to break the chain of COVID-19 transmission. Overall, Indonesians showed trust and expressed hope toward the government’s ability to manage this current global health crisis and win against COVID-19. %M 34280116 %R 10.2196/28249 %U https://www.jmir.org/2021/8/e28249 %U https://doi.org/10.2196/28249 %U http://www.ncbi.nlm.nih.gov/pubmed/34280116 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e26478 %T Using Machine Learning–Based Approaches for the Detection and Classification of Human Papillomavirus Vaccine Misinformation: Infodemiology Study of Reddit Discussions %A Du,Jingcheng %A Preston,Sharice %A Sun,Hanxiao %A Shegog,Ross %A Cunningham,Rachel %A Boom,Julie %A Savas,Lara %A Amith,Muhammad %A Tao,Cui %+ School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin St, #600, Houston, TX, 77030, United States, 1 713 500 981, cui.tao@uth.tmc.edu %K HPV vaccine %K social media %K misinformation %K infodemiology %K infoveillance %K deep learning %K Reddit %K machine learning %D 2021 %7 5.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapid growth of social media as an information channel has made it possible to quickly spread inaccurate or false vaccine information, thus creating obstacles for vaccine promotion. Objective: The aim of this study is to develop and evaluate an intelligent automated protocol for identifying and classifying human papillomavirus (HPV) vaccine misinformation on social media using machine learning (ML)–based methods. Methods: Reddit posts (from 2007 to 2017, N=28,121) that contained keywords related to HPV vaccination were compiled. A random subset (2200/28,121, 7.82%) was manually labeled for misinformation and served as the gold standard corpus for evaluation. A total of 5 ML-based algorithms, including a support vector machine, logistic regression, extremely randomized trees, a convolutional neural network, and a recurrent neural network designed to identify vaccine misinformation, were evaluated for identification performance. Topic modeling was applied to identify the major categories associated with HPV vaccine misinformation. Results: A convolutional neural network model achieved the highest area under the receiver operating characteristic curve of 0.7943. Of the 28,121 Reddit posts, 7207 (25.63%) were classified as vaccine misinformation, with discussions about general safety issues identified as the leading type of misinformed posts (2666/7207, 36.99%). Conclusions: ML-based approaches are effective in the identification and classification of HPV vaccine misinformation on Reddit and may be generalizable to other social media platforms. ML-based methods may provide the capacity and utility to meet the challenge involved in intelligent automated monitoring and classification of public health misinformation on social media platforms. The timely identification of vaccine misinformation on the internet is the first step in misinformation correction and vaccine promotion. %M 34383667 %R 10.2196/26478 %U https://www.jmir.org/2021/8/e26478 %U https://doi.org/10.2196/26478 %U http://www.ncbi.nlm.nih.gov/pubmed/34383667 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28074 %T Association Between Public Opinion and Malaysian Government Communication Strategies About the COVID-19 Crisis: Content Analysis of Image Repair Strategies in Social Media %A Masngut,Nasaai %A Mohamad,Emma %+ Centre for Research in Media and Communication, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Jalan Nik Ahmed Kamil, Bangi, 43600, Malaysia, 60 389215456, emmamohamad@ukm.edu.my %K COVID-19 %K crisis %K health communication %K image repair %K Malaysian government %K sentiment %K communication %K content analysis %K public opinion %K social media %K strategy %D 2021 %7 4.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 health crisis has posed an unprecedented challenge for governments worldwide to manage and communicate about the pandemic effectively, while maintaining public trust. Good leadership image in times of a health emergency is paramount to ensure public confidence in governments’ abilities to manage the crisis. Objective: The aim of this study was to identify types of image repair strategies utilized by the Malaysian government in their communication about COVID-19 in the media and analyze public responses to these messages on social media. Methods: Content analysis was employed to analyze 120 media statements and 382 comments retrieved from Facebook pages of 2 mainstream newspapers—Berita Harian and The Star. These media statements and comments were collected within a span of 6 weeks prior to and during the first implementation of Movement Control Order by the Malaysian Government. The media statements were analyzed according to Image Repair Theory to categorize strategies employed in government communications related to COVID-19 crisis. Public opinion responses were measured using modified lexicon-based sentiment analysis to categorize positive, negative, and neutral statements. Results: The Malaysian government employed all 5 Image Repair Theory strategies in their communications in both newspapers. The strategy most utilized was reducing offensiveness (75/120, 62.5%), followed by corrective action (30/120, 25.0%), evading responsibilities (10/120, 8.3%), denial (4/120, 3.3%), and mortification (1/120, 0.8%). This study also found multiple substrategies in government media statements including denial, shifting blame, provocation, defeasibility, accident, good intention, bolstering, minimization, differentiation, transcendence, attacking accuser, resolve problem, prevent recurrence, admit wrongdoing, and apologize. This study also found that 64.7% of public opinion was positive in response to media statements made by the Malaysian government and also revealed a significant positive association (P=.04) between image repair strategies utilized by the Malaysian government and public opinion. Conclusions: Communication in the media may assist the government in fostering positive support from the public. Suitable image repair strategies could garner positive public responses and help build trust in times of crisis. %M 34156967 %R 10.2196/28074 %U https://www.jmir.org/2021/8/e28074 %U https://doi.org/10.2196/28074 %U http://www.ncbi.nlm.nih.gov/pubmed/34156967 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e28888 %T The Influence of COVID-19 Information Sources on the Attitudes and Practices Toward COVID-19 Among the General Public of Saudi Arabia: Cross-sectional Online Survey Study %A Alshareef,Noor %A Yunusa,Ismaeel %A Al-Hanawi,Mohammed Khaled %+ Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, University Building 125 Faculties Street, Jeddah, 80200, Saudi Arabia, 966 556522222, mkalhanawi@kau.edu.sa %K attitudes %K communications media %K COVID-19 %K information-seeking behavior %K pandemics %K practices %K Saudi Arabia %K social media %K sources %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has resulted in panic among the general public, leading many people to seek out information related to COVID-19 through various sources, including social media and traditional media. Identifying public preferences for obtaining such information may help health authorities to effectively plan successful health preventive and educational intervention strategies. Objective: The aim of this study was to examine the impact of the types of sources used for obtaining COVID-19 information on the attitudes and practices of the general public in Saudi Arabia during the pandemic, and to identify the socioeconomic and demographic factors associated with the use of different sources of information. Methods: This study used data from a cross-sectional online survey conducted on residents of Saudi Arabia from March 20 to 24, 2020. Data were analyzed using descriptive, bivariate, and multivariable logistic regression analyses. Bivariate analysis of categorical variables was performed to determine the associations between information sources and socioeconomic and demographic factors. Multivariable logistic regression analyses were employed to examine whether socioeconomic and demographic variables were associated with the source of information used to obtain information about COVID-19. Moreover, univariable and multivariable logistic regression analyses were conducted to examine how sources of information influence attitudes and practices of adhering to preventive measures. Results: In this analysis of cross-sectional survey data, 3358 participants were included. Most participants reported using social media, followed by the Ministry of Health (MOH) of the Kingdom of Saudi Arabia, as their primary source of information. Seeking information via social media was significantly associated with lower odds of having an optimistic attitude (adjusted odds ratio [aOR] 0.845, 95% CI 0.733-0.974; P=.02) and adhering to preventive measures (aOR 0.725, 95% CI 0.630-0.835; P<.001) compared to other sources of information. Participants who obtained their COVID-19 information via the MOH had greater odds of having an optimistic attitude (aOR 1.437, 95% CI 1.234-1.673; P<.001) and adhering to preventive measures (aOR 1.393, 95% CI 1.201-1.615; P<.001) than those who obtained information via other sources. Conclusions: This study provides evidence that different sources of information influence attitudes and preventive actions differently within a pandemic crisis context. Health authorities in Saudi Arabia should pay attention to the use of appropriate social media channels and sources to allow for more effective dissemination of critical information to the public. %M 34081610 %R 10.2196/28888 %U https://publichealth.jmir.org/2021/7/e28888 %U https://doi.org/10.2196/28888 %U http://www.ncbi.nlm.nih.gov/pubmed/34081610 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e28147 %T Use of Social Media for Cancer Prevention Through Neighborhood Social Cohesion: Protocol for a Feasibility Study %A Oakley-Girvan,Ingrid %A Watterson,Jessica L %A Jones,Cheryl %A Houghton,Lauren C %A Gibbons,Marley P %A Gokal,Kajal %A Magsamen-Conrad,Kate %+ Medable, 525 University Ave, Palo Alto, CA, 94301, United States, 1 4086562948, ingrid@medable.com %K social cohesion %K mothers %K neighborhood %K physical activity %K social media %K social %K behavior %K health outcomes %K socioeconomic status %K community health %K chronic disease %K social network %K feasibility %K wellbeing %K cancer %D 2021 %7 30.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social cohesion is associated with healthier behaviors and better health outcomes, and therefore may offer a mechanism for promoting better health. Low socioeconomic status (SES) communities face higher rates of chronic disease due to both community- and individual-level factors. Objective: The aim of this study is to leverage social cohesion to promote healthier behaviors and prevent chronic disease in a low SES community. This protocol outlines the methodology for a pilot study to assess the feasibility of an intervention (Free Time For Wellness [FT4W]) using a social networking platform (Nextdoor) with mothers living in an urban, low-income community to improve social cohesion and promote healthy behaviors. Methods: The study will involve three phases: (I) co-designing the intervention with mothers in the neighborhoods of interest, (II) implementing the intervention with community leaders through the social networking platform, and (III) evaluating the intervention’s feasibility. Phase I of the study will include qualitative data collection and analysis from in-depth, semistructured interviews and a co-design group session with mothers. Phases II and III of the study include a pre- and postintervention survey of participating mothers. Neighborhood-level data on social cohesion will also be collected to enable comparison of outcomes between neighborhoods with higher and lower baseline social cohesion. Results: As of March 2021, recruitment and data collection for this study are complete. This protocol outlines our original study plan, although the final enrollment numbers and intervention implementation deviated from our initial planned methodology that is outlined in this protocol. These implementation learnings will be shared in subsequent publications of our study results. Conclusions: Ultimately, this study aims to: (1) determine the barriers and facilitators to finding free time for wellness among a population of low-income mothers to inform the co-design process, and (2) implement and study the feasibility of an intervention that leverages social cohesion to promote physical activity in a community of low-income mothers. The results of this study will provide preliminary feasibility evidence to inform a larger effectiveness trial, and will further our understanding of how social cohesion might influence well-being. International Registered Report Identifier (IRRID): RR1-10.2196/28147 %M 34328445 %R 10.2196/28147 %U https://www.researchprotocols.org/2021/7/e28147 %U https://doi.org/10.2196/28147 %U http://www.ncbi.nlm.nih.gov/pubmed/34328445 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e29060 %T The Effect of a Wordless, Animated, Social Media Video Intervention on COVID-19 Prevention: Online Randomized Controlled Trial %A Vandormael,Alain %A Adam,Maya %A Greuel,Merlin %A Gates,Jennifer %A Favaretti,Caterina %A Hachaturyan,Violetta %A Bärnighausen,Till %+ Heidelberg Institute of Global Health, Heidelberg University, 130.3 Im Neuenheimer Feld, Heidelberg, 69120, Germany, 49 163 481 3452, alain.vandormael@uni-heidelberg.de %K social media %K cultural and social implications %K randomized controlled trial %K list experiment %K information literacy %K COVID-19 %K pandemic %K digital health %K infodemiology %K global health %K public health %D 2021 %7 27.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Innovative approaches to the dissemination of evidence-based COVID-19 health messages are urgently needed to counter social media misinformation about the pandemic. To this end, we designed a short, wordless, animated global health communication video (the CoVideo), which was rapidly distributed through social media channels to an international audience. Objective: The objectives of this study were to (1) establish the CoVideo’s effectiveness in improving COVID-19 prevention knowledge, and (2) establish the CoVideo’s effectiveness in increasing behavioral intent toward COVID-19 prevention. Methods: In May and June 2020, we enrolled 15,163 online participants from the United States, Mexico, the United Kingdom, Germany, and Spain. We randomized participants to (1) the CoVideo arm, (2) an attention placebo control (APC) arm, and (3) a do-nothing arm, and presented 18 knowledge questions about preventive COVID-19 behaviors, which was our first primary endpoint. To measure behavioral intent, our second primary endpoint, we randomized participants in each arm to five list experiments. Results: Globally, the video intervention was viewed 1.2 million times within the first 10 days of its release and more than 15 million times within the first 4 months. Knowledge in the CoVideo arm was significantly higher (mean 16.95, 95% CI 16.91-16.99) than in the do-nothing (mean 16.86, 95% CI 16.83-16.90; P<.001) arm. We observed high baseline levels of behavioral intent to perform many of the preventive behaviors featured in the video intervention. We were only able to detect a statistically significant impact of the CoVideo on one of the five preventive behaviors. Conclusions: Despite high baseline levels, the intervention was effective at boosting knowledge of COVID-19 prevention. We were only able to capture a measurable change in behavioral intent toward one of the five COVID-19 preventive behaviors examined in this study. The global reach of this health communication intervention and the high voluntary engagement of trial participants highlight several innovative features that could inform the design and dissemination of public health messages. Short, wordless, animated videos, distributed by health authorities via social media, may be an effective pathway for rapid global health communication during health crises. Trial Registration: German Clinical Trials Register DRKS00021582; https://tinyurl.com/6r4zkbbn International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04942-7 %M 34174778 %R 10.2196/29060 %U https://publichealth.jmir.org/2021/7/e29060 %U https://doi.org/10.2196/29060 %U http://www.ncbi.nlm.nih.gov/pubmed/34174778 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e23876 %T Pre-exposure Prophylaxis (PrEP) Information on Instagram: Content Analysis %A Walsh-Buhi,Eric %A Houghton,Rebecca Fagen %A Lange,Claire %A Hockensmith,Ryli %A Ferrand,John %A Martinez,Lourdes %+ Department of Applied Health Science, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Room 116, Bloomington, IN, 47405, United States, 1 812 855 4867, erwals@iu.edu %K digital health %K social media %K HIV %K pre-exposure prophylaxis %K Instagram %K content analysis %K communication %D 2021 %7 27.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There is still an HIV epidemic in the United States, which is a substantial issue for populations bearing a disproportionate burden of HIV infections. Daily oral pre-exposure prophylaxis (PrEP) has proven to be safe and effective in reducing HIV acquisition risk. However, studies document that PrEP awareness/usage is low. There is also limited understanding of social media platforms, such as Instagram, as PrEP information sources. Objective: Given the paucity of research on PrEP-related Instagram posts and popularity of this social media platform, the purpose of this research is to describe the source characteristics, image types, and textual contents of PrEP-related posts on Instagram. Methods: Using Crowdtangle Search, a public insights tool owned/operated by Facebook, we retrieved publicly accessible and English-language-only Instagram posts for the 12-month period preceding April 22, 2020, using the following terms: Truvada or “pre-exposure prophylaxis” or #truvada or #truvadaprep or #truvadawhore or #truvadaforprep. We employed a qualitative coding methodology to manually extract information from posts. Using a pretested codebook, we performed content analysis on 250 posts, examining message and source characteristics (ie, organization type [eg, government, news] and individual type [eg, physician]), including information about PrEP (eg, how it works, cost), and indicated users. Frequencies and percentages were calculated for all categorical variables. A Chi-square test was conducted to determine differences between source types on a variety of message characteristics. Results: Three-quarters of the posts (193/250, 77.2%) were posted by organizations. Of the 250 posts reviewed, approximately two-thirds (174/250, 69.6%) included a photograph, more than half (142/250, 56.8%) included an infographic, and approximately one-tenth (30/250, 12%) included a video. More than half defined PrEP (137/250, 54.8%), but fewer posts promoted PrEP use, explained how PrEP works, and included information on the effectiveness of PrEP or who can use it. The most commonly hashtagged populations among posts were men who have sex with men (MSM), but not necessarily bisexual men. Few posts contained race-/ethnicity-related hashtags (11/250, 4.4%). Fewer posts contained transgender-associated tags (eg, #transgirl; 5/250, 2%). No posts contained tags related to heterosexuals or injection drug users. We found statistical differences between source types (ie, individual versus organization). Specifically, posts from organizations more frequently contained information about who can use PrEP, whereas posts from individuals more frequently contained information describing adverse effects. Conclusions: This study is among the first to review Instagram for PrEP-related content, and it answers the National AIDS Strategy’s call for a clearer articulation of the science surrounding HIV risk/prevention through better understanding of the current public information environment. This study offers a snapshot of how PrEP is being discussed (and by whom) on one of the most popular social media platforms and provides a foundation for developing and implementing PrEP promotion interventions on Instagram. %M 34061759 %R 10.2196/23876 %U https://publichealth.jmir.org/2021/7/e23876 %U https://doi.org/10.2196/23876 %U http://www.ncbi.nlm.nih.gov/pubmed/34061759 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e27448 %T Evaluation of a Social Media Campaign in Saskatchewan to Promote Healthy Eating During the COVID-19 Pandemic: Social Media Analysis and Qualitative Interview Study %A Grantham,Jordyn L %A Verishagen,Carrie L %A Whiting,Susan J %A Henry,Carol J %A Lieffers,Jessica R L %+ College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada, 1 306 966 8594, jrl210@usask.ca %K COVID-19 %K diet, healthy %K nutrition %K health promotion %K social media %K dietitian %K Saskatchewan %D 2021 %7 21.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The beginning of the COVID-19 pandemic presented many sudden challenges regarding food, including grocery shopping changes (eg, reduced store hours, capacity restrictions, and empty store shelves due to food hoarding), restaurant closures, the need to cook more at home, and closures of food access programs. Eat Well Saskatchewan (EWS) implemented a 16-week social media campaign, #eatwellcovid19, led by a dietitian and nutrition student that focused on sharing stories submitted by the Saskatchewan public about how they were eating healthy during the COVID-19 pandemic. Objective: The goal of this study was to describe the implementation of the #eatwellcovid19 social media campaign and the results from the evaluation of the campaign, which included campaign performance using social media metrics and experiences and perspectives of campaign followers. Methods: Residents of Saskatchewan, Canada, were invited to submit personal stories and experiences to EWS about how they were eating healthy during the COVID-19 pandemic from April to August 2020. Each week, one to three stories were featured on EWS social media platforms—Facebook, Instagram, and Twitter—along with evidence-based nutrition information to help residents become more resilient to challenges related to food and nutrition experienced during the COVID-19 pandemic. Individuals who submitted stories were entered into a weekly draw for a Can $100 grocery gift card. Social media metrics and semistructured qualitative interviews of campaign followers were used to evaluate the #eatwellcovid19 campaign. Results: In total, 75 stories were submitted by 74 individuals on a variety of topics (eg, grocery shopping, traditional skills, and gardening), and 42 stories were featured on social media. EWS shared 194 #eatwellcovid19 posts across social media platforms (Facebook: n=100; Instagram: n=55; and Twitter: n=39). On Facebook, #eatawellcovid19 reached 100,571 followers and left 128,818 impressions, resulting in 9575 engagements. On Instagram, the campaign reached 11,310 followers, made 14,145 impressions, and received 823 likes and 15 comments. On Twitter, #eatwellcovid19 made 15,199 impressions and received 424 engagements. Featured story submission posts had the best engagement on Facebook and the most likes and comments on Instagram. The EWS social media pages reported increases in their following during the campaign (Instagram: +30%; Facebook: +14%; and Twitter: +12%). Results from the interviews revealed that there were two types of campaign followers: those who appreciated hearing the stories submitted by followers, as it helped them to feel connected to the community during social isolation, and those who appreciated the evidence-based information. Conclusions: Numerous stories were submitted to the #eatwellcovid19 social media campaign on various topics. On Instagram and Facebook, posts that featured these stories had the highest engagement. During this campaign, EWS’s social media following increased by more than 10% on each platform. The approach used for the #eatwellcovid19 campaign could be considered by others looking to develop health promotion campaigns. %M 34133314 %R 10.2196/27448 %U https://www.jmir.org/2021/7/e27448 %U https://doi.org/10.2196/27448 %U http://www.ncbi.nlm.nih.gov/pubmed/34133314 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26510 %T Leading Topics in Twitter Discourse on JUUL and Puff Bar Products: Content Analysis %A Allem,Jon-Patrick %A Dormanesh,Allison %A Majmundar,Anuja %A Rivera,Vanessa %A Chu,Maya %A Unger,Jennifer B %A Cruz,Tess Boley %+ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N Soto Street, 3rd Floor, SSB K318, Los Angeles, CA, 90032, United States, 1 323 442 7921, allem@usc.edu %K electronic cigarettes %K JUUL %K public health %K Puff Bar %K social media %K Twitter %K infodemiology %D 2021 %7 19.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In response to the recent government restrictions, flavored JUUL products, which are rechargeable closed-system electronic cigarettes (e-cigarettes), are no longer available for sale. However, disposable closed-system products such as the flavored Puff Bar e-cigarette continues to be available. If e-cigarette consumers simply switch between products during the current government restrictions limited to 1 type of product over another, then such restrictions would be less effective. A step forward in this line of research is to understand how the public discusses these products by examining discourse referencing both Puff Bar and JUUL in the same conversation. Twitter data provide ample opportunity to capture such early trends that could be used to help public health researchers stay abreast of the rapidly changing e-cigarette marketplace. Objective: The goal of this study was to examine public discourse referencing both Puff Bar and JUUL products in the same conversation on Twitter. Methods: We collected data from Twitter’s streaming application programming interface between July 16, 2019, and August 29, 2020, which included both “Puff Bar” and “JUUL” (n=2632). We then used an inductive approach to become familiar with the data and generate a codebook to identify common themes. Saturation was determined to be reached with 10 themes. Results: Posts often mentioned flavors, dual use, design features, youth use, health risks, switching 1 product for the other, price, confusion over the differences between products, longevity of the products, and nicotine concentration. Conclusions: On examining the public’s conversations about Puff Bar and JUUL products on Twitter, having described themes in posts, this study aimed to help the tobacco control community stay informed about 2 popular e-cigarette products with different device features, which can be potentially substituted for one another. Future health communication campaigns may consider targeting the health consequences of using multiple e-cigarette products or dual use to reduce exposure to high levels of nicotine among younger populations. %M 34279236 %R 10.2196/26510 %U https://www.jmir.org/2021/7/e26510 %U https://doi.org/10.2196/26510 %U http://www.ncbi.nlm.nih.gov/pubmed/34279236 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e28563 %T COVID-19 Information Dissemination Using the WeChat Communication Index: Retrospective Analysis Study %A Fan,Zina %A Yin,Wenqiang %A Zhang,Han %A Wang,Dandan %A Fan,Chengxin %A Chen,Zhongming %A Hu,Jinwei %A Ma,Dongping %A Guo,Hongwei %+ School of Management, Weifang Medical University, No. 7166 Baotong West Street, Weifang, Shandong, 261053, China, 86 05368462573, guohongww@126.com %K COVID-19 %K information dissemination %K People’s Daily %K Chinese news %K public health and communication %K media salience %K WeChat %D 2021 %7 16.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 outbreak has tremendously impacted the world. The number of confirmed cases has continued to increase, causing damage to society and the economy worldwide. The public pays close attention to information on the pandemic and learns about the disease through various media outlets. The dissemination of comprehensive and accurate COVID-19 information that the public needs helps to educate people so they can take preventive measures. Objective: This study aimed to examine the dissemination of COVID-19 information by analyzing the information released by the official WeChat account of the People’s Daily during the pandemic. The most-read COVID-19 information in China was summarized, and the factors that influence information dissemination were studied to understand the characteristics that affect its dissemination. Moreover, this was conducted in order to identify how to effectively disseminate COVID-19 information and to provide suggestions on how to manage public opinion and information governance during a pandemic. Methods: This was a retrospective study based on a WeChat official account. We collected all COVID-19–related information, starting with the first report about COVID-19 from the People’s Daily and ending with the last piece of information about lifting the first-level emergency response in 34 Chinese provinces. A descriptive analysis was then conducted on this information, as well as on Qingbo Big Data’s dissemination index. Multiple linear regression was utilized to study the factors that affected information dissemination based on various characteristics and the dissemination index. Results: From January 19 to May 2, 2020, the People’s Daily released 1984 pieces of information; 1621 were related to COVID-19, which mainly included headline news items, items with emotional content, and issues related to the pandemic’s development. By analyzing the dissemination index, seven information dissemination peaks were discerned. Among the three dimensions of COVID-19 information—media salience, content, and format—eight factors affected the spread of COVID-19 information. Conclusions: Different types of pandemic-related information have varying dissemination power. To effectively disseminate information and prevent the spread of COVID-19, we should identify the factors that affect this dissemination. We should then disseminate the types of information the public is most concerned about, use information to educate people to improve their health literacy, and improve public opinion and information governance. %M 34129515 %R 10.2196/28563 %U https://www.jmir.org/2021/7/e28563 %U https://doi.org/10.2196/28563 %U http://www.ncbi.nlm.nih.gov/pubmed/34129515 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e23242 %T Using Social Media for the Prevention of Pediatric Burn Injuries: Pilot Design and Usability Study %A Batra,Nikita %A Colson,Cindy D %A Alberto,Emily C %A Burd,Randall S %+ Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, United States, 1 202 476 2151, rburd@cnmc.org %K accident prevention %K burns %K pediatric %K public health %K social media %D 2021 %7 15.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Most pediatric burn injuries are preventable. Social media is an effective method for delivering large-scale messaging and may be useful for injury prevention in this domain. Objective: This study evaluates the feasibility of creating a social media campaign for pediatric burn injury prevention. Methods: Ad spots containing a headline, short introduction, and video were created and posted on Facebook and Instagram over 4 months. Ad spots were targeted to parents and caregivers of children in our region with the highest number of burn injuries. We assessed the impact of each ad set using ThruPlays, reach, and video plays. Results: We created 55 ad spots, with an average length of 24.1 (range 10-44) seconds. We reached 26,496 people during the campaign. The total ThruPlays of the 55 ad spots were 14,460 at US $0.19 per ThruPlay. Ad spots related to home safety had a significantly higher daily ThruPlay rate than those related to fire safety (6.5 vs 0.5 per day; P<.001). Conclusions: Social media is a feasible modality for delivering public health messages focused on preventing pediatric burn injuries. Engagement with these ads is influenced by ad presentation and the focus of the underlying injury prevention message. %M 34264194 %R 10.2196/23242 %U https://formative.jmir.org/2021/7/e23242 %U https://doi.org/10.2196/23242 %U http://www.ncbi.nlm.nih.gov/pubmed/34264194 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e27942 %T The Saudi Ministry of Health’s Twitter Communication Strategies and Public Engagement During the COVID-19 Pandemic: Content Analysis Study %A Alhassan,Fatimah Mohammed %A AlDossary,Sharifah Abdullah %+ Department of Health Informatics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, PO Box 3660, Riyadh, 11481, Saudi Arabia, 966 11 4299999, fatimah.m.alhasan@gmail.com %K COVID-19 %K Crisis and Emergency Risk Communication %K effective communication %K health authorities %K outbreak %K pandemic %K public engagement %K public health %K social media %K Twitter %D 2021 %7 12.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During a public health crisis such as the current COVID-19 pandemic, governments and health authorities need quick and accurate methods of communicating with the public. While social media can serve as a useful tool for effective communication during disease outbreaks, few studies have elucidated how these platforms are used by the Ministry of Health (MOH) during disease outbreaks in Saudi Arabia. Objective: Guided by the Crisis and Emergency Risk Communication model, this study aimed to explore the MOH’s use of Twitter and the public’s engagement during different stages of the COVID-19 pandemic in Saudi Arabia. Methods: Tweets and corresponding likes and retweets were extracted from the official Twitter account of the MOH in Saudi Arabia for the period of January 1 through August 31, 2020. Tweets related to COVID-19 were identified; subsequently, content analysis was performed, in which tweets were coded for the following message types: risk messages, warnings, preparations, uncertainty reduction, efficacy, reassurance, and digital health responses. Public engagement was measured by examining the numbers of likes and retweets. The association between outbreak stages and types of messages was assessed, as well as the effect of these messages on public engagement. Results: The MOH posted a total of 1393 original tweets during the study period. Of the total tweets, 1293 (92.82%) were related to COVID-19, and 1217 were ultimately included in the analysis. The MOH posted the majority of its tweets (65.89%) during the initial stage of the outbreak. Accordingly, the public showed the highest level of engagement (as indicated by numbers of likes and retweets) during the initial stage. The types of messages sent by the MOH significantly differed across outbreak stages, with messages related to uncertainty reduction, reassurance, and efficacy being prevalent among all stages. Tweet content, media type, and crisis stage influenced the level of public engagement. Engagement was negatively associated with the inclusion of hyperlinks and multimedia files, while higher level of public engagement was associated with the use of hashtags. Tweets related to warnings, uncertainty reduction, and reassurance received high levels of public engagement. Conclusions: This study provides insights into the Saudi MOH’s communication strategy during the COVID-19 pandemic. Our results have implications for researchers, governments, health organizations, and practitioners with regard to their communication practices during outbreaks. To increase public engagement, governments and health authorities should consider the public’s need for information. This, in turn, could raise public awareness regarding disease outbreaks. %M 34117860 %R 10.2196/27942 %U https://publichealth.jmir.org/2021/7/e27942 %U https://doi.org/10.2196/27942 %U http://www.ncbi.nlm.nih.gov/pubmed/34117860 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 7 %P e24512 %T Understanding the Role of Social Media–Based Mental Health Support Among College Students: Survey and Semistructured Interviews %A Vornholt,Piper %A De Choudhury,Munmun %+ School of Interactive Computing, College of Computing, Georgia Institute of Technology, 756 W Peachtree St NW, Atlanta, GA, 30308, United States, 1 4043858603, munmund@gatech.edu %K college mental health %K social media %K social support %K mobile phone %D 2021 %7 12.7.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental illness is a growing concern within many college campuses. Limited access to therapy resources, along with the fear of stigma, often prevents students from seeking help. Introducing supportive interventions, coping strategies, and mitigation programs might decrease the negative effects of mental illness among college students. Objective: Many college students find social support for a variety of needs through social media platforms. With the pervasive adoption of social media sites in college populations, in this study, we examine whether and how these platforms may help meet college students’ mental health needs. Methods: We first conducted a survey among 101 students, followed by semistructured interviews (n=11), of a large public university in the southeast region of the United States to understand whether, to what extent, and how students appropriate social media platforms to suit their struggle with mental health concerns. The interviews were intended to provide comprehensive information on students’ attitudes and their perceived benefits and limitations of social media as platforms for mental health support. Results: Our survey revealed that a large number of participating students (71/101, 70.3%) had recently experienced some form of stress, anxiety, or other mental health challenges related to college life. Half of them (52/101, 51.5%) also reported having appropriated some social media platforms for self-disclosure or help, indicating the pervasiveness of this practice. Through our interviews, we obtained deeper insights into these initial observations. We identified specific academic, personal, and social life stressors; motivations behind social media use for mental health needs; and specific platform affordances that helped or hindered this use. Conclusions: Students recognized the benefits of social media in helping connect with peers on campus and promoting informal and candid disclosures. However, they argued against complete anonymity in platforms for mental health help and advocated the need for privacy and boundary regulation mechanisms in social media platforms supporting this use. Our findings bear implications for informing campus counseling efforts and in designing social media–based mental health support tools for college students. %M 34255701 %R 10.2196/24512 %U https://mental.jmir.org/2021/7/e24512 %U https://doi.org/10.2196/24512 %U http://www.ncbi.nlm.nih.gov/pubmed/34255701 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 7 %P e24340 %T Examining the Pro-Eating Disorders Community on Twitter Via the Hashtag #proana: Statistical Modeling Approach %A Sukunesan,Suku %A Huynh,Minh %A Sharp,Gemma %+ Information Systems Deptartment, Swinburne University of Technology, John St, Hawthorn, 3122, Australia, 61 9213 4373, ssinnappan@swin.edu.au %K Twitter %K infodemiology %K eating disorders %K proana %K thinspo %K hashtags %K transient %K cybersectarianism %D 2021 %7 9.7.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is increasing concern around communities that promote eating disorders (Pro-ED) on social media sites through messages and images that encourage dangerous weight control behaviors. These communities share group identity formed through interactions between members and can involve the exchange of “tips,” restrictive dieting plans, extreme exercise plans, and motivating imagery of thin bodies. Unlike Instagram, Facebook, or Tumblr, the absence of adequate policy to moderate Pro-ED content on Twitter presents a unique space for the Pro-ED community to freely communicate. While recent research has identified terms, themes, and common lexicon used within the Pro-ED online community, very few have been longitudinal. It is important to focus upon the engagement of Pro-ED online communities over time to further understand how members interact and stay connected, which is currently lacking. Objective: The purpose of this study was to explore beyond the common messages of Pro-ED on Twitter to understand how Pro-ED communities get traction over time by using the hashtag considered to symbolize the Pro-ED movement, #proana. Our focus was to collect longitudinal data to gain a further understanding of the engagement of Pro-ED communities on Twitter. Methods: Descriptive statistics were used to identify the preferred tweeting style of Twitter users (either as mentioning another user in a tweet or without) as well as their most frequently used hashtag, in addition to #proana. A series of Mann Whitney U tests were then conducted to compare preferred posting style across number of followed, followers, tweets, and favorites. This was followed by linear models using a forward step-wise approach that were applied for Pro-ED Twitter users to examine the factors associated with their number of followers. Results: This study reviewed 11,620 Pro-ED Twitter accounts that posted using the hashtag #proana between September 2015 and July 2018. These profiles then underwent a 2-step screening of inclusion and exclusion criteria to reach the final sample of 967 profiles. Over 90% (10,484/11,620) of the profiles were found to have less than 6 tweets within the 34-month period. Most of the users were identified as preferring a mentioning style of tweeting (718/967, 74.3%) over not mentioning (248/967, 25.7%). Further, #proana and #thinspo were used interchangeably to propagate shared themes, and there was a reciprocal effect between followers and the followed. Conclusions: Our analysis showed that the number of accounts followed and number of Pro-ED tweets posted were significant predictors for the number of followers a user has, compared to likes. Our results could potentially be useful to social media platforms to understand which features could help or otherwise curtail the spread of ED messages and activity. Our findings also show that Pro-ED communities are transient in nature, engaging in superficial discussion threads but resilient, emulating cybersectarian behavior. %M 34255707 %R 10.2196/24340 %U https://mental.jmir.org/2021/7/e24340 %U https://doi.org/10.2196/24340 %U http://www.ncbi.nlm.nih.gov/pubmed/34255707 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e29942 %T The Reliability and Quality of YouTube Videos as a Source of Public Health Information Regarding COVID-19 Vaccination: Cross-sectional Study %A Chan,Calvin %A Sounderajah,Viknesh %A Daniels,Elisabeth %A Acharya,Amish %A Clarke,Jonathan %A Yalamanchili,Seema %A Normahani,Pasha %A Markar,Sheraz %A Ashrafian,Hutan %A Darzi,Ara %+ Department of Surgery & Cancer, Imperial College London, 10th floor, Queen Elizabeth Queen Mother Building, St. Mary's Hospital, South Wharf Road, London, W2 1NY, United Kingdom, 44 02033126666, vs1108@imperial.ac.uk %K COVID-19 %K infodemiology %K public health %K quality %K reliability %K social media %K vaccination %K vaccine %K video %K web-based health information %K YouTube %D 2021 %7 8.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Recent emergency authorization and rollout of COVID-19 vaccines by regulatory bodies has generated global attention. As the most popular video-sharing platform globally, YouTube is a potent medium for the dissemination of key public health information. Understanding the nature of available content regarding COVID-19 vaccination on this widely used platform is of substantial public health interest. Objective: This study aimed to evaluate the reliability and quality of information on COVID-19 vaccination in YouTube videos. Methods: In this cross-sectional study, the phrases “coronavirus vaccine” and “COVID-19 vaccine” were searched on the UK version of YouTube on December 10, 2020. The 200 most viewed videos of each search were extracted and screened for relevance and English language. Video content and characteristics were extracted and independently rated against Health on the Net Foundation Code of Conduct and DISCERN quality criteria for consumer health information by 2 authors. Results: Forty-eight videos, with a combined total view count of 30,100,561, were included in the analysis. Topics addressed comprised the following: vaccine science (n=18, 58%), vaccine trials (n=28, 58%), side effects (n=23, 48%), efficacy (n=17, 35%), and manufacturing (n=8, 17%). Ten (21%) videos encouraged continued public health measures. Only 2 (4.2%) videos made nonfactual claims. The content of 47 (98%) videos was scored to have low (n=27, 56%) or moderate (n=20, 42%) adherence to Health on the Net Foundation Code of Conduct principles. Median overall DISCERN score per channel type ranged from 40.3 (IQR 34.8-47.0) to 64.3 (IQR 58.5-66.3). Educational channels produced by both medical and nonmedical professionals achieved significantly higher DISCERN scores than those of other categories. The highest median DISCERN scores were achieved by educational videos produced by medical professionals (64.3, IQR 58.5-66.3) and the lowest median scores by independent users (18, IQR 18-20). Conclusions: The overall quality and reliability of information on COVID-19 vaccines on YouTube remains poor. Videos produced by educational channels, especially by medical professionals, were higher in quality and reliability than those produced by other sources, including health-related organizations. Collaboration between health-related organizations and established medical and educational YouTube content producers provides an opportunity for the dissemination of high-quality information on COVID-19 vaccination. Such collaboration holds potential as a rapidly implementable public health intervention aiming to engage a wide audience and increase public vaccination awareness and knowledge. %M 34081599 %R 10.2196/29942 %U https://publichealth.jmir.org/2021/7/e29942 %U https://doi.org/10.2196/29942 %U http://www.ncbi.nlm.nih.gov/pubmed/34081599 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e29238 %T Incorporating Unstructured Patient Narratives and Health Insurance Claims Data in Pharmacovigilance: Natural Language Processing Analysis of Patient-Generated Texts About Systemic Lupus Erythematosus %A Matsuda,Shinichi %A Ohtomo,Takumi %A Tomizawa,Shiho %A Miyano,Yuki %A Mogi,Miwako %A Kuriki,Hiroshi %A Nakayama,Terumi %A Watanabe,Shinichi %+ Real-World Data Science Department, Chugai Pharmaceutical Co Ltd, 2-1-1 Nihonbashi-Muromachi, Chuo-ku, Tokyo, 103-8324, Japan, 81 332730769, matsudasni@chugai-pharm.co.jp %K social media %K adverse drug reaction %K pharmacovigilance %K text mining %K systemic lupus erythematosus %K natural language processing %K NLP %K lupus %K chronic disease %K narrative %K insurance %K data %K epidemiology %K burden %K Japan %K patient-generated %D 2021 %7 29.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Gaining insights that cannot be obtained from health care databases from patients has become an important topic in pharmacovigilance. Objective: Our objective was to demonstrate a use case, in which patient-generated data were incorporated in pharmacovigilance, to understand the epidemiology and burden of illness in Japanese patients with systemic lupus erythematosus. Methods: We used data on systemic lupus erythematosus, an autoimmune disease that substantially impairs quality of life, from 2 independent data sets. To understand the disease’s epidemiology, we analyzed a Japanese health insurance claims database. To understand the disease’s burden, we analyzed text data collected from Japanese disease blogs (tōbyōki) written by patients with systemic lupus erythematosus. Natural language processing was applied to these texts to identify frequent patient-level complaints, and term frequency–inverse document frequency was used to explore patient burden during treatment. We explored health-related quality of life based on patient descriptions. Results: We analyzed data from 4694 and 635 patients with systemic lupus erythematosus in the health insurance claims database and tōbyōki blogs, respectively. Based on health insurance claims data, the prevalence of systemic lupus erythematosus is 107.70 per 100,000 persons. Tōbyōki text data analysis showed that pain-related words (eg, pain, severe pain, arthralgia) became more important after starting treatment. We also found an increase in patients’ references to mobility and self-care over time, which indicated increased attention to physical disability due to disease progression. Conclusions: A classical medical database represents only a part of a patient's entire treatment experience, and analysis using solely such a database cannot represent patient-level symptoms or patient concerns about treatments. This study showed that analysis of tōbyōki blogs can provide added information on patient-level details, advancing patient-centric pharmacovigilance. %M 34255719 %R 10.2196/29238 %U https://publichealth.jmir.org/2021/6/e29238 %U https://doi.org/10.2196/29238 %U http://www.ncbi.nlm.nih.gov/pubmed/34255719 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24435 %T COVID-19 Vaccine–Related Discussion on Twitter: Topic Modeling and Sentiment Analysis %A Lyu,Joanne Chen %A Han,Eileen Le %A Luli,Garving K %+ Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Avenue, San Francisco, CA, 94143-1390, United States, 1 415 502 4181, chenjoanne.lyu@ucsf.edu %K COVID-19 %K vaccine %K vaccination %K Twitter %K infodemiology %K infoveillance %K topic %K sentiment %K opinion %K discussion %K communication %K social media %K perception %K concern %K emotion %D 2021 %7 29.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccination is a cornerstone of the prevention of communicable infectious diseases; however, vaccines have traditionally met with public fear and hesitancy, and COVID-19 vaccines are no exception. Social media use has been demonstrated to play a role in the low acceptance of vaccines. Objective: The aim of this study is to identify the topics and sentiments in the public COVID-19 vaccine–related discussion on social media and discern the salient changes in topics and sentiments over time to better understand the public perceptions, concerns, and emotions that may influence the achievement of herd immunity goals. Methods: Tweets were downloaded from a large-scale COVID-19 Twitter chatter data set from March 11, 2020, the day the World Health Organization declared COVID-19 a pandemic, to January 31, 2021. We used R software to clean the tweets and retain tweets that contained the keywords vaccination, vaccinations, vaccine, vaccines, immunization, vaccinate, and vaccinated. The final data set included in the analysis consisted of 1,499,421 unique tweets from 583,499 different users. We used R to perform latent Dirichlet allocation for topic modeling as well as sentiment and emotion analysis using the National Research Council of Canada Emotion Lexicon. Results: Topic modeling of tweets related to COVID-19 vaccines yielded 16 topics, which were grouped into 5 overarching themes. Opinions about vaccination (227,840/1,499,421 tweets, 15.2%) was the most tweeted topic and remained a highly discussed topic during the majority of the period of our examination. Vaccine progress around the world became the most discussed topic around August 11, 2020, when Russia approved the world’s first COVID-19 vaccine. With the advancement of vaccine administration, the topic of instruction on getting vaccines gradually became more salient and became the most discussed topic after the first week of January 2021. Weekly mean sentiment scores showed that despite fluctuations, the sentiment was increasingly positive in general. Emotion analysis further showed that trust was the most predominant emotion, followed by anticipation, fear, sadness, etc. The trust emotion reached its peak on November 9, 2020, when Pfizer announced that its vaccine is 90% effective. Conclusions: Public COVID-19 vaccine–related discussion on Twitter was largely driven by major events about COVID-19 vaccines and mirrored the active news topics in mainstream media. The discussion also demonstrated a global perspective. The increasingly positive sentiment around COVID-19 vaccines and the dominant emotion of trust shown in the social media discussion may imply higher acceptance of COVID-19 vaccines compared with previous vaccines. %M 34115608 %R 10.2196/24435 %U https://www.jmir.org/2021/6/e24435 %U https://doi.org/10.2196/24435 %U http://www.ncbi.nlm.nih.gov/pubmed/34115608 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e25742 %T Twitter Users’ Views on Mental Health Crisis Resolution Team Care Compared With Stakeholder Interviews and Focus Groups: Qualitative Analysis %A Chilman,Natasha %A Morant,Nicola %A Lloyd-Evans,Brynmor %A Wackett,Jane %A Johnson,Sonia %+ Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7BN, United Kingdom, 44 7969688554, n.morant@ucl.ac.uk %K Twitter %K social media %K qualitative %K crisis resolution team %K home treatment team %K mental health %K acute care %K severe mental illness %D 2021 %7 29.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Analyzing Twitter posts enables rapid access to how issues and experiences are socially shared and constructed among communities of health service users and providers, in ways that traditional qualitative methods may not. Objective: To enrich the understanding of mental health crisis care in the United Kingdom, this study explores views on crisis resolution teams (CRTs) expressed on Twitter. We aim to identify the similarities and differences among views expressed on Twitter compared with interviews and focus groups. Methods: We used Twitter’s advanced search function to retrieve public tweets on CRTs. A thematic analysis was conducted on 500 randomly selected tweets. The principles of refutational synthesis were applied to compare themes with those identified in a multicenter qualitative interview study. Results: The most popular hashtag identified was #CrisisTeamFail, where posts were principally related to poor quality of care and access, particularly for people given a personality disorder diagnosis. Posts about CRTs giving unhelpful self-management advice were common, as were tweets about resource strains on mental health services. This was not identified in the research interviews. Although each source yielded unique themes, there were some overlaps with themes identified via interviews and focus groups, including the importance of rapid access to care. Views expressed on Twitter were generally more critical than those obtained via face-to-face methods. Conclusions: Traditional qualitative studies may underrepresent the views of more critical stakeholders by collecting data from participants accessed via mental health services. Research on social media content can complement traditional or face-to-face methods and ensure that a broad spectrum of viewpoints can inform service development and policy. %M 34185017 %R 10.2196/25742 %U https://mental.jmir.org/2021/6/e25742 %U https://doi.org/10.2196/25742 %U http://www.ncbi.nlm.nih.gov/pubmed/34185017 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e30137 %T The Use of Social Media in Detecting Drug Safety–Related New Black Box Warnings, Labeling Changes, or Withdrawals: Scoping Review %A Lee,Jae-Young %A Lee,Yae-Seul %A Kim,Dong Hyun %A Lee,Han Sol %A Yang,Bo Ram %A Kim,Myeong Gyu %+ College of Pharmacy, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea, 82 02 3277 3102, kimmg@ewha.ac.kr %K adverse event %K black box warning %K detect %K pharmacovigilance %K real-world data %K review %K safety %K social media %K withdrawal of approval %D 2021 %7 28.6.2021 %9 Review %J JMIR Public Health Surveill %G English %X Background: Social media has become a new source for obtaining real-world data on adverse drug reactions. Many studies have investigated the use of social media to detect early signals of adverse drug reactions. However, the trustworthiness of signals derived from social media is questionable. To confirm this, a confirmatory study with a positive control (eg, new black box warnings, labeling changes, or withdrawals) is required. Objective: This study aimed to evaluate the use of social media in detecting new black box warnings, labeling changes, or withdrawals in advance. Methods: This scoping review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. A researcher searched PubMed and EMBASE in January 2021. Original studies analyzing black box warnings, labeling changes, or withdrawals from social media were selected, and the results of the studies were summarized. Results: A total of 14 studies were included in this scoping review. Most studies (8/14, 57.1%%) collected data from a single source, and 10 (71.4%) used specialized health care social networks and forums. The analytical methods used in these studies varied considerably. Three studies (21.4%) manually annotated posts, while 5 (35.7%) adopted machine learning algorithms. Nine studies (64.2%) concluded that social media could detect signals 3 months to 9 years before action from regulatory authorities. Most of these studies (8/9, 88.9%) were conducted on specialized health care social networks and forums. On the contrary, 5 (35.7%) studies yielded modest or negative results. Of these, 2 (40%) used generic social networking sites, 2 (40%) used specialized health care networks and forums, and 1 (20%) used both generic social networking sites and specialized health care social networks and forums. The most recently published study recommends not using social media for pharmacovigilance. Several challenges remain in using social media for pharmacovigilance regarding coverage, data quality, and analytic processing. Conclusions: Social media, along with conventional pharmacovigilance measures, can be used to detect signals associated with new black box warnings, labeling changes, or withdrawals. Several challenges remain; however, social media will be useful for signal detection of frequently mentioned drugs in specialized health care social networks and forums. Further studies are required to advance natural language processing and mine real-world data on social media. %M 34185021 %R 10.2196/30137 %U https://publichealth.jmir.org/2021/6/e30137 %U https://doi.org/10.2196/30137 %U http://www.ncbi.nlm.nih.gov/pubmed/34185021 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e24353 %T Virtual Engagement in a Social Media Community of Mothers With Substance Use Disorders: Content Analysis %A Mazel,Shayna %A Zisman-Ilani,Yaara %A Hennig,Shannon %A Garnick,Deborah %A Nicholson,Joanne %+ Heller School for Social Policy and Management, Brandeis University, 415 South Street, Mailstop 035, Waltham, MA, 02454-9110, United States, 1 (781) 736 3820, mazel@brandeis.edu %K virtual engagement %K virtual community participation %K social media %K mental health %K opioids %K substance use %D 2021 %7 24.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Co-occurring substance use disorder is common among pregnant and parenting women with mental illness, but their engagement with and utilization of relevant services and treatment is low. Social media has the potential to convey benefits and facilitate engagement among this target group. Objective: This study aimed to explore the reach and engagement of specific social media posts among pregnant women and mothers with substance use disorders. Methods: Eighteen posts providing content related to substance use (cannabis, opioids, or alcohol), varying in type of content (informational or experiential) and target (policy-, practice-, or perception-related), were posted in a closed Facebook community page comprising over 33,000 pregnant women and mothers between May 2019 and October 2019. Results: The overall level of reach of these Facebook posts ranged from 453 to 3045 community members. Engagement levels, measured via the number of likes, comments, or posts shared, varied based on the type of post content (ie, informational or experiential). Conclusions: Participation in a virtual community via social media platforms can facilitate engagement among pregnant women and mothers with mental illness by communicating relevant information about substance use, as well as potentially promoting awareness of, access to, and engagement with treatment services. %M 34184993 %R 10.2196/24353 %U https://formative.jmir.org/2021/6/e24353/ %U https://doi.org/10.2196/24353 %U http://www.ncbi.nlm.nih.gov/pubmed/34184993 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e23105 %T Using Machine Learning to Compare Provaccine and Antivaccine Discourse Among the Public on Social Media: Algorithm Development Study %A Argyris,Young Anna %A Monu,Kafui %A Tan,Pang-Ning %A Aarts,Colton %A Jiang,Fan %A Wiseley,Kaleigh Anne %+ Michigan State University, 404 Wilson Road, East Lansing, MI, 48823, United States, 1 517 353 2198, argyris@msu.edu %K antivaccination movement %K Twitter messaging %K public health informatics %K supervised machine learning algorithm %K unsupervised machine learning algorithm %K qualitative content analysis %K data visualization %K infodemiology %K infodemic %K health misinformation %K infoveillance %K social listening %D 2021 %7 24.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite numerous counteracting efforts, antivaccine content linked to delays and refusals to vaccinate has grown persistently on social media, while only a few provaccine campaigns have succeeded in engaging with or persuading the public to accept immunization. Many prior studies have associated the diversity of topics discussed by antivaccine advocates with the public’s higher engagement with such content. Nonetheless, a comprehensive comparison of discursive topics in pro- and antivaccine content in the engagement-persuasion spectrum remains unexplored. Objective: We aimed to compare discursive topics chosen by pro- and antivaccine advocates in their attempts to influence the public to accept or reject immunization in the engagement-persuasion spectrum. Our overall objective was pursued through three specific aims as follows: (1) we classified vaccine-related tweets into provaccine, antivaccine, and neutral categories; (2) we extracted and visualized discursive topics from these tweets to explain disparities in engagement between pro- and antivaccine content; and (3) we identified how those topics frame vaccines using Entman’s four framing dimensions. Methods: We adopted a multimethod approach to analyze discursive topics in the vaccine debate on public social media sites. Our approach combined (1) large-scale balanced data collection from a public social media site (ie, 39,962 tweets from Twitter); (2) the development of a supervised classification algorithm for categorizing tweets into provaccine, antivaccine, and neutral groups; (3) the application of an unsupervised clustering algorithm for identifying prominent topics discussed on both sides; and (4) a multistep qualitative content analysis for identifying the prominent discursive topics and how vaccines are framed in these topics. In so doing, we alleviated methodological challenges that have hindered previous analyses of pro- and antivaccine discursive topics. Results: Our results indicated that antivaccine topics have greater intertopic distinctiveness (ie, the degree to which discursive topics are distinct from one another) than their provaccine counterparts (t122=2.30, P=.02). In addition, while antivaccine advocates use all four message frames known to make narratives persuasive and influential, provaccine advocates have neglected having a clear problem statement. Conclusions: Based on our results, we attribute higher engagement among antivaccine advocates to the distinctiveness of the topics they discuss, and we ascribe the influence of the vaccine debate on uptake rates to the comprehensiveness of the message frames. These results show the urgency of developing clear problem statements for provaccine content to counteract the negative impact of antivaccine content on uptake rates. %M 34185004 %R 10.2196/23105 %U https://publichealth.jmir.org/2021/6/e23105/ %U https://doi.org/10.2196/23105 %U http://www.ncbi.nlm.nih.gov/pubmed/34185004 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27853 %T Facebook Users’ Interactions, Organic Reach, and Engagement in a Smoking Cessation Intervention: Content Analysis %A Pócs,Dávid %A Adamovits,Otília %A Watti,Jezdancher %A Kovács,Róbert %A Kelemen,Oguz %+ Department of Behavioral Sciences, Faculty of Medicine, University of Szeged, Szentháromság u. 5, Szeged, 6722, Hungary, 36 62 420 530, drpocsdavid@gmail.com %K smoking %K smoking cessation %K behavior %K health behavior %K internet %K social media %K love %K comment %K motivation %K language %K public health %D 2021 %7 21.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Facebook can be a suitable platform for public health interventions. Facebook users can express their reaction to the given social media content in many ways using interaction buttons. The analysis of these interactions can be advantageous in increasing reach and engagement of public health interventions. Objective: This research aimed at understanding how Facebook users’ interactions correlate with organic reach and engagement regarding the same smoking cessation support contents. Methods: The study population consisted of Facebook users who were reached by a public smoking cessation support page without advertising. We included 1025 nonpaid Facebook posts (N=1025) which used smoking cessation strategies based on a motivational interviewing counseling style. The following data were collected from the “Post Details”: the number of people who saw the given nonpaid content (organic reach) which consisted of fan and nonfan reach according to previous “page like” activity; each rate of “engagement indicators” (such as the symbols of “like,” “love,” “haha,” “wow,” “sad,” “angry”; or other interactions: “shares,” “comments,” “clicks”); and the rate of negative Facebook interactions (eg, “post hides” or “unlike of page”). Overall, these data were analyzed with the Spearman correlation method. Results: Surprisingly, we found a significant negative correlation between organic reach and the “like” reaction (rs=–0.418; P<.001). The strongest significant positive correlations of organic reach were observed with the “haha” reaction (rs=0.396; P<.001), comments (rs=0.368; P<.001), and the “love” reaction (rs=0.264; P<.001). Furthermore, nonfan reach correlated positively with “shares” (rs=0.388; P<.001) and clicks (rs=0.135; P<.001), while fan reach correlated positively with the “haha” reaction (rs=0.457; P<.001), comments (rs=0.393; P<.001), and the “love” reaction (rs=0.310; P<.001). Contrary to expectations, the “like” reaction was sharply separated by significant negative correlations from “wow” (rs=–0.077; P=.013), “sad” (rs=–0.120; P<.001), “angry” reactions (rs=–0.136; P<.001), and comments (rs=–0.130; P<.001). Additionally, a high rate of negative Facebook interactions was significantly associated with “wow” (rs=0.076; P=.016) and “sad” reactions (rs=0.091; P=.003). Conclusions: This study has shown that it is possible to hypothesize a disadvantage of the “like” reaction and advantages of other interactions (eg, the “haha” reaction or “comments”) in content algorithmic ranking on Facebook. In addition, the correlational analysis revealed a need of a further categorization to fan-specific interactions (eg, “haha” or “love” reactions) and nonfan-specific interactions (eg, “shares” and “clicks”). Regarding the direction of the correlations, these findings suggest that some interactions (eg, negative Facebook interactions, “wow,” “sad,” and “angry” reactions) may decrease the engagement, while other interactions (“like,” “love,” “haha” reactions, “shares,” and “clicks”) may increase the engagement during Facebook-based smoking cessation interventions. This hypothesis-generating research offers an important insight into the relationship between organic reach, engagement, and Facebook users’ interactions for public health professionals who design Facebook-based interventions. %M 34152280 %R 10.2196/27853 %U https://www.jmir.org/2021/6/e27853 %U https://doi.org/10.2196/27853 %U http://www.ncbi.nlm.nih.gov/pubmed/34152280 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e28648 %T Language and Sentiment Regarding Telemedicine and COVID-19 on Twitter: Longitudinal Infodemiology Study %A Pollack,Catherine C %A Gilbert-Diamond,Diane %A Alford-Teaster,Jennifer A %A Onega,Tracy %+ Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03766, United States, 1 540 497 3419, Catherine.c.pollack.gr@dartmouth.edu %K telemedicine %K telehealth %K COVID-19 pandemic %K social media %K sentiment analysis %K Twitter %K COVID-19 %K pandemic %D 2021 %7 21.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has necessitated a rapid shift in how individuals interact with and receive fundamental services, including health care. Although telemedicine is not a novel technology, previous studies have offered mixed opinions surrounding its utilization. However, there exists a dearth of research on how these opinions have evolved over the course of the current pandemic. Objective: This study aims to evaluate how the language and sentiment surrounding telemedicine has evolved throughout the COVID-19 pandemic. Methods: Tweets published between January 1, 2020, and April 24, 2021, containing at least one telemedicine-related and one COVID-19–related search term (“telemedicine-COVID”) were collected from the Twitter full archive search (N=351,718). A comparator sample containing only COVID-19 terms (“general-COVID”) was collected and sampled based on the daily distribution of telemedicine-COVID tweets. In addition to analyses of retweets and favorites, sentiment analysis was performed on both data sets in aggregate and within a subset of tweets receiving the top 100 most and least retweets. Results: Telemedicine gained prominence during the early stages of the pandemic (ie, March through May 2020) before leveling off and reaching a steady state from June 2020 onward. Telemedicine-COVID tweets had a 21% lower average number of retweets than general-COVID tweets (incidence rate ratio 0.79, 95% CI 0.63-0.99; P=.04), but there was no difference in favorites. A majority of telemedicine-COVID tweets (180,295/351,718, 51.3%) were characterized as “positive,” compared to only 38.5% (135,434/351,401) of general-COVID tweets (P<.001). This trend was also true on a monthly level from March 2020 through April 2021. The most retweeted posts in both telemedicine-COVID and general-COVID data sets were authored by journalists and politicians. Whereas the majority of the most retweeted posts within the telemedicine-COVID data set were positive (55/101, 54.5%), a plurality of the most retweeted posts within the general-COVID data set were negative (44/89, 49.4%; P=.01). Conclusions: During the COVID-19 pandemic, opinions surrounding telemedicine evolved to become more positive, especially when compared to the larger pool of COVID-19–related tweets. Decision makers should capitalize on these shifting public opinions to invest in telemedicine infrastructure and ensure its accessibility and success in a postpandemic world. %M 34086591 %R 10.2196/28648 %U https://www.jmir.org/2021/6/e28648 %U https://doi.org/10.2196/28648 %U http://www.ncbi.nlm.nih.gov/pubmed/34086591 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24458 %T Receptiveness and Responsiveness Toward Using Social Media for Safe Firearm Storage Outreach: Mixed Methods Study %A Lam,Esther %A Moreno,Megan %A Bennett,Elizabeth %A Rowhani-Rahbar,Ali %+ Department of Epidemiology, School of Public Health, University of Washington, UW Box #351619, Seattle, WA, 98195, United States, 1 4088901256, estherwmlam@gmail.com %K firearm storage %K gun safety %K public health outreach %K social media %K mixed methods %K family %D 2021 %7 18.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Childhood and adolescent firearm injury and death rates have increased over the past decade and remain major public health concerns in the United States. Safe firearm storage has proven to be an effective measure to prevent firearm injury and death among youth. Social media has been used as an avenue to promote safe firearm storage, but perceptions of this tool remain unknown. Objective: The aim of this study was to determine receptiveness and responsiveness in promoting firearm lock box and trigger lock giveaway events on social media, and to describe the characteristics of participants who learned of these events through social media. Methods: We performed a mixed methods study combining a content analysis of Facebook event post comments, quantitative analysis of positive and negative feedback on social media, and a descriptive analysis of event participant characteristics. Through a qualitative content analysis approach, we thematically coded comments from each event’s social media page posting. Interrater reliability and κ statistics were calculated. We calculated the prevalence of positive and negative feedback data. Further, we calculated descriptive statistics for demographic characteristics gathered from day-of-event intake surveys. Differences between collected measures were analyzed with χ2 and t tests according to how the participant found out about the event (social media vs other means). Using concurrent analysis, we synthesized the results from both the qualitative and quantitative aims. Results: Through qualitative content analysis, 414 comments from 13 events were coded. Seven themes emerged through the comment coding process with the most common being “positive receptiveness” (294/414, 71.0%). From quantitative analysis of the social media content, we found higher levels of positive feedback compared to negative feedback. The average number of event post “likes” was 1271.3 per event, whereas the average count in which “hide post” was clicked was 72.3 times per event. Overall, 35.9% (1457/4054) of participants found out about the event through social media. The participants who learned about the event through social media were on average significantly younger than those who learned about the event through other means (–6.4 years, 95% CI –5.5 to –7.3). Among the group that learned of the event through social media, 43.9% (629/1433) identified as female, whereas 35.5% (860/2420) identified as female among the group that learned of the event through other means. Conclusions: There was overall positive receptiveness and responsiveness toward firearm lock box and trigger lock giveaway events when promoted on social media. Compared with other promotional tools, social media has the ability to reach those who are younger and those who identify as female. Future studies should extend this research to determine whether there is a difference between rural and urban settings, and consider other social media platforms in the analysis. %M 34142974 %R 10.2196/24458 %U https://www.jmir.org/2021/6/e24458 %U https://doi.org/10.2196/24458 %U http://www.ncbi.nlm.nih.gov/pubmed/34142974 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e27976 %T Public Discussion of Anthrax on Twitter: Using Machine Learning to Identify Relevant Topics and Events %A Miller,Michele %A Romine,William %A Oroszi,Terry %+ Department of Pharmacology & Toxicology, Wright State University, 3640 Colonel Glenn Hwy, Dayton, OH, 45435, United States, 1 (937) 775 1000, millerme91@gmail.com %K anthrax %K big data %K internet %K infodemiology %K infoveillance %K social listening %K digital health %K biological weapon %K terrorism %K Federal Bureau of Investigation %K machine learning %K public health threat %K Twitter %D 2021 %7 18.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media allows researchers to study opinions and reactions to events in real time. One area needing more study is anthrax-related events. A computational framework that utilizes machine learning techniques was created to collect tweets discussing anthrax, further categorize them as relevant by the month of data collection, and detect discussions on anthrax-related events. Objective: The objective of this study was to detect discussions on anthrax-related events and to determine the relevance of the tweets and topics of discussion over 12 months of data collection. Methods: This is an infoveillance study, using tweets in English containing the keyword “Anthrax” and “Bacillus anthracis”, collected from September 25, 2017, through August 15, 2018. Machine learning techniques were used to determine what people were tweeting about anthrax. Data over time was plotted to determine whether an event was detected (a 3-fold spike in tweets). A machine learning classifier was created to categorize tweets by relevance to anthrax. Relevant tweets by month were examined using a topic modeling approach to determine the topics of discussion over time and how these events influence that discussion. Results: Over the 12 months of data collection, a total of 204,008 tweets were collected. Logistic regression analysis revealed the best performance for relevance (precision=0.81; recall=0.81; F1-score=0.80). In total, 26 topics were associated with anthrax-related events, tweets that were highly retweeted, natural outbreaks, and news stories. Conclusions: This study shows that tweets related to anthrax can be collected and analyzed over time to determine what people are discussing and to detect key anthrax-related events. Future studies are required to focus only on opinion tweets, use the methodology to study other terrorism events, or to monitor for terrorism threats. %M 34142975 %R 10.2196/27976 %U https://publichealth.jmir.org/2021/6/e27976 %U https://doi.org/10.2196/27976 %U http://www.ncbi.nlm.nih.gov/pubmed/34142975 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e27140 %T Indications of Depressive Symptoms During the COVID-19 Pandemic in Germany: Comparison of National Survey and Twitter Data %A Cohrdes,Caroline %A Yenikent,Seren %A Wu,Jiawen %A Ghanem,Bilal %A Franco-Salvador,Marc %A Vogelgesang,Felicitas %+ Mental Health Research Unit, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, Berlin, 12101, Germany, 49 30 18754 2692, CohrdesC@rki.de %K depressive symptoms %K GEDA/EHIS survey %K Twitter %K COVID-19 %K pandemic %K social contact ban %K temporal progression %K data correspondence %K public mental health surveillance %K depression %K survey %K social media %K data %K infodemiology %K infoveillance %K twitter %K mental health %K public health %K surveillance %K monitoring %K symptom %D 2021 %7 18.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The current COVID-19 pandemic is associated with extensive individual and societal challenges, including challenges to both physical and mental health. To date, the development of mental health problems such as depressive symptoms accompanying population-based federal distancing measures is largely unknown, and opportunities for rapid, effective, and valid monitoring are currently a relevant matter of investigation. Objective: In this study, we aim to investigate, first, the temporal progression of depressive symptoms during the COVID-19 pandemic and, second, the consistency of the results from tweets and survey-based self-reports of depressive symptoms within the same time period. Methods: Based on a cross-sectional population survey of 9011 German adolescents and adults (n=4659, 51.7% female; age groups from 15 to 50 years and older) and a sample of 88,900 tweets (n=74,587, 83.9% female; age groups from 10 to 50 years and older), we investigated five depressive symptoms (eg, depressed mood and energy loss) using items from the Patient Health Questionnaire (PHQ-8) before, during, and after relaxation of the first German social contact ban from January to July 2020. Results: On average, feelings of worthlessness were the least frequently reported symptom (survey: n=1011, 13.9%; Twitter: n=5103, 5.7%) and fatigue or loss of energy was the most frequently reported depressive symptom (survey: n=4472, 51.6%; Twitter: n=31,005, 34.9%) among both the survey and Twitter respondents. Young adult women and people living in federal districts with high COVID-19 infection rates were at an increased risk for depressive symptoms. The comparison of the survey and Twitter data before and after the first contact ban showed that German adolescents and adults had a significant decrease in feelings of fatigue and energy loss over time. The temporal progression of depressive symptoms showed high correspondence between both data sources (ρ=0.76-0.93; P<.001), except for diminished interest and depressed mood, which showed a steady increase even after the relaxation of the contact ban among the Twitter respondents but not among the survey respondents. Conclusions: Overall, the results indicate relatively small differences in depressive symptoms associated with social distancing measures during the COVID-19 pandemic and highlight the need to differentiate between positive (eg, energy level) and negative (eg, depressed mood) associations and variations over time. The results also underscore previous suggestions of Twitter data’s potential to help identify hot spots of declining and improving public mental health and thereby help provide early intervention measures, especially for young and middle-aged adults. Further efforts are needed to investigate the long-term consequences of recurring lockdown phases and to address the limitations of social media data such as Twitter data to establish real-time public mental surveillance approaches. %M 34142973 %R 10.2196/27140 %U https://mental.jmir.org/2021/6/e27140 %U https://doi.org/10.2196/27140 %U http://www.ncbi.nlm.nih.gov/pubmed/34142973 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e15551 %T Typology and Impact of YouTube Videos Posted in Response to a Student Suicide Crisis: Social Media Metrics and Content Analyses %A Cheng,Qijin %A Lui,Carrie %A Ip,Flora Wai Lam %A Yip,Paul Siu Fai %+ Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 2/F, 5 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 28315232, sfpyip@hku.hk %K suicide %K suicide prevention %K social media %K infodemiology %K internet %K digital health %K YouTube %K impact evaluation %K network visualization %D 2021 %7 18.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Videos relating to suicide are available on YouTube, but their characteristics and impacts have seldom been examined. Objective: This study aimed to examine YouTube videos posted in response to a sudden spate of student suicides in Hong Kong during the 2015-2016 school year and evaluate the impacts of those videos. Methods: Keyword search was performed on YouTube, and relevant videos were identified. Video typology was examined through content analysis, specifically grouping the videos by who uploaded the videos, what presentation formats were used in the videos, whether the videos were originally created by the uploaders, and whether the videos disclosed the uploaders’ personal experiences with suicide. Impacts of the videos were assessed in terms of reach (measured by view count), engagement (measured by comment count), and insights (measured as to what extent the comments to each video could reveal personal suicide risk and attitude toward help-seeking). Statistical analysis was conducted to compare the impacts of different types of videos. The 7 most impactful videos that were originally created by the YouTubers were selected for further analysis. They were compared with 7 videos uploaded by the same YouTubers right before the student suicide videos and 7 right after the student suicide videos. The comparison focused on their impacts and the network structure of the comments to those videos. Results: A total of 162 relevant YouTube videos were identified. They were uploaded by 7 types of stakeholders, and the most common format was one person talking to the camera. A total of 87.0% (141/162) of the videos were originally created by the uploaders and only 8.0% (13/162) of the videos disclosed uploader personal experiences with suicide. The uploader profiles being popular or top YouTubers and the video containing disclosure of the uploader’s personal experiences were found to be significantly correlated with greater impacts (P<.001). Focusing on the 7 most impactful original videos, it is found that those videos generated more engagement, especially more interactions between the viewers, and more insights than regular videos uploaded by the same YouTubers. Conclusions: When responding to a youth suicide crisis, videos made by key opinion leaders on YouTube sharing their own experiences of overcoming suicide risks could generate significant positive impacts. These types of videos offer a precious opportunity to craft online campaigns and activities to raise suicide prevention awareness and engage vulnerable youth. %R 10.2196/15551 %U https://mental.jmir.org/2021/6/e15551/ %U https://doi.org/10.2196/15551 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e29802 %T Health Information Seeking Behaviors on Social Media During the COVID-19 Pandemic Among American Social Networking Site Users: Survey Study %A Neely,Stephen %A Eldredge,Christina %A Sanders,Ron %+ School of Public Affairs, College of Arts and Sciences, University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, United States, 1 8139748423, srneely@usf.edu %K social media %K internet %K communication %K public health %K COVID-19 %K usage %K United States %K information seeking %K web-based health information %K survey %K mistrust %D 2021 %7 11.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, medical journals have emphasized the increasingly critical role that social media plays in the dissemination of public health information and disease prevention guidelines. However, platforms such as Facebook and Twitter continue to pose unique challenges for clinical health care providers and public health officials alike. In order to effectively communicate during public health emergencies, such as the COVID-19 pandemic, it is increasingly critical for health care providers and public health officials to understand how patients gather health-related information on the internet and adjudicate the merits of such information. Objective: With that goal in mind, we conducted a survey of 1003 US-based adults to better understand how health consumers have used social media to learn and stay informed about the COVID-19 pandemic, the extent to which they have relied on credible scientific information sources, and how they have gone about fact-checking pandemic-related information. Methods: A web-based survey was conducted with a sample that was purchased through an industry-leading market research provider. The results were reported with a 95% confidence level and a margin of error of 3. Participants included 1003 US-based adults (aged ≥18 years). Participants were selected via a stratified quota sampling approach to ensure that the sample was representative of the US population. Balanced quotas were determined (by region of the country) for gender, age, race, and ethnicity. Results: The results showed a heavy reliance on social media during the COVID-19 pandemic; more than three-quarters of respondents (762/1003, 76%) reported that they have relied on social media at least “a little,” and 59.2% (594/1003) of respondents indicated that they read information about COVID-19 on social media at least once per week. According to the findings, most social media users (638/1003, 63.6%) were unlikely to fact-check what they see on the internet with a health professional, despite the high levels of mistrust in the accuracy of COVID-19–related information on social media. We also found a greater likelihood of undergoing vaccination among those following more credible scientific sources on social media during the pandemic (χ216=50.790; φ=0.258; P<.001). Conclusions: The findings suggest that health professionals will need to be both strategic and proactive when engaging with health consumers on social media if they hope to counteract the deleterious effects of misinformation and disinformation. Effective training, institutional support, and proactive collaboration can help health professionals adapt to the evolving patterns of health information seeking. %M 34043526 %R 10.2196/29802 %U https://www.jmir.org/2021/6/e29802 %U https://doi.org/10.2196/29802 %U http://www.ncbi.nlm.nih.gov/pubmed/34043526 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27632 %T Assessing COVID-19 Vaccine Hesitancy, Confidence, and Public Engagement: A Global Social Listening Study %A Hou,Zhiyuan %A Tong,Yixin %A Du,Fanxing %A Lu,Linyao %A Zhao,Sihong %A Yu,Kexin %A Piatek,Simon J %A Larson,Heidi J %A Lin,Leesa %+ School of Public Health, Fudan University, Mailbox 250, 138# Yixueyuan Road, Xuhui District, Shanghai, 200030, China, 86 2133563935, zyhou@fudan.edu.cn %K COVID-19 vaccine %K hesitancy %K infoveillance %K infodemiology %K confidence %K acceptance %K engagement %K social media %K COVID-19 %D 2021 %7 11.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Monitoring public confidence and hesitancy is crucial for the COVID-19 vaccine rollout. Social media listening (infoveillance) can not only monitor public attitudes on COVID-19 vaccines but also assess the dissemination of and public engagement with these opinions. Objective: This study aims to assess global hesitancy, confidence, and public engagement toward COVID-19 vaccination. Methods: We collected posts mentioning the COVID-19 vaccine between June and July 2020 on Twitter from New York (United States), London (United Kingdom), Mumbai (India), and Sao Paulo (Brazil), and Sina Weibo posts from Beijing (China). In total, we manually coded 12,886 posts from the five global metropolises with high COVID-19 burdens, and after assessment, 7032 posts were included in the analysis. We manually double-coded these posts using a coding framework developed according to the World Health Organization’s Confidence, Complacency, and Convenience model of vaccine hesitancy, and conducted engagement analysis to investigate public communication about COVID-19 vaccines on social media. Results: Among social media users, 36.4% (571/1568) in New York, 51.3% (738/1440) in London, 67.3% (144/214) in Sao Paulo, 69.8% (726/1040) in Mumbai, and 76.8% (2128/2770) in Beijing indicated that they intended to accept a COVID-19 vaccination. With a high perceived risk of getting COVID-19, more tweeters in New York and London expressed a lack of confidence in vaccine safety, distrust in governments and experts, and widespread misinformation or rumors. Tweeters from Mumbai, Sao Paulo, and Beijing worried more about vaccine production and supply, whereas tweeters from New York and London had more concerns about vaccine distribution and inequity. Negative tweets expressing lack of vaccine confidence and misinformation or rumors had more followers and attracted more public engagement online. Conclusions: COVID-19 vaccine hesitancy is prevalent worldwide, and negative tweets attract higher engagement on social media. It is urgent to develop an effective vaccine campaign that boosts public confidence and addresses hesitancy for COVID-19 vaccine rollouts. %M 34061757 %R 10.2196/27632 %U https://www.jmir.org/2021/6/e27632 %U https://doi.org/10.2196/27632 %U http://www.ncbi.nlm.nih.gov/pubmed/34061757 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e29528 %T Community Mitigation of COVID-19 and Portrayal of Testing on TikTok: Descriptive Study %A Basch,Corey H %A Mohlman,Jan %A Fera,Joseph %A Tang,Hao %A Pellicane,Alessia %A Basch,Charles E %+ Department of Public Health, William Paterson University, University Hall, Wayne, NJ, 07470, United States, 1 9737202603, baschc@wpunj.edu %K TikTok %K social media %K COVID-19 %K testing %K disgust %K anxiety %K content analysis %K communication %K infodemiology %K infoveillance %K public health %K digital public health %K digital health %K community mitigation %D 2021 %7 10.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 testing remains an essential element of a comprehensive strategy for community mitigation. Social media is a popular source of information about health, including COVID-19 and testing information. One of the most popular communication channels used by adolescents and young adults who search for health information is TikTok—an emerging social media platform. Objective: The purpose of this study was to describe TikTok videos related to COVID-19 testing. Methods: The hashtag #covidtesting was searched, and the first 100 videos were included in the study sample. At the time the sample was drawn, these 100 videos garnered more than 50% of the views for all videos cataloged under the hashtag #covidtesting. The content characteristics that were coded included mentions, displays, or suggestions of anxiety, COVID-19 symptoms, quarantine, types of tests, results of test, and disgust/unpleasantness. Additional data that were coded included the number and percentage of views, likes, and comments and the use of music, dance, and humor. Results: The 100 videos garnered more than 103 million views; 111,000 comments; and over 12.8 million likes. Even though only 44 videos mentioned or suggested disgust/unpleasantness and 44 mentioned or suggested anxiety, those that portrayed tests as disgusting/unpleasant garnered over 70% of the total cumulative number of views (73,479,400/103,071,900, 71.29%) and likes (9,354,691/12,872,505, 72.67%), and those that mentioned or suggested anxiety attracted about 60% of the total cumulative number of views (61,423,500/103,071,900, 59.59%) and more than 8 million likes (8,339,598/12,872,505, 64.79%). Independent one-tailed t tests (α=.05) revealed that videos that mentioned or suggested that COVID-19 testing was disgusting/unpleasant were associated with receiving a higher number of views and likes. Conclusions: Our finding of an association between TikTok videos that mentioned or suggested that COVID-19 tests were disgusting/unpleasant and these videos’ propensity to garner views and likes is of concern. There is a need for public health agencies to recognize and address connotations of COVID-19 testing on social media. %M 34081591 %R 10.2196/29528 %U https://publichealth.jmir.org/2021/6/e29528 %U https://doi.org/10.2196/29528 %U http://www.ncbi.nlm.nih.gov/pubmed/34081591 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e26043 %T Age-Related Differences in Experiences With Social Distancing at the Onset of the COVID-19 Pandemic: A Computational and Content Analytic Investigation of Natural Language From a Social Media Survey %A Moore,Ryan C %A Lee,Angela Y %A Hancock,Jeffrey T %A Halley,Meghan C %A Linos,Eleni %+ Department of Communication, Stanford University, 450 Jane Stanford Way, Building 120, Room 110, Stanford, CA, 94305, United States, 1 650 723 5499, hancockj@stanford.edu %K COVID-19 %K natural language processing %K public health messaging %K social distancing compliance %K age differences %K older adults %K younger adults %K age %K NLP %K public health %K elderly %K youth %K adult %K emotion %K compliance %K guideline %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: As COVID-19 poses different levels of threat to people of different ages, health communication regarding prevention measures such as social distancing and isolation may be strengthened by understanding the unique experiences of various age groups. Objective: The aim of this study was to examine how people of different ages (1) experienced the impact of the COVID-19 pandemic and (2) their respective rates and reasons for compliance or noncompliance with social distancing and isolation health guidance. Methods: We fielded a survey on social media early in the pandemic to examine the emotional impact of COVID-19 and individuals’ rates and reasons for noncompliance with public health guidance, using computational and content analytic methods of linguistic analysis. Results: A total of 17,287 participants were surveyed. The majority (n=13,183, 76.3%) were from the United States. Younger (18-31 years), middle-aged (32-44 years and 45-64 years), and older (≥65 years) individuals significantly varied in how they described the impact of COVID-19 on their lives, including their emotional experience, self-focused attention, and topical concerns. Younger individuals were more emotionally negative and self-focused, while middle-aged people were other-focused and concerned with family. The oldest and most at-risk group was most concerned with health-related terms but were lower in anxiety (use of fewer anxiety-related terms) and higher in the use of emotionally positive terms than the other less at-risk age groups. While all groups discussed topics such as acquiring essential supplies, they differentially experienced the impact of school closures and limited social interactions. We also found relatively high rates of noncompliance with COVID-19 prevention measures, such as social distancing and self-isolation, with younger people being more likely to be noncompliant than older people (P<.001). Among the 43.1% (n=7456) of respondents who did not fully comply with health orders, people differed substantially in the reasons they gave for noncompliance. The most common reason for noncompliance was not being able to afford to miss work (n=4273, 57.3%). While work obligations proved challenging for participants across ages, younger people struggled more to find adequate space to self-isolate and manage their mental and physical health; middle-aged people had more concerns regarding childcare; and older people perceived themselves as being able to take sufficient precautions. Conclusions: Analysis of natural language can provide insight into rapidly developing public health challenges like the COVID-19 pandemic, uncovering individual differences in emotional experiences and health-related behaviors. In this case, our analyses revealed significant differences between different age groups in feelings about and responses to public health orders aimed to mitigate the spread of COVID-19. To improve public compliance with health orders as the pandemic continues, health communication strategies could be made more effective by being tailored to these age-related differences. %M 33914689 %R 10.2196/26043 %U https://humanfactors.jmir.org/2021/2/e26043 %U https://doi.org/10.2196/26043 %U http://www.ncbi.nlm.nih.gov/pubmed/33914689 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25579 %T Topics of Nicotine-Related Discussions on Twitter: Infoveillance Study %A Allem,Jon-Patrick %A Dormanesh,Allison %A Majmundar,Anuja %A Unger,Jennifer B %A Kirkpatrick,Matthew G %A Choube,Akshat %A Aithal,Aneesh %A Ferrara,Emilio %A Boley Cruz,Tess %+ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N Soto Street, 3rd Floor, SSB 312D, Los Angeles, CA, 90032, United States, 1 323 442 7921, allem@usc.edu %K nicotine %K electronic cigarettes %K Twitter %K social media %K social bots %K cessation %D 2021 %7 7.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Cultural trends in the United States, the nicotine consumer marketplace, and tobacco policies are changing. Objective: The goal of this study was to identify and describe nicotine-related topics of conversation authored by the public and social bots on Twitter, including any misinformation or misconceptions that health education campaigns could potentially correct. Methods: Twitter posts containing the term “nicotine” were obtained from September 30, 2018 to October 1, 2019. Methods were used to distinguish between posts from social bots and nonbots. Text classifiers were used to identify topics in posts (n=300,360). Results: Prevalent topics of posts included vaping, smoking, addiction, withdrawal, nicotine health risks, and quit nicotine, with mentions of going “cold turkey” and needing help in quitting. Cessation was a common topic, with mentions of quitting and stopping smoking. Social bots discussed unsubstantiated health claims including how hypnotherapy, acupuncture, magnets worn on the ears, and time spent in the sauna can help in smoking cessation. Conclusions: Health education efforts are needed to correct unsubstantiated health claims on Twitter and ultimately direct individuals who want to quit smoking to evidence-based cessation strategies. Future interventions could be designed to follow these topics of discussions on Twitter and engage with members of the public about evidence-based cessation methods in near real time when people are contemplating cessation. %M 34096875 %R 10.2196/25579 %U https://www.jmir.org/2021/6/e25579 %U https://doi.org/10.2196/25579 %U http://www.ncbi.nlm.nih.gov/pubmed/34096875 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e26481 %T YouTube Videos Related to the Fukushima Nuclear Disaster: Content Analysis %A Cui,Limeng %A Chu,Lijuan %+ Department of Radiation Protection, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, No 16 Hepinglizhongjie, Dongcheng, Beijing, , China, 86 13910742374, cuilimeng1103@sina.com %K YouTube %K Fukushima nuclear disaster %K social media %K risk communication %K disaster %K video platform %K radiation %K public safety %K nuclear disaster %D 2021 %7 7.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: YouTube (Alphabet Incorporated) has become the most popular video-sharing platform in the world. The Fukushima Daiichi Nuclear Power Plant (FDNPP) disaster resulted in public anxiety toward nuclear power and radiation worldwide. YouTube is an important source of information about the FDNPP disaster for the world. Objective: This study's objectives were to examine the characteristics of YouTube videos related to the FDNPP disaster, analyze the content and comments of videos with a quantitative method, and determine which features contribute to making a video popular with audiences. This study is the first to examine FDNPP disaster–related videos on YouTube. Methods: We searched for the term “Fukushima nuclear disaster” on YouTube on November 2, 2019. The first 60 eligible videos in the relevance, upload date, view count, and rating categories were recorded. Videos that were irrelevant, were non-English, had inappropriate words, were machine synthesized, and were <3 minutes long were excluded. In total, 111 videos met the inclusion criteria. Parameters of the videos, including the number of subscribers, length, the number of days since the video was uploaded, region, video popularity (views, views/day, likes, likes/day, dislikes, dislikes/day, comments, comments/day), the tone of the videos, the top ten comments, affiliation, whether Japanese people participated in the video, whether the video recorder visited Fukushima, whether the video contained theoretical knowledge, and whether the video contained information about the recent situation in Fukushima, were recorded. By using criteria for content and technical design, two evaluators scored videos and grouped them into the useful (score: 11-14), slightly useful (score: 6-10), and useless (score: 0-5) video categories. Results: Of the 111 videos, 43 (38.7%) videos were useful, 43 (38.7%) were slightly useful, and 25 (22.5%) were useless. Useful videos had good visual and aural effects, provided vivid information on the Fukushima disaster, and had a mean score of 12 (SD 0.9). Useful videos had more views per day (P<.001), likes per day (P<.001), and comments per day (P=.02) than useless and slightly useful videos. The popularity of videos had a significant correlation with clear sounds (likes/day: P=.001; comments/day: P=.02), vivid information (likes/day: P<.001; comments/day: P=.007), understanding content (likes/day: P=.001; comments/day: P=.04). There was no significant difference in likes per day (P=.72) and comments per day (P=.11) between negative and neutral- and mixed-tone videos. Videos about the recent situation in Fukushima had more likes and comments per day. Video recorders who personally visited Fukushima Prefecture had more subscribers and received more views and likes. Conclusions: The possible features that made videos popular to the public included video quality, videos made in Fukushima, and information on the recent situation in Fukushima. During risk communication on new forms of media, health institutes should increase publicity and be more approachable to resonate with international audiences. %M 34096880 %R 10.2196/26481 %U https://publichealth.jmir.org/2021/6/e26481 %U https://doi.org/10.2196/26481 %U http://www.ncbi.nlm.nih.gov/pubmed/34096880 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24564 %T Characteristics of Antivaccine Messages on Social Media: Systematic Review %A Wawrzuta,Dominik %A Jaworski,Mariusz %A Gotlib,Joanna %A Panczyk,Mariusz %+ Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, ul Żwirki i Wigury 81, Warsaw, 02-091, Poland, 48 225720490, dwawrzuta@wum.edu.pl %K vaccination %K social media %K antivaccination movement %K vaccination refusal %K health communication %K public health %K vaccines %D 2021 %7 4.6.2021 %9 Review %J J Med Internet Res %G English %X Background: Supporters of the antivaccination movement can easily spread information that is not scientifically proven on social media. Therefore, learning more about their posts and activities is instrumental in effectively reacting and responding to the false information they publish, which is aimed at discouraging people from taking vaccines. Objective: This study aims to gather, assess, and synthesize evidence related to the current state of knowledge about antivaccine social media users’ web-based activities. Methods: We systematically reviewed English-language papers from 3 databases (Scopus, Web of Science, and PubMed). A data extraction form was established, which included authors, year of publication, specific objectives, study design, comparison, and outcomes of significance. We performed an aggregative narrative synthesis of the included studies. Results: The search strategy retrieved 731 records in total. After screening for duplicates and eligibility, 18 articles were included in the qualitative synthesis. Although most of the authors analyzed text messages, some of them studied images or videos. In addition, although most of the studies examined vaccines in general, 5 focused specifically on human papillomavirus vaccines, 2 on measles vaccines, and 1 on influenza vaccines. The synthesized studies dealt with the popularity of provaccination and antivaccination content, the style and manner in which messages about vaccines were formulated for the users, a range of topics concerning vaccines (harmful action, limited freedom of choice, and conspiracy theories), and the role and activity of bots in the dissemination of these messages in social media. Conclusions: Proponents of the antivaccine movement use a limited number of arguments in their messages; therefore, it is possible to prepare publications clarifying doubts and debunking the most common lies. Public health authorities should continuously monitor social media to quickly find new antivaccine arguments and then create information campaigns for both health professionals and other users. %M 34085943 %R 10.2196/24564 %U https://www.jmir.org/2021/6/e24564 %U https://doi.org/10.2196/24564 %U http://www.ncbi.nlm.nih.gov/pubmed/34085943 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e19697 %T Adolescent Peer Influence on Eating Behaviors via Social Media: Scoping Review %A Chung,Alicia %A Vieira,Dorice %A Donley,Tiffany %A Tan,Nicholas %A Jean-Louis,Girardin %A Kiely Gouley,Kathleen %A Seixas,Azizi %+ Center for Early Childhood Health and Development, Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street, New York, NY, United States, 1 212 263 1359, alicia.chung@nyumc.org %K social media %K eating behaviors %K adolescent health %D 2021 %7 3.6.2021 %9 Review %J J Med Internet Res %G English %X Background: The influence of social media among adolescent peer groups can be a powerful change agent. Objective: Our scoping review aimed to elucidate the ways in which social media use among adolescent peers influences eating behaviors. Methods: A scoping review of the literature of articles published from journal inception to 2019 was performed by searching PubMed (ie, MEDLINE), Embase, CINAHL, PsycINFO, Web of Science, and other databases. The review was conducted in three steps: (1) identification of the research question and clarification of criteria using the population, intervention, comparison, and outcome (PICO) framework; (2) selection of articles from the literature using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines; and (3) charting and summarizing information from selected articles. PubMed’s Medical Subject Headings (MeSH) and Embase’s Emtree subject headings were reviewed along with specific keywords to construct a comprehensive search strategy. Subject headings and keywords were based on adolescent age groups, social media platforms, and eating behaviors. After screening 1387 peer-reviewed articles, 37 articles were assessed for eligibility. Participant age, gender, study location, social media channels utilized, user volume, and content themes related to findings were extracted from the articles. Results: Six articles met the final inclusion criteria. A final sample size of 1225 adolescents (aged 10 to 19 years) from the United States, the United Kingdom, Sweden, Norway, Denmark, Portugal, Brazil, and Australia were included in controlled and qualitative studies. Instagram and Facebook were among the most popular social media platforms that influenced healthful eating behaviors (ie, fruit and vegetable intake) as well as unhealthful eating behaviors related to fast food advertising. Online forums served as accessible channels for eating disorder relapse prevention among youth. Social media influence converged around four central themes: (1) visual appeal, (2) content dissemination, (3) socialized digital connections, and (4) adolescent marketer influencers. Conclusions: Adolescent peer influence in social media environments spans the spectrum of healthy eating (ie, pathological) to eating disorders (ie, nonpathological). Strategic network-driven approaches should be considered for engaging adolescents in the promotion of positive dietary behaviors. %M 34081018 %R 10.2196/19697 %U https://www.jmir.org/2021/6/e19697 %U https://doi.org/10.2196/19697 %U http://www.ncbi.nlm.nih.gov/pubmed/34081018 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e27917 %T Impact of Public Health and Social Measures on the COVID-19 Pandemic in the United States and Other Countries: Descriptive Analysis %A Zweig,Sophia Alison %A Zapf,Alexander John %A Xu,Hanmeng %A Li,Qingfeng %A Agarwal,Smisha %A Labrique,Alain Bernard %A Peters,David H %+ Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21202, United States, 1 9175749743, szweig3@jh.edu %K surveillance %K COVID-19 %K public health %K health policy %K global health %K policy %K epidemiology %K descriptive epidemiology %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The United States of America has the highest global number of COVID-19 cases and deaths, which may be due in part to delays and inconsistencies in implementing public health and social measures (PHSMs). Objective: In this descriptive analysis, we analyzed the epidemiological evidence for the impact of PHSMs on COVID-19 transmission in the United States and compared these data to those for 10 other countries of varying income levels, population sizes, and geographies. Methods: We compared PHSM implementation timing and stringency against COVID-19 daily case counts in the United States and against those in Canada, China, Ethiopia, Japan, Kazakhstan, New Zealand, Singapore, South Korea, Vietnam, and Zimbabwe from January 1 to November 25, 2020. We descriptively analyzed the impact of border closures, contact tracing, household confinement, mandated face masks, quarantine and isolation, school closures, limited gatherings, and states of emergency on COVID-19 case counts. We also compared the relationship between global socioeconomic indicators and national pandemic trajectories across the 11 countries. PHSMs and case count data were derived from various surveillance systems, including the Health Intervention Tracking for COVID-19 database, the World Health Organization PHSM database, and the European Centre for Disease Prevention and Control. Results: Implementing a specific package of 4 PHSMs (quarantine and isolation, school closures, household confinement, and the limiting of social gatherings) early and stringently was observed to coincide with lower case counts and transmission durations in Vietnam, Zimbabwe, New Zealand, South Korea, Ethiopia, and Kazakhstan. In contrast, the United States implemented few PHSMs stringently or early and did not use this successful package. Across the 11 countries, national income positively correlated (r=0.624) with cumulative COVID-19 incidence. Conclusions: Our findings suggest that early implementation, consistent execution, adequate duration, and high adherence to PHSMs represent key factors of reducing the spread of COVID-19. Although national income may be related to COVID-19 progression, a country’s wealth appears to be less important in controlling the pandemic and more important in taking rapid, centralized, and consistent public health action. %M 33975277 %R 10.2196/27917 %U https://publichealth.jmir.org/2021/6/e27917 %U https://doi.org/10.2196/27917 %U http://www.ncbi.nlm.nih.gov/pubmed/33975277 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26385 %T Interests, Motives, and Psychological Burdens in Times of Crisis and Lockdown: Google Trends Analysis to Inform Policy Makers %A Rotter,Dominik %A Doebler,Philipp %A Schmitz,Florian %+ Department of Psychology, University of Duisburg-Essen, Universitätsstraße 2, Essen, 45141, Germany, 49 201 183 2173, dominik.rotter@uni-due.de %K coronavirus %K Google Trends %K infodemiology %K infoveillance %K pandemic %K information search %K trend %K COVID-19 %K burden %K mental health %K policy %K online health information %D 2021 %7 1.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In the face of the COVID-19 pandemic, the German government and the 16 German federal states implemented a variety of nonpharmaceutical interventions (NPIs) to decelerate the spread of the SARS-CoV-2 virus and thus prevent a collapse of the health care system. These measures comprised, among others, social distancing, the temporary closure of shops and schools, and a ban of large public gatherings and meetings with people not living in the same household. Objective: It is fair to assume that the issued NPIs have heavily affected social life and psychological functioning. We therefore aimed to examine possible effects of this lockdown in conjunction with daily new infections and the state of the national economy on people’s interests, motives, and other psychological states. Methods: We derived 249 keywords from the Google Trends database, tapping into 27 empirically and rationally selected psychological domains. To overcome issues with reliability and specificity of individual indicator variables, broad factors were derived by means of time series factor analysis. All domains were subjected to a change point analysis and time series regression analysis with infection rates, NPIs, and the state of the economy as predictors. All keywords and analyses were preregistered prior to analysis. Results: With the pandemic arriving in Germany, significant increases in people’s search interests were observed in virtually all domains. Although most of the changes were short-lasting, each had a distinguishable onset during the lockdown period. Regression analysis of the Google Trends data confirmed pronounced autoregressive effects for the investigated variables, while forecasting by means of the tested predictors (ie, daily new infections, NPIs, and the state of economy) was moderate at best. Conclusions: Our findings indicate that people’s interests, motives, and psychological states are heavily affected in times of crisis and lockdown. Specifically, disease- and virus-related domains (eg, pandemic disease, symptoms) peaked early, whereas personal health strategies (eg, masks, homeschooling) peaked later during the lockdown. Domains addressing social life and psychosocial functioning showed long-term increases in public interest. Renovation was the only domain to show a decrease in search interest with the onset of the lockdown. As changes in search behavior are consistent over multiple domains, a Google Trends analysis may provide information for policy makers on how to adapt and develop intervention, information, and prevention strategies, especially when NPIs are in effect. %M 33999837 %R 10.2196/26385 %U https://www.jmir.org/2021/6/e26385 %U https://doi.org/10.2196/26385 %U http://www.ncbi.nlm.nih.gov/pubmed/33999837 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e24199 %T Social Media Content of Idiopathic Pulmonary Fibrosis Groups and Pages on Facebook: Cross-sectional Analysis %A Kochan,Andrew %A Ong,Shaun %A Guler,Sabina %A Johannson,Kerri A %A Ryerson,Christopher J %A Goobie,Gillian C %+ Division of Cardiology, Department of Medicine, University of British Columbia, 9th Floor Gordon and Leslie and Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada, 1 (604) 875 4111 ext 69821, andrew.kochan@alumni.ubc.ca %K interstitial lung disease %K idiopathic pulmonary fibrosis %K patient education %K social media %K internet %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Patients use Facebook as a resource for medical information. We analyzed posts on idiopathic pulmonary fibrosis (IPF)-related Facebook groups and pages for the presence of guideline content, user engagement, and usefulness. Objective: The objective of this study was to describe and analyze posts from Facebook groups and pages that primarily focus on IPF-related content. Methods: Cross-sectional analysis was performed on a single date, identifying Facebook groups and pages resulting from separately searching “IPF” and “idiopathic pulmonary fibrosis.” For inclusion, groups and pages needed to meet either search term and be in English, publicly available, and relevant to IPF. Every 10th post was assessed for general characteristics, source, focus, and user engagement metrics. Posts were analyzed for presence of IPF guideline content, useful scientific information (eg, scientific publications), useful support information (eg, information about support groups), and potentially harmful information. Results: Eligibility criteria were met by 12 groups and 27 pages, leading to analysis of 523 posts. Of these, 42% contained guideline content, 24% provided useful support, 20% provided useful scientific information, and 5% contained potentially harmful information. The most common post source was nonmedical users (85%). Posts most frequently focused on IPF-related news (29%). Posts containing any guideline content had fewer likes or comments and a higher likelihood of containing potentially harmful content. Posts containing useful supportive information had more likes, shares, and comments. Conclusions: Facebook contains useful information about IPF, but posts with misinformation and less guideline content have higher user engagement, making them more visible. Identifying ways to help patients with IPF discriminate between useful and harmful information on Facebook and other social media platforms is an important task for health care professionals. %M 34057425 %R 10.2196/24199 %U https://publichealth.jmir.org/2021/5/e24199 %U https://doi.org/10.2196/24199 %U http://www.ncbi.nlm.nih.gov/pubmed/34057425 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e24623 %T The Differential Effects of Social Media on Depressive Symptoms and Suicidal Ideation Among the Younger and Older Adult Population in Hong Kong During the COVID-19 Pandemic: Population-Based Cross-sectional Survey Study %A Yang,Xue %A Yip,Benjamin H K %A Mak,Arthur D P %A Zhang,Dexing %A Lee,Eric K P %A Wong,Samuel Y S %+ Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, School of Public Health Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, Hong Kong, 852 2252 8488, yeungshanwong@cuhk.edu.hk %K social media %K depression %K suicidal ideation %K social loneliness %K posttraumatic stress %K suicide %K mental health %K COVID-19 %K loneliness %K age %K mediation %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media has become a ubiquitous part of daily life during the COVID-19 pandemic isolation. However, the role of social media use in depression and suicidal ideation of the general public remains unclear. Related empirical studies were limited and reported inconsistent findings. Little is known about the potential underlying mechanisms that may illustrate the relationship between social media use and depression and suicidal ideation during the COVID-19 pandemic. Objective: This study tested the mediation effects of social loneliness and posttraumatic stress disorder (PTSD) symptoms on the relationship between social media use and depressive symptoms and suicidal ideation, as well as the moderation effect of age on the mediation models. Methods: We administered a population-based random telephone survey in May and June 2020, when infection control measures were being vigorously implemented in Hong Kong. A total of 1070 adults (658 social media users and 412 nonusers) completed the survey. Structural equation modeling (SEM) and multigroup SEM were conducted to test the mediation and moderation effects. Results: The weighted prevalence of probable depression was 11.6%; 1.6% had suicidal ideation in the past 2 weeks. Both moderated mediation models of depressive symptoms (χ262=335.3; P<.05; comparative fit index [CFI]=0.94; nonnormed fit index [NNFI]=0.92; root mean square error of approximation [RMSEA]=0.06) and suicidal ideation (χ234=50.8; P<.05; CFI=0.99; NNFI=0.99; RMSEA=0.02) showed acceptable model fit. There was a significantly negative direct effect of social media use on depressive symptoms among older people (β=–.07; P=.04) but not among younger people (β=.04; P=.55). The indirect effect via PTSD symptoms was significantly positive among both younger people (β=.09; P=.02) and older people (β=.10; P=.01). The indirect effect via social loneliness was significant among older people (β=–.01; P=.04) but not among younger people (β=.01; P=.31). The direct effect of social media use on suicidal ideation was not statistically significant in either age group (P>.05). The indirect effects via PTSD symptoms were statistically significant among younger people (β=.02; P=.04) and older people (β=.03; P=.01). Social loneliness was not a significant mediator between social media use and suicidal ideation among either age group (P>.05). Conclusions: Social media may be a “double-edged sword” for psychosocial well-being during the COVID-19 pandemic, and its roles vary across age groups. The mediators identified in this study can be addressed by psychological interventions to prevent severe mental health problems during and after the COVID-19 pandemic. %M 33835937 %R 10.2196/24623 %U https://publichealth.jmir.org/2021/5/e24623 %U https://doi.org/10.2196/24623 %U http://www.ncbi.nlm.nih.gov/pubmed/33835937 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26933 %T Bots and Misinformation Spread on Social Media: Implications for COVID-19 %A Himelein-Wachowiak,McKenzie %A Giorgi,Salvatore %A Devoto,Amanda %A Rahman,Muhammad %A Ungar,Lyle %A Schwartz,H Andrew %A Epstein,David H %A Leggio,Lorenzo %A Curtis,Brenda %+ Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd, Suite 200, Baltimore, MD, 21224, United States, 1 443 740 2126, brenda.curtis@nih.gov %K COVID-19 %K coronavirus %K social media %K bots %K infodemiology %K infoveillance %K social listening %K infodemic %K spambots %K misinformation %K disinformation %K fake news %K online communities %K Twitter %K public health %D 2021 %7 20.5.2021 %9 Viewpoint %J J Med Internet Res %G English %X As of March 2021, the SARS-CoV-2 virus has been responsible for over 115 million cases of COVID-19 worldwide, resulting in over 2.5 million deaths. As the virus spread exponentially, so did its media coverage, resulting in a proliferation of conflicting information on social media platforms—a so-called “infodemic.” In this viewpoint, we survey past literature investigating the role of automated accounts, or “bots,” in spreading such misinformation, drawing connections to the COVID-19 pandemic. We also review strategies used by bots to spread (mis)information and examine the potential origins of bots. We conclude by conducting and presenting a secondary analysis of data sets of known bots in which we find that up to 66% of bots are discussing COVID-19. The proliferation of COVID-19 (mis)information by bots, coupled with human susceptibility to believing and sharing misinformation, may well impact the course of the pandemic. %M 33882014 %R 10.2196/26933 %U https://www.jmir.org/2021/5/e26933 %U https://doi.org/10.2196/26933 %U http://www.ncbi.nlm.nih.gov/pubmed/33882014 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e28991 %T Use of the Instagram Hashtags #winemom and #momjuice Among Mothers During the COVID-19 Pandemic: Descriptive, Cross-sectional Study %A Basch,Corey H %A Meleo-Erwin,Zoe C %A Mohlman,Jan %A Fera,Joseph %A Quinones,Nasia %+ Department of Public Health, William Paterson University, 300 Pompton Rd, Wayne, NJ, United States, 1 973 720 2603, baschc@wpunj.edu %K Instagram %K alcohol consumption %K COVID-19 %K social media %K communication %K parenting %D 2021 %7 18.5.2021 %9 Short Paper %J JMIR Pediatr Parent %G English %X Background: The tendency of parents to consume alcohol during the COVID-19 pandemic is likely to be moderated by pandemic-related stress combined with the ongoing demands of childcare and home-based education, which are reported to be more burdensome for females than males. Objective: The purpose of this study was to describe alcohol-related content posted by mothers on Instagram during the COVID-19 pandemic. Methods: Using two popular hashtags, #momjuice and #winemom, 50 Instagram posts on each were collected from the “top posts” tab. The coding categories were created inductively and were as follows: displays alcohol (drinking/holding alcohol or alcohol itself), person is making alcoholic beverages, type of alcohol featured or discussed, highlights anxiety and/or depression/mental state, highlights struggling (in general), highlights parenting challenges, encourages alcohol consumption, discourages alcohol consumption, features a person wearing clothing or shows products promoting alcohol, promotes alcohol rehabilitation, highlights caffeine to alcohol daily transition throughout the day, and highlights other drugs besides caffeine and alcohol. Results: Overall, the 100 selected posts had a total of 5108 comments and 94,671 likes. The respective averages were 51.08 (SD 77.94) and 946.71 (SD 1731.72). A majority (>50%) of the posts reviewed encouraged alcohol consumption (n=66) and/or displayed alcohol (n=56). Of the 66 that encouraged and/or displayed alcohol, the common type of alcohol discussed or featured was wine (n=55). Only 6 posts discouraged alcohol use and only 4 provided the audience with a disclaimer. None of the videos promoted or endorsed alcohol rehabilitation in any way. Only 37 posts highlighted struggle. However, these posts garnered more than a majority of the likes (n=50,034, 52.3%). Posts that showed struggle received an average of 1359.57 (SD 2108.02) likes. Those that did not show struggle had an average of 704.24 (SD 1447.46) likes. An independent one-tailed t test demonstrated this difference to be statistically significant (P=.0499). Conclusions: The findings of this investigation suggest that though these hashtags ostensibly exist to valorize excess alcohol consumption, they may be serving as a support system for mothers who are experiencing increased burdens and role stress during the pandemic. Given the strains placed on mothers overall and especially during the COVID-19 pandemic, efforts must be taken to increase access to and affordability of telehealth-based mental health care. %M 33848257 %R 10.2196/28991 %U https://pediatrics.jmir.org/2021/2/e28991 %U https://doi.org/10.2196/28991 %U http://www.ncbi.nlm.nih.gov/pubmed/33848257 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26618 %T Understanding Public Perceptions of COVID-19 Contact Tracing Apps: Artificial Intelligence–Enabled Social Media Analysis %A Cresswell,Kathrin %A Tahir,Ahsen %A Sheikh,Zakariya %A Hussain,Zain %A Domínguez Hernández,Andrés %A Harrison,Ewen %A Williams,Robin %A Sheikh,Aziz %A Hussain,Amir %+ Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 (0)131 651 4151, kathrin.cresswell@ed.ac.uk %K artificial intelligence %K sentiment analysis %K COVID-19 %K contact tracing %K social media %K perception %K app %K exploratory %K suitability %K AI %K Facebook %K Twitter %K United Kingdom %K sentiment %K attitude %K infodemiology %K infoveillance %D 2021 %7 17.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of SARS-CoV-2 in late 2019 and its subsequent spread worldwide continues to be a global health crisis. Many governments consider contact tracing of citizens through apps installed on mobile phones as a key mechanism to contain the spread of SARS-CoV-2. Objective: In this study, we sought to explore the suitability of artificial intelligence (AI)–enabled social media analyses using Facebook and Twitter to understand public perceptions of COVID-19 contact tracing apps in the United Kingdom. Methods: We extracted and analyzed over 10,000 relevant social media posts across an 8-month period, from March 1 to October 31, 2020. We used an initial filter with COVID-19–related keywords, which were predefined as part of an open Twitter-based COVID-19 dataset. We then applied a second filter using contract tracing app–related keywords and a geographical filter. We developed and utilized a hybrid, rule-based ensemble model, combining state-of-the-art lexicon rule-based and deep learning–based approaches. Results: Overall, we observed 76% positive and 12% negative sentiments, with the majority of negative sentiments reported in the North of England. These sentiments varied over time, likely influenced by ongoing public debates around implementing app-based contact tracing by using a centralized model where data would be shared with the health service, compared with decentralized contact-tracing technology. Conclusions: Variations in sentiments corroborate with ongoing debates surrounding the information governance of health-related information. AI-enabled social media analysis of public attitudes in health care can help facilitate the implementation of effective public health campaigns. %M 33939622 %R 10.2196/26618 %U https://www.jmir.org/2021/5/e26618 %U https://doi.org/10.2196/26618 %U http://www.ncbi.nlm.nih.gov/pubmed/33939622 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 5 %P e26654 %T Assessing Suicide Reporting in Top Newspaper Social Media Accounts in China: Content Analysis Study %A Lai,Kaisheng %A Li,Dan %A Peng,Huijuan %A Zhao,Jingyuan %A He,Lingnan %+ School of Communication and Design, Sun Yat-Sen University, No. 132 Waihuan East Road, Higher Education Mega Center, Guangzhou, , China, 86 020 3933 1935, heln3@mail.sysu.edu.cn %K suicide %K suicide reporting %K mainstream publishers %K social media %K WHO guidelines %D 2021 %7 13.5.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Previous studies have shown that suicide reporting in mainstream media has a significant impact on suicidal behaviors (eg, irresponsible suicide reporting can trigger imitative suicide). Traditional mainstream media are increasingly using social media platforms to disseminate information on public-related topics, including health. However, there is little empirical research on how mainstream media portrays suicide on social media platforms and the quality of their coverage. Objective: This study aims to explore the characteristics and quality of suicide reporting by mainstream publishers via social media in China. Methods: Via the application programming interface of the social media accounts of the top 10 Chinese mainstream publishers (eg, People’s Daily and Beijing News), we obtained 2366 social media posts reporting suicide. This study conducted content analysis to demonstrate the characteristics and quality of the suicide reporting. According to the World Health Organization (WHO) guidelines, we assessed the quality of suicide reporting by indicators of harmful information and helpful information. Results: Chinese mainstream publishers most frequently reported on suicides stated to be associated with conflict on their social media (eg, 24.47% [446/1823] of family conflicts and 16.18% [295/1823] of emotional frustration). Compared with the suicides of youth (730/1446, 50.48%) and urban populations (1454/1588, 91.56%), social media underreported suicides in older adults (118/1446, 8.16%) and rural residents (134/1588, 8.44%). Harmful reporting practices were common (eg, 54.61% [1292/2366] of the reports contained suicide-related words in the headline and 49.54% [1172/2366] disclosed images of people who died by suicide). Helpful reporting practices were very limited (eg, 0.08% [2/2366] of reports provided direct information about support programs). Conclusions: The suicide reporting of mainstream publishers on social media in China broadly had low adherence to the WHO guidelines. Considering the tremendous information dissemination power of social media platforms, we suggest developing national suicide reporting guidelines that apply to social media. By effectively playing their separate roles, we believe that social media practitioners, health institutions, social organizations, and the general public can endeavor to promote responsible suicide reporting in the Chinese social media environment. %M 33983127 %R 10.2196/26654 %U https://mental.jmir.org/2021/5/e26654 %U https://doi.org/10.2196/26654 %U http://www.ncbi.nlm.nih.gov/pubmed/33983127 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e28352 %T YouTube Videos and Informed Decision-Making About COVID-19 Vaccination: Successive Sampling Study %A Basch,Charles E %A Basch,Corey H %A Hillyer,Grace C %A Meleo-Erwin,Zoe C %A Zagnit,Emily A %+ Teachers College, Columbia University, 525 W 120th St, New York, NY, 10027, United States, 1 212 678 3983, ceb35@columbia.edu %K YouTube %K vaccination %K COVID-19 %K social media %K communication %K misinformation %K disinformation %K adverse reactions %D 2021 %7 6.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media platforms such as YouTube are used by many people to seek and share health-related information that may influence their decision-making about COVID-19 vaccination. Objective: The purpose of this study was to improve the understanding about the sources and content of widely viewed YouTube videos on COVID-19 vaccination. Methods: Using the keywords “coronavirus vaccination,” we searched for relevant YouTube videos, sorted them by view count, and selected two successive samples (with replacement) of the 100 most widely viewed videos in July and December 2020, respectively. Content related to COVID-19 vaccines were coded by two observers, and inter-rater reliability was demonstrated. Results: The videos observed in this study were viewed over 55 million times cumulatively. The number of videos that addressed fear increased from 6 in July to 20 in December 2020, and the cumulative views correspondingly increased from 2.6% (1,449,915 views) to 16.6% (9,553,368 views). There was also a large increase in the number of videos and cumulative views with respect to concerns about vaccine effectiveness, from 6 videos with approximately 6 million views in July to 25 videos with over 12 million views in December 2020. The number of videos and total cumulative views covering adverse reactions almost tripled, from 11 videos with approximately 6.5 million (11.7% of cumulative views) in July to 31 videos with almost 15.7 million views (27.2% of cumulative views) in December 2020. Conclusions: Our data show the potentially inaccurate and negative influence social media can have on population-wide vaccine uptake, which should be urgently addressed by agencies of the United States Public Health Service as well as its global counterparts. %M 33886487 %R 10.2196/28352 %U https://publichealth.jmir.org/2021/5/e28352 %U https://doi.org/10.2196/28352 %U http://www.ncbi.nlm.nih.gov/pubmed/33886487 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e28973 %T People’s Willingness to Vaccinate Against COVID-19 Despite Their Safety Concerns: Twitter Poll Analysis %A Eibensteiner,Fabian %A Ritschl,Valentin %A Nawaz,Faisal A %A Fazel,Sajjad S %A Tsagkaris,Christos %A Kulnik,Stefan Tino %A Crutzen,Rik %A Klager,Elisabeth %A Völkl-Kernstock,Sabine %A Schaden,Eva %A Kletecka-Pulker,Maria %A Willschke,Harald %A Atanasov,Atanas G %+ Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria, 43 6641929852, Atanas.Atanasov@dhps.lbg.ac.at %K COVID-19 %K SARS-CoV-2 %K vaccine %K vaccination %K Twitter %K survey %K vaccination willingness %K vaccination hesitancy %K coronavirus %K vaccine confidence %K willingness %K hesitancy %K social media %K safety %K concern %K public health %K opinion %K perception %D 2021 %7 29.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: On January 30, 2020, the World Health Organization’s Emergency Committee declared the rapid, worldwide spread of COVID-19 a global health emergency. Since then, tireless efforts have been made to mitigate the spread of the disease and its impact, and these efforts have mostly relied on nonpharmaceutical interventions. By December 2020, the safety and efficacy of the first COVID-19 vaccines were demonstrated. The large social media platform Twitter has been used by medical researchers for the analysis of important public health topics, such as the public’s perception on antibiotic use and misuse and human papillomavirus vaccination. The analysis of Twitter-generated data can be further facilitated by using Twitter’s built-in, anonymous polling tool to gain insight into public health issues and obtain rapid feedback on an international scale. During the fast-paced course of the COVID-19 pandemic, the Twitter polling system has provided a viable method for gaining rapid, large-scale, international public health insights on highly relevant and timely SARS-CoV-2–related topics. Objective: The purpose of this study was to understand the public’s perception on the safety and acceptance of COVID-19 vaccines in real time by using Twitter polls. Methods: We developed 2 Twitter polls to explore the public’s views on available COVID-19 vaccines. The surveys were pinned to the Digital Health and Patient Safety Platform Twitter timeline for 1 week in mid-February 2021, and Twitter users and influencers were asked to participate in and retweet the polls to reach the largest possible audience. Results: The adequacy of COVID-19 vaccine safety (ie, the safety of currently available vaccines; poll 1) was agreed upon by 1579 out of 3439 (45.9%) Twitter users. In contrast, almost as many Twitter users (1434/3439, 41.7%) were unsure about the safety of COVID-19 vaccines. Only 5.2% (179/3439) of Twitter users rated the available COVID-19 vaccines as generally unsafe. Poll 2, which addressed the question of whether users would undergo vaccination, was answered affirmatively by 82.8% (2862/3457) of Twitter users, and only 8% (277/3457) categorically rejected vaccination at the time of polling. Conclusions: In contrast to the perceived high level of uncertainty about the safety of the available COVID-19 vaccines, we observed an elevated willingness to undergo vaccination among our study sample. Since people's perceptions and views are strongly influenced by social media, the snapshots provided by these media platforms represent a static image of a moving target. Thus, the results of this study need to be followed up by long-term surveys to maintain their validity. This is especially relevant due to the circumstances of the fast-paced pandemic and the need to not miss sudden rises in the incidence of vaccine hesitancy, which may have detrimental effects on the pandemic’s course. %M 33872185 %R 10.2196/28973 %U https://www.jmir.org/2021/4/e28973 %U https://doi.org/10.2196/28973 %U http://www.ncbi.nlm.nih.gov/pubmed/33872185 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25215 %T Patterns of Media Use, Strength of Belief in COVID-19 Conspiracy Theories, and the Prevention of COVID-19 From March to July 2020 in the United States: Survey Study %A Romer,Daniel %A Jamieson,Kathleen Hall %+ Annnenberg Public Policy Center, University of Pennsylvania, 202 S 36th St, Philadelphia, PA, 19104, United States, 1 610 202 7315, dan.romer@appc.upenn.edu %K COVID-19 %K conspiracy beliefs %K social media %K print news media %K broadcast news media %K conservative media %K vaccination %K mask wearing %K belief %K misinformation %K infodemic %K United States %K intention %K prevention %D 2021 %7 27.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Holding conspiracy beliefs regarding the COVID-19 pandemic in the United States has been associated with reductions in both actions to prevent the spread of the infection (eg, mask wearing) and intentions to accept a vaccine when one becomes available. Patterns of media use have also been associated with acceptance of COVID-19 conspiracy beliefs. Here we ask whether the type of media on which a person relies increased, decreased, or had no additional effect on that person’s COVID-19 conspiracy beliefs over a 4-month period. Objective: We used panel data to explore whether use of conservative and social media in the United States, which were previously found to be positively related to holding conspiracy beliefs about the origins and prevention of COVID-19, were associated with a net increase in the strength of those beliefs from March to July of 2020. We also asked whether mainstream news sources, which were previously found to be negatively related to belief in pandemic-related conspiracies, were associated with a net decrease in the strength of such beliefs over the study period. Additionally, we asked whether subsequent changes in pandemic conspiracy beliefs related to the use of media were also related to subsequent mask wearing and vaccination intentions. Methods: A survey that we conducted with a national US probability sample in March of 2020 and again in July with the same 840 respondents assessed belief in pandemic-related conspiracies, use of various types of media information sources, actions taken to prevent the spread of the disease and intentions to vaccinate, and various demographic characteristics. Change across the two waves was analyzed using path analytic techniques. Results: We found that conservative media use predicted an increase in conspiracy beliefs (β=.17, 99% CI .10-.25) and that reliance on mainstream print predicted a decrease in their belief (β=–.08, 99% CI –.14 to –.02). Although many social media platforms reported downgrading or removing false or misleading content, ongoing use of such platforms by respondents predicted growth in conspiracy beliefs as well (β=.072, 99% CI .018-.123). Importantly, conspiracy belief changes related to media use between the two waves of the study were associated with the uptake of mask wearing and changes in vaccination intentions in July. Unlike other media, use of mainstream broadcast television predicted greater mask wearing (β=.17, 99% CI .09-.26) and vaccination intention (β=.08, 95% CI .02-.14), independent of conspiracy beliefs. Conclusions: The findings point to the need for greater efforts on the part of commentators, reporters, and guests on conservative media to report verifiable information about the pandemic. The results also suggest that social media platforms need to be more aggressive in downgrading, blocking, and counteracting claims about COVID-19 vaccines, claims about mask wearing, and conspiracy beliefs that have been judged problematic by public health authorities. %M 33857008 %R 10.2196/25215 %U https://www.jmir.org/2021/4/e25215 %U https://doi.org/10.2196/25215 %U http://www.ncbi.nlm.nih.gov/pubmed/33857008 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e26720 %T Texas Public Agencies’ Tweets and Public Engagement During the COVID-19 Pandemic: Natural Language Processing Approach %A Tang,Lu %A Liu,Wenlin %A Thomas,Benjamin %A Tran,Hong Thoai Nga %A Zou,Wenxue %A Zhang,Xueying %A Zhi,Degui %+ Department of Communication, Texas A&M University, 456 Ross Street, College Station, TX, 77840-77845, United States, 1 12136754090, ltang@tamu.edu %K COVID-19 %K public health agencies %K natural language processing %K Twitter %K health belief model %K public engagement %K social media %K belief %K public health %K engagement %K communication %K strategy %K content analysis %K dissemination %D 2021 %7 26.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The ongoing COVID-19 pandemic is characterized by different morbidity and mortality rates across different states, cities, rural areas, and diverse neighborhoods. The absence of a national strategy for battling the pandemic also leaves state and local governments responsible for creating their own response strategies and policies. Objective: This study examines the content of COVID-19–related tweets posted by public health agencies in Texas and how content characteristics can predict the level of public engagement. Methods: All COVID-19–related tweets (N=7269) posted by Texas public agencies during the first 6 months of 2020 were classified in terms of each tweet’s functions (whether the tweet provides information, promotes action, or builds community), the preventative measures mentioned, and the health beliefs discussed, by using natural language processing. Hierarchical linear regressions were conducted to explore how tweet content predicted public engagement. Results: The information function was the most prominent function, followed by the action or community functions. Beliefs regarding susceptibility, severity, and benefits were the most frequently covered health beliefs. Tweets that served the information or action functions were more likely to be retweeted, while tweets that served the action and community functions were more likely to be liked. Tweets that provided susceptibility information resulted in the most public engagement in terms of the number of retweets and likes. Conclusions: Public health agencies should continue to use Twitter to disseminate information, promote action, and build communities. They need to improve their strategies for designing social media messages about the benefits of disease prevention behaviors and audiences’ self-efficacy. %M 33847587 %R 10.2196/26720 %U https://publichealth.jmir.org/2021/4/e26720 %U https://doi.org/10.2196/26720 %U http://www.ncbi.nlm.nih.gov/pubmed/33847587 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e23488 %T Novel Predictors of COVID-19 Protective Behaviors Among US Adults: Cross-sectional Survey %A Resnicow,Ken %A Bacon,Elizabeth %A Yang,Penny %A Hawley,Sarah %A Van Horn,M Lee %A An,Lawrence %+ Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 109 Observatory Street, Room 3867 SPH I, Ann Arbor, MI, 48109, United States, 1 734 764 9494, kresnic@umich.edu %K COVID-19 %K protective behavior %K psychological predictors %K reactance %K conspiracy beliefs %K public health %K health communication %K communication %K protection %K behavior %K psychology %D 2021 %7 20.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A central component of the public health strategy to control the COVID-19 pandemic involves encouraging mask wearing and social distancing to protect individuals from acquiring and transmitting the virus. Objective: This study aims to understand the psychological factors that drive adoption or rejection of these protective behaviors, which can inform public health interventions to control the pandemic. Methods: We conducted an online survey of a representative sample of 1074 US adults and assessed three novel potential predictors of COVID-19 behaviors: trait reactance, COVID-19 conspiracy beliefs, and COVID-19 apocalypse beliefs. Key outcomes (dependent variables) included an index of COVID-19 protective behaviors, the number of trips taken from the home, and COVID-19 knowledge. Results: In bivariate analyses, all three predictors were significantly correlated in the hypothesized direction with the three COVID-19 outcomes. Specifically, each predictor was negatively (P<.01) correlated with the COVID-19 protective behaviors index and COVID-19 knowledge score, and positively correlated with trips taken from home per week (more of which was considered higher risk). COVID-19 protective behaviors and COVID-19 knowledge were significantly lower in the top median compared to the bottom median for all three predictors. In general, these findings remained significant after adjusting for all novel predictors plus age, gender, income, education, race, political party, and religiosity. Self-identified Republicans (vs other political affiliations) reported the highest values for each of the novel predictors. Conclusions: This study can inform the development of health communication interventions to encourage the adoption of COVID-19 protective behaviors. Interestingly, we found that higher scores of all three novel predictors were associated with lower COVID-19 knowledge, suggesting that lack of an accurate understanding of the virus may be driving some of these attitudes; although, it is also possible that these attributes may interfere with one’s willingness or ability to seek and absorb accurate health information. These individuals may be particularly immune to accepting new information and yielding their beliefs. Health communication professionals may apply lessons learned from countering similar beliefs around climate change and vaccine hesitancy. Messages designed for individuals prone to reactance may be more effective if they minimize controlling language and emphasize the individual’s independence in adopting these behavioral recommendations. Messaging for those who possess conspiracy beliefs should similarly not assume that providing evidence contrary to these beliefs will alone alter behavior. Other communication techniques such as rolling with resistance, a strategy used in motivational interviewing, may be helpful. Messaging for those with apocalyptic beliefs may require using religious leaders as the message source and using scripture that would support the adoption of COVID-19 protection behaviors. %M 33835930 %R 10.2196/23488 %U https://www.jmir.org/2021/4/e23488 %U https://doi.org/10.2196/23488 %U http://www.ncbi.nlm.nih.gov/pubmed/33835930 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 4 %N 2 %P e25114 %T Comparison of Intercom and Megaphone Hashtags Using Four Years of Tweets From the Top 44 Schools of Nursing: Thematic Analysis %A Acquaviva,Kimberly %+ School of Nursing, University of Virginia, 4005 McLeod Hall, Charlottesville, VA, 22903, United States, 1 202 423 0984, kda8xj@virginia.edu %K Twitter %K hashtag %K nurses %K media %K intercom hashtag %K megaphone hashtag %D 2021 %7 20.4.2021 %9 Original Paper %J JMIR Nursing %G English %X Background: When this study began in 2018, I sought to determine the extent to which the top 50 schools of nursing were using hashtags that could attract attention from journalists on Twitter. In December 2020, the timeframe was expanded to encompass 2 more years of data, and an analysis was conducted of the types of hashtags used. Objective: The study attempted to answer the following question: to what extent are top-ranked schools of nursing using hashtags that could attract attention from journalists, policy makers, and the public on Twitter? Methods: In February 2018, 47 of the top 50 schools of nursing had public Twitter accounts. The most recent 3200 tweets were extracted from each account and analyzed. There were 31,762 tweets in the time period covered (September 29, 2016, through February 22, 2018). After 13,429 retweets were excluded, 18,333 tweets remained. In December 2020, 44 of the original 47 schools of nursing still had public Twitter accounts under the same name used in the first phase of the study. Three accounts that were no longer active were removed from the 2016-2018 data set, resulting in 16,939 tweets from 44 schools of nursing. The Twitter data for the 44 schools of nursing were obtained for the time period covered in the second phase of the study (February 23, 2018, through December 13, 2020), and the most recent 3200 tweets were extracted from each of the accounts. On excluding retweets, there were 40,368 tweets in the 2018-2020 data set. The 2016-2018 data set containing 16,939 tweets was merged with the 2018-2020 data set containing 40,368 tweets, resulting in 57,307 tweets in the 2016-2020 data set. Results: Each hashtag used 100 times or more in the 2016-2020 data set was categorized as one of the following seven types: nursing, school, conference or tweet chat, health, illness/disease/condition, population, and something else. These types were then broken down into the following two categories: intercom hashtags and megaphone hashtags. Approximately 83% of the time, schools of nursing used intercom hashtags (inward-facing hashtags focused on in-group discussion within and about the profession). Schools of nursing rarely used outward-facing megaphone hashtags. There was no discernible shift in the way that schools of nursing used hashtags after the publication of The Woodhull Study Revisited. Conclusions: Top schools of nursing use hashtags more like intercoms to communicate with other nurses rather than megaphones to invite attention from journalists, policy makers, and the public. If schools of nursing want the media to showcase their faculty members as experts, they need to increase their use of megaphone hashtags to connect the work of their faculty with topics of interest to the public. %M 34345795 %R 10.2196/25114 %U https://nursing.jmir.org/2021/2/e25114 %U https://doi.org/10.2196/25114 %U http://www.ncbi.nlm.nih.gov/pubmed/34345795 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e26527 %T “Thought I’d Share First” and Other Conspiracy Theory Tweets from the COVID-19 Infodemic: Exploratory Study %A Gerts,Dax %A Shelley,Courtney D %A Parikh,Nidhi %A Pitts,Travis %A Watson Ross,Chrysm %A Fairchild,Geoffrey %A Vaquera Chavez,Nidia Yadria %A Daughton,Ashlynn R %+ Analytics, Intelligence, and Technology Division, Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM, 87545, United States, 1 505 664 0062, adaughton@lanl.gov %K COVID-19 %K coronavirus %K social media %K misinformation %K health communication %K Twitter %K infodemic %K infodemiology %K conspiracy theories %K vaccine hesitancy %K 5G %K unsupervised learning %K random forest %K active learning %K supervised learning %K machine learning %K conspiracy %K communication %K vaccine %K public health %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 outbreak has left many people isolated within their homes; these people are turning to social media for news and social connection, which leaves them vulnerable to believing and sharing misinformation. Health-related misinformation threatens adherence to public health messaging, and monitoring its spread on social media is critical to understanding the evolution of ideas that have potentially negative public health impacts. Objective: The aim of this study is to use Twitter data to explore methods to characterize and classify four COVID-19 conspiracy theories and to provide context for each of these conspiracy theories through the first 5 months of the pandemic. Methods: We began with a corpus of COVID-19 tweets (approximately 120 million) spanning late January to early May 2020. We first filtered tweets using regular expressions (n=1.8 million) and used random forest classification models to identify tweets related to four conspiracy theories. Our classified data sets were then used in downstream sentiment analysis and dynamic topic modeling to characterize the linguistic features of COVID-19 conspiracy theories as they evolve over time. Results: Analysis using model-labeled data was beneficial for increasing the proportion of data matching misinformation indicators. Random forest classifier metrics varied across the four conspiracy theories considered (F1 scores between 0.347 and 0.857); this performance increased as the given conspiracy theory was more narrowly defined. We showed that misinformation tweets demonstrate more negative sentiment when compared to nonmisinformation tweets and that theories evolve over time, incorporating details from unrelated conspiracy theories as well as real-world events. Conclusions: Although we focus here on health-related misinformation, this combination of approaches is not specific to public health and is valuable for characterizing misinformation in general, which is an important first step in creating targeted messaging to counteract its spread. Initial messaging should aim to preempt generalized misinformation before it becomes widespread, while later messaging will need to target evolving conspiracy theories and the new facets of each as they become incorporated. %M 33764882 %R 10.2196/26527 %U https://publichealth.jmir.org/2021/4/e26527 %U https://doi.org/10.2196/26527 %U http://www.ncbi.nlm.nih.gov/pubmed/33764882 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e25762 %T Assessment of the Effectiveness of Identity-Based Public Health Announcements in Increasing the Likelihood of Complying With COVID-19 Guidelines: Randomized Controlled Cross-sectional Web-Based Study %A Dennis,Alexander S %A Moravec,Patricia L %A Kim,Antino %A Dennis,Alan R %+ Kelley School of Business, Indiana University, 1309 E 10th St, Bloomington, IN, 47405, United States, 1 8128552691, ardennis@indiana.edu %K Amazon Mechanical Turk %K compliance %K COVID-19 %K custom %K effectiveness %K guideline %K identity %K public health %K public health announcement %K public service announcement %K social media %K web-based health information %D 2021 %7 13.4.2021 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: Public health campaigns aimed at curbing the spread of COVID-19 are important in reducing disease transmission, but traditional information-based campaigns have received unexpectedly extreme backlash. Objective: This study aimed to investigate whether customizing of public service announcements (PSAs) providing health guidelines to match individuals’ identities increases their compliance. Methods: We conducted a within- and between-subjects, randomized controlled cross-sectional, web-based study in July 2020. Participants viewed two PSAs: one advocating wearing a mask in public settings and one advocating staying at home. The control PSA only provided information, and the treatment PSAs were designed to appeal to the identities held by individuals; that is, either a Christian identity or an economically motivated identity. Participants were asked about their identity and then provided a control PSA and treatment PSA matching their identity, in random order. The PSAs were of approximately 100 words. Results: We recruited 300 social media users from Amazon Mechanical Turk in accordance with usual protocols to ensure data quality. In total, 8 failed the data quality checks, and the remaining 292 were included in the analysis. In the identity-based PSA, the source of the PSA was changed, and a phrase of approximately 12 words relevant to the individual’s identity was inserted. A PSA tailored for Christians, when matched with a Christian identity, increased the likelihood of compliance by 12 percentage points. A PSA that focused on economic values, when shown to individuals who identified as economically motivated, increased the likelihood of compliance by 6 points. Conclusions: Using social media to deliver COVID-19 public health announcements customized to individuals’ identities is a promising measure to increase compliance with public health guidelines. Trial Registration: ISRCTN Registry 22331899; https://www.isrctn.com/ISRCTN22331899. %M 33819910 %R 10.2196/25762 %U https://publichealth.jmir.org/2021/4/e25762 %U https://doi.org/10.2196/25762 %U http://www.ncbi.nlm.nih.gov/pubmed/33819910 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e19022 %T Facebook Ads Manager as a Recruitment Tool for a Health and Safety Survey of Farm Mothers: Pilot Study %A Burke,Richard R %A Weichelt,Bryan P %A Namkoong,Kang %+ National Farm Medicine Center, Marshfield Clinic Research Institute, 1000 N Oak Avenue, Marshfield, WI, 54449, United States, 1 715 389 3789, burke.richard@marshfieldresearch.org %K Facebook %K recruitment %K advertisement %K agriculture %K health %K safety %K survey %K online %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media platforms have experienced unprecedented levels of growth and usage over the past decade, with Facebook hosting 2.7 billion active users worldwide, including over 200 million users in the United States. Facebook users have been underutilized and understudied by the academic community as a resource for participant recruitment. Objective: We performed a pilot study to explore the efficacy and cost-effectiveness of Facebook advertisements for the recruitment of an online agricultural health and safety survey. Methods: We undertook a 1-week advertising campaign utilizing the integrated, targeted advertising platform of Facebook Ads Manager with a target-spending limit of US $294. We created and posted three advertisements depicting varying levels of agricultural safety adoption leading to a brief survey on farm demographics and safety attitudes. We targeted our advertisements toward farm mothers aged 21-50 years in the United States and determined cost-effectiveness and potential biases. No participant incentive was offered. Results: We reached 40,024 users and gathered 318 advertisement clicks. Twenty-nine participants consented to the survey with 24 completions. Including personnel costs, the cost per completed survey was US $17.42. Compared to the distribution of female producers in the United States, our advertisements were unexpectedly overrepresented in the eastern United States and were underrepresented in the western United States. Conclusions: Facebook Ads Manager represents a potentially cost-effective and timely method to recruit participants for online health and safety research when targeting a specific population. However, social media recruitment mirrors traditional recruitment methods in its limitations, exhibiting geographic, response, and self-selection biases that need to be addressed. %M 33825686 %R 10.2196/19022 %U https://formative.jmir.org/2021/4/e19022 %U https://doi.org/10.2196/19022 %U http://www.ncbi.nlm.nih.gov/pubmed/33825686 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26627 %T Artificial Intelligence–Enabled Analysis of Public Attitudes on Facebook and Twitter Toward COVID-19 Vaccines in the United Kingdom and the United States: Observational Study %A Hussain,Amir %A Tahir,Ahsen %A Hussain,Zain %A Sheikh,Zakariya %A Gogate,Mandar %A Dashtipour,Kia %A Ali,Azhar %A Sheikh,Aziz %+ School of Computing, Edinburgh Napier University, 10 Colinton Road, Edinburgh, EH10 5DT, United Kingdom, 44 0845 260 6040, a.hussain@napier.ac.uk %K artificial intelligence %K COVID-19 %K deep learning %K Facebook %K health informatics %K natural language processing %K public health %K sentiment analysis %K social media %K Twitter %K infodemiology %K vaccination %D 2021 %7 5.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Global efforts toward the development and deployment of a vaccine for COVID-19 are rapidly advancing. To achieve herd immunity, widespread administration of vaccines is required, which necessitates significant cooperation from the general public. As such, it is crucial that governments and public health agencies understand public sentiments toward vaccines, which can help guide educational campaigns and other targeted policy interventions. Objective: The aim of this study was to develop and apply an artificial intelligence–based approach to analyze public sentiments on social media in the United Kingdom and the United States toward COVID-19 vaccines to better understand the public attitude and concerns regarding COVID-19 vaccines. Methods: Over 300,000 social media posts related to COVID-19 vaccines were extracted, including 23,571 Facebook posts from the United Kingdom and 144,864 from the United States, along with 40,268 tweets from the United Kingdom and 98,385 from the United States from March 1 to November 22, 2020. We used natural language processing and deep learning–based techniques to predict average sentiments, sentiment trends, and topics of discussion. These factors were analyzed longitudinally and geospatially, and manual reading of randomly selected posts on points of interest helped identify underlying themes and validated insights from the analysis. Results: Overall averaged positive, negative, and neutral sentiments were at 58%, 22%, and 17% in the United Kingdom, compared to 56%, 24%, and 18% in the United States, respectively. Public optimism over vaccine development, effectiveness, and trials as well as concerns over their safety, economic viability, and corporation control were identified. We compared our findings to those of nationwide surveys in both countries and found them to correlate broadly. Conclusions: Artificial intelligence–enabled social media analysis should be considered for adoption by institutions and governments alongside surveys and other conventional methods of assessing public attitude. Such analyses could enable real-time assessment, at scale, of public confidence and trust in COVID-19 vaccines, help address the concerns of vaccine sceptics, and help develop more effective policies and communication strategies to maximize uptake. %M 33724919 %R 10.2196/26627 %U https://www.jmir.org/2021/4/e26627 %U https://doi.org/10.2196/26627 %U http://www.ncbi.nlm.nih.gov/pubmed/33724919 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e26780 %T Public Discourse Against Masks in the COVID-19 Era: Infodemiology Study of Twitter Data %A Al-Ramahi,Mohammad %A Elnoshokaty,Ahmed %A El-Gayar,Omar %A Nasralah,Tareq %A Wahbeh,Abdullah %+ Supply Chain and Information Management Group, D’Amore-McKim School of Business, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, United States, 1 617 373 4460, t.nasralah@northeastern.edu %K pandemic %K coronavirus %K masks %K social medial, opinion analysis %K COVID-19 %D 2021 %7 5.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite scientific evidence supporting the importance of wearing masks to curtail the spread of COVID-19, wearing masks has stirred up a significant debate particularly on social media. Objective: This study aimed to investigate the topics associated with the public discourse against wearing masks in the United States. We also studied the relationship between the anti-mask discourse on social media and the number of new COVID-19 cases. Methods: We collected a total of 51,170 English tweets between January 1, 2020, and October 27, 2020, by searching for hashtags against wearing masks. We used machine learning techniques to analyze the data collected. We investigated the relationship between the volume of tweets against mask-wearing and the daily volume of new COVID-19 cases using a Pearson correlation analysis between the two-time series. Results: The results and analysis showed that social media could help identify important insights related to wearing masks. The results of topic mining identified 10 categories or themes of user concerns dominated by (1) constitutional rights and freedom of choice; (2) conspiracy theory, population control, and big pharma; and (3) fake news, fake numbers, and fake pandemic. Altogether, these three categories represent almost 65% of the volume of tweets against wearing masks. The relationship between the volume of tweets against wearing masks and newly reported COVID-19 cases depicted a strong correlation wherein the rise in the volume of negative tweets led the rise in the number of new cases by 9 days. Conclusions: These findings demonstrated the potential of mining social media for understanding the public discourse about public health issues such as wearing masks during the COVID-19 pandemic. The results emphasized the relationship between the discourse on social media and the potential impact on real events such as changing the course of the pandemic. Policy makers are advised to proactively address public perception and work on shaping this perception through raising awareness, debunking negative sentiments, and prioritizing early policy intervention toward the most prevalent topics. %M 33720841 %R 10.2196/26780 %U https://publichealth.jmir.org/2021/4/e26780 %U https://doi.org/10.2196/26780 %U http://www.ncbi.nlm.nih.gov/pubmed/33720841 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e27015 %T Social Media and Emotional Burnout Regulation During the COVID-19 Pandemic: Multilevel Approach %A Shao,Ruosi %A Shi,Zhen %A Zhang,Di %+ The Research Center for Journalism and Social Development, Renmin University of China, RM713 Mingde Journalism Building, 59 Zhongguancun Rd, Haidian Dist, Beijing, 100872, China, 86 13801247280, zhangdi204@gmail.com %K COVID-19 %K pandemic %K emotion regulation %K emotional exhaustion %K multilevel approach %K well-being %K emotion %K mental health %K social media %K perspective %K strategy %K effective %K modeling %K buffer %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In February 2020, the Chinese government imposed a complete lockdown of Wuhan and other cities in Hubei Province to contain a spike of COVID-19 cases. Although such measures are effective in preventing the spread of the virus, medical professionals strongly voiced a caveat concerning the pandemic emotional burnout at the individual level. Although the lockdown limited individuals’ interpersonal communication with people in their social networks, it is common that individuals turn to social media to seek and share health information, exchange social support, and express pandemic-generated feelings. Objective: Based on a holistic and multilevel perspective, this study examines how pandemic-related emotional exhaustion enacts intrapersonal, interpersonal, and hyperpersonal emotional regulation strategies, and then evaluates the effectiveness of these strategies, with a particular interest in understanding the role of hyperpersonal-level regulation or social media–based regulation. Methods: Using an online panel, this study sampled 538 Chinese internet users from Hubei Province, the epicenter of the COVID-19 outbreak in China. Survey data collection lasted for 12 days from February 7-18, 2020, two weeks after Hubei Province was placed under quarantine. The sample had an average age of 35 (SD 10.65, range 18-78) years, and a majority were married (n=369, 68.6%). Results: Using structural equation modeling, this study found that intrapersonal-level (B=0.22; β=.24; P<.001) and interpersonal-level (B=0.35; β=.49; P<.001) emotional regulation strategies were positively associated with individuals’ outcome reappraisal. In contrast with intrapersonal and interpersonal regulations, hyperpersonal (social media–based) regulation strategies, such as disclosing and retweeting negative emotions, were negatively related to the outcome reappraisal (B=–1.00; β=–.80; P<.001). Conclusions: Consistent with previous literature, intrapersonal-level regulation (eg, cognitive reappraisal, mindfulness, and self-kindness) and interpersonal-level supportive interaction may generate a buffering effect on emotional exhaustion and promote individuals’ reappraisal toward the stressful situation. However, hyperpersonal-level regulation may exacerbate the experienced negative emotions and impede reappraisal of the pandemic situation. It is speculated that retweeting content that contains pandemic-related stress and anxiety may cause a digital emotion contagion. Individuals who share other people’s negative emotional expressions on social media are likely to be affected by the negative affect contagion. More importantly, the possible benefits of intrapersonal and interpersonal emotion regulations may be counteracted by social media or hyperpersonal regulation. This suggests the necessity to conduct social media–based health communication interventions to mitigate the social media–wide negative affect contagion if lockdown policies related to highly infectious diseases are initiated. %M 33661753 %R 10.2196/27015 %U https://www.jmir.org/2021/3/e27015 %U https://doi.org/10.2196/27015 %U http://www.ncbi.nlm.nih.gov/pubmed/33661753 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e27079 %T Emotional Attitudes of Chinese Citizens on Social Distancing During the COVID-19 Outbreak: Analysis of Social Media Data %A Shen,Lining %A Yao,Rui %A Zhang,Wenli %A Evans,Richard %A Cao,Guang %A Zhang,Zhiguo %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, No 13 Hangkong Road, Wuhan, 430030, China, 86 02783692730, sln2008@hust.edu.cn %K COVID-19 %K Sina Weibo %K social distancing measures %K emotional analysis %K machine learning %K moderating effects %K deep learning %K social media %K emotion %K attitude %K infodemiology %K infoveillance %D 2021 %7 16.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Wuhan, China, the epicenter of the COVID-19 pandemic, imposed citywide lockdown measures on January 23, 2020. Neighboring cities in Hubei Province followed suit with the government enforcing social distancing measures to restrict the spread of the disease throughout the province. Few studies have examined the emotional attitudes of citizens as expressed on social media toward the imposed social distancing measures and the factors that affected their emotions. Objective: The aim of this study was twofold. First, we aimed to detect the emotional attitudes of different groups of users on Sina Weibo toward the social distancing measures imposed by the People’s Government of Hubei Province. Second, the influencing factors of their emotions, as well as the impact of the imposed measures on users’ emotions, was studied. Methods: Sina Weibo, one of China’s largest social media platforms, was chosen as the primary data source. The time span of selected data was from January 21, 2020, to March 24, 2020, while analysis was completed in late June 2020. Bi-directional long short-term memory (Bi-LSTM) was used to analyze users’ emotions, while logistic regression analysis was employed to explore the influence of explanatory variables on users’ emotions, such as age and spatial location. Further, the moderating effects of social distancing measures on the relationship between user characteristics and users’ emotions were assessed by observing the interaction effects between the measures and explanatory variables. Results: Based on the 63,169 comments obtained, we identified six topics of discussion—(1) delaying the resumption of work and school, (2) travel restrictions, (3) traffic restrictions, (4) extending the Lunar New Year holiday, (5) closing public spaces, and (6) community containment. There was no multicollinearity in the data during statistical analysis; the Hosmer-Lemeshow goodness-of-fit was 0.24 (χ28=10.34, P>.24). The main emotions shown by citizens were negative, including anger and fear. Users located in Hubei Province showed the highest amount of negative emotions in Mainland China. There are statistically significant differences in the distribution of emotional polarity between social distancing measures (χ220=19,084.73, P<.001), as well as emotional polarity between genders (χ24=1784.59, P<.001) and emotional polarity between spatial locations (χ24=1659.67, P<.001). Compared with other types of social distancing measures, the measures of delaying the resumption of work and school or travel restrictions mainly had a positive moderating effect on public emotion, while traffic restrictions or community containment had a negative moderating effect on public emotion. Conclusions: Findings provide a reference point for the adoption of epidemic prevention and control measures, and are considered helpful for government agencies to take timely actions to alleviate negative emotions during public health emergencies. %M 33724200 %R 10.2196/27079 %U https://medinform.jmir.org/2021/3/e27079 %U https://doi.org/10.2196/27079 %U http://www.ncbi.nlm.nih.gov/pubmed/33724200 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23272 %T COVID-19 Discourse on Twitter in Four Asian Countries: Case Study of Risk Communication %A Park,Sungkyu %A Han,Sungwon %A Kim,Jeongwook %A Molaie,Mir Majid %A Vu,Hoang Dieu %A Singh,Karandeep %A Han,Jiyoung %A Lee,Wonjae %A Cha,Meeyoung %+ Data Science Group, Institute for Basic Science, 55, Expo-ro, Yuseong-gu, Daejeon, 34126, Republic of Korea, 82 428788114, meeyoung.cha@gmail.com %K COVID-19 %K coronavirus %K infodemic %K infodemiology %K infoveillance %K Twitter %K topic phase detection %K topic modeling %K latent Dirichlet allocation %K risk communication %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19, caused by SARS-CoV-2, has led to a global pandemic. The World Health Organization has also declared an infodemic (ie, a plethora of information regarding COVID-19 containing both false and accurate information circulated on the internet). Hence, it has become critical to test the veracity of information shared online and analyze the evolution of discussed topics among citizens related to the pandemic. Objective: This research analyzes the public discourse on COVID-19. It characterizes risk communication patterns in four Asian countries with outbreaks at varying degrees of severity: South Korea, Iran, Vietnam, and India. Methods: We collected tweets on COVID-19 from four Asian countries in the early phase of the disease outbreak from January to March 2020. The data set was collected by relevant keywords in each language, as suggested by locals. We present a method to automatically extract a time–topic cohesive relationship in an unsupervised fashion based on natural language processing. The extracted topics were evaluated qualitatively based on their semantic meanings. Results: This research found that each government’s official phases of the epidemic were not well aligned with the degree of public attention represented by the daily tweet counts. Inspired by the issue-attention cycle theory, the presented natural language processing model can identify meaningful transition phases in the discussed topics among citizens. The analysis revealed an inverse relationship between the tweet count and topic diversity. Conclusions: This paper compares similarities and differences of pandemic-related social media discourse in Asian countries. We observed multiple prominent peaks in the daily tweet counts across all countries, indicating multiple issue-attention cycles. Our analysis identified which topics the public concentrated on; some of these topics were related to misinformation and hate speech. These findings and the ability to quickly identify key topics can empower global efforts to fight against an infodemic during a pandemic. %M 33684054 %R 10.2196/23272 %U https://www.jmir.org/2021/3/e23272 %U https://doi.org/10.2196/23272 %U http://www.ncbi.nlm.nih.gov/pubmed/33684054 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e22916 %T Systematic Delineation of Media Polarity on COVID-19 Vaccines in Africa: Computational Linguistic Modeling Study %A Gbashi,Sefater %A Adebo,Oluwafemi Ayodeji %A Doorsamy,Wesley %A Njobeh,Patrick Berka %+ Faculty of Science, University of Johannesburg, 55 Beit Street, Doornfontein, Johannesburg, 2028, South Africa, 27 620402580, sefatergbashi@gmail.com %K COVID-19 %K coronavirus %K vaccine %K infodemiology %K infoveillance %K infodemic %K sentiment analysis %K natural language processing %K media %K computation %K linguistic %K model %K communication %D 2021 %7 16.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The global onset of COVID-19 has resulted in substantial public health and socioeconomic impacts. An immediate medical breakthrough is needed. However, parallel to the emergence of the COVID-19 pandemic is the proliferation of information regarding the pandemic, which, if uncontrolled, cannot only mislead the public but also hinder the concerted efforts of relevant stakeholders in mitigating the effect of this pandemic. It is known that media communications can affect public perception and attitude toward medical treatment, vaccination, or subject matter, particularly when the population has limited knowledge on the subject. Objective: This study attempts to systematically scrutinize media communications (Google News headlines or snippets and Twitter posts) to understand the prevailing sentiments regarding COVID-19 vaccines in Africa. Methods: A total of 637 Twitter posts and 569 Google News headlines or descriptions, retrieved between February 2 and May 5, 2020, were analyzed using three standard computational linguistics models (ie, TextBlob, Valence Aware Dictionary and Sentiment Reasoner, and Word2Vec combined with a bidirectional long short-term memory neural network). Results: Our findings revealed that, contrary to general perceptions, Google News headlines or snippets and Twitter posts within the stated period were generally passive or positive toward COVID-19 vaccines in Africa. It was possible to understand these patterns in light of increasingly sustained efforts by various media and health actors in ensuring the availability of factual information about the pandemic. Conclusions: This type of analysis could contribute to understanding predominant polarities and associated potential attitudinal inclinations. Such knowledge could be critical in informing relevant public health and media engagement policies. %M 33667172 %R 10.2196/22916 %U https://medinform.jmir.org/2021/3/e22916 %U https://doi.org/10.2196/22916 %U http://www.ncbi.nlm.nih.gov/pubmed/33667172 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24948 %T Using Narrative Evidence to Convey Health Information on Social Media: The Case of COVID-19 %A Gesser-Edelsburg,Anat %+ School of Public Health, University of Haifa, 199 Aba Khoushy Ave, Mount Carmel, Haifa, 3498838, Israel, 972 544243530, ageser@univ.haifa.ac.il %K health and risk communication %K social media %K narrative evidence %K crisis %K pandemic %K misinformation %K infodemic %K infodemiology %K COVID-19 %K policy %K segmentation %K barrier reduction %K role models %K empathy and support %K strengthening self/community-efficacy %K coping tools %K preventing stigmatization %K at-risk populations %K communicating uncertainty %K positive deviance %K tailor messaging %K targeted behavioral change %D 2021 %7 15.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X During disease outbreaks or pandemics, policy makers must convey information to the public for informative purposes (eg, morbidity or mortality rates). They must also motivate members of the public to cooperate with the guidelines, specifically by changing their usual behavior. Policy makers have traditionally adopted a didactic and formalistic stance by conveying dry, statistics-based health information to the public. They have not yet considered the alternative of providing health information in the form of narrative evidence, using stories that address both cognitive and emotional aspects. The aim of this viewpoint paper is to introduce policy makers to the advantages of using narrative evidence to provide health information during a disease outbreak or pandemic such as COVID-19. Throughout human history, authorities have tended to employ apocalyptic narratives during disease outbreaks or pandemics. This viewpoint paper proposes an alternative coping narrative that includes the following components: segmentation; barrier reduction; role models; empathy and support; strengthening self-efficacy, community efficacy, and coping tools; preventing stigmatization of at-risk populations; and communicating uncertainty. It also discusses five conditions for using narrative evidence to produce an effective communication campaign on social media: (1) identifying narratives that reveal the needs, personal experiences, and questions of different subgroups to tailor messaging to produce targeted behavioral change; (2) providing separate and distinct treatment of each information unit or theory that arises on social networks; (3) identifying positive deviants who found creative solutions for stress during the COVID-19 crisis not found by other members of the community; (4) creating different stories of coping; and (5) maintaining a dialogue with population subgroups (eg, skeptical and hesitant groups). The paper concludes by proposing criteria for evaluating the effectiveness of a narrative. %M 33674257 %R 10.2196/24948 %U https://www.jmir.org/2021/3/e24948 %U https://doi.org/10.2196/24948 %U http://www.ncbi.nlm.nih.gov/pubmed/33674257 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e25202 %T The Nature and Extent of Online Marketing by Big Food and Big Alcohol During the COVID-19 Pandemic in Australia: Content Analysis Study %A Martino,Florentine %A Brooks,Ruby %A Browne,Jennifer %A Carah,Nicholas %A Zorbas,Christina %A Corben,Kirstan %A Saleeba,Emma %A Martin,Jane %A Peeters,Anna %A Backholer,Kathryn %+ Deakin University, Global Obesity Centre, Institute for Health Transformation, 1 Gheringhap Street, Geelong, 3220, Australia, 61 3 924 43836, kathryn.backholer@deakin.edu.au %K alcohol %K food and beverage %K COVID-19 %K marketing %K social media %D 2021 %7 12.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Emerging evidence demonstrates that obesity is associated with a higher risk of COVID-19 morbidity and mortality. Excessive alcohol consumption and “comfort eating” as coping mechanisms during times of high stress have been shown to further exacerbate mental and physical ill-health. Global examples suggest that unhealthy food and alcohol brands and companies are using the COVID-19 pandemic to further market their products. However, there has been no systematic, in-depth analysis of how “Big Food” and “Big Alcohol” are capitalizing on the COVID-19 pandemic to market their products and brands. Objective: We aimed to quantify the extent and nature of online marketing by alcohol and unhealthy food and beverage companies during the COVID-19 pandemic in Australia. Methods: We conducted a content analysis of all COVID-19-related social media posts made by leading alcohol and unhealthy food and beverage brands (n=42) and their parent companies (n=12) over a 4-month period (February to May 2020) during the COVID-19 pandemic in Australia. Results: Nearly 80% of included brands and all parent companies posted content related to COVID-19 during the 4-month period. Quick service restaurants (QSRs), food and alcohol delivery companies, alcohol brands, and bottle shops were the most active in posting COVID-19-related content. The most common themes for COVID-19-related marketing were isolation activities and community support. Promotion of hygiene and home delivery was also common, particularly for QSRs and alcohol and food delivery companies. Parent companies were more likely to post about corporate social responsibility (CSR) initiatives, such as donations of money and products, and to offer health advice. Conclusions: This is the first study to show that Big Food and Big Alcohol are incessantly marketing their products and brands on social media platforms using themes related to COVID-19, such as isolation activities and community support. Parent companies are frequently posting about CSR initiatives, such as donations of money and products, thereby creating a fertile environment to loosen current regulation or resist further industry regulation. “COVID-washing” by large alcohol brands, food and beverage brands, and their parent companies is both common and concerning. The need for comprehensive regulations to restrict unhealthy food and alcohol marketing, as recommended by the World Health Organization, is particularly acute in the COVID-19 context and is urgently required to “build back better” in a post-COVID-19 world. %M 33709935 %R 10.2196/25202 %U https://publichealth.jmir.org/2021/3/e25202 %U https://doi.org/10.2196/25202 %U http://www.ncbi.nlm.nih.gov/pubmed/33709935 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24883 %T Examining Tweet Content and Engagement of Canadian Public Health Agencies and Decision Makers During COVID-19: Mixed Methods Analysis %A Slavik,Catherine E %A Buttle,Charlotte %A Sturrock,Shelby L %A Darlington,J Connor %A Yiannakoulias,Niko %+ School of Earth, Environment and Society, McMaster University, General Science Building, 1280 Main Street West, Room 204, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 20118, yiannan@mcmaster.ca %K COVID-19 %K coronavirus %K pandemic %K public health %K Twitter %K social media %K engagement %K risk communication %K infodemiology %K content analysis %D 2021 %7 11.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective communication during a health crisis can ease public concerns and promote the adoption of important risk-mitigating behaviors. Public health agencies and leaders have served as the primary communicators of information related to COVID-19, and a key part of their public outreach has taken place on social media platforms. Objective: This study examined the content and engagement of COVID-19 tweets authored by Canadian public health agencies and decision makers. We propose ways for public health accounts to adjust their tweeting practices during public health crises to improve risk communication and maximize engagement. Methods: We retrieved data from tweets by Canadian public health agencies and decision makers from January 1, 2020, to June 30, 2020. The Twitter accounts were categorized as belonging to either a public health agency, regional or local health department, provincial health authority, medical health officer, or minister of health. We analyzed trends in COVID-19 tweet engagement and conducted a content analysis on a stratified random sample of 485 tweets to examine the message functions and risk communication strategies used by each account type. Results: We analyzed 32,737 tweets authored by 118 Canadian public health Twitter accounts, of which 6982 tweets were related to COVID-19. Medical health officers authored the largest percentage of COVID-19–related tweets (n=1337, 35%) relative to their total number of tweets and averaged the highest number of retweets per COVID-19 tweet (112 retweets per tweet). Public health agencies had the highest frequency of daily tweets about COVID-19 throughout the study period. Compared to tweets containing media and user mentions, hashtags and URLs were used in tweets more frequently by all account types, appearing in 69% (n=4798 tweets) and 68% (n=4781 tweets) of COVID-19–related tweets, respectively. Tweets containing hashtags also received the highest average retweets (47 retweets per tweet). Our content analysis revealed that of the three tweet message functions analyzed (information, action, community), tweets providing information were the most commonly used across most account types, constituting 39% (n=181) of all tweets; however, tweets promoting actions from users received higher than average retweets (55 retweets per tweet). When examining tweets that received one or more retweet (n=359), the difference between mean retweets across the message functions was statistically significant (P<.001). The risk communication strategies that we examined were not widely used by any account type, appearing in only 262 out of 485 tweets. However, when these strategies were used, these tweets received more retweets compared to tweets that did not use any risk communication strategies (P<.001) (61 retweets versus 13 retweets on average). Conclusions: Public health agencies and decision makers should examine what messaging best meets the needs of their Twitter audiences to maximize sharing of their communications. Public health accounts that do not currently employ risk communication strategies in their tweets may be missing an important opportunity to engage with users about the mitigation of health risks related to COVID-19. %M 33651705 %R 10.2196/24883 %U https://www.jmir.org/2021/3/e24883 %U https://doi.org/10.2196/24883 %U http://www.ncbi.nlm.nih.gov/pubmed/33651705 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e23892 %T Acceptability, Safety, and Resonance of the Pilot Digital Suicide Prevention Campaign “Better Off With You”: Qualitative Study %A Carrotte,Elise Rose %A Webb,Marianne %A Flego,Anna %A Vincent,Bonnie %A Heath,Jack %A Blanchard,Michelle %+ Anne Deveson Research Centre, SANE Australia, PO Box 226, South Melbourne, 3205, Australia, 61 3 9682 5933, elise.carrotte@sane.org %K suicide %K interpersonal theory of suicide %K social media %K co-design %K lived experience %D 2021 %7 3.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Interpersonal Theory of Suicide posits that there are three key elements of suicidal behavior: perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. The digital campaign Better Off With You was developed to directly challenge the idea of perceived burdensomeness among people who are contemplating suicide in 2 communities within Australia. Objective: The aim of this study is to explore the needs and preferences of people with lived experience of suicidal thoughts and actions to inform the development of Better Off With You. Methods: This study involved a series of focus groups that aimed to discuss campaign messaging, scope, and approach. People with lived experience of suicidal thoughts and actions attended the focus groups. After the completion of initial focus groups, the results informed the creation of campaign collateral by creative agencies. Early versions of the campaign collateral were then presented in the user testing sessions. Transcriptions were analyzed via thematic analysis. Results: In total, 13 participants attended the focus groups and 14 attended the user testing sessions. The following three overarching themes were presented: acceptability, safety, and resonance. Participants believed that suicide is a serious and ongoing issue in their communities and welcomed a localized suicide prevention focus via peer-to-peer storytelling. The idea of perceived burdensomeness required clarification but was perceived as acceptable and relevant. Participants seemed drawn toward peer narratives that they perceived to be authentic, genuine, and believable as given by real people with lived experience. Campaign messaging needs to be clear and empathetic while directly talking about suicide. Participants did not anticipate any significant negative or harmful impact from any campaign videos and highlighted the importance of providing appropriate help-seeking information. Conclusions: This iterative study provided important insights and knowledge about peer-to-peer storytelling in suicide prevention campaigns. Future campaigns should involve simple messaging, be validating and empathetic, and consider including a lived experience perspective. %M 33656441 %R 10.2196/23892 %U https://formative.jmir.org/2021/3/e23892 %U https://doi.org/10.2196/23892 %U http://www.ncbi.nlm.nih.gov/pubmed/33656441 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e21266 %T Use of #SaludTues Tweetchats for the Dissemination of Culturally Relevant Information on Latino Health Equity: Exploratory Case Study %A Ramirez,Amelie G %A Aguilar,Rosalie P %A Merck,Amanda %A Despres,Cliff %A Sukumaran,Pramod %A Cantu-Pawlik,Stacy %A Chalela,Patricia %+ Department of Population Health Sciences, Institute for Health Promotion Research, UT Health San Antonio, 7411 John Smith, San Antonio, TX, 78229, United States, 1 2105626500, ramirezag@uthscsa.edu %K Latino %K social media %K social cognitive theory %K health communication %K health equity %K policy %K community health %K mobile phone %D 2021 %7 1.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Latinx people comprise 18% of the US adult population and a large share of youth and continue to experience inequities that perpetuate health disparities. To engage Latinx people in advocacy for health equity based on this population’s heavy share of smartphone, social media, and Twitter users, Salud America! launched the #SaludTues Tweetchat series. In this paper, we explore the use of #SaludTues to promote advocacy for Latinx health equity. Objective: This study aims to understand how #SaludTues Tweetchats are used to promote dissemination of culturally relevant information on social determinants of health, to determine whether tweetchats serve to drive web traffic to the Salud America! website, and to understand who participates in #SaludTues Tweetchats and what we can learn about the participants. We also aim to share our own experiences and present a step-by-step guide of how tweetchats are planned, developed, promoted, and executed. Methods: We explored tweetchat data collected between 2014 and 2018 using Symplur and Google Analytics to identify groups of stakeholders and web traffic. Network analysis and mapping tools were also used to derive insights from this series of chats. Results: We conducted 187 chats with 24,609 reported users, 177,466 tweets, and more than 1.87 billion impressions using the hashtag #SaludTues during this span, demonstrating effective dissemination of and exposure to culturally relevant information. Traffic to the Salud America! website was higher on Tuesdays than any other day of the week, suggesting that #SaludTues Tweetchats acted effectively as a website traffic–driving tool. Most participants came from advocacy organizations (165/1000, 16.5%) and other health care–related organizations (162/1000, 16.2%), whereas others were unknown users (147/1000, 14.7%) and individual users outside of the health care sector (117/1000, 11.7%). The majority of participants were located in Texas, California, New York, and Florida, all states with high Latinx populations. Conclusions: Carefully planned, culturally relevant tweetchats such as #SaludTues can be a powerful tool for public health practitioners and advocates to engage audiences on Twitter around health issues, advocacy, and policy solutions for Latino health equity. Further information is needed to determine the effect that #SaludTues Tweetchats have on self- and collective efficacy for advocacy in the area of Latino health equity. %M 33646131 %R 10.2196/21266 %U https://publichealth.jmir.org/2021/3/e21266 %U https://doi.org/10.2196/21266 %U http://www.ncbi.nlm.nih.gov/pubmed/33646131 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e23279 %T Prevalence of Misinformation and Factchecks on the COVID-19 Pandemic in 35 Countries: Observational Infodemiology Study %A Cha,Meeyoung %A Cha,Chiyoung %A Singh,Karandeep %A Lima,Gabriel %A Ahn,Yong-Yeol %A Kulshrestha,Juhi %A Varol,Onur %+ School of Computing, Korea Advanced Institute of Science and Technology, 291 Daehak-ro Yuseong-gu, Daejeon, Republic of Korea, 82 8789300, mcha@ibs.re.kr %K COVID-19 %K coronavirus %K infodemic %K infodemiology %K misinformation %K vulnerability %K LMIC countries %D 2021 %7 13.2.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has been accompanied by an infodemic, in which a plethora of false information has been rapidly disseminated online, leading to serious harm worldwide. Objective: This study aims to analyze the prevalence of common misinformation related to the COVID-19 pandemic. Methods: We conducted an online survey via social media platforms and a survey company to determine whether respondents have been exposed to a broad set of false claims and fact-checked information on the disease. Results: We obtained more than 41,000 responses from 1257 participants in 85 countries, but for our analysis, we only included responses from 35 countries that had at least 15 respondents. We identified a strong negative correlation between a country’s Gross Domestic Product per-capita and the prevalence of misinformation, with poorer countries having a higher prevalence of misinformation (Spearman ρ=–0.72; P<.001). We also found that fact checks spread to a lesser degree than their respective false claims, following a sublinear trend (β=.64). Conclusions: Our results imply that the potential harm of misinformation could be more substantial for low-income countries than high-income countries. Countries with poor infrastructures might have to combat not only the spreading pandemic but also the COVID-19 infodemic, which can derail efforts in saving lives. %M 33395395 %R 10.2196/23279 %U https://humanfactors.jmir.org/2021/1/e23279 %U https://doi.org/10.2196/23279 %U http://www.ncbi.nlm.nih.gov/pubmed/33395395 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 1 %P e24737 %T Risks and Benefits of Using Social Media in Dermatology: Cross-sectional Questionnaire Study %A Bressler,Moshe Y %A Grudnikoff,Eugene %A Bressler,Yaakov %A Tamez,Rebecca %A Zampella,John G %+ Ronald O Perelman Department of Dermatology, New York University, 555 Madison Ave, 4th Floor, New York, NY, 10022, United States, 1 646 754 2000, John.zampella@nyulangone.org %K social media %K dermatologist %K generational differences %K Instagram %K Facebook %K information quality %K patient education %K online content %K risk %K benefit %K dermatology %K cross-sectional %K survey %K online health information %D 2021 %7 24.2.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: Dermatological information on social media is often presented by nondermatologists. Increasing the online engagement of trained dermatologists may improve information quality, patient education, and care. Objective: Our study assesses dermatologists’ perceptions of social media and patterns of use to identify barriers limiting engagement. Methods: In our cohort study, a 36-item online survey was distributed to dermatologists in the United States; responses were captured on a 1-100 sliding scale. Results: Of 166 initiated surveys, 128 valid responses were submitted. Dermatologists showed greater concern for social media risk-related issues (mean 77.9, SD 15.1) than potential benefits (mean 61.8, SD 16.4; P<.001). Leading concerns were poor patient care, nonevidence-based information, and breaching patient privacy. Benefits included interphysician collaboration, patient education, and public health awareness. The most avid and enthusiastic social media users were millennials (mean total optimism score 67.5, SD 14.9) and baby boomers (mean total optimism score 63.1, SD 11.2) compared with Generation X dermatologists (mean total optimism score 52.2, SD 16.3, P<.001). Of 128 dermatologists, 103 (82.4%) plan on increasing their social media use (P=.003). Predictors showing an intent to increase future social media use were younger age, integration into professional use, and an optimistic view (r2=.39; P<.001). Conclusions: Dermatologists perceive the risk of social media to be considerable but still intend to increase its use, likely recognizing the value and importance of social media to the field. %M 37632799 %R 10.2196/24737 %U https://derma.jmir.org/2021/1/e24737 %U https://doi.org/10.2196/24737 %U http://www.ncbi.nlm.nih.gov/pubmed/37632799 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23957 %T Public Opinions and Concerns Regarding the Canadian Prime Minister’s Daily COVID-19 Briefing: Longitudinal Study of YouTube Comments Using Machine Learning Techniques %A Zheng,Chengda %A Xue,Jia %A Sun,Yumin %A Zhu,Tingshao %+ Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang district, Beijing, 100101, China, 86 1064871661, tszhu@psych.ac.cn %K Canada %K PM Trudeau %K YouTube %K machine learning %K big data %K infodemiology %K infodemic %K public concerns %K communication %K concern %K social media %K video %D 2021 %7 23.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic in Canada, Prime Minister Justin Trudeau provided updates on the novel coronavirus and the government’s responses to the pandemic in his daily briefings from March 13 to May 22, 2020, delivered on the official Canadian Broadcasting Corporation (CBC) YouTube channel. Objective: The aim of this study was to examine comments on Canadian Prime Minister Trudeau’s COVID-19 daily briefings by YouTube users and track these comments to extract the changing dynamics of the opinions and concerns of the public over time. Methods: We used machine learning techniques to longitudinally analyze a total of 46,732 English YouTube comments that were retrieved from 57 videos of Prime Minister Trudeau’s COVID-19 daily briefings from March 13 to May 22, 2020. A natural language processing model, latent Dirichlet allocation, was used to choose salient topics among the sampled comments for each of the 57 videos. Thematic analysis was used to classify and summarize these salient topics into different prominent themes. Results: We found 11 prominent themes, including strict border measures, public responses to Prime Minister Trudeau’s policies, essential work and frontline workers, individuals’ financial challenges, rental and mortgage subsidies, quarantine, government financial aid for enterprises and individuals, personal protective equipment, Canada and China’s relationship, vaccines, and reopening. Conclusions: This study is the first to longitudinally investigate public discourse and concerns related to Prime Minister Trudeau’s daily COVID-19 briefings in Canada. This study contributes to establishing a real-time feedback loop between the public and public health officials on social media. Hearing and reacting to real concerns from the public can enhance trust between the government and the public to prepare for future health emergencies. %M 33544690 %R 10.2196/23957 %U https://www.jmir.org/2021/2/e23957 %U https://doi.org/10.2196/23957 %U http://www.ncbi.nlm.nih.gov/pubmed/33544690 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e24429 %T General Audience Engagement With Antismoking Public Health Messages Across Multiple Social Media Sites: Comparative Analysis %A Reuter,Katja %A Wilson,Melissa L %A Moran,Meghan %A Le,NamQuyen %A Angyan,Praveen %A Majmundar,Anuja %A Kaiser,Elsi M %A Unger,Jennifer B %+ Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, 766 Irving Avenue, Syracuse, NY, 13210, United States, 1 315 464 1520, reuterk@upstate.edu %K affordance %K digital %K dissemination of science %K Facebook %K health communication %K health promotion %K Instagram %K online %K smoking %K social media %K tobacco %K Twitter %K user engagement %D 2021 %7 19.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Public health organizations have begun to use social media to increase awareness of health harm and positively improve health behavior. Little is known about effective strategies to disseminate health education messages digitally and ultimately achieve optimal audience engagement. Objective: This study aims to assess the difference in audience engagement with identical antismoking health messages on three social media sites (Twitter, Facebook, and Instagram) and with a referring link to a tobacco prevention website cited in these messages. We hypothesized that health messages might not receive the same user engagement on these media, although these messages were identical and distributed at the same time. Methods: We measured the effect of health promotion messages on the risk of smoking among users of three social media sites (Twitter, Facebook, and Instagram) and disseminated 1275 health messages between April 19 and July 12, 2017 (85 days). The identical messages were distributed at the same time and as organic (unpaid) and advertised (paid) messages, each including a link to an educational website with more information about the topic. Outcome measures included message engagement (ie, the click-through rate [CTR] of the social media messages) and educational website engagement (ie, the CTR on the educational website [wCTR]). To analyze the data and model relationships, we used mixed effects negative binomial regression, z-statistic, and the Hosmer-Lemeshow goodness-of-fit test. Results: Comparisons between social media sites showed that CTRs for identical antitobacco health messages differed significantly across social media (P<.001 for all). Instagram showed the statistically significant highest overall mean message engagement (CTR=0.0037; 95% CI 0.0032-0.0042), followed by Facebook (CTR=0.0026; 95% CI 0.0022-0.0030) and Twitter (CTR=0.0015; 95% CI 0.0013-0.0017). Facebook showed the highest as well as the lowest CTR for any individual message. However, the message CTR is not indicative of user engagement with the educational website content. Pairwise comparisons of the social media sites differed with respect to the wCTR (P<.001 for all). Messages on Twitter showed the lowest CTR, but they resulted in the highest level of website engagement (wCTR=0.6308; 95% CI 0.5640-0.6975), followed by Facebook (wCTR=0.2213; 95% CI 0.1932-0.2495) and Instagram (wCTR=0.0334; 95% CI 0.0230-0.0438). We found a statistically significant higher CTR for organic (unpaid) messages (CTR=0.0074; 95% CI 0.0047-0.0100) compared with paid advertisements (CTR=0.0022; 95% CI 0.0017-0.0027; P<.001 and P<.001, respectively). Conclusions: Our study provides evidence-based insights to guide the design of health promotion efforts on social media. Future studies should examine the platform-specific impact of psycholinguistic message variations on user engagement, include newer sites such as Snapchat and TikTok, and study the correlation between web-based behavior and real-world health behavior change. The need is urgent in light of increased health-related marketing and misinformation on social media. %M 33605890 %R 10.2196/24429 %U http://publichealth.jmir.org/2021/2/e24429/ %U https://doi.org/10.2196/24429 %U http://www.ncbi.nlm.nih.gov/pubmed/33605890 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e24988 %T Factors Contributing to Adolescents’ and Young Adults’ Participation in Web-Based Challenges: Survey Study %A Khasawneh,Amro %A Chalil Madathil,Kapil %A Zinzow,Heidi %A Rosopa,Patrick %A Natarajan,Gitanjali %A Achuthan,Krishnashree %A Narasimhan,Meera %+ Department of Anesthesiology and Critical Care, Johns Hopkins University, 750 E Pratt St, 15th Fl, Baltimore, MD, 21202, United States, 1 607 245 9600, akhasaw1@jhmi.edu %K web-based challenges %K self-injurious behavior %K behavior %K integrated behavioral model %K social media %K challenge %K adolescent %K young adult %K participation %K survey %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Web-based challenges, phenomena that are familiar to adolescents and young adults who spend large amounts of time on social media, range from minimally harmful behaviors intended to support philanthropic endeavors to significantly harmful behaviors that may culminate in injury or death. Objective: This study aims to investigate the beliefs that lead adolescents and young adults to participate in these activities by analyzing the amyotrophic lateral sclerosis (ALS) ice bucket challenge, representing nonharmful behaviors associated with web-based challenges, and the cinnamon challenge, representing web-based challenges that lead to harmful behaviors. Methods: A retrospective quantitative study was conducted with a total of 471 participants aged between 13 and 35 years who either had participated in the ALS ice bucket challenge or the cinnamon challenge, or had never participated in any web-based challenge. Binomial logistic regression models were used to classify those who participated in the ALS ice bucket challenge or cinnamon challenge versus those who did not engage in either challenge using the integrated behavioral model’s beliefs as predictors. Results: The findings showed that participants of both the cinnamon challenge and the ALS ice bucket challenge had significantly greater expectations from the public to participate in the challenge they completed in comparison with individuals who never participated in any challenge (P=.01 for the cinnamon challenge and P=.003 for the ALS ice bucket challenge). Cinnamon challenge participants had greater value for the outcomes of the challenge (P<.001) and perceived positive public opinion about the challenge (P<.001), in comparison with individuals who never participated in any challenge. In contrast, ALS ice bucket challenge participants had significantly greater positive emotional responses than individuals who never participated in any challenge (P<.001). Conclusions: The constructs that contribute to the spread of web-based challenges vary based on the level of self-harm involved in the challenge and its purpose. Intervention efforts could be tailored to address the beliefs associated with different types of web-based challenges. %M 33595450 %R 10.2196/24988 %U http://pediatrics.jmir.org/2021/1/e24988/ %U https://doi.org/10.2196/24988 %U http://www.ncbi.nlm.nih.gov/pubmed/33595450 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e16348 %T A Social Media Campaign (#datasaveslives) to Promote the Benefits of Using Health Data for Research Purposes: Mixed Methods Analysis %A Hassan,Lamiece %A Nenadic,Goran %A Tully,Mary Patricia %+ Division of Informatics, Imaging and Data Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 01612751160, lamiece.hassan@manchester.ac.uk %K social media %K public engagement %K social network analysis %K medical research %D 2021 %7 16.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media provides the potential to engage a wide audience about scientific research, including the public. However, little empirical research exists to guide health scientists regarding what works and how to optimize impact. We examined the social media campaign #datasaveslives established in 2014 to highlight positive examples of the use and reuse of health data in research. Objective: This study aims to examine how the #datasaveslives hashtag was used on social media, how often, and by whom; thus, we aim to provide insights into the impact of a major social media campaign in the UK health informatics research community and further afield. Methods: We analyzed all publicly available posts (tweets) that included the hashtag #datasaveslives (N=13,895) on the microblogging platform Twitter between September 1, 2016, and August 31, 2017. Using a combination of qualitative and quantitative analyses, we determined the frequency and purpose of tweets. Social network analysis was used to analyze and visualize tweet sharing (retweet) networks among hashtag users. Results: Overall, we found 4175 original posts and 9720 retweets featuring #datasaveslives by 3649 unique Twitter users. In total, 66.01% (2756/4175) of the original posts were retweeted at least once. Higher frequencies of tweets were observed during the weeks of prominent policy publications, popular conferences, and public engagement events. Cluster analysis based on retweet relationships revealed an interconnected series of groups of #datasaveslives users in academia, health services and policy, and charities and patient networks. Thematic analysis of tweets showed that #datasaveslives was used for a broader range of purposes than indexing information, including event reporting, encouraging participation and action, and showing personal support for data sharing. Conclusions: This study shows that a hashtag-based social media campaign was effective in encouraging a wide audience of stakeholders to disseminate positive examples of health research. Furthermore, the findings suggest that the campaign supported community building and bridging practices within and between the interdisciplinary sectors related to the field of health data science and encouraged individuals to demonstrate personal support for sharing health data. %M 33591280 %R 10.2196/16348 %U http://www.jmir.org/2021/2/e16348/ %U https://doi.org/10.2196/16348 %U http://www.ncbi.nlm.nih.gov/pubmed/33591280 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e26392 %T Promoting Mask Use on TikTok: Descriptive, Cross-sectional Study %A Basch,Corey H %A Fera,Joseph %A Pierce,Isabela %A Basch,Charles E %+ Department of Public Health, William Paterson University, 300 Pompton Rd, University Hall, Wayne, NJ, 07470, United States, 1 9737202603, baschc@wpunj.edu %K TikTok %K COVID-19 %K social media %K infodemiology %K infoveillance %K mask use %K prevention %K promotion %K communication %K public health %K cross-sectional %K content analysis %K transmission %D 2021 %7 12.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Over the past decade, there has been an increasing secular trend in the number of studies on social media and health. Objective: The purpose of this cross-sectional study was to examine the content and characteristics of TikTok videos that are related to an important aspect of community mitigation—the use of masks as a method for interrupting the transmission of SARS-CoV-2. Methods: In total, 100 trending videos with the hashtag #WearAMask (ie, a campaign on TikTok), along with 32 videos that were posted by the World Health Organization (WHO) and involved masks in any way (ie, all related WHO videos at the time of this study), were included in our sample. We collected the metadata of each post, and created content categories based on fact sheets that were provided by the WHO and the US Centers for Disease Control and Prevention. We used these fact sheets to code the characteristics of mask use. Results: Videos that were posted on TikTok and had the hashtag #WearAMask garnered almost 500 million views, and videos that were posted by the WHO garnered almost 57 million views. Although the ratio of the number of trending #WearAMask videos to the number of WHO videos was around 3:1, the #WearAMask videos received almost 10 times as many cumulative views as the WHO videos. In total, 68% (68/100) of the trending #WearAMask videos involved humor and garnered over 355 million cumulative views. However, only 9% (3/32) of the WHO videos involved humor. Furthermore, 27% (27/100) of the trending #WearAMask videos involved dance and garnered over 130 million cumulative views, whereas none of the WHO videos involved dance. Conclusions: This study is one of the first to describe how TikTok is being used to mitigate the community spread of COVID-19 by promoting mask use. Due to the platform’s incredible reach, TikTok has great potential in conveying important public health messages to various segments of the population. %M 33523823 %R 10.2196/26392 %U http://publichealth.jmir.org/2021/2/e26392/ %U https://doi.org/10.2196/26392 %U http://www.ncbi.nlm.nih.gov/pubmed/33523823 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25431 %T Tracking COVID-19 Discourse on Twitter in North America: Infodemiology Study Using Topic Modeling and Aspect-Based Sentiment Analysis %A Jang,Hyeju %A Rempel,Emily %A Roth,David %A Carenini,Giuseppe %A Janjua,Naveed Zafar %+ British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada, 1 604 707 2514, naveed.janjua@bccdc.ca %K COVID-19 %K Twitter %K topic modeling %K aspect-based sentiment analysis %K racism %K anti-Asians %K Canada %K North America %K sentiment analysis %K social media %K discourse %K reaction %K public health %D 2021 %7 10.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media is a rich source where we can learn about people’s reactions to social issues. As COVID-19 has impacted people’s lives, it is essential to capture how people react to public health interventions and understand their concerns. Objective: We aim to investigate people’s reactions and concerns about COVID-19 in North America, especially in Canada. Methods: We analyzed COVID-19–related tweets using topic modeling and aspect-based sentiment analysis (ABSA), and interpreted the results with public health experts. To generate insights on the effectiveness of specific public health interventions for COVID-19, we compared timelines of topics discussed with the timing of implementation of interventions, synergistically including information on people’s sentiment about COVID-19–related aspects in our analysis. In addition, to further investigate anti-Asian racism, we compared timelines of sentiments for Asians and Canadians. Results: Topic modeling identified 20 topics, and public health experts provided interpretations of the topics based on top-ranked words and representative tweets for each topic. The interpretation and timeline analysis showed that the discovered topics and their trend are highly related to public health promotions and interventions such as physical distancing, border restrictions, handwashing, staying home, and face coverings. After training the data using ABSA with human-in-the-loop, we obtained 545 aspect terms (eg, “vaccines,” “economy,” and “masks”) and 60 opinion terms such as “infectious” (negative) and “professional” (positive), which were used for inference of sentiments of 20 key aspects selected by public health experts. The results showed negative sentiments related to the overall outbreak, misinformation and Asians, and positive sentiments related to physical distancing. Conclusions: Analyses using natural language processing techniques with domain expert involvement can produce useful information for public health. This study is the first to analyze COVID-19–related tweets in Canada in comparison with tweets in the United States by using topic modeling and human-in-the-loop domain-specific ABSA. This kind of information could help public health agencies to understand public concerns as well as what public health messages are resonating in our populations who use Twitter, which can be helpful for public health agencies when designing a policy for new interventions. %M 33497352 %R 10.2196/25431 %U http://www.jmir.org/2021/2/e25431/ %U https://doi.org/10.2196/25431 %U http://www.ncbi.nlm.nih.gov/pubmed/33497352 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e24585 %T Comparing News Articles and Tweets About COVID-19 in Brazil: Sentiment Analysis and Topic Modeling Approach %A de Melo,Tiago %A Figueiredo,Carlos M S %+ Intelligent Systems Laboratory, Superior School of Technology, Amazonas State University, Av Darcy Vargas, 1200, Manaus, Brazil, 55 9233487601, tmelo@uea.edu.br %K COVID-19 %K Twitter %K infodemiology %K news %K sentiment analysis %K social media %K Brazil %K monitoring %K topic modeling %K entity recognition %K text analysis %D 2021 %7 10.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic is severely affecting people worldwide. Currently, an important approach to understand this phenomenon and its impact on the lives of people consists of monitoring social networks and news on the internet. Objective: The purpose of this study is to present a methodology to capture the main subjects and themes under discussion in news media and social media and to apply this methodology to analyze the impact of the COVID-19 pandemic in Brazil. Methods: This work proposes a methodology based on topic modeling, namely entity recognition, and sentiment analysis of texts to compare Twitter posts and news, followed by visualization of the evolution and impact of the COVID-19 pandemic. We focused our analysis on Brazil, an important epicenter of the pandemic; therefore, we faced the challenge of addressing Brazilian Portuguese texts. Results: In this work, we collected and analyzed 18,413 articles from news media and 1,597,934 tweets posted by 1,299,084 users in Brazil. The results show that the proposed methodology improved the topic sentiment analysis over time, enabling better monitoring of internet media. Additionally, with this tool, we extracted some interesting insights about the evolution of the COVID-19 pandemic in Brazil. For instance, we found that Twitter presented similar topic coverage to news media; the main entities were similar, but they differed in theme distribution and entity diversity. Moreover, some aspects represented negative sentiment toward political themes in both media, and a high incidence of mentions of a specific drug denoted high political polarization during the pandemic. Conclusions: This study identified the main themes under discussion in both news and social media and how their sentiments evolved over time. It is possible to understand the major concerns of the public during the pandemic, and all the obtained information is thus useful for decision-making by authorities. %M 33480853 %R 10.2196/24585 %U http://publichealth.jmir.org/2021/2/e24585/ %U https://doi.org/10.2196/24585 %U http://www.ncbi.nlm.nih.gov/pubmed/33480853 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e21463 %T Factors Driving Citizen Engagement With Government TikTok Accounts During the COVID-19 Pandemic: Model Development and Analysis %A Chen,Qiang %A Min,Chen %A Zhang,Wei %A Ma,Xiaoyue %A Evans,Richard %+ School of Medicine and Health Management, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430074, China, 86 13397110378, weizhanghust@hust.edu.cn %K government social media %K citizen engagement %K public health crisis %K TikTok %K emotion valence %K dialogic loop %K COVID-19 %D 2021 %7 4.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, growth in citizen engagement with social media platforms has enabled public health departments to accelerate and improve health information dissemination, developing transparency and trust between governments and citizens. In light of these benefits, it is imperative to learn the antecedents and underlying mechanisms for this to maintain and enhance engagement. Objective: The aim of this study is to determine the factors and influencing mechanisms related to citizen engagement with the TikTok account of the National Health Commission of China during the COVID-19 pandemic. Methods: Using a web crawler, 355 short videos were collected from the Healthy China account on TikTok (with more than 3 million followers throughout China), covering the period from January 21, 2020, to April 25, 2020. The title and video length, as well as the number of likes, shares, and comments were collected for each video. After classifying them using content analysis, a series of negative binomial regression analyses were completed. Results: Among the 355 videos, 154 (43.4%) related to guidance for clinicians, patients, and ordinary citizens, followed by information concerning the government’s handling of the pandemic (n=100, 28.2%), the latest news about COVID-19 (n=61, 17.2%), and appreciation toward frontline emergency services (n=40, 11.3%). Video length, titles, dialogic loop, and content type all influenced the level of citizen engagement. Specifically, video length was negatively associated with the number of likes (incidence rate ratio [IRR]=0.19, P<.001) and comments (IRR=0.39, P<.001). Title length was positively related to the number of shares (IRR=24.25, P=.01), likes (IRR=8.50, P=.03), and comments (IRR=7.85, P=.02). Dialogic loop negatively predicted the number of shares (IRR=0.56, P=.03). In comparison to appreciative information, information about the government’s handling of the situation (IRR=5.16, P<.001) and guidelines information (IRR=7.31, P<.001) were positively correlated with the number of shares, while the latest news was negatively related to the number of likes received (IRR=0.46, P=.004). More importantly, the relationship between predictors and citizen engagement was moderated by the emotional valence of video titles. Longer videos with positive titles received a higher number of likes (IRR=21.72, P=.04) and comments (IRR=10.14, P=.047). Furthermore, for short videos related to government handling of the pandemic (IRR=14.48, P=.04) and guidance for stakeholders (IRR=7.59, P=.04), positive titles received a greater number of shares. Videos related to the latest news (IRR=66.69, P=.04) received more likes if the video title displayed higher levels of positive emotion. Conclusions: During the COVID-19 pandemic, videos were frequently published on government social media platforms. Video length, title, dialogic loop, and content type significantly influenced the level of citizen engagement. These relationships were moderated by the emotional valence of the video’s title. Our findings have implications for maintaining and enhancing citizen engagement via government social media. %M 33481756 %R 10.2196/21463 %U http://www.jmir.org/2021/2/e21463/ %U https://doi.org/10.2196/21463 %U http://www.ncbi.nlm.nih.gov/pubmed/33481756 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e23178 %T Using a Twitter Chat to Rapidly Identify Barriers and Policy Solutions for Metastatic Breast Cancer Care: Qualitative Study %A Shimkhada,Riti %A Attai,Deanna %A Scheitler,AJ %A Babey,Susan %A Glenn,Beth %A Ponce,Ninez %+ Center for Health Policy Research, University of California, Los Angeles, 10960 Wilshire Blvd, Los Angeles, CA, 90024, United States, 1 310 7940909, riti@ucla.edu %K metastatic breast cancer %K Twitter %K infodemiology %K infoveillance %K health care barriers %K health care policy %K social media %K policy %K breast cancer %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Real-time, rapid assessment of barriers to care experienced by patients can be used to inform relevant health care legislation. In recent years, online communities have become a source of support for patients as well as a vehicle for discussion and collaboration among patients, clinicians, advocates, and researchers. The Breast Cancer Social Media (#BCSM) community has hosted weekly Twitter chats since 2011. Topics vary each week, and chats draw a diverse group of participants. Partnering with the #BCSM community, we used Twitter to gather data on barriers to care for patients with metastatic breast cancer and potential policy solutions. Metastatic breast cancer survival rates are low and in large part conditioned by time-sensitive access to care factors that might be improved through policy changes. Objective: This study was part of an assessment of the barriers to care for metastatic breast cancer with the goal of offering policy solutions for the legislative session in California. Methods: We provided 5 questions for a chat specific to metastatic breast cancer care barriers and potential policy solutions. These were discussed during the course of a #BCSM chat on November 18, 2019. We used Symplur (Symplur LLC) analytics to generate a transcript of tweets and a profile of participants. Responses to the questions are presented in this paper. Results: There were 288 tweets from 42 users, generating 2.1 million impressions during the 1-hour chat. Participants included 23 patient advocates (most of whom were patients themselves), 7 doctors, 6 researchers or academics, 3 health care providers (2 nurses, 1 clinical psychologist), and 2 advocacy organizations. Participants noted communication gaps between patient and provider especially as related to the need for individualized medication dosing to minimize side effects and maximize quality of life. Timeliness of insurance company response, for example, to authorize treatments, was also a concern. Chat participants noted that palliative care is not well integrated into metastatic breast cancer care and that insurance company denials of coverage for these services were common. Regarding financial challenges, chat participants mentioned unexpected copays, changes in insurance drug formularies that made it difficult to anticipate drug costs, and limits on the number of physical therapy visits covered by insurance. Last, on the topic of disability benefits, participants expressed frustration about how to access disability benefits. When prompted for input regarding what health system and policy changes are necessary, participants suggested a number of ideas, including expanding the availability of nurse navigation for metastatic breast cancer, developing and offering a guide for the range of treatment and support resources patients with metastatic breast cancer, and improving access to clinical trials. Conclusions: Rapid assessments drawing from online community insights may be a critical source of data that can be used to ensure more responsive policy action to improve patient care. %M 33315017 %R 10.2196/23178 %U http://publichealth.jmir.org/2021/1/e23178/ %U https://doi.org/10.2196/23178 %U http://www.ncbi.nlm.nih.gov/pubmed/33315017 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e16927 %T Facebook-Based Social Marketing to Reduce Smoking in Australia’s First Nations Communities: An Analysis of Reach, Shares, and Likes %A Hefler,Marita %A Kerrigan,Vicki %A Grunseit,Anne %A Freeman,Becky %A Kite,James %A Thomas,David P %+ Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, 0810, Australia, 61 889468517, marita.hefler@menzies.edu.au %K social media %K tobacco %K Australia %K indigenous peoples %K smoking %K health promotion %D 2020 %7 10.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Facebook is widely used by Australia’s First Nations people and has significant potential to promote health. However, evidence-based guidelines for its use in health promotion are lacking. Smoking prevalence among Australia’s First Nations people is nearly 3 times higher than other Australians. Locally designed programs in Aboriginal Community Controlled Health Services (ACCHOs) to reduce smoking often use Facebook. Objective: This study reports on an analysis of the reach and engagement of Facebook posts with smoking prevention and cessation messages posted by ACCHOs in the Northern Territory, Australia. Methods: Each service posted tobacco control content at least weekly for approximately 6 months. Posts were coded for the following variables: service posted, tailored First Nations Australian content, local or nonlocally produced content, video or nonvideo, communication technique, and emotional appeal. The overall reach, shares, and reactions were calculated. Results: Compared with posts developed by the health services, posts with content created by other sources had greater reach (adjusted incident rate ratio [IRR] 1.92, 95% CI 1.03-3.59). Similarly, reactions to posts (IRR 1.89, 95% CI 1.40-2.56) and shared posts (IRR 2.17, 95% CI 1.31-3.61) with content created by other sources also had more reactions, after controlling for reach, as did posts with local First Nations content compared with posts with no First Nations content (IRR 1.71, 95% CI 1.21-2.34). Conclusions: Facebook posts with nonlocally produced content can be an important component of a social media campaign run by local health organizations. With the exception of nonlocally produced content, we did not find a definitive set of characteristics that were clearly associated with reach, shares, and reactions. Beyond reach, shares, and likes, further research is needed to understand the extent that social media content can influence health behavior. %M 33300883 %R 10.2196/16927 %U http://www.jmir.org/2020/12/e16927/ %U https://doi.org/10.2196/16927 %U http://www.ncbi.nlm.nih.gov/pubmed/33300883 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e20649 %T Public Response to a Social Media Tobacco Prevention Campaign: Content Analysis %A Majmundar,Anuja %A Le,NamQuyen %A Moran,Meghan Bridgid %A Unger,Jennifer B %A Reuter,Katja %+ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N Soto St, Los Angeles, CA, 90032, United States, 1 (800) 872 2273, katja.reuter@gmail.com %K social media %K health campaign %K tobacco %K online %K health communication %K internet %K Twitter %K Facebook %K Instagram %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Prior research suggests that social media–based public health campaigns are often targeted by countercampaigns. Objective: Using reactance theory as the theoretical framework, this research characterizes the nature of public response to tobacco prevention messages disseminated via a social media–based campaign. We also examine whether agreement with the prevention messages is associated with comment tone and nature of the contribution to the overall discussion. Methods: User comments to tobacco prevention messages, posted between April 19, 2017 and July 12, 2017, were extracted from Twitter, Facebook, and Instagram. Two coders categorized comments in terms of tone, agreement with message, nature of contribution, mentions of government agency and regulation, promotional or spam comments, and format of comment. Chi-square analyses tested associations between agreement with the message and tone of the public response and the nature of contributions to the discussions. Results: Of the 1242 comments received (Twitter: n=1004; Facebook: n=176; Instagram: n=62), many comments used a negative tone (42.75%) and disagreed with the health messages (39.77%), while the majority made healthy contributions to the discussions (84.38%). Only 0.56% of messages mentioned government agencies, and only 0.48% of the comments were antiregulation. Comments employing a positive tone (84.13%) or making healthy contributions (69.11%) were more likely to agree with the campaign messages (P=0.01). Comments employing a negative tone (71.25%) or making toxic contributions (36.26%) generally disagreed with the messages (P=0.01). Conclusions: The majority of user comments in response to a tobacco prevention campaign made healthy contributions. Our findings encourage the use of social media to promote dialogue about controversial health topics such as smoking. However, toxicity was characteristic of comments that disagreed with the health messages. Managing negative and toxic comments on social media is a crucial issue for social media–based tobacco prevention campaigns to consider. %M 33284120 %R 10.2196/20649 %U http://publichealth.jmir.org/2020/4/e20649/ %U https://doi.org/10.2196/20649 %U http://www.ncbi.nlm.nih.gov/pubmed/33284120 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e19470 %T Social Media Use for Health Communication by the CDC in Mainland China: National Survey Study 2009-2020 %A Zeng,Runxi %A Li,Menghan %+ Center for Communication and Social Development, School of Journalism and Communication, Chongqing University, South Road 55, Daxuecheng, Shapingba District, Chongqing, 401331, China, 86 18971570595, zrx@cqu.edu.cn %K social media %K public health agencies %K Center for Disease Control and Prevention %K China %K government Weibo %K COVID-19 %D 2020 %7 2.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, public health incidents that pose a serious threat to public life have occurred frequently in China. The use of social media by public health authorities has helped to reduce these threats by increasing effective risk communication between the government and the public. Objective: The aim of this study is to reveal how China’s Center for Disease Control and Prevention (CDC) uses social media to improve three aspects of health communication between the government and the public: adoption, operation, and interaction. Methods: To analyze the 134 CDC government Weibo accounts at the provincial- and prefecture-level administration regions in mainland China, we collected their account data and extracted 1215 Weibo tweets. We also supplemented the data to reveal the overall performance of the CDC’s government Weibo use during the COVID-19 crisis. Results: The registration rate of the CDC’s government Weibo accounts increased year by year, and the local authorities registered Weibo accounts before the central government authorities. In total, 29.8% (n=134) of the 450 CDC facilities have registered an account. Among the 134 CDC facilities that have registered Weibo accounts, the registration rate in the eastern region (n=68, 50.7%) was higher than those in the central region (n=30, 22.4%) and the western region (n=36, 26.9%). Nearly 90.0% of these Weibo accounts had official certification, but there were dropouts in the specific operating process. One-third of the accounts have not been updated for more than 1 year, and the number of Weibo followers was polarized, with a maximum and minimum difference of 1 million. The response rate to users’ comments was less than 1%. Emergency information, multimedia content, and original content were more helpful in promoting communication between the government and the public. Such interaction was partially improved during the COVID-19 pandemic. The CDC updated the daily epidemic situation and provided popular science information for epidemic prevention and control for the public in a timely manner. Conclusions: China’s CDC is using more social media to popularize daily health information and has taken the first step to improve communication between the government and the public. However, equal dialogue, two-way interactions, and effective communication with the public still need improvement. %M 33151892 %R 10.2196/19470 %U https://www.jmir.org/2020/12/e19470 %U https://doi.org/10.2196/19470 %U http://www.ncbi.nlm.nih.gov/pubmed/33151892 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21886 %T Real-Time Communication: Creating a Path to COVID-19 Public Health Activism in Adolescents Using Social Media %A Sobowale,Kunmi %A Hilliard,Heather %A Ignaszewski,Martha J %A Chokroverty,Linda %+ Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Suite 37-384, Los Angeles, CA, 90024, United States, 1 310 794 7035, osobowale@mednet.ucla.edu %K social media %K digital health %K COVID-19 %K adolescent %K public health %K disaster %K communication %K affordances %D 2020 %7 1.12.2020 %9 Viewpoint %J J Med Internet Res %G English %X The COVID-19 pandemic and related public health efforts limiting in-person social interactions present unique challenges to adolescents. Social media, which is widely used by adolescents, presents an opportunity to counteract these challenges and promote adolescent health and public health activism. However, public health organizations and officials underuse social media to communicate with adolescents. Using well-established risk communication strategies and insights from adolescent development and human-computer interaction literature, we identify current efforts and gaps, and propose recommendations to advance the use of social media risk communication for adolescents during the COVID-19 pandemic and future disasters. %M 33226956 %R 10.2196/21886 %U https://www.jmir.org/2020/12/e21886 %U https://doi.org/10.2196/21886 %U http://www.ncbi.nlm.nih.gov/pubmed/33226956 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20044 %T Impact of Trump's Promotion of Unproven COVID-19 Treatments and Subsequent Internet Trends: Observational Study %A Niburski,Kacper %A Niburski,Oskar %+ McGill University, 3655 Promenade Sir William Osler, Montreal, QC, H3G 0B1, Canada, 1 9055162020, kacperniburski@gmail.com %K COVID-19 %K behavioral economics %K public health %K behavior %K economics %K media %K influence %K infodemic %K infodemiology %K infoveillance %K Twitter %K analysis %K trend %D 2020 %7 20.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals with large followings can influence public opinions and behaviors, especially during a pandemic. In the early days of the pandemic, US president Donald J Trump has endorsed the use of unproven therapies. Subsequently, a death attributed to the wrongful ingestion of a chloroquine-containing compound occurred. Objective: We investigated Donald J Trump’s speeches and Twitter posts, as well as Google searches and Amazon purchases, and television airtime for mentions of hydroxychloroquine, chloroquine, azithromycin, and remdesivir. Methods: Twitter sourcing was catalogued with Factba.se, and analytics data, both past and present, were analyzed with Tweet Binder to assess average analytics data on key metrics. Donald J Trump’s time spent discussing unverified treatments on the United States’ 5 largest TV stations was catalogued with the Global Database of Events, Language, and Tone, and his speech transcripts were obtained from White House briefings. Google searches and shopping trends were analyzed with Google Trends. Amazon purchases were assessed using Helium 10 software. Results: From March 1 to April 30, 2020, Donald J Trump made 11 tweets about unproven therapies and mentioned these therapies 65 times in White House briefings, especially touting hydroxychloroquine and chloroquine. These tweets had an impression reach of 300% above Donald J Trump’s average. Following these tweets, at least 2% of airtime on conservative networks for treatment modalities like azithromycin and continuous mentions of such treatments were observed on stations like Fox News. Google searches and purchases increased following his first press conference on March 19, 2020, and increased again following his tweets on March 21, 2020. The same is true for medications on Amazon, with purchases for medicine substitutes, such as hydroxychloroquine, increasing by 200%. Conclusions: Individuals in positions of power can sway public purchasing, resulting in undesired effects when the individuals’ claims are unverified. Public health officials must work to dissuade the use of unproven treatments for COVID-19. %M 33151895 %R 10.2196/20044 %U http://www.jmir.org/2020/11/e20044/ %U https://doi.org/10.2196/20044 %U http://www.ncbi.nlm.nih.gov/pubmed/33151895 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 11 %P e24012 %T The Relationships of Deteriorating Depression and Anxiety With Longitudinal Behavioral Changes in Google and YouTube Use During COVID-19: Observational Study %A Zhang,Boyu %A Zaman,Anis %A Silenzio,Vincent %A Kautz,Henry %A Hoque,Ehsan %+ Department of Computer Science, University of Rochester, 2513 Wegmans Hall, Rochester, NY, 14627, United States, 1 6262981861, azaman2@cs.rochester.edu %K mental health %K anxiety %K depression %K Google Search %K YouTube %K pandemic %K COVID-19 %D 2020 %7 23.11.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression and anxiety disorders among the global population have worsened during the COVID-19 pandemic. Yet, current methods for screening these two issues rely on in-person interviews, which can be expensive, time-consuming, and blocked by social stigma and quarantines. Meanwhile, how individuals engage with online platforms such as Google Search and YouTube has undergone drastic shifts due to COVID-19 and subsequent lockdowns. Such ubiquitous daily behaviors on online platforms have the potential to capture and correlate with clinically alarming deteriorations in depression and anxiety profiles of users in a noninvasive manner. Objective: The goal of this study is to examine, among college students in the United States, the relationships of deteriorating depression and anxiety conditions with the changes in user behaviors when engaging with Google Search and YouTube during COVID-19. Methods: This study recruited a cohort of undergraduate students (N=49) from a US college campus during January 2020 (prior to the pandemic) and measured the anxiety and depression levels of each participant. The anxiety level was assessed via the General Anxiety Disorder-7 (GAD-7). The depression level was assessed via the Patient Health Questionnaire-9 (PHQ-9). This study followed up with the same cohort during May 2020 (during the pandemic), and the anxiety and depression levels were assessed again. The longitudinal Google Search and YouTube history data of all participants were anonymized and collected. From individual-level Google Search and YouTube histories, we developed 5 features that can quantify shifts in online behaviors during the pandemic. We then assessed the correlations of deteriorating depression and anxiety profiles with each of these features. We finally demonstrated the feasibility of using the proposed features to build predictive machine learning models. Results: Of the 49 participants, 49% (n=24) of them reported an increase in the PHQ-9 depression scores; 53% (n=26) of them reported an increase in the GAD-7 anxiety scores. The results showed that a number of online behavior features were significantly correlated with deteriorations in the PHQ-9 scores (r ranging between –0.37 and 0.75, all P values less than or equal to .03) and the GAD-7 scores (r ranging between –0.47 and 0.74, all P values less than or equal to .03). Simple machine learning models were shown to be useful in predicting the change in anxiety and depression scores (mean squared error ranging between 2.37 and 4.22, R2 ranging between 0.68 and 0.84) with the proposed features. Conclusions: The results suggested that deteriorating depression and anxiety conditions have strong correlations with behavioral changes in Google Search and YouTube use during the COVID-19 pandemic. Though further studies are required, our results demonstrate the feasibility of using pervasive online data to establish noninvasive surveillance systems for mental health conditions that bypasses many disadvantages of existing screening methods. %M 33180743 %R 10.2196/24012 %U http://mental.jmir.org/2020/11/e24012/ %U https://doi.org/10.2196/24012 %U http://www.ncbi.nlm.nih.gov/pubmed/33180743 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21501 %T Use of Facebook by Academic Medical Centers in Taiwan During the COVID-19 Pandemic: Observational Study %A Chu,Wei-Min %A Shieh,Gow-Jen %A Wu,Shi-Liang %A Sheu,Wayne Huey-Herng %+ Department of Top Hospital Administration, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Section 4, Taichung, 40705, Taiwan, 886 23592525 ext 2005, whhsheu@vghtc.gov.tw %K COVID-19 %K social media %K Facebook %K medical centers %K Taiwan %K communication %K video post %K survey %K health promotion %K engagement %D 2020 %7 20.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The battle against COVID-19 remains ongoing, and social media has played an important role during the crisis for both communication and health promotion, particularly for health care organizations. Taiwan’s success during the COVID-19 outbreak is well known and the use of social media is one of the key contributing factors to that success. Objective: This nationwide observational study in Taiwan aimed to explore the use of Facebook by academic medical centers during the COVID-19 pandemic. Methods: We conducted a nationwide observational study of all Facebook fan page posts culled from the official accounts of all medical centers in Taiwan from December 2019 to April 2020. All Facebook posts were categorized into either COVID-19–related posts or non–COVID-19–related posts. COVID-19–related posts were split into 4 categories: policy of Taiwan’s Center for Disease Control (TCDC), gratitude notes, news and regulations from hospitals, and education. Data from each post was also recorded as follows: date of post, headline, number of “likes,” number of messages left, number of shares, video or non-video post, and date of search. Results: The Facebook fan pages of 13 academic medical centers, with a total of 1816 posts, were analyzed. From January 2020, the percentage of COVID-19 posts increased rapidly, from 21% (January 2020) to 56.3% (April 2020). The trends of cumulative COVID-19 posts and reported confirmed cases were significantly related (Pearson correlation coefficient=0.93, P<.001). Pages from private hospitals had more COVID-19 posts (362 versus 289), as well as more video posts (72 posts, 19.9% versus 36 posts, 12.5%, P=.011), when compared to public hospitals. However, Facebook pages from public hospitals had significantly more “likes,” comments, and shares per post (314, 5, 14, respectively, P<.001). Additionally, medical centers from different regions displayed different strategies for using video posts on Facebook. Conclusions: Social media has been a useful tool for communication during the COVID-19 pandemic. This nationwide observational study has helped demonstrate the value of Facebook for academic medical centers in Taiwan, along with its engagement efficacy. We believe that the experience of Taiwan and the knowledge it can share will be helpful to health care organizations worldwide during our global battle against COVID-19. %M 33119536 %R 10.2196/21501 %U http://www.jmir.org/2020/11/e21501/ %U https://doi.org/10.2196/21501 %U http://www.ncbi.nlm.nih.gov/pubmed/33119536 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23019 %T Threat, Coping, and Social Distance Adherence During COVID-19: Cross-Continental Comparison Using an Online Cross-Sectional Survey %A Al-Hasan,Abrar %A Khuntia,Jiban %A Yim,Dobin %+ Kuwait University, College of Business Administration, AlShadadiya University City, 13055, Kuwait, 965 51165005, abrar.alhasan@ku.edu.kw %K COVID-19 %K adherence %K coping appraisal %K threat appraisal %K protection motivation theory %K social distancing %K information sources %K social media %K knowledge %K coping %K threat %K protection %K motivation %K cross-sectional %K survey %D 2020 %7 18.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social distancing is an effective preventative policy for COVID-19 that is enforced by governments worldwide. However, significant variations are observed in adherence to social distancing across individuals and countries. Due to the lack of treatment, rapid spread, and prevalence of COVID-19, panic and fear associated with the disease causes great stress. Subsequent effects will be a variation around the coping and mitigation strategies for different individuals following different paths to manage the situation. Objective: This study aims to explore how threat and coping appraisal processes work as mechanisms between information and citizens’ adherence to COVID-19–related recommendations (ie, how the information sources and social media influence threat and coping appraisal processes with COVID-19 and how the threat and coping appraisal processes influence adherence to policy guidelines). In addition, this study aims to explore how citizens in three different countries (the United States, Kuwait, and South Korea), randomly sampled, are effectively using the mechanisms. Methods: Randomly sampled online survey data collected by a global firm in May 2020 from 162 citizens of the United States, 185 of Kuwait, and 71 of South Korea were analyzed, resulting in a total sample size of 418. A seemingly unrelated regression model, controlling for several counterfactuals, was used for analysis. The study’s focal estimated effects were compared across the three countries using the weighted distance between the parameter estimates. Results: The seemingly unrelated regression model estimation results suggested that, overall, the intensity of information source use for the COVID-19 pandemic positively influenced the threat appraisal for the disease (P<.001). Furthermore, the intensity of social media use for the COVID-19 pandemic positively influenced the coping appraisal for the disease (P<.001). Higher COVID-19 threat appraisal had a positive effect on social distancing adherence (P<.001). Higher COVID-19 coping appraisal had a positive effect on social distancing adherence (P<.001). Higher intensity of COVID-19 knowledge positively influenced social distancing adherence (P<.001). There were country-level variations. Broadly, we found that the United States had better results than South Korea and Kuwait in leveraging the information to threat and coping appraisal to the adherence process, indicating that individuals in countries like the United States and South Korea may be more pragmatic to appraise the situation before making any decisions. Conclusions: This study’s findings suggest that the mediation of threat and coping strategies are essential, in varying effects, to shape the information and social media strategies for adherence outcomes. Accordingly, coordinating public service announcements along with information source outlets such as mainstream media (eg, TV and newspaper) as well as social media (eg, Facebook and Twitter) to inform citizens and, at the same time, deliver balanced messages about the threat and coping appraisal is critical in implementing a staggered social distancing and sheltering strategy. %M 33119538 %R 10.2196/23019 %U http://www.jmir.org/2020/11/e23019/ %U https://doi.org/10.2196/23019 %U http://www.ncbi.nlm.nih.gov/pubmed/33119538 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23922 %T Relationship Between COVID-19 Information Sources and Attitudes in Battling the Pandemic Among the Malaysian Public: Cross-Sectional Survey Study %A Mohamad,Emma %A Tham,Jen Sern %A Ayub,Suffian Hadi %A Hamzah,Mohammad Rezal %A Hashim,Hasrul %A Azlan,Arina Anis %+ Centre for Research in Media and Communication, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600 UKM, Bangi, Selangor, 43600, Malaysia, 60 389215456, arina@ukm.edu.my %K COVID-19 %K information source %K confidence %K media %K social media %K government %K Malaysia %K online information %K survey %D 2020 %7 12.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: There are multiple media platforms and various resources available for information on COVID-19. Identifying people’s preferences is key to building public confidence and planning for successful national health intervention strategies. Objective: This study examines the sources of information for COVID-19 used by the Malaysian public and identifies those that are associated with building public confidence and positive perceptions toward the Malaysian government. Methods: A cross-sectional online survey of 4850 Malaysian residents was conducted. Participant demographics, media use, information sources, and attitudes surrounding COVID-19 were assessed. Descriptive statistics and multiple logistic regression analyses were conducted to gauge the relationship between demographics, information sources, and attitudes toward COVID-19. Results: Malaysians primarily used television and internet news portals to access information on COVID-19. The Malaysian Ministry of Health was the most preferred source of COVID-19 information. Respondents who referred to the Ministry of Health, television, and the Malaysian National Security Council for information were more likely to believe that the country could win the battle against COVID-19 and that the government was handling the health crisis well compared to those who referred to other information sources. Those who used the World Health Organization, friends, YouTube, family, and radio as sources of information were less likely to harbor confidence and positive belief toward combating COVID-19. Conclusions: Managing information and sustaining public confidence is important during a pandemic. Health authorities should pay considerable attention to the use of appropriate media channels and sources to allow for more effective dissemination of critical information to the public. %M 33151897 %R 10.2196/23922 %U http://www.jmir.org/2020/11/e23922/ %U https://doi.org/10.2196/23922 %U http://www.ncbi.nlm.nih.gov/pubmed/33151897 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21582 %T Use of Social Media to Promote Cancer Screening and Early Diagnosis: Scoping Review %A Plackett,Ruth %A Kaushal,Aradhna %A Kassianos,Angelos P %A Cross,Aaron %A Lewins,Douglas %A Sheringham,Jessica %A Waller,Jo %A von Wagner,Christian %+ Department of Applied Health Research, University College London, 1-19 Torrington Place,, Bloomsbury, London, WC1E 7HB, United Kingdom, 44 20 3108 3242, ruth.plackett.15@ucl.ac.uk %K social media %K review %K cancer %K campaign %K health promotion %K public health %K early detection of cancer %K cancer screening %K health care disparities %D 2020 %7 9.11.2020 %9 Review %J J Med Internet Res %G English %X Background: Social media is commonly used in public health interventions to promote cancer screening and early diagnosis, as it can rapidly deliver targeted public health messages to large numbers of people. However, there is currently little understanding of the breadth of social media interventions and evaluations, whether they are effective, and how they might improve outcomes. Objective: This scoping review aimed to map the evidence for social media interventions to improve cancer screening and early diagnosis, including their impact on behavior change and how they facilitate behavior change. Methods: Five databases and the grey literature were searched to identify qualitative and quantitative evaluations of social media interventions targeting cancer screening and early diagnosis. Two reviewers independently reviewed each abstract. Data extraction was carried out by one author and verified by a second author. Data on engagement was extracted using an adapted version of the key performance indicators and metrics related to social media use in health promotion. Insights, exposure, reach, and differing levels of engagement, including behavior change, were measured. The behavior change technique taxonomy was used to identify how interventions facilitated behavior change. Results: Of the 23 publications and reports included, the majority (16/23, 70%) evaluated national cancer awareness campaigns (eg, breast cancer awareness month). Most interventions delivered information via Twitter (13/23, 57%), targeted breast cancer (12/23, 52%), and measured exposure, reach, and low- to medium-level user engagement, such as number of likes (9/23, 39%). There were fewer articles about colorectal and lung cancer than about breast and prostate cancer campaigns. One study found that interventions had less reach and engagement from ethnic minority groups. A small number of articles (5/23, 22%) suggested that some types of social media interventions might improve high-level engagement, such as intended and actual uptake of screening. Behavior change techniques, such as providing social support and emphasizing the consequences of cancer, were used to engage users. Many national campaigns delivered fundraising messages rather than actionable health messages. Conclusions: The limited evidence suggests that social media interventions may improve cancer screening and early diagnosis. Use of evaluation frameworks for social media interventions could help researchers plan more robust evaluations that measure behavior change. We need a greater understanding of who engages with these interventions to know whether social media can be used to reduce some health inequalities in cancer screening and early diagnosis. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-033592 %M 33164907 %R 10.2196/21582 %U http://www.jmir.org/2020/11/e21582/ %U https://doi.org/10.2196/21582 %U http://www.ncbi.nlm.nih.gov/pubmed/33164907 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e21963 %T Electronic Cigarette–Related Contents on Instagram: Observational Study and Exploratory Analysis %A Gao,Yankun %A Xie,Zidian %A Sun,Li %A Xu,Chenliang %A Li,Dongmei %+ University of Rochester Medical Center, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K electronic cigarettes %K infodemiology %K Instagram %K user engagement %K exploratory %K smoking %K e-cig %K social media %K vape %K vaping %K risk %K public health %D 2020 %7 5.11.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Instagram is a popular social networking platform for users to upload pictures sharing their experiences. Instagram has been widely used by vaping companies and stores to promote electronic cigarettes (e-cigarettes), as well as by public health entities to communicate the risks of e-cigarette use (vaping) to the public. Objective: We aimed to characterize current vaping-related content on Instagram through descriptive analyses. Methods: From Instagram, 42,951 posts were collected using vaping-related hashtags in November 2019. The posts were grouped as (1) pro-vaping, (2) vaping warning, (3) neutral to vaping, and (4) not related to vaping based on the attitudes to vaping expressed within the posts. From these Instagram posts and the corresponding 18,786 unique Instagram user accounts, 200 pro-vaping and 200 vaping-warning posts as well as 200 pro-vaping and 200 vaping-warning user accounts were randomly selected for hand coding. Furthermore, follower counts and media counts of the Instagram user accounts as well as the “like” counts and hashtags of the posts were compared between pro-vaping and vaping-warning groups. Results: There were more posts in the pro-vaping group (41,412 posts) than there were in the vaping-warning group (1539 posts). The majority of pro-vaping images were product display images (163/200, 81.5%), and the most popular image type in vaping-warning posts was educational (95/200, 47.5%). The highest proportion of pro-vaping user account type was vaping store (110/189, 58.1%), and the store account type had the highest mean number of posts (10.33 posts/account). The top 3 vaping-warning user account types were personal (79/155, 51%), vaping-warning community (37/155, 23.9%), and community (35/155, 22.6%), of which the vaping-warning community had the highest mean number of posts (3.68 posts/account). Pro-vaping user accounts had more followers (median 850) and media (median 232) than vaping-warning user accounts had (follower count: median 191; media count: 92). Pro-vaping posts had more “likes” (median 22) and hashtags (mean 20.39) than vaping-warning posts had (“like” count: median 12; hashtags: mean 7.16). Conclusions: Instagram is dominated by pro-vaping content, and pro-vaping posts and user accounts seem to have more user engagement than vaping-warning accounts have. These results highlight the importance of regulating e-cigarette posts on social media and the urgency of identifying effective communication content and message delivery methods with the public about the health effects of e-cigarettes to ameliorate the epidemic of vaping in youth. %M 33151157 %R 10.2196/21963 %U http://publichealth.jmir.org/2020/4/e21963/ %U https://doi.org/10.2196/21963 %U http://www.ncbi.nlm.nih.gov/pubmed/33151157 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e15577 %T E-Cigarette Promotion on Twitter in Australia: Content Analysis of Tweets %A McCausland,Kahlia %A Maycock,Bruce %A Leaver,Tama %A Wolf,Katharina %A Freeman,Becky %A Thomson,Katie %A Jancey,Jonine %+ Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, 6102, Australia, 61 92667382, kahlia.mccausland@curtin.edu.au %K electronic cigarette %K e-cigarette %K electronic nicotine delivery systems %K vaping %K vape %K social media %K twitter %K content analysis %K public health %K public policy %D 2020 %7 5.11.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The sale of electronic cigarettes (e-cigarettes) containing nicotine is prohibited in all Australian states and territories; yet, the growing availability and convenience of the internet enable the promotion and exposure of e-cigarettes across countries. Social media’s increasing pervasiveness has provided a powerful avenue to market products and influence social norms and risk behaviors. At present, there is no evidence of how e-cigarettes and vaping are promoted on social media in Australia. Objective: This study aimed to investigate how e-cigarettes are portrayed and promoted on Twitter through a content analysis of vaping-related tweets containing an image posted and retweeted by Australian users and how the portrayal and promotion have emerged and trended over time. Methods: In total, we analyzed 1303 tweets and accompanying images from 2012, 2014, 2016, and 2018 collected through the Tracking Infrastructure for Social Media Analysis (TrISMA), a contemporary technical and organizational infrastructure for the tracking of public communication by Australian users of social media, via a list of 15 popular e-cigarette–related terms. Results: Despite Australia’s cautious approach toward e-cigarettes and the limited evidence supporting them as an efficacious smoking cessation aid, it is evident that there is a concerted effort by some Twitter users to promote these devices as a health-conducive (91/129, 70.5%), smoking cessation product (266/1303, 20.41%). Further, Twitter is being used in an attempt to circumvent Australian regulation and advocate for a more liberal approach to personal vaporizers (90/1303, 6.90%). A sizeable proportion of posts was dedicated to selling or promoting vape products (347/1303, 26.63%), and 19.95% (260/1303) were found to be business listings. These posts used methods to try and expand their clientele further than immediate followers by touting competitions and giveaways, with those wanting to enter having to perform a sequence of steps such as liking, tagging, and reposting, ultimately exposing the post among the user’s network and to others not necessarily interested in vaping. Conclusions: The borderless nature of social media presents a clear challenge for enforcing Article 13 of the World Health Organization Framework Convention on Tobacco Control, which requires all ratifying nations to implement a ban on tobacco advertising, promotion, and sponsorship. Countering the advertising and promotion of these products is a public health challenge that will require cross-border cooperation with other World Health Organization Framework Convention on Tobacco Control parties. Further research aimed at developing strategies to counter the advertising and promotion of e-cigarettes is therefore needed. %M 33151159 %R 10.2196/15577 %U http://publichealth.jmir.org/2020/4/e15577/ %U https://doi.org/10.2196/15577 %U http://www.ncbi.nlm.nih.gov/pubmed/33151159 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e17543 %T E-Cigarette Advocates on Twitter: Content Analysis of Vaping-Related Tweets %A McCausland,Kahlia %A Maycock,Bruce %A Leaver,Tama %A Wolf,Katharina %A Freeman,Becky %A Jancey,Jonine %+ Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, 6102, Australia, 61 92667382, kahlia.mccausland@curtin.edu.au %K electronic nicotine delivery systems %K electronic cigarettes %K e-cigarette %K infodemiology %K infoveillance %K vaping %K Twitter %K social media %K public health %K content analysis %D 2020 %7 14.10.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As the majority of Twitter content is publicly available, the platform has become a rich data source for public health surveillance, providing insights into emergent phenomena, such as vaping. Although there is a growing body of literature that has examined the content of vaping-related tweets, less is known about the people who generate and disseminate these messages and the role of e-cigarette advocates in the promotion of these devices. Objective: This study aimed to identify key conversation trends and patterns over time, and discern the core voices, message frames, and sentiment surrounding e-cigarette discussions on Twitter. Methods: A random sample of data were collected from Australian Twitter users who referenced at least one of 15 identified e-cigarette related keywords during 2012, 2014, 2016, or 2018. Data collection was facilitated by TrISMA (Tracking Infrastructure for Social Media Analysis) and analyzed by content analysis. Results: A sample of 4432 vaping-related tweets posted and retweeted by Australian users was analyzed. Positive sentiment (3754/4432, 84.70%) dominated the discourse surrounding e-cigarettes, and vape retailers and manufacturers (1161/4432, 26.20%), the general public (1079/4432, 24.35%), and e-cigarette advocates (1038/4432, 23.42%) were the most prominent posters. Several tactics were used by e-cigarette advocates to communicate their beliefs, including attempts to frame e-cigarettes as safer than traditional cigarettes, imply that federal government agencies lack sufficient competence or evidence for the policies they endorse about vaping, and denounce as propaganda “gateway” claims of youth progressing from e-cigarettes to combustible tobacco. Some of the most common themes presented in tweets were advertising or promoting e-cigarette products (2040/4432, 46.03%), promoting e-cigarette use or intent to use (970/4432, 21.89%), and discussing the potential of e-cigarettes to be used as a smoking cessation aid or tobacco alternative (716/4432, 16.16%), as well as the perceived health and safety benefits and consequences of e-cigarette use (681/4432, 15.37%). Conclusions: Australian Twitter content does not reflect the country’s current regulatory approach to e-cigarettes. Rather, the conversation on Twitter generally encourages e-cigarette use, promotes vaping as a socially acceptable practice, discredits scientific evidence of health risks, and rallies around the idea that e-cigarettes should largely be outside the bounds of health policy. The one-sided nature of the discussion is concerning, as is the lack of disclosure and transparency, especially among vaping enthusiasts who dominate the majority of e-cigarette discussions on Twitter, where it is unclear if comments are endorsed, sanctioned, or even supported by the industry. %M 33052130 %R 10.2196/17543 %U http://publichealth.jmir.org/2020/4/e17543/ %U https://doi.org/10.2196/17543 %U http://www.ncbi.nlm.nih.gov/pubmed/33052130 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19684 %T Social Media Use, eHealth Literacy, Disease Knowledge, and Preventive Behaviors in the COVID-19 Pandemic: Cross-Sectional Study on Chinese Netizens %A Li,Xiaojing %A Liu,Qinliang %+ Center for Health and Medical Communication, School of Media & Communication, Shanghai Jiao Tong University, 800 Dongchuan Rd, Shanghai, 200240, China, 86 13918611103, lixiaojing@sjtu.edu.cn %K social media %K media use %K COVID-19 %K pandemic %K disease knowledge %K eHealth literacy %K public health %K preventive behaviors %D 2020 %7 9.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since its outbreak in January 2020, COVID-19 has quickly spread worldwide and has become a global pandemic. Social media platforms have been recognized as important tools for health-promoting practices in public health, and the use of social media is widespread among the public. However, little is known about the effects of social media use on health promotion during a pandemic such as COVID-19. Objective: In this study, we aimed to explore the predictive role of social media use on public preventive behaviors in China during the COVID-19 pandemic and how disease knowledge and eHealth literacy moderated the relationship between social media use and preventive behaviors. Methods: A national web-based cross-sectional survey was conducted by a proportionate probability sampling among 802 Chinese internet users (“netizens”) in February 2020. Descriptive statistics, Pearson correlations, and hierarchical multiple regressions were employed to examine and explore the relationships among all the variables. Results: Almost half the 802 study participants were male (416, 51.9%), and the average age of the participants was 32.65 years. Most of the 802 participants had high education levels (624, 77.7%), had high income >¥5000 (US $736.29) (525, 65.3%), were married (496, 61.8%), and were in good health (486, 60.6%). The average time of social media use was approximately 2 to 3 hours per day (mean 2.34 hours, SD 1.11), and the most frequently used media types were public social media (mean score 4.49/5, SD 0.78) and aggregated social media (mean score 4.07/5, SD 1.07). Social media use frequency (β=.20, P<.001) rather than time significantly predicted preventive behaviors for COVID-19. Respondents were also equipped with high levels of disease knowledge (mean score 8.15/10, SD 1.43) and eHealth literacy (mean score 3.79/5, SD 0.59). Disease knowledge (β=.11, P=.001) and eHealth literacy (β=.27, P<.001) were also significant predictors of preventive behaviors. Furthermore, eHealth literacy (P=.038) and disease knowledge (P=.03) positively moderated the relationship between social media use frequency and preventive behaviors, while eHealth literacy (β=.07) affected this relationship positively and disease knowledge (β=–.07) affected it negatively. Different social media types differed in predicting an individual’s preventive behaviors for COVID-19. Aggregated social media (β=.22, P<.001) was the best predictor, followed by public social media (β=.14, P<.001) and professional social media (β=.11, P=.002). However, official social media (β=.02, P=.597) was an insignificant predictor. Conclusions: Social media is an effective tool to promote behaviors to prevent COVID-19 among the public. Health literacy is essential for promotion of individual health and influences the extent to which the public engages in preventive behaviors during a pandemic. Our results not only enrich the theoretical paradigm of public health management and health communication but also have practical implications in pandemic control for China and other countries. %M 33006940 %R 10.2196/19684 %U http://www.jmir.org/2020/10/e19684/ %U https://doi.org/10.2196/19684 %U http://www.ncbi.nlm.nih.gov/pubmed/33006940 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 10 %P e20558 %T Factors Associated With Influential Health-Promoting Messages on Social Media: Content Analysis of Sina Weibo %A Rao,Qingmao %A Zhang,Zuyue %A Lv,Yalan %A Zhao,Yong %A Bai,Li %A Hou,Xiaorong %+ College of Medical Informatics, Chongqing Medical University, No.1, Medical College Road, Yuzhong District, Chongqing, 400016, China, 86 138 8390 1680, xiaoronghou@cqmu.edu.cn %K health-promoting messages %K social media %K Sina Weibo %K influence %K framing effects %K health communication %D 2020 %7 9.10.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Social media is a powerful tool for the dissemination of health messages. However, few studies have focused on the factors that improve the influence of health messages on social media. Objective: To explore the influence of goal-framing effects, information organizing, and the use of pictures or videos in health-promoting messages, we conducted a case study of Sina Weibo, a popular social media platform in China. Methods: Literature review and expert discussion were used to determine the health themes of childhood obesity, smoking, and cancer. Web crawler technology was employed to capture data on health-promoting messages. We used the number of retweets, comments, and likes to evaluate the influence of a message. Statistical analysis was then conducted after manual coding. Specifically, binary logistic regression was used for the data analyses. Results: We crawled 20,799 Sina Weibo messages and selected 389 health-promoting messages for this study. Results indicated that the use of gain-framed messages could improve the influence of messages regarding childhood obesity (P<.001), smoking (P=.03), and cancer (P<.001). Statistical expressions could improve the influence of messages about childhood obesity (P=.02), smoking (P=.002), and cancer (P<.001). However, the use of videos significantly improved the influence of health-promoting messages only for the smoking-related messages (P=.009). Conclusions: The findings suggested that gain-framed messages and statistical expressions can be successful strategies to improve the influence of messages. Moreover, appropriate pictures and videos should be added as much as possible when generating health-promoting messages. %M 33034569 %R 10.2196/20558 %U http://medinform.jmir.org/2020/10/e20558/ %U https://doi.org/10.2196/20558 %U http://www.ncbi.nlm.nih.gov/pubmed/33034569 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20955 %T Excessive Media Consumption About COVID-19 is Associated With Increased State Anxiety: Outcomes of a Large Online Survey in Russia %A Nekliudov,Nikita A %A Blyuss,Oleg %A Cheung,Ka Yan %A Petrou,Loukia %A Genuneit,Jon %A Sushentsev,Nikita %A Levadnaya,Anna %A Comberiati,Pasquale %A Warner,John O %A Tudor-Williams,Gareth %A Teufel,Martin %A Greenhawt,Matthew %A DunnGalvin,Audrey %A Munblit,Daniel %+ Department of Infectious Disease, Faculty of Medicine, Imperial College London, Wright Fleming Building, Norfolk Place, Paddington, London, W2 1PG, United Kingdom, 44 (0) 7898257151, daniel.munblit08@imperial.ac.uk %K anxiety %K COVID-19 %K media consumption %K SARS-CoV-2 %K STAI %K state anxiety %K trait anxiety %K trust to government %K trust %K mental health %K social media %K survey %D 2020 %7 11.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has potentially had a negative impact on the mental health and well-being of individuals and families. Anxiety levels and risk factors within particular populations are poorly described. Objective: This study aims to evaluate confidence, understanding, trust, concerns, and levels of anxiety during the COVID-19 pandemic in the general population and assess risk factors for increased anxiety. Methods: We launched a cross-sectional online survey of a large Russian population between April 6 and 15, 2020, using multiple social media platforms. A set of questions targeted confidence, understanding, trust, and concerns in respondents. The State-Trait Anxiety Inventory was used to measure anxiety. Multiple linear regressions were used to model predictors of COVID-19–related anxiety. Results: The survey was completed by 23,756 out of 53,966 (44.0% response rate) unique visitors; of which, 21,364 were residing in 62 areas of Russia. State Anxiety Scale (S-Anxiety) scores were higher than Trait Anxiety Scale scores across all regions of Russia (median S-Anxiety score 52, IQR 44-60), exceeding published norms. Time spent following news on COVID-19 was strongly associated with an increased S-Anxiety adjusted for baseline anxiety level. One to two hours spent reading COVID-19 news was associated with a 5.46 (95% CI 5.03-5.90) point difference, 2-3 hours with a 7.06 (95% CI 6.37-7.74) point difference, and more than three hours with an 8.65 (95% CI 7.82-9.47) point difference, all compared to less than 30 minutes per day. Job loss during the pandemic was another important factor associated with higher S-Anxiety scores (3.95, 95% CI 3.31-4.58). Despite survey respondents reporting high confidence in information regarding COVID-19 as well as an understanding of health care guidance, they reported low overall trust in state and local authorities, and perception of country readiness. Conclusions: Among Russian respondents from multiple social media platforms, there was evidence of higher levels of state anxiety associated with recent job loss and increased news consumption, as well as lower than expected trust in government agencies. These findings can help inform the development of key public health messages to help reduce anxiety and raise perceived trust in governmental response to this current national emergency. Using a similar methodology, comparative surveys are ongoing in other national populations. %M 32788143 %R 10.2196/20955 %U https://www.jmir.org/2020/9/e20955 %U https://doi.org/10.2196/20955 %U http://www.ncbi.nlm.nih.gov/pubmed/32788143 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e20794 %T Big Data, Natural Language Processing, and Deep Learning to Detect and Characterize Illicit COVID-19 Product Sales: Infoveillance Study on Twitter and Instagram %A Mackey,Tim Ken %A Li,Jiawei %A Purushothaman,Vidya %A Nali,Matthew %A Shah,Neal %A Bardier,Cortni %A Cai,Mingxiang %A Liang,Bryan %+ Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, United States, 1 951 491 4161, tmackey@ucsd.edu %K COVID-19 %K coronavirus %K infectious disease %K social media %K surveillance %K infoveillance %K infodemiology %K infodemic %K fraud %K cybercrime %D 2020 %7 25.8.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic is perhaps the greatest global health challenge of the last century. Accompanying this pandemic is a parallel “infodemic,” including the online marketing and sale of unapproved, illegal, and counterfeit COVID-19 health products including testing kits, treatments, and other questionable “cures.” Enabling the proliferation of this content is the growing ubiquity of internet-based technologies, including popular social media platforms that now have billions of global users. Objective: This study aims to collect, analyze, identify, and enable reporting of suspected fake, counterfeit, and unapproved COVID-19–related health care products from Twitter and Instagram. Methods: This study is conducted in two phases beginning with the collection of COVID-19–related Twitter and Instagram posts using a combination of web scraping on Instagram and filtering the public streaming Twitter application programming interface for keywords associated with suspect marketing and sale of COVID-19 products. The second phase involved data analysis using natural language processing (NLP) and deep learning to identify potential sellers that were then manually annotated for characteristics of interest. We also visualized illegal selling posts on a customized data dashboard to enable public health intelligence. Results: We collected a total of 6,029,323 tweets and 204,597 Instagram posts filtered for terms associated with suspect marketing and sale of COVID-19 health products from March to April for Twitter and February to May for Instagram. After applying our NLP and deep learning approaches, we identified 1271 tweets and 596 Instagram posts associated with questionable sales of COVID-19–related products. Generally, product introduction came in two waves, with the first consisting of questionable immunity-boosting treatments and a second involving suspect testing kits. We also detected a low volume of pharmaceuticals that have not been approved for COVID-19 treatment. Other major themes detected included products offered in different languages, various claims of product credibility, completely unsubstantiated products, unapproved testing modalities, and different payment and seller contact methods. Conclusions: Results from this study provide initial insight into one front of the “infodemic” fight against COVID-19 by characterizing what types of health products, selling claims, and types of sellers were active on two popular social media platforms at earlier stages of the pandemic. This cybercrime challenge is likely to continue as the pandemic progresses and more people seek access to COVID-19 testing and treatment. This data intelligence can help public health agencies, regulatory authorities, legitimate manufacturers, and technology platforms better remove and prevent this content from harming the public. %M 32750006 %R 10.2196/20794 %U http://publichealth.jmir.org/2020/3/e20794/ %U https://doi.org/10.2196/20794 %U http://www.ncbi.nlm.nih.gov/pubmed/32750006 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21360 %T Grappling With the COVID-19 Health Crisis: Content Analysis of Communication Strategies and Their Effects on Public Engagement on Social Media %A Ngai,Cindy Sing Bik %A Singh,Rita Gill %A Lu,Wenze %A Koon,Alex Chun %+ School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Laboratory Block, Pok Fu Lam, Hong Kong, Hong Kong (China), 852 39179500, alexkoon@hku.hk %K COVID-19 %K communication %K public engagement %K social media %K infodemiology %K infodemic %K message style %K health content frames %K interactive features %K framework %K content analysis %D 2020 %7 24.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The coronavirus disease (COVID-19) has posed an unprecedented challenge to governments worldwide. Effective government communication of COVID-19 information with the public is of crucial importance. Objective: We investigate how the most-read state-owned newspaper in China, People’s Daily, used an online social networking site, Sina Weibo, to communicate about COVID-19 and whether this could engage the public. The objective of this study is to develop an integrated framework to examine the content, message style, and interactive features of COVID-19–related posts and determine their effects on public engagement in the largest social media network in China. Methods: Content analysis was employed to scrutinize 608 COVID-19 posts, and coding was performed on three main dimensions: content, message style, and interactive features. The content dimension was coded into six subdimensions: action, new evidence, reassurance, disease prevention, health care services, and uncertainty, and the style dimension was coded into the subdimensions of narrative and nonnarrative. As for interactive features, they were coded into links to external sources, use of hashtags, use of questions to solicit feedback, and use of multimedia. Public engagement was measured in the form of the number of shares, comments, and likes on the People’s Daily’s Sina Weibo account from January 20, 2020, to March 11, 2020, to reveal the association between different levels of public engagement and communication strategies. A one-way analysis of variance followed by a post-hoc Tukey test and negative binomial regression analysis were employed to generate the results. Results: We found that although the content frames of action, new evidence, and reassurance delivered in a nonnarrative style were predominant in COVID-19 communication by the government, posts related to new evidence and a nonnarrative style were strong negative predictors of the number of shares. In terms of generating a high number of shares, it was found that disease prevention posts delivered in a narrative style were able to achieve this purpose. Additionally, an interaction effect was found between content and style. The use of a narrative style in disease prevention posts had a significant positive effect on generating comments and likes by the Chinese public, while links to external sources fostered sharing. Conclusions: These results have implications for governments, health organizations, medical professionals, the media, and researchers on their epidemic communication to engage the public. Selecting suitable communication strategies may foster active liking and sharing of posts on social media, which in turn, might raise the public’s awareness of COVID-19 and motivate them to take preventive measures. The sharing of COVID-19 posts is particularly important because this action can reach out to a large audience, potentially helping to contain the spread of the virus. %M 32750013 %R 10.2196/21360 %U http://www.jmir.org/2020/8/e21360/ %U https://doi.org/10.2196/21360 %U http://www.ncbi.nlm.nih.gov/pubmed/32750013 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e18401 %T Characteristics of Twitter Use by State Medicaid Programs in the United States: Machine Learning Approach %A Zhu,Jane M %A Sarker,Abeed %A Gollust,Sarah %A Merchant,Raina %A Grande,David %+ Division of General Internal Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States, 1 5034945040, zhujan@ohsu.edu %K medicaid %K public health %K health communication %K community engagement %K social media %D 2020 %7 17.8.2020 %9 Short Paper %J J Med Internet Res %G English %X Background: Twitter is a potentially valuable tool for public health officials and state Medicaid programs in the United States, which provide public health insurance to 72 million Americans. Objective: We aim to characterize how Medicaid agencies and managed care organization (MCO) health plans are using Twitter to communicate with the public. Methods: Using Twitter’s public application programming interface, we collected 158,714 public posts (“tweets”) from active Twitter profiles of state Medicaid agencies and MCOs, spanning March 2014 through June 2019. Manual content analyses identified 5 broad categories of content, and these coded tweets were used to train supervised machine learning algorithms to classify all collected posts. Results: We identified 15 state Medicaid agencies and 81 Medicaid MCOs on Twitter. The mean number of followers was 1784, the mean number of those followed was 542, and the mean number of posts was 2476. Approximately 39% of tweets came from just 10 accounts. Of all posts, 39.8% (63,168/158,714) were classified as general public health education and outreach; 23.5% (n=37,298) were about specific Medicaid policies, programs, services, or events; 18.4% (n=29,203) were organizational promotion of staff and activities; and 11.6% (n=18,411) contained general news and news links. Only 4.5% (n=7142) of posts were responses to specific questions, concerns, or complaints from the public. Conclusions: Twitter has the potential to enhance community building, beneficiary engagement, and public health outreach, but appears to be underutilized by the Medicaid program. %M 32804085 %R 10.2196/18401 %U http://www.jmir.org/2020/8/e18401/ %U https://doi.org/10.2196/18401 %U http://www.ncbi.nlm.nih.gov/pubmed/32804085 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17478 %T Machine Learning Classifiers for Twitter Surveillance of Vaping: Comparative Machine Learning Study %A Visweswaran,Shyam %A Colditz,Jason B %A O’Halloran,Patrick %A Han,Na-Rae %A Taneja,Sanya B %A Welling,Joel %A Chu,Kar-Hai %A Sidani,Jaime E %A Primack,Brian A %+ Department of Biomedical Informatics, University of Pittsburgh, The Offices at Baum, 5607 Baum Blvd, Suite 523, Pittsburgh, PA, 15206, United States, 1 (412) 648 7119, shv3@pitt.edu %K vaping %K social media %K infodemiology %K infoveillance %K machine learning %K deep learning %D 2020 %7 12.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Twitter presents a valuable and relevant social media platform to study the prevalence of information and sentiment on vaping that may be useful for public health surveillance. Machine learning classifiers that identify vaping-relevant tweets and characterize sentiments in them can underpin a Twitter-based vaping surveillance system. Compared with traditional machine learning classifiers that are reliant on annotations that are expensive to obtain, deep learning classifiers offer the advantage of requiring fewer annotated tweets by leveraging the large numbers of readily available unannotated tweets. Objective: This study aims to derive and evaluate traditional and deep learning classifiers that can identify tweets relevant to vaping, tweets of a commercial nature, and tweets with provape sentiments. Methods: We continuously collected tweets that matched vaping-related keywords over 2 months from August 2018 to October 2018. From this data set of tweets, a set of 4000 tweets was selected, and each tweet was manually annotated for relevance (vape relevant or not), commercial nature (commercial or not), and sentiment (provape or not). Using the annotated data, we derived traditional classifiers that included logistic regression, random forest, linear support vector machine, and multinomial naive Bayes. In addition, using the annotated data set and a larger unannotated data set of tweets, we derived deep learning classifiers that included a convolutional neural network (CNN), long short-term memory (LSTM) network, LSTM-CNN network, and bidirectional LSTM (BiLSTM) network. The unannotated tweet data were used to derive word vectors that deep learning classifiers can leverage to improve performance. Results: LSTM-CNN performed the best with the highest area under the receiver operating characteristic curve (AUC) of 0.96 (95% CI 0.93-0.98) for relevance, all deep learning classifiers including LSTM-CNN performed better than the traditional classifiers with an AUC of 0.99 (95% CI 0.98-0.99) for distinguishing commercial from noncommercial tweets, and BiLSTM performed the best with an AUC of 0.83 (95% CI 0.78-0.89) for provape sentiment. Overall, LSTM-CNN performed the best across all 3 classification tasks. Conclusions: We derived and evaluated traditional machine learning and deep learning classifiers to identify vaping-related relevant, commercial, and provape tweets. Overall, deep learning classifiers such as LSTM-CNN had superior performance and had the added advantage of requiring no preprocessing. The performance of these classifiers supports the development of a vaping surveillance system. %M 32784184 %R 10.2196/17478 %U https://www.jmir.org/2020/8/e17478 %U https://doi.org/10.2196/17478 %U http://www.ncbi.nlm.nih.gov/pubmed/32784184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17432 %T Review of Evaluation Metrics Used in Digital and Traditional Tobacco Control Campaigns %A Chan,Lilian %A O'Hara,Blythe %A Phongsavan,Philayrath %A Bauman,Adrian %A Freeman,Becky %+ Sydney School of Public Health and Charles Perkins Centre, Prevention Research Collaboration, The University of Sydney, Johns Hopkins Dr, Camperdown, NSW 2006, Australia, 61 2 8627 7554, lilian.chan@sydney.edu.au %K mass media %K internet %K evaluation studies as topic %K smoking cessation %K public health %D 2020 %7 11.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Mass media campaigns for public health are increasingly using digital media platforms, such as web-based advertising and social media; however, there is a lack of evidence on how to best use these digital platforms for public health campaigns. To generate this evidence, appropriate campaign evaluations are needed, but with the proliferation of digital media–related metrics, there is no clear consensus on which evaluation metrics should be used. Public health campaigns are diverse in nature, so to facilitate analysis, this review has selected tobacco control campaigns as the scope of the study. Objective: This literature review aimed to examine how tobacco control campaigns that use traditional and digital media platforms have been evaluated. Methods: Medicine and science databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature [CINAHL], and Scopus), and a marketing case study database (World Advertising Research Center) were searched for articles published between 2013 and 2018. Two authors established the eligibility criteria and reviewed articles for inclusion. Individual campaigns were identified from the articles, and information on campaigns and their evaluations were supplemented with searches on Google, Google Scholar, and social media platforms. Data about campaign evaluations were tabulated and mapped to a conceptual framework. Results: In total, 17 campaigns were included in this review, with evaluations reported on by 51 articles, 17 marketing reports, and 4 grey literature reports. Most campaigns were from English-speaking countries, with behavioral change as the primary objective. In the process evaluations, a wide range of metrics were used to assess the reach of digital campaign activities, making comparison between campaigns difficult. Every campaign in the review, except one, reported some type of engagement impact measure, with website visits being the most commonly reported metric (11 of the 17 campaigns). Other commonly reported evaluation measures identified in this review include engagement on social media, changes in attitudes, and number of people contacting smoking cessation services. Of note, only 7 of the 17 campaigns attempted to measure media platform attribution, for example, by asking participants where they recalled seeing the campaign or using unique website tracking codes for ads on different media platforms. Conclusions: One of the key findings of this review is the numerous and diverse range of measures and metrics used in tobacco control campaign evaluations. To address this issue, we propose principles to guide the selection of digital media–related metrics for campaign evaluations, and also outline a conceptual framework to provide a coherent organization to the diverse range of metrics. Future research is needed to specifically investigate whether engagement metrics are associated with desired campaign outcomes, to determine whether reporting of engagement metrics is meaningful in campaign evaluations. %M 32348272 %R 10.2196/17432 %U https://www.jmir.org/2020/8/e17432 %U https://doi.org/10.2196/17432 %U http://www.ncbi.nlm.nih.gov/pubmed/32348272 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e20923 %T General Public’s Information-Seeking Patterns of Topics Related to Obesity: Google Trends Analysis %A Pawar,Aditya S %A Nagpal,Sajan %A Pawar,Neha %A Lerman,Lilach O %A Eirin,Alfonso %+ Division of Nephrology, Mayo Clinic, 200 First Street SW, Rochester, MN, , United States, 1 5078844863, eirinmassat.alfonso@mayo.edu %K obesity %K normalization %K public awareness %K infodemiology %K infoveillance %D 2020 %7 11.8.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Obesity is a major public health challenge, and recent literature sheds light on the concept of “normalization” of obesity. Objective: We aimed to study the worldwide pattern of web-based information seeking by public on obesity and on its related terms and topics using Google Trends. Methods: We compared the relative frequency of obesity-related search terms and topics between 2004 and 2019 on Google Trends. The mean relative interest scores for these terms over the 4-year quartiles were compared. Results: The mean relative interest score of the search term “obesity” consistently decreased with time in all four quartiles (2004-2019), whereas the relative interest scores of the search topics “weight loss” and “abdominal obesity” increased. The topic “weight loss” was popular during the month of January, and its median relative interest score for January was higher than that for other months for the entire study period (P<.001). The relative interest score for the search term “obese” decreased over time, whereas those scores for the terms “body positivity” and “self-love” increased after 2013. Conclusions: Despite a worldwide increase in the prevalence of obesity, its popularity as an internet search term diminished over time. The reason for peaks in months should be explored and applied to the awareness campaigns for better effectiveness. These patterns suggest normalization of obesity in society and a rise of public curiosity about image-related obesity rather than its medical implications and harm. %M 32633725 %R 10.2196/20923 %U http://publichealth.jmir.org/2020/3/e20923/ %U https://doi.org/10.2196/20923 %U http://www.ncbi.nlm.nih.gov/pubmed/32633725 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19611 %T Assessment of the Impact of Media Coverage on COVID-19–Related Google Trends Data: Infodemiology Study %A Sousa-Pinto,Bernardo %A Anto,Aram %A Czarlewski,Wienia %A Anto,Josep M %A Fonseca,João Almeida %A Bousquet,Jean %+ Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Plácido Costa s/n, Porto, 4400, Portugal, 351 912362153, bernardosousapinto@protonmail.com %K COVID-19 %K infodemiology %K infodemic %K Google Trends %K media coverage %K media %K coronavirus %K symptom %K monitoring %K trend %K pandemic %D 2020 %7 10.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The influence of media coverage on web-based searches may hinder the role of Google Trends (GT) in monitoring coronavirus disease (COVID-19). Objective: The aim of this study was to assess whether COVID-19–related GT data, particularly those related to ageusia and anosmia, were primarily related to media coverage or to epidemic trends. Methods: We retrieved GT query data for searches on coronavirus, cough, anosmia, and ageusia and plotted them over a period of 5 years. In addition, we analyzed the trends of those queries for 17 countries throughout the year 2020 with a particular focus on the rises and peaks of the searches. For anosmia and ageusia, we assessed whether the respective GT data correlated with COVID-19 cases and deaths both throughout 2020 and specifically before March 16, 2020 (ie, the date when the media started reporting that these symptoms can be associated with COVID-19). Results: Over the last five years, peaks for coronavirus searches in GT were only observed during the winter of 2020. Rises and peaks in coronavirus searches appeared at similar times in the 17 different assessed countries irrespective of their epidemic situations. In 15 of these countries, rises in anosmia and ageusia searches occurred in the same week or 1 week after they were identified in the media as symptoms of COVID-19. When data prior to March 16, 2020 were analyzed, anosmia and ageusia GT data were found to have variable correlations with COVID-19 cases and deaths in the different countries. Conclusions: Our results indicate that COVID-19–related GT data are more closely related to media coverage than to epidemic trends. %M 32530816 %R 10.2196/19611 %U https://www.jmir.org/2020/8/e19611 %U https://doi.org/10.2196/19611 %U http://www.ncbi.nlm.nih.gov/pubmed/32530816 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18474 %T Sudden Infant Death Syndrome on Facebook: Qualitative Descriptive Content Analysis to Guide Prevention Efforts %A Pretorius,Kelly %A Choi,Eunju %A Kang,Sookja %A Mackert,Michael %+ The University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, United States, 1 5124717913, kpretorius@utexas.edu %K sudden infant death %K SIDS %K infant mortality %K safe sleep %K social media %K social support %K health communication %K maternal health %K qualitative research %K health care providers %D 2020 %7 30.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Sudden unexpected infant death (SUID), which includes the diagnosis of sudden infant death syndrome (SIDS), is a leading cause of infant mortality in the United States. Despite prevention efforts, many parents continue to create unsafe infant sleep environments and use potentially dangerous infant sleep and monitoring devices, ultimately leading to sleep-related infant deaths. Analyzing Facebook conversations regarding SIDS may offer a unique maternal perspective to guide future research and prevention efforts. Objective: This study aims to describe and analyze conversations among mothers engaged in discussions about SIDS on a Facebook mother’s group. We were interested in understanding maternal knowledge of SIDS, identifying information sources for SIDS, describing actual infant sleep practices, exploring opinions regarding infant sleep products and monitoring devices, and discovering evidence of provider communication regarding SIDS. Methods: We extracted and analyzed 20 posts and 912 comments from 512 mothers who participated in a specific Facebook mother’s group and engaged in conversations about SIDS. There were 2 reviewers who coded the data using qualitative descriptive content analysis. Themes were induced after discussion among researchers and after the study objectives were addressed. Results: The theme of social support emerged, specifically informational and emotional support. A variety of informational sources for SIDS and safe sleep were identified, as was a continuum of infant sleep practices (ranging from unsafe to safe sleep per the American Academy of Pediatrics standards). There was widespread discussion regarding infant sleep products and monitoring devices. Embedded within conversations were (1) confusion among commonly used medical terminology, (2) the practice of unsafe infant sleep, (3) inconsistency in provider communication about SIDS, and (4) maternal anxiety regarding SIDS. Conclusions: We uncovered new findings in this analysis, such as the commonality of infant sleep products and monitoring devices and widespread maternal anxiety regarding SIDS. Additionally, mothers who participated in the Facebook group provided and received informational and emotional support regarding SIDS via this social media format. Such results can guide future prevention efforts by informing health communication regarding SUID and safe sleep. Future provider and public health agency communication on the topic of SUID and safe sleep should be simple and clear, address infant sleep products and monitoring devices, address maternal anxiety regarding SIDS, and address the common practice of unsafe sleep. %M 32729842 %R 10.2196/18474 %U http://www.jmir.org/2020/7/e18474/ %U https://doi.org/10.2196/18474 %U http://www.ncbi.nlm.nih.gov/pubmed/32729842 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16212 %T The Development of a Smart Health Awareness Message Framework Based on the Use of Social Media: Quantitative Study %A Alsisi,Elaf Ali %A Al-Ashaab,Ahmed %A Abualfaraa,Wadhah Ahmed %+ Cranfield University, Bedfordshire, MK43 0AL, Cranfield, United Kingdom, 44 1234750111 ext 5622, e.alsisi85@gmail.com %K social media %K health promotion and social media %K health awareness %K health promotion %K eHealth %K technology acceptance theory %D 2020 %7 23.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media has recently provided a remarkable means of delivering health information broadly and in a cost-effective way. Despite its benefits, some difficulties are encountered in attempting to influence the public to change their behavior in response to social media health messages. Objective: This study aimed to explore the factors that affect individuals’ acceptance of using social media as a tool for receiving health awareness messages and adapting such content accordingly by developing a smart health awareness message framework. Methods: A quantitative method was adapted to validate the hypotheses and proposed framework through the development of a survey based on the technology acceptance model with the extension of other constructs. The survey was distributed on the web to 701 participants from different countries via Qualtrics software; it generated 391 completed questionnaires, and the response rate was 55.8% (391/701). Results: Of the 391 respondents, 121 (30.9%) used social media platforms often during the week, and 27 participants (6.9%) did not use social media. In addition, 24.0% (94/391) of the respondents used these platforms to seek health information. On the basis of the results, perceived usefulness (β=.37; P<.001), gain-framed message (β=.04; P<.001), and loss-framed message (β=.08; P<.001) were seen to positively and significantly influence people’s intention to use social media as a means to spread information about health promotion. The proposed smart health awareness message framework identifies 64.2% of the variance in intention to use, 55.4% of the variance of perceived usefulness, and 26.2% of the variance of perceived ease of use. Conclusions: This study sheds light on the factors that are associated with people’s intention to use and adopt social media in the health promotion domain. The findings reveal that the intention of using social media for health awareness purposes is positively impacted by the perception of usefulness of social media and the design of health messages. Future research might seek to explore other factors that relate to people’s behavior. This point of view will assist health organizations in developing their health messages more effectively and to be patient friendly. %M 32459627 %R 10.2196/16212 %U https://www.jmir.org/2020/7/e16212 %U https://doi.org/10.2196/16212 %U http://www.ncbi.nlm.nih.gov/pubmed/32459627 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e20469 %T The Story of #GetMePPE and GetUsPPE.org to Mobilize Health Care Response to COVID-19 : Rapidly Deploying Digital Tools for Better Health Care %A He,Shuhan %A Ojo,Ayotomiwa %A Beckman,Adam L %A Gondi,Suhas %A Ranney,Megan %A Betz,Marian %A Faust,Jeremy S %A Choo,Esther %A Kass,Dara %A Raja,Ali S %+ Center for Innovation in Digital HealthCare, Massachusetts General Hospital, 50 Staniford street, suite 750, Boston, MA, 02114, United States, 1 8477074695, She8@partners.org %K digital health %K getusppe %K getmeppe %K COVID-19 %K personal protective equipment %K protection %K Twitter %K pandemic %K health care worker %D 2020 %7 20.7.2020 %9 Viewpoint %J J Med Internet Res %G English %X Physicians, nurses, and other health care providers initiated the #GetMePPE movement on Twitter to spread awareness of the shortage of personal protective equipment (PPE) during the coronavirus disease (COVID-19) pandemic. Dwindling supplies, such as face masks, gowns and goggles, and inadequate production to meet increasing demand have placed health care workers and patients at risk. The momentum of the #GetMePPE Twitter hashtag resulted in the creation of a petition to urge public officials to address the PPE shortage through increased funding and production. Simultaneously, the GetUsPPE.org website was launched through the collaboration of physicians and software engineers to develop a digital platform for the donation, request, and distribution of multi-modal sources of PPE. GetUsPPE.org and #GetMePPE were merged in an attempt to combine public engagement and advocacy on social media with the coordination of PPE donation and distribution. Within 10 days, over 1800 hospitals and PPE suppliers were registered in a database that enabled the rapid coordination and distribution of scarce and in-demand materials. One month after its launch, the organization had distributed hundreds of thousands of PPE items and had built a database of over 6000 PPE requesters. The call for action on social media and the rapid development of this digital tool created a productive channel for the public to contribute to the health care response to COVID-19 in meaningful ways. #GetMePPE and GetUsPPE.org were able to mobilize individuals and organizations outside of the health care system to address the unmet needs of the medical community. The success of GetUsPPE.org demonstrates the potential of digital tools as a platform for larger health care institutions to rapidly address urgent issues in health care. In this paper, we outline this process and discuss key factors determining success. %M 32530813 %R 10.2196/20469 %U https://www.jmir.org/2020/7/e20469 %U https://doi.org/10.2196/20469 %U http://www.ncbi.nlm.nih.gov/pubmed/32530813 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17626 %T Eating Disorder Awareness Campaigns: Thematic and Quantitative Analysis Using Twitter %A Viguria,Iranzu %A Alvarez-Mon,Miguel Angel %A Llavero-Valero,Maria %A Asunsolo del Barco,Angel %A Ortuño,Felipe %A Alvarez-Mon,Melchor %+ Department of Medicine and Medical Specialities, University of Alcala, Campus Universitario - C/ 19, Av de Madrid, Km 33,600, Alcalá de Henares, 28871, Spain, 34 918854505, maalvarezdemon@icloud.com %K awareness campaigns %K eating disorders %K Twitter %K social media %D 2020 %7 14.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Health awareness initiatives are frequent but their efficacy is a matter of controversy. We have investigated the effect of the Eating Disorder Awareness Week and Wake Up Weight Watchers campaigns on Twitter. Objective: We aimed to examine whether the Eating Disorder Awareness Week and Wake Up Weight Watchers initiatives increased the volume and dissemination of Twitter conversations related to eating disorders and investigate what content generates the most interest on Twitter. Methods: Over a period of 12 consecutive days in 2018, we collected tweets containing the hashtag #wakeupweightwatchers and hashtags related to Eating Disorder Awareness Week (#eatingdisorderawarenessweek, #eatingdisorderawareness, or #EDAW), with the hashtag #eatingdisorder as a control. The content of each tweet was rated as medical, testimony, help offer, awareness, pro-ana, or anti-ana. We analyzed the number of retweets and favorites generated, as well as the potential reach and impact of the hashtags and the characteristics of contributors. Results: The number of #wakeupweightwatchers tweets was higher than that of Eating Disorder Awareness Week and #eatingdisorder tweets (3900, 2056, and 1057, respectively). The content of tweets was significantly different between the hashtags analyzed (P<.001). Medical content was lower in the awareness campaigns. Awareness and help offer content were lower in #wakeupweightwatchers tweets. Retweet and favorite ratios were highest in #wakeupweightwatchers tweets. Eating Disorder Awareness Week achieved the highest impact, and very influential contributors participated. Conclusions: Both awareness campaigns effectively promoted tweeting about eating disorders. The majority of tweets did not promote any specific preventive or help-seeking behaviors. %M 32673225 %R 10.2196/17626 %U http://www.jmir.org/2020/7/e17626/ %U https://doi.org/10.2196/17626 %U http://www.ncbi.nlm.nih.gov/pubmed/32673225 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17693 %T Evaluation of Volume of News Reporting and Opioid-Related Deaths in the United States: Comparative Analysis Study of Geographic and Socioeconomic Differences %A Hswen,Yulin %A Zhang,Amanda %A Freifeld,Clark %A Brownstein,John S %+ University of California San Francisco, Department of Epidemiology and Biostatistics, Bakar Computational Health Sciences Institute, 505 Parnassus Ave, San Francisco, CA, 94143, United States, 1 6177751889, yhswen@gmail.com %K opioid epidemic %K news media %K geographic %K socioeconomic %K addiction %K overdose %D 2020 %7 10.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: News media coverage is a powerful influence on public attitude and government action. The digitization of news media covering the current opioid epidemic has changed the landscape of coverage and may have implications for how to effectively respond to the opioid crisis. Objective: This study aims to characterize the relationship between volume of online opioid news reporting and opioid-related deaths in the United States and how these measures differ across geographic and socioeconomic county-level factors. Methods: Online news reports from February 2018 to April 2019 on opioid-related events in the United States were extracted from Google News. News data were aggregated at the county level and compared against opioid-related death counts. Ordinary least squares regression was used to model opioid-related death rate and opioid news coverage with the inclusion of socioeconomic and geographic explanatory variables. Results: A total of 35,758 relevant news reports were collected representing 1789 counties. Regression analysis revealed that opioid-related death rate was positively associated with news reporting. However, opioid-related death rate and news reporting volume showed opposite correlations with educational attainment and rurality. When controlling for variation in death rate, counties in the Northeast were overrepresented by news coverage. Conclusions: Our results suggest that regional variation in the volume of opioid-related news reporting does not reflect regional variation in opioid-related death rate. Differences in the amount of media attention may influence perceptions of the severity of opioid epidemic. Future studies should investigate the influence of media reporting on public support and action on opioid issues. %M 32673248 %R 10.2196/17693 %U http://www.jmir.org/2020/7/e17693/ %U https://doi.org/10.2196/17693 %U http://www.ncbi.nlm.nih.gov/pubmed/32673248 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16002 %T Behavior Change Techniques Included in Reports of Social Media Interventions for Promoting Health Behaviors in Adults: Content Analysis Within a Systematic Review %A Simeon,Rosiane %A Dewidar,Omar %A Trawin,Jessica %A Duench,Stephanie %A Manson,Heather %A Pardo Pardo,Jordi %A Petkovic,Jennifer %A Hatcher Roberts,Janet %A Tugwell,Peter %A Yoganathan,Manosila %A Presseau,Justin %A Welch,Vivian %+ Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, ON, Canada, 1 6138181154, rsime006@uottawa.ca %K health behavior %K taxonomy %K social media %K health promotion %K public health %D 2020 %7 11.6.2020 %9 Review %J J Med Internet Res %G English %X Background: Social media are an increasingly commonly used platform for delivering health promotion interventions. Although recent research has focused on the effectiveness of social media interventions for health promotion, very little is known about the optimal content within such interventions, and the active ingredients to promote health behavior change using social media are not clear. Identifying which behavior change techniques (BCTs) are reported may help to clarify the content of interventions using a generalizable terminology that may facilitate future intervention development. Objective: This study aimed to identify which BCTs are reported in social media interventions for promoting health behavior change in adults. Methods: We included 71 studies conducted with adult participants (aged ≥18 years) and for which social media intervention was considered interactive in a Cochrane review of the effectiveness of such interventions. We developed a coding manual informed by the Behavior Change Technique Taxonomy version 1 (BCTTv1) to identify BCTs in the included studies. We identified BCTs in all study arms (including control) and described BCTs in the group and self-directed components of studies. We characterized the dose of delivery for each BCT by low and high intensity. We used descriptive analyses to characterize the reported BCTs. Results: Our data consisted of 71 studies published from 2001 to 2017, mainly conducted in high-income countries (n=65). Most studies (n=31) used tailored, interactive websites to deliver the intervention; Facebook was the most used mainstream platform. In developing our coding manual, we adapted some BCTTv1 instructions to better capture unique nuances of how BCTs were operationalized in social media with respect to likes, retweets, smiles, congratulations, and badges. Social support (unspecified), instruction on how to perform the behavior, and credible source were most frequently identified BCTs in intervention arms of studies and group-delivery settings, whereas instruction on how to perform the behavior was most commonly applied in self-directed components of studies, control arms, and individual participant settings. Instruction on how to perform the behavior was also the most frequently reported BCT in both intervention and control arms simultaneously. Instruction on how to perform the behavior, social support (unspecified), self-monitoring of behavior, information about health consequences, and credible source were identified in the top 5 BCTs delivered with the highest intensity. Conclusions: This study within a review provides a detailed description of the BCTs and their dose to promote behavior change in web-based, interactive social media interventions. Clarifying active ingredients in social media interventions and the intensity of their delivery may help to develop future interventions that can more clearly build upon the existing evidence. %M 32525482 %R 10.2196/16002 %U http://www.jmir.org/2020/6/e16002/ %U https://doi.org/10.2196/16002 %U http://www.ncbi.nlm.nih.gov/pubmed/32525482 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e18014 %T Health Gain, Cost Impacts, and Cost-Effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Physical Activity: Modeling Study %A Mizdrak,Anja %A Telfer,Kendra %A Direito,Artur %A Cobiac,Linda J %A Blakely,Tony %A Cleghorn,Christine L %A Wilson,Nick %+ Department of Public Health, University of Otago Wellington, Department of Public Health, 23 Mein Street, Newtown, Wellington, 6021, New Zealand, 64 49186192, anja.mizdrak@otago.ac.nz %K physical activity %K mHealth %K mobile health %K smartphone apps %K modeling %K mass media campaigns %D 2020 %7 11.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity smartphone apps are a promising strategy to increase population physical activity, but it is unclear whether government mass media campaigns to promote these apps would be a cost-effective use of public funds. Objective: We aimed to estimate the health impacts, costs, and cost-effectiveness of a one-off national mass media campaign to promote the use of physical activity apps. Methods: We used an established multistate life table model to estimate the lifetime health gains (in quality-adjusted life years [QALYs]) that would accrue if New Zealand adults were exposed to a one-off national mass media campaign to promote physical activity app use, with a 1-year impact on physical activity, compared to business-as-usual. A health-system perspective was used to assess cost-effectiveness. and a 3% discount rate was applied to future health gains and health system costs. Results: The modeled intervention resulted in 28 QALYs (95% uncertainty interval [UI] 8-72) gained at a cost of NZ $81,000/QALY (2018 US $59,500; 95% UI 17,000-345,000), over the remaining life course of the 2011 New Zealand population. The intervention had a low probability (20%) of being cost-effective at a cost-effectiveness threshold of NZ $45,000 (US $32,900) per QALY. The health impact and cost-effectiveness of the intervention were highly sensitive to assumptions around the maintenance of physical activity behaviors beyond the duration of the intervention. Conclusions: A mass media campaign to promote smartphone apps for physical activity is unlikely to generate much health gain or be cost-effective at the population level. Other investments to promote physical activity, particularly those that result in sustained behavior change, are likely to have greater health impacts. %M 32525493 %R 10.2196/18014 %U http://mhealth.jmir.org/2020/6/e18014/ %U https://doi.org/10.2196/18014 %U http://www.ncbi.nlm.nih.gov/pubmed/32525493 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e15973 %T Examining the Self-Harm and Suicide Contagion Effects of the Blue Whale Challenge on YouTube and Twitter: Qualitative Study %A Khasawneh,Amro %A Chalil Madathil,Kapil %A Dixon,Emma %A Wiśniewski,Pamela %A Zinzow,Heidi %A Roth,Rebecca %+ Department of Anesthesiology and Critical Care, Johns Hopkins University, 750 E Pratt St, 15th Fl, Baltimore, MD, 21202, United States, 1 410 637 4365, akhasaw1@jhmi.edu %K suicide %K suicidal ideation %K self-mutilation %K mental health %K self-injurious behavior %K behavioral symptoms %D 2020 %7 5.6.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Research suggests that direct exposure to suicidal behaviors and acts of self-harm through social media may increase suicidality through imitation and modeling, particularly in more vulnerable populations. One example of a social media phenomenon that demonstrates how self-harming behavior could potentially be propagated is the blue whale challenge. In this challenge, adolescents and young adults are encouraged to engage in self-harm and eventually kill themselves. Objective: This paper aimed to investigate the way individuals portray the blue whale challenge on social media, with an emphasis on factors that could pose a risk to vulnerable populations. Methods: We first used a thematic analysis approach to code 60 publicly posted YouTube videos, 1112 comments on those videos, and 150 Twitter posts that explicitly referenced the blue whale challenge. We then deductively coded the YouTube videos based on the Suicide Prevention Resource Center (SPRC) safe messaging guidelines as a metric for the contagion risk associated with each video. Results: The thematic analysis revealed that social media users post about the blue whale challenge to raise awareness and discourage participation, express sorrow for the participants, criticize the participants, or describe a relevant experience. The deductive coding of the YouTube videos showed that most of the videos violated at least 50% of the SPRC safe and effective messaging guidelines. Conclusions: These posts might have the problematic effect of normalizing the blue whale challenge through repeated exposure, modeling, and reinforcement of self-harming and suicidal behaviors, especially among vulnerable populations such as adolescents. More effort is needed to educate social media users and content generators on safe messaging guidelines and factors that encourage versus discourage contagion effects. %M 32515741 %R 10.2196/15973 %U https://mental.jmir.org/2020/6/e15973 %U https://doi.org/10.2196/15973 %U http://www.ncbi.nlm.nih.gov/pubmed/32515741 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19509 %T Machine Learning to Detect Self-Reporting of Symptoms, Testing Access, and Recovery Associated With COVID-19 on Twitter: Retrospective Big Data Infoveillance Study %A Mackey,Tim %A Purushothaman,Vidya %A Li,Jiawei %A Shah,Neal %A Nali,Matthew %A Bardier,Cortni %A Liang,Bryan %A Cai,Mingxiang %A Cuomo,Raphael %+ Department of Anesthesiology and Division of Global Public Health and Infectious Diseases, School of Medicine, University of California San Diego, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, United States, 1 9514914161, tmackey@ucsd.edu %K infoveillance %K COVID-19 %K Twitter %K machine learning %K surveillance %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic is a global health emergency with over 6 million cases worldwide as of the beginning of June 2020. The pandemic is historic in scope and precedent given its emergence in an increasingly digital era. Importantly, there have been concerns about the accuracy of COVID-19 case counts due to issues such as lack of access to testing and difficulty in measuring recoveries. Objective: The aims of this study were to detect and characterize user-generated conversations that could be associated with COVID-19-related symptoms, experiences with access to testing, and mentions of disease recovery using an unsupervised machine learning approach. Methods: Tweets were collected from the Twitter public streaming application programming interface from March 3-20, 2020, filtered for general COVID-19-related keywords and then further filtered for terms that could be related to COVID-19 symptoms as self-reported by users. Tweets were analyzed using an unsupervised machine learning approach called the biterm topic model (BTM), where groups of tweets containing the same word-related themes were separated into topic clusters that included conversations about symptoms, testing, and recovery. Tweets in these clusters were then extracted and manually annotated for content analysis and assessed for their statistical and geographic characteristics. Results: A total of 4,492,954 tweets were collected that contained terms that could be related to COVID-19 symptoms. After using BTM to identify relevant topic clusters and removing duplicate tweets, we identified a total of 3465 (<1%) tweets that included user-generated conversations about experiences that users associated with possible COVID-19 symptoms and other disease experiences. These tweets were grouped into five main categories including first- and secondhand reports of symptoms, symptom reporting concurrent with lack of testing, discussion of recovery, confirmation of negative COVID-19 diagnosis after receiving testing, and users recalling symptoms and questioning whether they might have been previously infected with COVID-19. The co-occurrence of tweets for these themes was statistically significant for users reporting symptoms with a lack of testing and with a discussion of recovery. A total of 63% (n=1112) of the geotagged tweets were located in the United States. Conclusions: This study used unsupervised machine learning for the purposes of characterizing self-reporting of symptoms, experiences with testing, and mentions of recovery related to COVID-19. Many users reported symptoms they thought were related to COVID-19, but they were not able to get tested to confirm their concerns. In the absence of testing availability and confirmation, accurate case estimations for this period of the outbreak may never be known. Future studies should continue to explore the utility of infoveillance approaches to estimate COVID-19 disease severity. %M 32490846 %R 10.2196/19509 %U http://publichealth.jmir.org/2020/2/e19509/ %U https://doi.org/10.2196/19509 %U http://www.ncbi.nlm.nih.gov/pubmed/32490846 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e18796 %T Public Engagement and Government Responsiveness in the Communications About COVID-19 During the Early Epidemic Stage in China: Infodemiology Study on Social Media Data %A Liao,Qiuyan %A Yuan,Jiehu %A Dong,Meihong %A Yang,Lin %A Fielding,Richard %A Lam,Wendy Wing Tak %+ School of Public Health, The University of Hong Kong, 2/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, 852 39179289, qyliao11@hku.hk %K risk communication %K social media %K epidemic %K COVID-19 %K pandemic %K outbreak %K infectious disease %K content analysis %D 2020 %7 26.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective risk communication about the outbreak of a newly emerging infectious disease in the early stage is critical for managing public anxiety and promoting behavioral compliance. China has experienced the unprecedented epidemic of the coronavirus disease (COVID-19) in an era when social media has fundamentally transformed information production and consumption patterns. Objective: This study examined public engagement and government responsiveness in the communications about COVID-19 during the early epidemic stage based on an analysis of data from Sina Weibo, a major social media platform in China. Methods: Weibo data relevant to COVID-19 from December 1, 2019, to January 31, 2020, were retrieved. Engagement data (likes, comments, shares, and followers) of posts from government agency accounts were extracted to evaluate public engagement with government posts online. Content analyses were conducted for a random subset of 644 posts from personal accounts of individuals, and 273 posts from 10 relatively more active government agency accounts and the National Health Commission of China to identify major thematic contents in online discussions. Latent class analysis further explored main content patterns, and chi-square for trend examined how proportions of main content patterns changed by time within the study time frame. Results: The public response to COVID-19 seemed to follow the spread of the disease and government actions but was earlier for Weibo than the government. Online users generally had low engagement with posts relevant to COVID-19 from government agency accounts. The common content patterns identified in personal and government posts included sharing epidemic situations; general knowledge of the new disease; and policies, guidelines, and official actions. However, personal posts were more likely to show empathy to affected people (χ21=13.3, P<.001), attribute blame to other individuals or government (χ21=28.9, P<.001), and express worry about the epidemic (χ21=32.1, P<.001), while government posts were more likely to share instrumental support (χ21=32.5, P<.001) and praise people or organizations (χ21=8.7, P=.003). As the epidemic evolved, sharing situation updates (for trend, χ21=19.7, P<.001) and policies, guidelines, and official actions (for trend, χ21=15.3, P<.001) became less frequent in personal posts but remained stable or increased significantly in government posts. Moreover, as the epidemic evolved, showing empathy and attributing blame (for trend, χ21=25.3, P<.001) became more frequent in personal posts, corresponding to a slight increase in sharing instrumental support, praising, and empathizing in government posts (for trend, χ21=9.0, P=.003). Conclusions: The government should closely monitor social media data to improve the timing of communications about an epidemic. As the epidemic evolves, merely sharing situation updates and policies may be insufficient to capture public interest in the messages. The government may adopt a more empathic communication style as more people are affected by the disease to address public concerns. %M 32412414 %R 10.2196/18796 %U http://www.jmir.org/2020/5/e18796/ %U https://doi.org/10.2196/18796 %U http://www.ncbi.nlm.nih.gov/pubmed/32412414 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19334 %T Measuring the Outreach Efforts of Public Health Authorities and the Public Response on Facebook During the COVID-19 Pandemic in Early 2020: Cross-Country Comparison %A Sesagiri Raamkumar,Aravind %A Tan,Soon Guan %A Wee,Hwee Lin %+ Saw Swee Hock School of Public Health, National University of Singapore, MD1 #10-01, 12 Science Drive 2, National University of Singapore, Singapore, 117549, Singapore, 65 65164975, ephwhl@nus.edu.sg %K COVID-19 %K sentiment analysis %K emotion analysis %K public health authorities %K infectious disease %K outbreak %K public engagement %K social media %K public health %K virus %D 2020 %7 19.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The coronavirus disease (COVID-19) pandemic presents one of the most challenging global crises at the dawn of a new decade. Public health authorities (PHAs) are increasingly adopting the use of social media such as Facebook to rapidly communicate and disseminate pandemic response measures to the public. Understanding of communication strategies across different PHAs and examining the public response on the social media landscapes can help improve practices for disseminating information to the public. Objective: This study aims to examine COVID-19-related outreach efforts of PHAs in Singapore, the United States, and England, and the corresponding public response to these outreach efforts on Facebook. Methods: Posts and comments from the Facebook pages of the Ministry of Health (MOH) in Singapore, the Centers for Disease Control and Prevention (CDC) in the United States, and Public Health England (PHE) in England were extracted from January 1, 2019, to March 18, 2020. Posts published before January 1, 2020, were categorized as pre-COVID-19, while the remaining posts were categorized as peri-COVID-19 posts. COVID-19-related posts were identified and classified into themes. Metrics used for measuring outreach and engagement were frequency, mean posts per day (PPD), mean reactions per post, mean shares per post, and mean comments per post. Responses to the COVID-19 posts were measured using frequency, mean sentiment polarity, positive to negative sentiments ratio (PNSR), and positive to negative emotions ratio (PNER). Toxicity in comments were identified and analyzed using frequency, mean likes per toxic comment, and mean replies per toxic comment. Trend analysis was performed to examine how the metrics varied with key events such as when COVID-19 was declared a pandemic. Results: The MOH published more COVID-19 posts (n=271; mean PPD 5.0) compared to the CDC (n=94; mean PPD 2.2) and PHE (n=45; mean PPD 1.4). The mean number of comments per COVID-19 post was highest for the CDC (mean CPP 255.3) compared to the MOH (mean CPP 15.6) and PHE (mean CPP 12.5). Six major themes were identified, with posts about prevention and safety measures and situation updates being prevalent across the three PHAs. The themes of the MOH’s posts were diverse, while the CDC and PHE posts focused on a few themes. Overall, response sentiments for the MOH posts (PNSR 0.94) were more favorable compared to response sentiments for the CDC (PNSR 0.57) and PHE (PNSR 0.55) posts. Toxic comments were rare (0.01%) across all PHAs. Conclusions: PHAs’ extent of Facebook use for outreach purposes during the COVID-19 pandemic varied among the three PHAs, highlighting the strategies and approaches that other PHAs can potentially adopt. Our study showed that social media analysis was capable of providing insights about the communication strategies of PHAs during disease outbreaks. %M 32401219 %R 10.2196/19334 %U http://www.jmir.org/2020/5/e19334/ %U https://doi.org/10.2196/19334 %U http://www.ncbi.nlm.nih.gov/pubmed/32401219 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 5 %P e17520 %T Developing a Suicide Prevention Social Media Campaign With Young People (The #Chatsafe Project): Co-Design Approach %A Thorn,Pinar %A Hill,Nicole TM %A Lamblin,Michelle %A Teh,Zoe %A Battersby-Coulter,Rikki %A Rice,Simon %A Bendall,Sarah %A Gibson,Kerry L %A Finlay,Summer May %A Blandon,Ryan %A de Souza,Libby %A West,Ashlee %A Cooksey,Anita %A Sciglitano,Joe %A Goodrich,Simon %A Robinson,Jo %+ Orygen, 35 Poplar Road, Parkville, VIC, Australia, 61 412 999 140, jo.robinson@orygen.org.au %K suicide %K social media %K health promotion %K co-design %K adolescent %K young adult %K #chatsafe %D 2020 %7 11.5.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Young people commonly use social media platforms to communicate about suicide. Although research indicates that this communication may be helpful, the potential for harm still exists. To facilitate safe communication about suicide on social media, we developed the #chatsafe guidelines, which we sought to implement via a national social media campaign in Australia. Population-wide suicide prevention campaigns have been shown to improve knowledge, awareness, and attitudes toward suicide. However, suicide prevention campaigns will be ineffective if they do not reach and resonate with their target audience. Co-designing suicide prevention campaigns with young people can increase the engagement and usefulness of these youth interventions. Objective: This study aimed to document key elements of the co-design process; to evaluate young people’s experiences of the co-design process; and to capture young people’s recommendations for the #chatsafe suicide prevention social media campaign. Methods: In total, 11 co-design workshops were conducted, with a total of 134 young people aged between 17 and 25 years. The workshops employed commonly used co-design strategies; however, modifications were made to create a safe and comfortable environment, given the population and complexity and sensitivity of the subject matter. Young people’s experiences of the workshops were evaluated through a short survey at the end of each workshop. Recommendations for the campaign strategy were captured through a thematic analysis of the postworkshop discussions with facilitators. Results: The majority of young people reported that the workshops were both safe (116/131, 88.5%) and enjoyable (126/131, 96.2%). They reported feeling better equipped to communicate safely about suicide on the web and feeling better able to identify and support others who may be at risk of suicide. Key recommendations for the campaign strategy were that young people wanted to see bite-sized sections of the guidelines come to life via shareable content such as short videos, animations, photographs, and images. They wanted to feel visible in campaign materials and wanted all materials to be fully inclusive and linked to resources and support services. Conclusions: This is the first study internationally to co-design a suicide prevention social media campaign in partnership with young people. The study demonstrates that it is feasible to safely engage young people in co-designing a suicide prevention intervention and that this process produces recommendations, which can usefully inform suicide prevention campaigns aimed at youth. The fact that young people felt better able to safely communicate about suicide on the web as a result of participation in the study augurs well for youth engagement with the national campaign, which was rolled out across Australia. If effective, the campaign has the potential to better prepare many young people to communicate safely about suicide on the web. %M 32391800 %R 10.2196/17520 %U https://mental.jmir.org/2020/5/e17520 %U https://doi.org/10.2196/17520 %U http://www.ncbi.nlm.nih.gov/pubmed/32391800 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19458 %T COVID-19 and the 5G Conspiracy Theory: Social Network Analysis of Twitter Data %A Ahmed,Wasim %A Vidal-Alaball,Josep %A Downing,Joseph %A López Seguí,Francesc %+ Newcastle University, 5 Barrack Rd, Newcastle upon Tyne, NE1 4SE, United Kingdom, 44 (0) 191 208 150, Wasim.Ahmed@Newcastle.ac.uk %K COVID-19 %K coronavirus %K twitter %K misinformation %K fake news %K 5G %K social network analysis %K social media %K public health %K pandemic %D 2020 %7 6.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the beginning of December 2019, the coronavirus disease (COVID-19) has spread rapidly around the world, which has led to increased discussions across online platforms. These conversations have also included various conspiracies shared by social media users. Amongst them, a popular theory has linked 5G to the spread of COVID-19, leading to misinformation and the burning of 5G towers in the United Kingdom. The understanding of the drivers of fake news and quick policies oriented to isolate and rebate misinformation are keys to combating it. Objective: The aim of this study is to develop an understanding of the drivers of the 5G COVID-19 conspiracy theory and strategies to deal with such misinformation. Methods: This paper performs a social network analysis and content analysis of Twitter data from a 7-day period (Friday, March 27, 2020, to Saturday, April 4, 2020) in which the #5GCoronavirus hashtag was trending on Twitter in the United Kingdom. Influential users were analyzed through social network graph clusters. The size of the nodes were ranked by their betweenness centrality score, and the graph’s vertices were grouped by cluster using the Clauset-Newman-Moore algorithm. The topics and web sources used were also examined. Results: Social network analysis identified that the two largest network structures consisted of an isolates group and a broadcast group. The analysis also revealed that there was a lack of an authority figure who was actively combating such misinformation. Content analysis revealed that, of 233 sample tweets, 34.8% (n=81) contained views that 5G and COVID-19 were linked, 32.2% (n=75) denounced the conspiracy theory, and 33.0% (n=77) were general tweets not expressing any personal views or opinions. Thus, 65.2% (n=152) of tweets derived from nonconspiracy theory supporters, which suggests that, although the topic attracted high volume, only a handful of users genuinely believed the conspiracy. This paper also shows that fake news websites were the most popular web source shared by users; although, YouTube videos were also shared. The study also identified an account whose sole aim was to spread the conspiracy theory on Twitter. Conclusions: The combination of quick and targeted interventions oriented to delegitimize the sources of fake information is key to reducing their impact. Those users voicing their views against the conspiracy theory, link baiting, or sharing humorous tweets inadvertently raised the profile of the topic, suggesting that policymakers should insist in the efforts of isolating opinions that are based on fake news. Many social media platforms provide users with the ability to report inappropriate content, which should be used. This study is the first to analyze the 5G conspiracy theory in the context of COVID-19 on Twitter offering practical guidance to health authorities in how, in the context of a pandemic, rumors may be combated in the future. %M 32352383 %R 10.2196/19458 %U http://www.jmir.org/2020/5/e19458/ %U https://doi.org/10.2196/19458 %U http://www.ncbi.nlm.nih.gov/pubmed/32352383 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19301 %T Creating COVID-19 Stigma by Referencing the Novel Coronavirus as the “Chinese virus” on Twitter: Quantitative Analysis of Social Media Data %A Budhwani,Henna %A Sun,Ruoyan %+ Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1720 University Blvd, RPHB #330C, Birmingham, AL, 35294, United States, 1 2059757613, budhwani@uab.edu %K COVID-19 %K coronavirus %K Twitter %K stigma %K social media %K public health %D 2020 %7 6.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Stigma is the deleterious, structural force that devalues members of groups that hold undesirable characteristics. Since stigma is created and reinforced by society—through in-person and online social interactions—referencing the novel coronavirus as the “Chinese virus” or “China virus” has the potential to create and perpetuate stigma. Objective: The aim of this study was to assess if there was an increase in the prevalence and frequency of the phrases “Chinese virus” and “China virus” on Twitter after the March 16, 2020, US presidential reference of this term. Methods: Using the Sysomos software (Sysomos, Inc), we extracted tweets from the United States using a list of keywords that were derivatives of “Chinese virus.” We compared tweets at the national and state levels posted between March 9 and March 15 (preperiod) with those posted between March 19 and March 25 (postperiod). We used Stata 16 (StataCorp) for quantitative analysis, and Python (Python Software Foundation) to plot a state-level heat map. Results: A total of 16,535 “Chinese virus” or “China virus” tweets were identified in the preperiod, and 177,327 tweets were identified in the postperiod, illustrating a nearly ten-fold increase at the national level. All 50 states witnessed an increase in the number of tweets exclusively mentioning “Chinese virus” or “China virus” instead of coronavirus disease (COVID-19) or coronavirus. On average, 0.38 tweets referencing “Chinese virus” or “China virus” were posted per 10,000 people at the state level in the preperiod, and 4.08 of these stigmatizing tweets were posted in the postperiod, also indicating a ten-fold increase. The 5 states with the highest number of postperiod “Chinese virus” tweets were Pennsylvania (n=5249), New York (n=11,754), Florida (n=13,070), Texas (n=14,861), and California (n=19,442). Adjusting for population size, the 5 states with the highest prevalence of postperiod “Chinese virus” tweets were Arizona (5.85), New York (6.04), Florida (6.09), Nevada (7.72), and Wyoming (8.76). The 5 states with the largest increase in pre- to postperiod “Chinese virus” tweets were Kansas (n=697/58, 1202%), South Dakota (n=185/15, 1233%), Mississippi (n=749/54, 1387%), New Hampshire (n=582/41, 1420%), and Idaho (n=670/46, 1457%). Conclusions: The rise in tweets referencing “Chinese virus” or “China virus,” along with the content of these tweets, indicate that knowledge translation may be occurring online and COVID-19 stigma is likely being perpetuated on Twitter. %M 32343669 %R 10.2196/19301 %U http://www.jmir.org/2020/5/e19301/ %U https://doi.org/10.2196/19301 %U http://www.ncbi.nlm.nih.gov/pubmed/32343669 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e18897 %T Conversations and Medical News Frames on Twitter: Infodemiological Study on COVID-19 in South Korea %A Park,Han Woo %A Park,Sejung %A Chong,Miyoung %+ Tim Russert Department of Communication, John Carroll University, 1 John Carroll Blvd, University Heights, Cleveland Heights, OH, 44118, United States, 1 216 397 4722, sjpark@jcu.edu %K infodemiology %K COVID-19 %K SARS-CoV-2 %K coronavirus %K Twitter %K South Korea %K medical news %K social media %K pandemic %K outbreak %K infectious disease %K public health %D 2020 %7 5.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: SARS-CoV-2 (severe acute respiratory coronavirus 2) was spreading rapidly in South Korea at the end of February 2020 following its initial outbreak in China, making Korea the new center of global attention. The role of social media amid the current coronavirus disease (COVID-19) pandemic has often been criticized, but little systematic research has been conducted on this issue. Social media functions as a convenient source of information in pandemic situations. Objective: Few infodemiology studies have applied network analysis in conjunction with content analysis. This study investigates information transmission networks and news-sharing behaviors regarding COVID-19 on Twitter in Korea. The real time aggregation of social media data can serve as a starting point for designing strategic messages for health campaigns and establishing an effective communication system during this outbreak. Methods: Korean COVID-19-related Twitter data were collected on February 29, 2020. Our final sample comprised of 43,832 users and 78,233 relationships on Twitter. We generated four networks in terms of key issues regarding COVID-19 in Korea. This study comparatively investigates how COVID-19-related issues have circulated on Twitter through network analysis. Next, we classified top news channels shared via tweets. Lastly, we conducted a content analysis of news frames used in the top-shared sources. Results: The network analysis suggests that the spread of information was faster in the Coronavirus network than in the other networks (Corona19, Shincheon, and Daegu). People who used the word “Coronavirus” communicated more frequently with each other. The spread of information was faster, and the diameter value was lower than for those who used other terms. Many of the news items highlighted the positive roles being played by individuals and groups, directing readers’ attention to the crisis. Ethical issues such as deviant behavior among the population and an entertainment frame highlighting celebrity donations also emerged often. There was a significant difference in the use of nonportal (n=14) and portal news (n=26) sites between the four network types. The news frames used in the top sources were similar across the networks (P=.89, 95% CI 0.004-0.006). Tweets containing medically framed news articles (mean 7.571, SD 1.988) were found to be more popular than tweets that included news articles adopting nonmedical frames (mean 5.060, SD 2.904; N=40, P=.03, 95% CI 0.169-4.852). Conclusions: Most of the popular news on Twitter had nonmedical frames. Nevertheless, the spillover effect of the news articles that delivered medical information about COVID-19 was greater than that of news with nonmedical frames. Social media network analytics cannot replace the work of public health officials; however, monitoring public conversations and media news that propagates rapidly can assist public health professionals in their complex and fast-paced decision-making processes. %M 32325426 %R 10.2196/18897 %U http://www.jmir.org/2020/5/e18897/ %U https://doi.org/10.2196/18897 %U http://www.ncbi.nlm.nih.gov/pubmed/32325426 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e19118 %T Health Communication Through News Media During the Early Stage of the COVID-19 Outbreak in China: Digital Topic Modeling Approach %A Liu,Qian %A Zheng,Zequan %A Zheng,Jiabin %A Chen,Qiuyi %A Liu,Guan %A Chen,Sihan %A Chu,Bojia %A Zhu,Hongyu %A Akinwunmi,Babatunde %A Huang,Jian %A Zhang,Casper J P %A Ming,Wai-Kit %+ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 Huangpu W Ave, Tianhe District, Guangzhou, Guangdong Province, 510632, China, 86 85228852, wkming@alumni.harvard.edu %K coronavirus %K COVID-19 %K outbreak %K health communication %K mass media %K public crisis %K topic modeling %D 2020 %7 28.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In December 2019, a few coronavirus disease (COVID-19) cases were first reported in Wuhan, Hubei, China. Soon after, increasing numbers of cases were detected in other parts of China, eventually leading to a disease outbreak in China. As this dreadful disease spreads rapidly, the mass media has been active in community education on COVID-19 by delivering health information about this novel coronavirus, such as its pathogenesis, spread, prevention, and containment. Objective: The aim of this study was to collect media reports on COVID-19 and investigate the patterns of media-directed health communications as well as the role of the media in this ongoing COVID-19 crisis in China. Methods: We adopted the WiseSearch database to extract related news articles about the coronavirus from major press media between January 1, 2020, and February 20, 2020. We then sorted and analyzed the data using Python software and Python package Jieba. We sought a suitable topic number with evidence of the coherence number. We operated latent Dirichlet allocation topic modeling with a suitable topic number and generated corresponding keywords and topic names. We then divided these topics into different themes by plotting them into a 2D plane via multidimensional scaling. Results: After removing duplications and irrelevant reports, our search identified 7791 relevant news reports. We listed the number of articles published per day. According to the coherence value, we chose 20 as the number of topics and generated the topics’ themes and keywords. These topics were categorized into nine main primary themes based on the topic visualization figure. The top three most popular themes were prevention and control procedures, medical treatment and research, and global or local social and economic influences, accounting for 32.57% (n=2538), 16.08% (n=1258), and 11.79% (n=919) of the collected reports, respectively. Conclusions: Topic modeling of news articles can produce useful information about the significance of mass media for early health communication. Comparing the number of articles for each day and the outbreak development, we noted that mass media news reports in China lagged behind the development of COVID-19. The major themes accounted for around half the content and tended to focus on the larger society rather than on individuals. The COVID-19 crisis has become a worldwide issue, and society has become concerned about donations and support as well as mental health among others. We recommend that future work addresses the mass media’s actual impact on readers during the COVID-19 crisis through sentiment analysis of news data. %M 32302966 %R 10.2196/19118 %U http://www.jmir.org/2020/4/e19118/ %U https://doi.org/10.2196/19118 %U http://www.ncbi.nlm.nih.gov/pubmed/32302966 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19145 %T The Role of YouTube and the Entertainment Industry in Saving Lives by Educating and Mobilizing the Public to Adopt Behaviors for Community Mitigation of COVID-19: Successive Sampling Design Study %A Basch,Charles E %A Basch,Corey H %A Hillyer,Grace C %A Jaime,Christie %+ Teachers College, Columbia University, 525 W 120th St, New York, NY, 10027, United States, 1 212 678 3983, ceb35@columbia.edu %K YouTube %K COVID-19 %K social media %K pandemic %K outbreak %K infectious disease %K public health %K prevention %D 2020 %7 21.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Effective community mitigation through voluntary behavior change is currently the best way to reduce mortality caused by coronavirus disease (COVID-19). This study builds on our prior study based on the scientific premise that YouTube is one of the most effective ways to communicate and mobilize the public in community mitigation to reduce exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective: Because of the rapidly changing nature of YouTube in the context of the COVID-19 pandemic, we conducted a follow-up study to document how coverage of preventive behaviors for effective community mitigation has changed. Methods: A successive sampling design was used to compare coverage of behaviors to mitigate community transmission of COVID-19 in the 100 most widely viewed YouTube videos in January 2020 and March 2020. Results: Videos in the January and March samples were viewed >125 million times and >355 million times, respectively. Fewer than half of the videos in either sample covered any of the prevention behaviors recommended by the US Centers for Disease Control and Prevention, but many covered key prevention behaviors and were very widely viewed. There were no videos uploaded by entertainment television in the January sample, but this source comprised the majority of videos and garnered the majority of cumulative views in the March sample. Conclusions: This study demonstrates the incredible reach of YouTube and the potential value of partnership with the entertainment industry for communicating and mobilizing the public about community mitigation to reduce mortality from the COVID-19 viral pandemic. %M 32297593 %R 10.2196/19145 %U http://publichealth.jmir.org/2020/2/e19145/ %U https://doi.org/10.2196/19145 %U http://www.ncbi.nlm.nih.gov/pubmed/32297593 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e16191 %T Exploring Substance Use Tweets of Youth in the United States: Mixed Methods Study %A Stevens,Robin C %A Brawner,Bridgette M %A Kranzler,Elissa %A Giorgi,Salvatore %A Lazarus,Elizabeth %A Abera,Maramawit %A Huang,Sarah %A Ungar,Lyle %+ Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Fagin Hall, Philadelphia, PA, United States, 1 2158984063, robin2@nursing.upenn.edu %K social media %K illicit drug %K youth %K adolescent %D 2020 %7 26.3.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Substance use by youth remains a significant public health concern. Social media provides the opportunity to discuss and display substance use–related beliefs and behaviors, suggesting that the act of posting drug-related content, or viewing posted content, may influence substance use in youth. This aligns with empirically supported theories, which posit that behavior is influenced by perceptions of normative behavior. Nevertheless, few studies have explored the content of posts by youth related to substance use. Objective: This study aimed to identify the beliefs and behaviors of youth related to substance use by characterizing the content of youths’ drug-related tweets. Using a sequential explanatory mixed methods approach, we sampled drug-relevant tweets and qualitatively examined their content. Methods: We used natural language processing to determine the frequency of drug-related words in public tweets (from 2011 to 2015) among youth Twitter users geolocated to Pennsylvania. We limited our sample by age (13-24 years), yielding approximately 23 million tweets from 20,112 users. We developed a list of drug-related keywords and phrases and selected a random sample of tweets with the most commonly used keywords to identify themes (n=249). Results: We identified two broad classes of emergent themes: functional themes and relational themes. Functional themes included posts that explicated a function of drugs in one’s life, with subthemes indicative of pride, longing, coping, and reminiscing as they relate to drug use and effects. Relational themes emphasized a relational nature of substance use, capturing substance use as a part of social relationships, with subthemes indicative of drug-related identity and companionship. We also identified topical areas in tweets related to drug use, including reference to polysubstance use, pop culture, and antidrug content. Across the tweets, the themes of pride (63/249, 25.3%) and longing (39/249, 15.7%) were the most popular. Most tweets that expressed pride (46/63, 73%) were explicitly related to marijuana. Nearly half of the tweets on coping (17/36, 47%) were related to prescription drugs. Very few of the tweets contained antidrug content (9/249, 3.6%). Conclusions: Data integration indicates that drugs are typically discussed in a positive manner, with content largely reflective of functional and relational patterns of use. The dissemination of this information, coupled with the relative absence of antidrug content, may influence youth such that they perceive drug use as normative and justified. Strategies to address the underlying causes of drug use (eg, coping with stressors) and engage antidrug messaging on social media may reduce normative perceptions and associated behaviors among youth. The findings of this study warrant research to further examine the effects of this content on beliefs and behaviors and to identify ways to leverage social media to decrease substance use in this population. %M 32213472 %R 10.2196/16191 %U http://publichealth.jmir.org/2020/1/e16191/ %U https://doi.org/10.2196/16191 %U http://www.ncbi.nlm.nih.gov/pubmed/32213472 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e15330 %T Examination of Gender Stereotypes and Norms in Health-Related Content Posted to Snapchat Discover Channels: Qualitative Content Analysis %A LeBeau,Kelsea %A Carr,Cary %A Hart,Mark %+ College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Health Professions, Nursing, and Pharmacy Room 4176, Gainesville, FL, 32610, United States, 1 8504991952, klebeau@ufl.edu %K social media %K online social networking %K health behavior %K sexual health %K social norms %K gender %K gender role %K mobile applications %D 2020 %7 20.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Snapchat has seen one of the most rapid, and unprecedented, growths in the history of social networking sites and social media with 3 billion Snapchats sent daily. In 2015, Snapchat introduced a new feature, Snapchat Discover, providing a unique way for publishers, such as magazines, to connect their content to Snapchat users. Objective: This study aimed to evaluate qualitatively the health-related content distributed among male-focused and female-focused Discover channels and to determine whether differences exist between the content posted to these channels. Methods: Magazine Discover channels with male and female target audiences were identified based on the magazine’s claimed audience and a search of Snapchat Discover’s magazine publishers, resulting in the selection of two male-focused and two female-focused channels. Stories were collected daily from each of the selected channels during a 4-week period. Using the constant comparative method, 406 Discover stories were collected and analyzed. Results: Differences in health content coverage existed between male- and female-focused channels. General health stories from male channels comprised 7.5% (10/134) of total stories compared with 22.8% (62/272) for female channels. Sexual health stories from male channels comprised 3.0% (4/134) of total stories compared with 18.8% (51/272) for female channels. Moreover, female-focused channels’ content was more comprehensive. Female audiences were portrayed as being health information seekers, concerned with sexual health and male satisfaction, primarily responsible for contraception and pregnancy prevention, and less informed about sex. Male audiences were portrayed as being less likely to seek health information, obsessed with and driven by sex, and less concerned with sexual health. Conclusions: Understanding the content shared to social media is important, especially when considering the implications content may have for behavior. In terms of content, these findings suggest Discover channels appear to promote gender stereotypes and norms for health and sexual health through the information posted. %M 32196461 %R 10.2196/15330 %U http://www.jmir.org/2020/3/e15330/ %U https://doi.org/10.2196/15330 %U http://www.ncbi.nlm.nih.gov/pubmed/32196461 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e14627 %T Media Reports as a Source for Monitoring Impact of Influenza on Hospital Care: Qualitative Content Analysis %A Reukers,Daphne F M %A Marbus,Sierk D %A Smit,Hella %A Schneeberger,Peter %A Donker,Gé %A van der Hoek,Wim %A van Gageldonk-Lafeber,Arianne B %+ Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Postbus 1, 3720 BA, Bilthoven, , Netherlands, 31 302743419, daphne.reukers@rivm.nl %K influenza %K severe acute respiratory infections %K SARI %K surveillance %K media reports %K news articles %K hospital care %D 2020 %7 4.3.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Netherlands, like most European countries, has a robust influenza surveillance system in primary care. However, there is a lack of real-time nationally representative data on hospital admissions for complications of influenza. Anecdotal information about hospital capacity problems during influenza epidemics can, therefore, not be substantiated. Objective: The aim of this study was to assess whether media reports could provide relevant information for estimating the impact of influenza on hospital capacity, in the absence of hospital surveillance data. Methods: Dutch news articles on influenza in hospitals during the influenza season (week 40 of 2017 until week 20 of 2018) were searched in a Web-based media monitoring program (Coosto). Trends in the number of weekly articles were compared with trends in 5 different influenza surveillance systems. A content analysis was performed on a selection of news articles, and information on the hospital, department, problem, and preventive or response measures was collected. Results: The trend in weekly news articles correlated significantly with the trends in all 5 surveillance systems, including severe acute respiratory infections (SARI) surveillance. However, the peak in all 5 surveillance systems preceded the peak in news articles. Content analysis showed hospitals (N=69) had major capacity problems (46/69, 67%), resulting in admission stops (9/46, 20%), postponement of nonurgent surgical procedures (29/46, 63%), or both (8/46, 17%). Only few hospitals reported the use of point-of-care testing (5/69, 7%) or a separate influenza ward (3/69, 4%) to accelerate clinical management, but most resorted to ad hoc crisis management (34/69, 49%). Conclusions: Media reports showed that the 2017/2018 influenza epidemic 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 to inform decision making. %M 32130197 %R 10.2196/14627 %U http://publichealth.jmir.org/2020/1/e14627/ %U https://doi.org/10.2196/14627 %U http://www.ncbi.nlm.nih.gov/pubmed/32130197 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e16382 %T Predictors of User Engagement With Facebook Posts Generated by a National Sample of Lesbian, Gay, Bisexual, Transgender, and Queer Community Centers in the United States: Content Analysis %A Goedel,William C %A Jin,Harry %A Sutten Coats,Cassandra %A Ogunbajo,Adedotun %A Restar,Arjee J %+ Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Box G-S121-3, Providence, RI, 02906, United States, 1 4018633713, william_goedel@brown.edu %K health communication %K social media %K sexual and gender minorities %K community networks %D 2020 %7 28.1.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Lesbian, gay, bisexual, transgender, and queer (LGBTQ) community centers remain important venues for reaching and providing crucial health and social services to LGBTQ individuals in the United States. These organizations commonly use Facebook to reach their target audiences, but little is known about factors associated with user engagement with their social media presence. Objective: This study aimed to identify factors associated with engagement with Facebook content generated by LGBTQ community centers in the United States. Methods: Content generated by LGBTQ community centers in 2017 was downloaded using Facebook’s application programming interface. Posts were classified by their content and sentiment. Correlates of user engagement were identified using negative binomial regression. Results: A total of 32,014 posts from 175 community centers were collected. Posts with photos (incidence rate ratio, [IRR] 1.07; 95% CI 1.06-1.09) and videos (IRR 1.54; 95% CI 1.52-1.56) that contained a direct invitation for engagement (IRR 1.03; 95% CI 1.02-1.04), that expressed a positive sentiment (IRR 1.11; 95% CI 1.10-1.12), and that contained content related to stigma (IRR 1.16; 95% CI 1.14-1.17), mental health (IRR 1.33; 95% CI 1.31-1.35), and politics (IRR 1.28; 95% CI 1.27-1.29) received higher levels of engagement. Conclusions: The results of this study provide support for the use of Facebook to extend the reach of LGBTQ community centers and highlight multiple factors that can be leveraged to optimize engagement. %M 32012104 %R 10.2196/16382 %U https://publichealth.jmir.org/2020/1/e16382 %U https://doi.org/10.2196/16382 %U http://www.ncbi.nlm.nih.gov/pubmed/32012104 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 2 %N 1 %P e14137 %T The Reach of the “Don’t Fry Day” Twitter Campaign: Content Analysis %A Nguyen,Jennifer %A Gilbert,Lauren %A Priede,Lianne %A Heckman,Carolyn %+ Department of Pharmacy Practice, College of Pharmacy, Mercer University, 3001 Mercer University Drive, Atlanta, GA, 30341, United States, 1 6785476168, nguyen_jl@mercer.edu %K social media %K skin neoplasms %K health communication %D 2019 %7 13.11.2019 %9 Original Paper %J JMIR Dermatol %G English %X Background: Skin cancer is the most common cancer in the United States, disproportionately affecting young women. Since many young adults use Twitter, it may be an effective channel to communicate skin cancer prevention information. Objective: The study aimed to assess the reach of the National Council on Skin Cancer Prevention (NCSCP)’s 2018 Don’t Fry Day Twitter campaign, categorize the types of individuals or tweeters who engaged in the campaign, and identify themes of the tweets. Methods: Descriptive statistics were used, and a content analysis of Twitter activity during the 2018 Don’t Fry Day campaign was conducted. The NCSCP tweeted about Don’t Fry Day and skin cancer prevention for 14 days in May 2018. Twitter contributors were categorized into groups. The number of impressions (potential views) and retweets were recorded. Content analysis was used to describe the text of the tweets. Results: A total of 1881 Twitter accounts, largely health professionals, used the Don’t Fry Day hashtag, generating over 45 million impressions. These accounts were grouped into nine categories (eg, news or media and public figures). The qualitative content analysis revealed informative, minimally informative, and self-interest campaign promotion themes. Informative tweets involved individuals and organizations who would mention and give further context and information about the #DontFryDay campaign. Subthemes of the informative theme were sun safety, contextual, and epidemiologic information. Minimally informative tweets used the hashtag (#DontFryDay) and other types of hashtags but did not give any further context or original material in the tweets. Self-interest campaign promotion involved businesses, firms, and medical practices that would utilize and promote the campaign to boost their own ventures. Conclusions: These analyses demonstrate the large potential reach of social media public health campaigns. However, limitations of such campaigns were also identified, for example, the relatively homogeneous groups actively engaged in the campaign. This study contributes to the understanding of the types of accounts and messages engaged in social media campaigns utilizing a hashtag, providing insight into the messages and participants that are effective and those that are not to achieve campaign goals. Further research on the potential impact of social media on health behaviors and outcomes is necessary to ensure wide-reaching implications. %R 10.2196/14137 %U http://derma.jmir.org/2019/1/e14137/ %U https://doi.org/10.2196/14137 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14080 %T Youth Study Recruitment Using Paid Advertising on Instagram, Snapchat, and Facebook: Cross-Sectional Survey Study %A Ford,Kelsey Lynett %A Albritton,Tashuna %A Dunn,Tara A %A Crawford,Kacy %A Neuwirth,Jessica %A Bull,Sheana %+ Anschutz Medical Campus, University of Colorado, 13001 E 17th Pl, Aurora, CO, 80045, United States, 1 303724 5000, kelsey.ford@cuanschutz.edu %K social media %K youth %K surveys and questionnaires %D 2019 %7 9.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The use of paid social media advertising for targeted study recruitment is an effective strategy in health research and evaluation, specifically to reach diverse youth participants. Although the literature adequately describes the utility of Facebook in recruitment, limited information exists for social media platforms that are more popular with youth, specifically Instagram and Snapchat. Objective: This paper outlines a paid advertising approach using Instagram, Snapchat, and Facebook to evaluate a statewide youth marijuana prevention campaign. The objective of this study was to compare recruitment metrics across Instagram, Snapchat, and Facebook for two surveys documenting youth knowledge, attitudes, and behaviors related to retail marijuana in Colorado post legalization. In addition, the study assessed the feasibility of using Instagram and Snapchat as effective additions to Facebook for youth study recruitment. Methods: A social media recruitment strategy was used to conduct two cross-sectional surveys of youth, aged 13 to 20 years, in Colorado. Geographically targeted ads across 3 social media platforms encouraged the completion of a Web-based self-administered survey. Ad Words and Snap Ads were used to deploy and manage advertising campaigns, including ad design, placement, and analysis. Ad costs and recruitment metrics (ie, impressions, link clicks, and conversion rates) were calculated across the three social media platforms. Results: Over two 1-month periods, 763,613 youth were reached (ie, impressions), 6089 of them clicked survey links (ie, clicks), and 828 eligible youth completed surveys about knowledge, attitudes, and behaviors related to retail marijuana. Instagram converted 36.13% (803/2222) of impressions to clicks (ie, conversion rate) in the first survey and 0.87% (864/98982) in the second survey. Snapchat generated the most impressions and link clicks, but it did so with the lowest conversion rate for both surveys, with a 1.40% (1600/114,200) conversion rate in the first survey and a 0.36% (1818/504700) conversion rate in the second survey. Facebook maintained a consistent conversion rate of roughly 2% across both surveys, despite reductions in budget for the second survey. The cost-per-click ranged between US $0.25 and $0.37 across the three platforms, with Snapchat as both the most cost-effective platform in the first survey and the most expensive platform in the second survey. Conclusions: Recruitment and enrollment outcomes indicate the use of Instagram and Snapchat, in addition to Facebook, may be a modern, useful, and cost-effective approach to reach youth with surveys on sensitive health topics. As the use of Facebook declines among youth, the use of more popular social media platforms can augment study recruitment for health research and evaluation efforts. %M 31599739 %R 10.2196/14080 %U https://publichealth.jmir.org/2019/4/e14080 %U https://doi.org/10.2196/14080 %U http://www.ncbi.nlm.nih.gov/pubmed/31599739 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e12878 %T Prevalence and Characteristics of Twitter Posts About Court-Ordered, Tobacco-Related Corrective Statements: Descriptive Content Analysis %A Kelley,Dannielle E %A Brown,Meredith %A Murray,Alice %A Blake,Kelly D %+ Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Dr, 3E536, Rockville, MD, 20850, United States, 1 240 276 7227, dannielle.kelley@nih.gov %K social media %K Twitter %K tobacco corrective statements %K tobacco industry/legislation and jurisprudence %D 2019 %7 8.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Three major US tobacco companies were recently ordered to publish corrective statements intended to prevent and restrain further fraud about the health effects of smoking. The court-ordered statements began appearing in newspapers and on television (TV) in late 2017. Objective: The objective of this study was to examine the social media dissemination of the tobacco corrective statements during the first 6 months of the implementation of the statements. Methods: We conducted a descriptive content analysis of Twitter posts using an iterative search strategy through Crimson Hexagon and randomly selected 19.74% (456/2309) of original posts occurring between November 1, 2017, and March 27, 2018, for coding and analysis. We assessed post volume over time, source or author, valence, linked content, and reference to the industry (eg, big tobacco, tobacco industry, and Philip Morris) and media outlet (TV or newspaper). Retweeted content was coded for source/author and prevalence. Results: Most posts were published in November 2017, surrounding the initial release of the corrective statements. Content was generally neutral (58.7%, 268/456) or positive (33.3%, 152/456) in valence, included links to additional information about the statements (94.9%, 433/456), referred to the industry (87.7%, 400/456), and did not mention a specific media channel on which the statements were aired or published (15%). The majority of original posts were created by individual users (55.2%, 252/456), whereas the majority of retweeted posts were posted by public health organizations (51%). Differences by source are reported, for example, organization posts are more likely to include a link to additional information compared with individual users (P=.03). Conclusions: Conversations about the court-ordered corrective statements are taking place on Twitter and are generally neutral or positive in nature. Public health organizations may be increasing the prevalence of these conversations through social media engagement. %M 31596243 %R 10.2196/12878 %U https://publichealth.jmir.org/2019/4/e12878 %U https://doi.org/10.2196/12878 %U http://www.ncbi.nlm.nih.gov/pubmed/31596243 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e13658 %T Social Media Use and HIV Screening Uptake Among Deaf Adults in the United States: Cross-Sectional Survey Study %A Argenyi,Michael %A Kushalnagar,Poorna %+ Gallaudet University, 800 Florida Ave, NE, Deaf Health Communication and Quality of Life Center, Washington, DC, 20002, United States, 1 2027502257, poorna.kushalnagar@gallaudet.edu %K HIV %K sexually transmitted disease %K sexually transmitted infection %K deaf %K sign language %K social media %K internet %D 2019 %7 2.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: About 46% of US adults obtain recommended HIV screening at least once during their lifetime. There is little knowledge of screening 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 both 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 Survey in ASL was administered to 1340 deaf US adults between 2015-2018. Modified Poisson with robust standard errors was used to assess the relationship between social media usage as a predictor and HIV screening as an outcome (screened more than one year ago, screened within the past year, and never been screened), after adjusting for sociodemographics and sexually transmitted disease (STD) covariates. Results: The estimated lifetime prevalence of HIV screening uptake among our sample was 54% (719/1340), with 32% (429/1340) in the past year. Being of younger age, male gender, black, lesbian, gay, bisexual, or queer, 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 screening in the past year, compared to either lifetime or never. Conclusions: Screening falls well short of universal screening targets, with gaps among heterosexual, female, Caucasian, or older deaf adults. HIV screening outreach may not be effective because of technological or linguistic inaccessibility, rendering ASL users an underrecognized minority group. However, social media is still a powerful tool, particularly among younger deaf adults at risk for HIV. %M 31579021 %R 10.2196/13658 %U https://publichealth.jmir.org/2019/4/e13658 %U https://doi.org/10.2196/13658 %U http://www.ncbi.nlm.nih.gov/pubmed/31579021 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 2 %N 1 %P e14589 %T Four Dissemination Pathways for a Social Media–Based Breastfeeding Campaign: Evaluation of the Impact on Key Performance Indicators %A Harding,Kassandra %A Pérez-Escamilla,Rafael %A Carroll,Grace %A Aryeetey,Richmond %A Lasisi,Opeyemi %+ Yale School of Public Health, 60 College Street, New Haven, CT, 06520, United States, 1 916 223 6168, kassandralharding@gmail.com %K social media %K health communication %K breastfeeding %K dissemination %K Ghana %D 2019 %7 26.9.2019 %9 Original Paper %J JMIR Nursing %G English %X Background: Social media utilization is on the rise globally, and the potential of social media for health behavior campaigns is widely recognized. However, as the landscape of social media evolves, so do techniques used to optimize campaign dissemination. Objective: The primary aim of this study was to evaluate the impact of 4 material dissemination paths for a breastfeeding social media marketing campaign in Ghana on exposure and engagement with campaign material. Methods: Campaign materials (n=60) were posted to a Facebook and Twitter campaign page over 12 weeks (ie, baseline). The top 40 performing materials were randomized to 1 of 4 redissemination arms (control simply posted on each platform, key influencers, random influencers, and paid advertisements). Key performance indicator data (ie, exposure and engagement) were extracted from both Facebook and Twitter 2 days after the material was posted. A difference-in-difference model was used to examine the impact of the dissemination paths on performance. Results: At baseline, campaign materials received an average (SD) exposure of 1178 (670) on Facebook and 1071 (905) on Twitter (n=60). On Facebook, materials posted with paid advertisements had significantly higher exposure and engagement compared with the control arm (P<.001), and performance of materials shared by either type of influencer did not differ significantly from the control arm. No differences in Twitter performance were detected across arms. Conclusions: Paid advertisements are an effective mechanism to increase exposure and engagement of campaign posts on Facebook, which was achieved at a low cost. %M 34345773 %R 10.2196/14589 %U https://nursing.jmir.org/2019/1/e14589/ %U https://doi.org/10.2196/14589 %U http://www.ncbi.nlm.nih.gov/pubmed/34345773 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e15298 %T Social Media Outrage in Response to a School-Based Substance Use Survey: Qualitative Analysis %A Gassman,Ruth Ann %A Dutta,Tapati %A Agley,Jon %A Jayawardene,Wasantha %A Jun,Mikyoung %+ Prevention Insights, Institute for Research on Addictive Behavior, School of Public Health, Indiana University Bloomington, 501 N Morton St, Suite 110, Bloomington, IN, 47404, United States, 1 812 855 1237, rgassman@indiana.edu %K social media %K ATOD %K survey %K firestorm %K digital %D 2019 %7 12.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: School-based alcohol, tobacco, and other drug use (ATOD) surveys are a common epidemiological means of understanding youth risk behaviors. They can be used to monitor national trends and provide data, in aggregate, to schools, communities, and states for the purposes of funding allocation, prevention programming, and other supportive infrastructure. However, such surveys sometimes are targeted by public criticism, and even legal action, often in response to a lack of perceived appropriateness. The ubiquity of social media has added the risk of potential online firestorms, or digital outrage events, to the hazards to be considered when administering such a survey. Little research has investigated the influence of online firestorms on public health survey administration, and no research has analyzed the content of such an occurrence. Analyzing this content will facilitate insights as to how practitioners can minimize the risk of generating outrage when conducting such surveys. Objective: This study aimed to identify common themes within social media comments comprising an online firestorm that erupted in response to a school-based ATOD survey in order to inform risk-reduction strategies. Methods: Data were collected by archiving all public comments made in response to a news study about a school-based ATOD survey that was featured on a common social networking platform. Using the general inductive approach and elements of thematic analysis, two researchers followed a multi-step protocol to clean, categorize, and consolidate data, generating codes for all 207 responses. Results: In total, 133 comments were coded as oppositional to the survey and 74 were coded as supportive. Among the former, comments tended to reflect government-related concerns, conspiratorial or irrational thinking, issues of parental autonomy and privacy, fear of child protective services or police, issues with survey mechanisms, and reasoned disagreement. Among the latter, responses showed that posters perceived the ability to prevent abuse and neglect and support holistic health, surmised that opponents were hiding something, expressed reasoned support, or made factual statements about the survey. Consistent with research on moral outrage and digital firestorms, few comments (<10%) contained factual information about the survey; nearly half of the comments, both supportive and oppositional, were coded in categories that presupposed misinformation. Conclusions: The components of even a small online firestorm targeting a school-based ATOD survey are nuanced and complex. It is likely impossible to be fully insulated against the risk of outrage in response to this type of public health work; however, careful articulation of procedures, anticipating specific concerns, and two-way community-based interaction may reduce risk. %M 31516129 %R 10.2196/15298 %U http://www.jmir.org/2019/9/e15298/ %U https://doi.org/10.2196/15298 %U http://www.ncbi.nlm.nih.gov/pubmed/31516129 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e13837 %T The #MeToo Movement in the United States: Text Analysis of Early Twitter Conversations %A Modrek,Sepideh %A Chakalov,Bozhidar %+ Health Equity Institute, San Francisco State University, 1600 Hollaway Avenue HSS 386, San Francisco, CA, 94132, United States, 1 415 405 7556, smodrek@sfsu.edu %K social media %K sexual abuse %K sexual assault %K machine learning %K infodemiology %K infoveillance %D 2019 %7 03.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The #MeToo movement sparked an international debate on the sexual harassment, abuse, and assault and has taken many directions since its inception in October of 2017. Much of the early conversation took place on public social media sites such as Twitter, where the hashtag movement began. Objective: The aim of this study is to document, characterize, and quantify early public discourse and conversation of the #MeToo movement from Twitter data in the United States. We focus on posts with public first-person revelations of sexual assault/abuse and early life experiences of such events. Methods: We purchased full tweets and associated metadata from the Twitter Premium application programming interface between October 14 and 21, 2017 (ie, the first week of the movement). We examined the content of novel English language tweets with the phrase “MeToo” from within the United States (N=11,935). We used machine learning methods, least absolute shrinkage and selection operator regression, and support vector machine models to summarize and classify the content of individual tweets with revelations of sexual assault and abuse and early life experiences of sexual assault and abuse. Results: We found that the most predictive words created a vivid archetype of the revelations of sexual assault and abuse. We then estimated that in the first week of the movement, 11% of novel English language tweets with the words “MeToo” revealed details about the poster’s experience of sexual assault or abuse and 5.8% revealed early life experiences of such events. We examined the demographic composition of posters of sexual assault and abuse and found that white women aged 25-50 years were overrepresented in terms of their representation on Twitter. Furthermore, we found that the mass sharing of personal experiences of sexual assault and abuse had a large reach, where 6 to 34 million Twitter users may have seen such first-person revelations from someone they followed in the first week of the movement. Conclusions: These data illustrate that revelations shared went beyond acknowledgement of having experienced sexual harassment and often included vivid and traumatic descriptions of early life experiences of assault and abuse. These findings and methods underscore the value of content analysis, supported by novel machine learning methods, to improve our understanding of how widespread the revelations were, which likely amplified the spread and saliency of the #MeToo movement. %M 31482849 %R 10.2196/13837 %U https://www.jmir.org/2019/9/e13837/ %U https://doi.org/10.2196/13837 %U http://www.ncbi.nlm.nih.gov/pubmed/31482849 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 3 %P e14447 %T Communicating Science in the Digital and Social Media Ecosystem: Scoping Review and Typology of Strategies Used by Health Scientists %A Fontaine,Guillaume %A Maheu-Cadotte,Marc-André %A Lavallée,Andréane %A Mailhot,Tanya %A Rouleau,Geneviève %A Bouix-Picasso,Julien %A Bourbonnais,Anne %+ Faculty of Nursing, Université de Montréal, 2375 ch de la Côte-Sainte-Catherine, Montréal, QC, H3T1A8, Canada, 1 376 3330 ext 3069, guillaume.fontaine@umontreal.ca %K health communication %K public health %K social media %K internet %K patient participation %D 2019 %7 03.09.2019 %9 Review %J JMIR Public Health Surveill %G English %X Background: The public’s understanding of science can be influential in a wide range of areas related to public health, including policy making and self-care. Through the digital and social media ecosystem, health scientists play a growing role in public science communication (SC). Objective: This review aimed to (1) synthesize the literature on SC initiated by health scientists targeting the public in the digital and social media ecosystem and (2) describe the SC strategies and communication channels used. Methods: This scoping review was based on the Joanna Briggs Institute Methodological Framework. A systematic search was performed in 6 databases (January 2000 to April 2018). Title and abstract screening, full-text review, data charting, and critical appraisal were performed independently by two review authors. Data regarding included studies and communication channels were synthesized descriptively. A typology of SC strategies was developed using a qualitative and inductive method of data synthesis. Results: Among 960 unique publications identified, 18 met inclusion criteria. A third of publications scored good quality (6/18, 33%), half scored moderate quality (9/18, 50%), and less than a fifth scored low quality (3/18, 16%). Overall, 75 SC strategies used by health scientists were identified. These were grouped into 9 types: content, credibility, engagement, intention, linguistics, planification, presentation, social exchange, and statistics. A total of 5 types of communication channels were identified: social networking platforms (eg, Twitter), content-sharing platforms (eg, YouTube), digital research communities (eg, ResearchGate), personal blogs and websites (eg, WordPress), and social news aggregation and discussion platforms (eg, Reddit). Conclusions: Evidence suggests that multiple types of SC strategies and communication channels are used by health scientists concurrently. Few empirical studies have been conducted on SC by health scientists in the digital and social media ecosystem. Future studies should examine the appropriateness and effectiveness of SC strategies for improving public health–related outcomes and identify the barriers, facilitators, and ethical considerations inherent to the involvement of health scientists in the digital and social media ecosystem. %M 31482854 %R 10.2196/14447 %U http://publichealth.jmir.org/2019/3/e14447/ %U https://doi.org/10.2196/14447 %U http://www.ncbi.nlm.nih.gov/pubmed/31482854 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e12443 %T Identifying Key Target Audiences for Public Health Campaigns: Leveraging Machine Learning in the Case of Hookah Tobacco Smoking %A Chu,Kar-Hai %A Colditz,Jason %A Malik,Momin %A Yates,Tabitha %A Primack,Brian %+ School of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, United States, 1 4126922578, chuk@pitt.edu %K smoking water pipes %K waterpipe tobacco %K tobacco %K smoking %K social media %K public health %K infodemiology %K infoveillance %K machine learning %D 2019 %7 08.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Hookah tobacco smoking (HTS) is a particularly important issue for public health professionals to address owing to its prevalence and deleterious health effects. Social media sites can be a valuable tool for public health officials to conduct informational health campaigns. Current social media platforms provide researchers with opportunities to better identify and target specific audiences and even individuals. However, we are not aware of systematic research attempting to identify audiences with mixed or ambivalent views toward HTS. Objective: The objective of this study was to (1) confirm previous research showing positively skewed HTS sentiment on Twitter using a larger dataset by leveraging machine learning techniques and (2) systematically identify individuals who exhibit mixed opinions about HTS via the Twitter platform and therefore represent key audiences for intervention. Methods: We prospectively collected tweets related to HTS from January to June 2016. We double-coded sentiment for a subset of approximately 5000 randomly sampled tweets for sentiment toward HTS and used these data to train a machine learning classifier to assess the remaining approximately 556,000 HTS-related Twitter posts. Natural language processing software was used to extract linguistic features (ie, language-based covariates). The data were processed by machine learning tools and algorithms using R. Finally, we used the results to identify individuals who, because they had consistently posted both positive and negative content, might be ambivalent toward HTS and represent an ideal audience for intervention. Results: There were 561,960 HTS-related tweets: 373,911 were classified as positive and 183,139 were classified as negative. A set of 12,861 users met a priori criteria indicating that they posted both positive and negative tweets about HTS. Conclusions: Sentiment analysis can allow researchers to identify audience segments on social media that demonstrate ambiguity toward key public health issues, such as HTS, and therefore represent ideal populations for intervention. Using large social media datasets can help public health officials to preemptively identify specific audience segments that would be most receptive to targeted campaigns. %M 31287063 %R 10.2196/12443 %U http://www.jmir.org/2019/7/e12443/ %U https://doi.org/10.2196/12443 %U http://www.ncbi.nlm.nih.gov/pubmed/31287063 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e12245 %T Factors Influencing User Engagement of Health Information Disseminated by Chinese Provincial Centers for Disease Control and Prevention on WeChat: Observational Study %A Zhang,Yan %A Xia,Tingsong %A Huang,Lingfeng %A Yin,Mingjuan %A Sun,Mingwei %A Huang,Jingxiao %A Ni,Yu %A Ni,Jindong %+ Guangdong Medical University, No. 1 Xincheng Road, Songshan Lake, Dongguan,, China, 86 769 2289 6570, nijd-gw@gdmu.edu.cn %K WeChat %K WeChat official accounts %K user engagement %K CDC %K health education %D 2019 %7 27.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Social media is currently becoming a new channel for information acquisition and exchange. In China, with the growing popularity of WeChat and WeChat official accounts (WOAs), health promotion agencies have an opportunity to use them for successful information distribution and diffusion online. Objective: We aimed to identify features of articles pushed by WOAs of Chinese provincial Centers for Disease Control and Prevention (CDC) that are associated with user engagement. Methods: We searched and subscribed to 28 WOAs of provincial CDCs. Data for this study consisted of WeChat articles on these WOAs between January 1, 2017 and December 31, 2017. We developed a features frame containing title type, article content, article type, communication skills, number of marketing elements, and article length for each article and coded the data quantitatively using a coding scheme that assigned numeric values to article features. We examined the descriptive characteristics of articles for every WOA and generated descriptive statistics for six article features. The amount of reading and liking was converted into the level of reading and liking by the 75% position. Two-category univariate logistic regression and multivariable logistic regression were conducted to explore associations between the features of the articles and user engagement, operationalized as reading level and liking level. Results: All provincial CDC WOAs provided a total of 5976 articles in 2017. Shanghai CDC articles attracted the most user engagement, and Ningxia CDC articles attracted the least. For all articles, the median reading was 551.5 and the median liking was 10. Multivariable logistic regression analysis revealed that article content, article type, communication skills, number of marketing elements, and article length were associated with reading level and liking level. However, title type was only associated with liking level. Conclusions: How social media can be used to best achieve health information dissemination and public health outcomes is a topic of much discussion and study in the public health community. Given the lack of related studies based on WeChat or official accounts, we conducted this study and found that article content, article type, communication skills, number of marketing elements, article length, and title type were associated with user engagement. Our study may provide public health and community leaders with insight into the diffusion of important health topics of concern. %M 31250833 %R 10.2196/12245 %U http://mhealth.jmir.org/2019/6/e12245/ %U https://doi.org/10.2196/12245 %U http://www.ncbi.nlm.nih.gov/pubmed/31250833 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13987 %T Using the Extended Parallel Process Model to Examine the Nature and Impact of Breast Cancer Prevention Information on Mobile-Based Social Media: Content Analysis %A Chen,Liang %A Yang,Xiaodong %A Fu,Lunrui %A Liu,Xiaoming %A Yuan,Congyi %+ School of Journalism and Communication, Shandong University, No.57 Shanda South Road, Jinan, 250100, China, 86 531 88361159, XYANG012@e.ntu.edu.sg %K breast cancer %K prevention information %K mobile social media %K EPPM %D 2019 %7 24.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the rise of mobile technology, an increasing number of people use mobile-based social media to access health information. Many scholars have explored the nature of health information on social media; however, the impact of such information on people was understudied. Objective: This study aimed to examine the nature and impact of health information on mobile-based social media. Specifically, we investigated how the levels of threat and efficacy of breast cancer prevention information affect individuals’ engagement with the information, such as readings and likes. Methods: Breast cancer prevention articles posted on a Chinese mobile-based social media platform (ie, WeChat Subscription Account [WeChat SA]) from January 1 to December 31, 2017, were extracted using the Python Web Crawler. We used content analysis and analysis of covariance to analyze our data. Results: The results revealed that the vast majority of titles and main bodies of the articles involved one of the extended parallel process model components: threat or efficacy. Conclusions: Breast cancer prevention information on WeChat SA was well designed. Both threat and efficacy significantly affected the number of readings, whereas only efficacy had a significant effect on the number of likes. Moreover, breast cancer prevention information that contained both high levels of threat and efficacy gained the largest number of readings and likes. %M 31237239 %R 10.2196/13987 %U http://mhealth.jmir.org/2019/6/e13987/ %U https://doi.org/10.2196/13987 %U http://www.ncbi.nlm.nih.gov/pubmed/31237239 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e12822 %T #PrEP4Love: An Evaluation of a Sex-Positive HIV Prevention Campaign %A Dehlin,Jessica M %A Stillwagon,Ryan %A Pickett,Jim %A Keene,Lance %A Schneider,John A %+ Department of Medicine, University of Chicago, 1525 E 55th St, Suite 314, Chicago, IL, 60615, United States, 1 7737024377, jdehlin@medicine.bsd.uchicago.edu %K pre-exposure prophylaxis %K public health %K health equity %K health promotion %D 2019 %7 17.06.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Pre-exposure prophylaxis (PrEP) is an effective but underutilized method for preventing HIV transmission in communities vulnerable to HIV. Public health campaigns aimed at increasing PrEP awareness and access have less evaluation data. Objective: The aim of this study was to evaluate Chicago’s PrEP campaign, PrEP4Love (P4L), a campaign that uses health equity and sex-positivity approaches for information dissemination. Methods: P4L launched in February 2016 and remains an active campaign to date. The analysis period for this paper was from the launch date in February 2016 through May 15, 2016. Our analysis reviews the Web-based reach of the campaign through views on social media platforms (Facebook and Instagram), smart ads, or ads served to individuals across a variety of Web platforms based on their demographics and browsing history, and P4L website clicks. Results: In total, 40,913,560 unique views were generated across various social media platforms. A total of 24,548 users clicked on P4L ads and 32,223,987 views were received from smart ads. The 3 most clicked on ads were STD Signs & Symptoms—More Information on STD Symptoms, HIV & AIDS Prevention, and HIV Prevention Medication. An additional 6,970,127 views were gained through Facebook and another 1,719,446 views through Instagram. There was an average of 182 clicks per day on the P4L website. Conclusions: This is the first study investigating public responses to a health equity and sex-positive social marketing campaign for PrEP. Overall, the campaign reached millions of individuals. More studies of PrEP social marketing are needed to evaluate the relationship of targeted public health campaigns on stigma and to guide future PrEP promotion strategies. %M 31210141 %R 10.2196/12822 %U http://publichealth.jmir.org/2019/2/e12822/ %U https://doi.org/10.2196/12822 %U http://www.ncbi.nlm.nih.gov/pubmed/31210141 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e14067 %T “Where There’s Smoke, There’s Fire”: A Content Analysis of Print and Web-Based News Media Reporting of the Philip Morris–Funded Foundation for a Smoke-Free World %A Watts,Christina %A Freeman,Becky %+ Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo,, Australia, 61 400709347, cmcb8303@uni.sydney.edu.au %K tobacco industry %K mass media %K smoking, nontobacco products %D 2019 %7 06.06.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In September 2017, the Foundation for a Smoke-Free World (FSFW), a not-for-profit organization with a core purpose “to accelerate global efforts to reduce deaths and harm from smoking” was launched. However, the legitimacy of the FSFW’s vision has been questioned by experts in tobacco control because of the organization’s only funding partner, Philip Morris International (PMI). Objective: This study aimed to examine the response to the FSFW in Web-based and print news media to understand how the FSFW and its funding partner, PMI, were framed. Methods: News articles published within a 6-month period after the FSFW was announced were downloaded via Google News and Factiva and coded for topic, framing argument, slant, mention of tobacco control policies, and direct quotes or position statements. Results: A total of 124 news articles were analyzed. The news coverage of the FSFW was framed by 6 key arguments. Over half of the news articles presented a framing argument in opposition to the FSFW (64/124, 51.6%). A further 20.2% (25/124) of articles framed the FSFW positively and 28.2% of articles (35/124) presented a neutral debate with no primary slant. The FSFW was presented as not credible because of the funding link to PMI in 29.0% (36/124) of articles and as a tactic to mislead and undermine effective tobacco control measures in 11.3% of articles (14/124). However, 12.9% of articles (16/124) argued that the FSFW or PMI is part of the solution to reducing the impact of tobacco use. Evidence-based tobacco control policies were mentioned positively in 66.9% (83/124) of news articles and 9.6% (12/124) of articles presented tobacco control policies negatively. Conclusions: The Web-based and print news media reporting of the formation of the FSFW and its mission and vision has primarily been framed by doubt, skepticism, and disapproval. %M 31172959 %R 10.2196/14067 %U http://publichealth.jmir.org/2019/2/e14067/ %U https://doi.org/10.2196/14067 %U http://www.ncbi.nlm.nih.gov/pubmed/31172959 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e11263 %T A Software Tool Aimed at Automating the Generation, Distribution, and Assessment of Social Media Messages for Health Promotion and Education Research %A Reuter,Katja %A MacLennan,Alicia %A Le,NamQuyen %A Unger,Jennifer B %A Kaiser,Elsi M %A Angyan,Praveen %+ Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Institute for Health Promotion & Disease Prevention Research, University of Southern California, 3rd Floor, MC 9239, 2001 N Soto Street, Los Angeles, CA, 90032, United States, 1 3234422046, katja.reuter@usc.edu %K algorithm %K automation %K digital %K Facebook %K health communication %K health promotion %K Instagram %K internet %K online %K smoking %K social network %K social media %K tobacco %K Twitter %D 2019 %7 07.05.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 31066708 %R 10.2196/11263 %U http://publichealth.jmir.org/2019/2/e11263/ %U https://doi.org/10.2196/11263 %U http://www.ncbi.nlm.nih.gov/pubmed/31066708 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11419 %T Using a Facebook Forum to Cope With Narcolepsy After Pandemrix Vaccination: Infodemiology Study %A Blomberg,Karin %A Eriksson,Mats %A Böö,Rickard %A Grönlund,Åke %+ School of Health Sciences, Örebro University, Faculty of Medicine and Health, Örebro, S-70182, Sweden, 46 19 301270, karin.blomberg@oru.se %K narcolepsy %K mass vaccination %K social media %D 2019 %7 16.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In 2010, newly diagnosed narcolepsy cases among children and adolescents were seen in several European countries as a consequence of comprehensive national vaccination campaigns with Pandemrix against H1N1 influenza. Since then, a large number of people have had to live with narcolepsy and its consequences in daily life, such as effects on school life, social relationships, and activities. Initially, the adverse effects were not well understood and there was uncertainty about whether there would be any financial compensation. The situation remained unresolved until 2016, and during these years affected people sought various ways to join forces to handle the many issues involved, including setting up a social media forum. Objective: Our aim was to examine how information was shared, and how opinions and beliefs about narcolepsy as a consequence of Pandemrix vaccination were formed through discussions on social media. Methods: We used quantitative and qualitative methods to investigate a series of messages posted in a social media forum for people affected by narcolepsy after vaccination. Results: Group activity was high throughout the years 2010 to 2016, with peaks corresponding to major narcolepsy-related events, such as the appearance of the first cases in 2010, the first payment of compensation in 2011, and passage of a law on compensation in July 2016. Unusually, most (462/774, 59.7%) of the group took part in discussions and only 312 of 774 (40.3%) were lurkers (compared with the usual 90% rule of thumb for participation in an online community). The conversation in the group was largely factual and had a civil tone, even though there was a long struggle for the link between the vaccine and narcolepsy to be acknowledged and regarding the compensation issue. Radical, nonscientific views, such as those expounded by the antivaccination movement, did not shape the discussions in the group but were being actively expressed elsewhere on the internet. At the outset of the pandemic, there were 18 active Swedish discussion groups on the topic, but most dissolved quickly and only one Facebook group remained active throughout the period. Conclusions: The group studied is a good example of social media use for self-help through a difficult situation among people affected by illness and disease. This shows that social media do not by themselves induce trench warfare but, given a good group composition, can provide a necessary forum for managing an emergency situation where health care and government have failed or are mistrusted, and patients have to organize themselves so as to cope. %M 30990457 %R 10.2196/11419 %U http://www.jmir.org/2019/4/e11419/ %U https://doi.org/10.2196/11419 %U http://www.ncbi.nlm.nih.gov/pubmed/30990457 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12441 %T Partnering With Mommy Bloggers to Disseminate Breast Cancer Risk Information: Social Media Intervention %A Wright,Kevin %A Fisher,Carla %A Rising,Camella %A Burke-Garcia,Amelia %A Afanaseva,Dasha %A Cai,Xiaomei %+ George Mason University, Northeast Module, Room 102, Fairfax, VA,, United States, 1 413 362 5611, kwrigh16@gmu.edu %K breast cancer %K environment and public health %K risk reduction behavior %K blogging %K social networking %K social media %K health communication %K information dissemination %D 2019 %7 07.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Women are concerned about reducing their breast cancer risk, particularly if they have daughters. Social media platforms, such as blogs written by mothers, are increasingly being recognized as a channel that women use to make personal and family health–related decisions. Government initiatives (eg, Interagency Breast Cancer and Environmental Research Coordinating Committee) and researchers have called for scientists and the community to partner and disseminate scientifically and community-informed environmental risk information. Objective: We developed and evaluated a blog intervention to disseminate breast cancer and environmental risk information to mothers. We teamed with mommy bloggers to disseminate a message that we developed and tailored for mothers and daughters based on scientific evidence from the Breast Cancer and the Environment Research Program (BCERP). We posited that the intervention would influence women’s exposure to, acceptance of, and beliefs about environmental risks while promoting their intention to adopt risk-reducing behaviors. Methods: Using a quasi-experimental design, we recruited 75 mommy bloggers to disseminate the breast cancer risk message on their respective blogs and examined the impact of the intervention on (1) readers exposed to the intervention (n=445) and (2) readers not exposed to the intervention (comparison group; n=353). Results: Following the intervention, blog reader scores indicating exposure to the breast cancer risk and prevention information were greater than scores of blog readers who were not exposed (or did not recall seeing the message; mean 3.92, SD 0.85 and mean 3.45, SD 0.92, respectively; P<.001). Readers who recalled the intervention messages also had higher breast cancer risk and prevention information satisfaction scores compared with readers who did not see (or recall) the messages (mean 3.97, SD 0.75 and mean 3.57, SD 0.94, respectively; P<.001). Blog readers who recalled seeing the intervention messages were significantly more likely to share the breast cancer risk and prevention information they read, with their daughters specifically, than readers who did not recall seeing them (χ21=8.1; P=.004). Those who recalled seeing the intervention messages reported significantly higher breast cancer risk and prevention information influence scores, indicative of behavioral intentions, than participants who did not recall seeing them (mean 11.22, SD 2.93 and mean 10.14, SD 3.24, respectively; P=.003). Most women ranked Facebook as their first choice for receiving breast cancer risk information. Conclusions: Results indicated that blog readers who were exposed to (and specifically recalled) the BCERP-adapted intervention messages from mommy bloggers had higher breast cancer risk and prevention information exposure scores and higher breast cancer risk and prevention information satisfaction and influence scores than those who did not see (or recall) them. Mommy bloggers may be important opinion leaders for some women and key to enhancing the messaging, delivery, and impact of environmental breast cancer risk information on mothers. %M 30843866 %R 10.2196/12441 %U https://www.jmir.org/2019/3/e12441/ %U https://doi.org/10.2196/12441 %U http://www.ncbi.nlm.nih.gov/pubmed/30843866 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11953 %T The Messages Presented in Electronic Cigarette–Related Social Media Promotions and Discussion: Scoping Review %A McCausland,Kahlia %A Maycock,Bruce %A Leaver,Tama %A Jancey,Jonine %+ Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, 6102, Australia, 61 92667382 ext 7382, kahlia.mccausland@curtin.edu.au %K electronic nicotine delivery systems %K social media %K public health %K review %D 2019 %7 05.02.2019 %9 Review %J J Med Internet Res %G English %X Background: There has been a rapid rise in the popularity of electronic cigarettes (e-cigarettes) over the last decade, with growth predicted to continue. The uptake of these devices has escalated despite inconclusive evidence of their efficacy as a smoking cessation device and unknown long-term health consequences. As smoking rates continue to drop or plateau in many well-developed countries, transnational tobacco companies have transitioned into the vaping industry and are now using social media to promote their products. Evidence indicates e-cigarettes are being marketed on social media as a harm reduction alternative, with retailers and manufacturers utilizing marketing techniques historically used by the tobacco industry. Objective: This study aimed to identify and describe the messages presented in e-cigarette–related social media (Twitter, YouTube, Instagram, and Pinterest) promotions and discussions and identify future directions for research, surveillance, and regulation. Methods: Data sources included MEDLINE, Scopus, ProQuest, Informit, the Journal of Medical Internet Research, and Google Scholar. Included studies were published in English between 2007 and 2017, analyzed content captured from e-cigarette–related social media promotions or discussions, and reported results for e-cigarettes separately from other forms of tobacco and nicotine delivery. Database search ceased in October 2017. Initial searches identified 536 studies. Two reviewers screened studies by title and abstract. One reviewer examined 71 full-text articles to determine eligibility and identified 25 studies for inclusion. This process was undertaken with the assistance of the Web-based screening and data extraction tool—Covidence. The review was registered with the Joanna Briggs Institute (JBI) Systematic Reviews database and followed the methodology for JBI Scoping Reviews. Results: Several key messages are being used to promote e-cigarettes including as a safer alternative to cigarettes, efficacy as a smoking cessation aid, and for use where smoking is prohibited. Other major marketing efforts aimed at capturing a larger market involve promotion of innovative flavoring and highlighting the public performance of vaping. Discussion and promotion of these devices appear to be predominantly occurring among the general public and those with vested interests such as retailers and manufacturers. There is a noticeable silence from the public health and government sector in these discussions on social media. Conclusions: The social media landscape is dominated by pro-vaping messages disseminated by the vaping industry and vaping proponents. The uncertainty surrounding e-cigarette regulation expressed within the public health field appears not to be reflected in ongoing social media dialogues and highlights the need for public health professionals to interact with the public to actively influence social media conversations and create a more balanced discussion. With the vaping industry changing so rapidly, real-time monitoring and surveillance of how these devices are discussed, promoted, and used on social media is necessary in conjunction with evidence published in academic journals. %M 30720440 %R 10.2196/11953 %U https://www.jmir.org/2019/2/e11953/ %U https://doi.org/10.2196/11953 %U http://www.ncbi.nlm.nih.gov/pubmed/30720440 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 1 %P e11573 %T Considering the Impact of Social Media on Contemporary Improvement of Australian Aboriginal Health: Scoping Review %A Walker,Troy %A Palermo,Claire %A Klassen,Karen %+ Be Active Sleep Eat, Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, 3168, Australia, 61 9902 4270, troy.walker@monash.edu %K aboriginal %K Indigenous %K social media %K health %K Web-based %D 2019 %7 05.02.2019 %9 Review %J JMIR Public Health Surveill %G English %X 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. %M 30720442 %R 10.2196/11573 %U http://publichealth.jmir.org/2019/1/e11573/ %U https://doi.org/10.2196/11573 %U http://www.ncbi.nlm.nih.gov/pubmed/30720442 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11534 %T Digital Marketing to Promote Healthy Weight Gain Among Pregnant Women in Alberta: An Implementation Study %A Graham,Jocelyn E %A Moore,Jana L %A Bell,Rhonda C %A Miller,Terri %+ Reproductive Health, Population, Public and Indigenous Health, Alberta Health Services, 10101 Southport Road SW, Calgary, AB, T2W 3N2, Canada, 1 403 943 1878, Jocelyn.Graham@ahs.ca %K internet %K maternal health %K mobile phone %K pregnant women %K search engine %K social media %D 2019 %7 01.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: As the use of digital media for health promotion has become increasingly common, descriptive studies exploring current and innovative marketing strategies can enhance the understanding of effective strategies and best practices. Objective: This study aims to describe the implementation of a provincial digital media campaign using complementary advertising platforms to promote healthy pregnancy weight gain messages and direct a Web audience to a credible website. Methods: The digital media campaign occurred in 3 phases, each for 8 weeks, and consisted of search engine marketing using Google AdWords and social media advertising through Facebook. All advertising materials directed users to evidence-based pregnancy-related weight gain content on the Healthy Parents, Healthy Children website. Results: Google Ads received a total of 43,449 impressions, 2522 clicks, and an average click-through rate (CTR) of 5.80%. Of people who clicked on a Google ad, 78.9% (1989/2522) completed an action on the website. Across all Facebook advertisements, there were 772,263 impressions, 14,482 clicks, and an average CTR of 1.88%. The highest-performing advertisement was an image of a group of diverse pregnant women with the headline “Pregnancy weight is not the same for every woman.” Conclusions: This study supports the use of digital marketing as an important avenue for delivering health messages and directing Web users to credible sources of information. The opportunity to reach large, yet targeted audiences, along with the ability to monitor and evaluate metrics to optimize activities throughout a campaign is a powerful advantage over traditional marketing tactics. Health organizations can use the results and insights of this study to help inform the design and implementation of similar Web-based activities. %M 30707100 %R 10.2196/11534 %U https://www.jmir.org/2019/2/e11534/ %U https://doi.org/10.2196/11534 %U http://www.ncbi.nlm.nih.gov/pubmed/30707100 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 1 %P e9544 %T Relationship Between Media Coverage and Measles-Mumps-Rubella (MMR) Vaccination Uptake in Denmark: Retrospective Study %A Hansen,Niels Dalum %A Mølbak,Kåre %A Cox,Ingemar Johansson %A Lioma,Christina %+ Statens Serum Institut, Artillerivej 5, Copenhagen, 2300, Denmark, 45 32683268, niels.dalum.hansen@gmail.com %K online news media %K vaccination uptake %K media influence on vaccination uptake %K MMR %K autism %D 2019 %7 23.01.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 30672743 %R 10.2196/publichealth.9544 %U https://publichealth.jmir.org/2019/1/e9544/ %U https://doi.org/10.2196/publichealth.9544 %U http://www.ncbi.nlm.nih.gov/pubmed/30672743 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e10171 %T Leading by Example: Web-Based Sexual Health Influencers Among Men Who Have Sex With Men Have Higher HIV and Syphilis Testing Rates in China %A Wu,Dan %A Tang,Weiming %A Lu,Haidong %A Zhang,Tiange P %A Cao,Bolin %A Ong,Jason J %A Lee,Amy %A Liu,Chuncheng %A Huang,Wenting %A Fu,Rong %A Li,Katherine %A Pan,Stephen W %A Zhang,Ye %A Fu,Hongyun %A Wei,Chongyi %A Tucker,Joseph D %+ University North Carolina at Chapel Hill, Project-China, No 2 Lujing Road, Yuexiu District, Guangzhou, 510091, China, 86 16602065374, wudan@seshglobal.org %K health promotion %K peer influence %K internet %K social networks %K social media %K HIV %K syphilis %K men who have sex with men %K China %D 2019 %7 21.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The spread of healthy behaviors through social networks may be accelerated by influential individuals. Previous studies have used lay health influencers to prevent sexually transmitted infections (STIs) among internet-using men who have sex with men (MSM). However, there is a lack of understanding of the characteristics of this key subset of MSM. Objective: This study aimed to examine sociodemographic characteristics, HIV and syphilis testing, and sexual behaviors of Web-based MSM sexual health influencers (SHIs) in China, defined as individuals with relatively stronger influence on spreading HIV and STI information online. Methods: A Web-based survey of MSM was conducted in August 2017 as a final follow-up of a randomized controlled trial promoting HIV testing in 8 Chinese cities. Men were recruited through a gay social networking mobile phone app and were included if they were born biologically male, aged 16 years and above, ever had sex with another man, and HIV negative or with unknown HIV status. Information regarding sociodemographic characteristics, sexual behaviors, and HIV and syphilis testing was obtained. We assessed men’s Web-based sexual health influence using a standardized 6-item opinion leadership scale focused on HIV and STI information. Influencers were defined as those whose mean score ranked within the top 13% (a higher score means greater influence). We used multivariable linear and logistic regression models to measure Web-based sexual health influence’s association with HIV and syphilis testing, controlling for intervention trial effects, age, education, income, and marital status. Results: Overall, 1031 men completed the survey. Most men were younger than 30 years (819/1031, 79.43%) and had at least college education (667/1031, 64.69%). Influencers were more likely to get tested for HIV (73/132, 55.3% vs 337/899, 37.5%; P<.001) and syphilis (35/132, 26.5% vs 137/899, 15.2%; P=.001) in the last 3 months compared with noninfluencers. There were no significant differences in condomless sex with male partners (26/132, 19.7% vs 203/899, 22.6%; P=.46), mean number of male sex partners (1.32 vs 1.11; P=.16) in the last 3 months, and mainly meeting male sex partners online in the last 12 months (97/132, 73.5% vs 669/899, 74.4%; P=.82) between influencers and noninfluencers. Regression analyses showed that influencers had higher odds of HIV testing (adjusted odds ratio, AOR 2.16, 95% CI 1.48-3.17) and syphilis testing (AOR 1.99, 95% CI 1.28-3.10) in the last 3 months. Conclusions: We identified Web-based SHIs who might be more likely to help promote healthy HIV and syphilis testing behaviors through MSM populations. Leveraging existing influencers may help improve HIV and syphilis testing among their networks. %M 30664490 %R 10.2196/10171 %U http://www.jmir.org/2019/1/e10171/ %U https://doi.org/10.2196/10171 %U http://www.ncbi.nlm.nih.gov/pubmed/30664490 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 1 %P e11132 %T Generating Engagement on the Make Healthy Normal Campaign Facebook Page: Analysis of Facebook Analytics %A Kite,James %A Grunseit,Anne %A Li,Vincy %A Vineburg,John %A Berton,Nathan %A Bauman,Adrian %A Freeman,Becky %+ Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, The University of Sydney, Australia, 61 0286270838, james.kite@sydney.edu.au %K social media %K Facebook %K overweight and obesity %K mass media campaign %K evaluation %D 2019 %7 14.01.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 31344679 %R 10.2196/11132 %U https://publichealth.jmir.org/2019/1/e11132/ %U https://doi.org/10.2196/11132 %U http://www.ncbi.nlm.nih.gov/pubmed/31344679 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 4 %P e71 %T Strategies to Increase Latino Immigrant Youth Engagement in Health Promotion Using Social Media: Mixed-Methods Study %A Andrade,Elizabeth Louise %A Evans,W Douglas %A Barrett,Nicole %A Edberg,Mark Cameron %A Cleary,Sean D %+ Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Office 324, Washington, DC, 20052, United States, 1 202 994 3577, elandrade@gwu.edu %K social media %K health promotion %K Latinos %K immigrants %K adolescent %K Hispanic Americans %K emigrants and immigrants %K adolescent health %D 2018 %7 19.12.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Generating participant engagement in social media applications for health promotion and disease prevention efforts is vital for their effectiveness and increases the likelihood of effecting sustainable behavior change. However, there is limited evidence regarding effective strategies for engaging Latino immigrant youth using social media. As part of the Avance Center for the Advancement of Immigrant/Refugee Health in Washington, DC, USA, we implemented Adelante, a branded primary prevention program, to address risk factors for co-occurring substance use, sexual risk, and interpersonal violence among Latino immigrant adolescents aged 12 to 19 years in a Washington, DC suburb. Objective: The objectives of this study were to (1) characterize Adelante participant Facebook reach and engagement and (2) identify post content and features that resulted in greater user engagement. Methods: We established the Adelante Facebook fan page in October of 2013, and the Adelante social marketing campaign used this platform for campaign activities from September 2015 to September 2016. We used Facebook Insights metrics to examine reach and post engagement of Adelante Facebook page fans (n=743). Data consisted of Facebook fan page posts between October 1, 2013 and September 30, 2016 (n=871). We developed a 2-phased mixed-methods analytical plan and coding scheme, and explored the association between post content categories and features and a composite measure of post engagement using 1-way analysis of variance tests. P<.05 determined statistical significance. Results: Posts on the Adelante Facebook page had a total of 34,318 clicks, 473 comments, 9080 likes or reactions, and 617 shares. Post content categories that were statistically significantly associated with post engagement were Adelante program updates (P<.001); youth achievement showcases (P=.001); news links (P<.001); social marketing campaign posts (P<.001); and prevention topics, including substance abuse (P<.001), safe sex (P=.02), sexually transmitted disease prevention (P<.001), and violence or fighting (P=.047). Post features that were significantly associated with post engagement comprised the inclusion of photos (P<.001); Spanish (P<.001) or bilingual (P=.001) posts; and portrayal of youth of both sexes (P<.001) portrayed in groups (P<.001) that were facilitated by adults (P<.001). Conclusions: Social media outreach is a promising strategy that youth programs can use to complement in-person programming for augmented engagement. The Latino immigrant youth audience in this study had a tendency toward more passive social media consumption, having implications for outreach strategies and engagement measurement in future studies. While study findings confirmed the utility of social marketing campaigns for increasing user engagement, findings also highlighted a high level of engagement among youth with posts that covered casual, day-to-day program activity participation. This finding identifies an underexplored area that should be considered for health messaging, and also supports interventions that use peer-to-peer and user-generated health promotion approaches. %M 30567689 %R 10.2196/publichealth.9332 %U http://publichealth.jmir.org/2018/4/e71/ %U https://doi.org/10.2196/publichealth.9332 %U http://www.ncbi.nlm.nih.gov/pubmed/30567689 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 2 %P e11073 %T How to Optimize Health Messages About Cancer on Facebook: Mixed-Methods Study %A Biancovilli,Priscila %A Jurberg,Claudia %+ Doctoral School of Health Sciences, University of Pécs, Vörösmarty utca 4, Pécs, 7621, Hungary, 36 (72) 513 678, biancovilli@bioqmed.ufrj.br %K cancer %K content analysis %K Facebook %K health %K software %D 2018 %7 18.12.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Incidence rate of cancer is increasing worldwide, with longer life expectancy being one of the main causes. Yet, between 30% and 50% of cancer cases are preventable, and early detection contributes to a better prognosis. This makes health communication strategies essential. Facebook, the world’s most used social networking site in 2017 and 2018, can be a useful tool for disseminating powerful messages on health promotion, prevention, and early detection. Objective: We aimed to (1) offer ways of optimizing health messages about cancer on Facebook, focusing on topics, such as risk factors, prevention, treatment, early diagnosis, and cure, and (2) investigate which aspects of these messages generate greater engagement. Methods: To verify what generates greater engagement in topics related to cancer on Facebook, we analyzed 16 Brazilian pages with the main theme of cancer. We performed a manual analysis of texts, content, and engagement rates. Finally, we developed a software program to operationalize the analysis of Facebook posts. The tool we devised aims to automate the analysis of any Facebook page with cancer as the main theme. Results: We analyzed 712 posts over a 1-month period. We divided the posts into the following 8 categories: “Testimonies or real-life stories,” “Solidarity,” “Anniversaries,” “Science and health,” “Events,” “Institutional,” “Risk factors,” and “Beauty.” The pages were also organized into groups according to the type of profile to which they belonged (ie, hospitals or foundations, informative, nongovernmental organizations, and personal pages).The results showed that the categories generating greater engagement in Brazil were not those with the highest percentage of cancer-related content. For instance, in the “Informative” group the “Testimonies or real-life stories” category generated an engagement of 79.5%. However, only 9.5% (25/261) of the content within the relevant time period dealt with such topics. Another example concerns the category “Science and health.” Despite being the one with the highest number of posts (129/261, 49.4%), it scored 5th in terms of engagement. This investigation served as the basis for the development of a tool designed to automate the analysis of Facebook pages. The list of categories and keywords generated by this analysis was employed to feed the system, which was then able to categorize posts appearing on a Facebook page. We tested the system on 163 posts and only 34 were classified incorrectly, which amounts to a 20.8% error rate (79.2% accuracy). Conclusions: The analysis we conducted by categorizing posts and calculating engagement rates shows that the potential of Facebook pages is often underutilized. This occurs because the categories that generate the greatest engagement are often not those most frequently used. The software developed in this research may help administrators of cancer-related pages analyze their posts more easily and increase public interest as a result. %M 30563821 %R 10.2196/11073 %U http://cancer.jmir.org/2018/2/e11073/ %U https://doi.org/10.2196/11073 %U http://www.ncbi.nlm.nih.gov/pubmed/30563821 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e12428 %T Website Analytics of a Google Ads Campaign for a Men’s Mental Health Website: Comparative Analysis %A Murphy,Andrea Lynn %A Peltekian,Sophie %A Gardner,David M %+ College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, PO Box 15000, Halifax, NS, B3H4R2, Canada, 1 902 494 1643, andrea.murphy@dal.ca %K alcohol %K alcoholism %K analytics %K anxiety %K consumer health informatics %K depression %K Google Ads %K insomnia %K men %K suicide %K tobacco %K tobacco use %D 2018 %7 13.12.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Men with mental health and addictions problems seek information and help from health service providers and community support less often than women with such problems. Online health resources offer men rapid access to self-care recommendations and resources and anonymity; however, only a few websites are specifically developed for men. Headstrong - Taking Things Head-On was a community pharmacy and online health promotion initiative for men living with mental health and addictions problems. The Headstrong website was developed to offer a curated collection of print and online recommended resources (primarily self-help oriented) for depression, anxiety, insomnia, tobacco and alcohol use problems, and suicide. To increase awareness of the initiative and use of the website’s content and resource recommendations, a Google Ads campaign was developed. Objective: This study aimed to compare user acquisition and behavior on the Headstrong website during and after a Google Ads campaign. Methods: The Google Ads campaign was launched on December 21, 2017, and run until February 28, 2018. Website analytics (acquisition of new users, behavior in terms of at-website actions and duration, devices used, and conversions [link-outs to recommended resources]) in a 30-day period during the campaign (January 26, 2018 to February 24, 2018) were compared to a similar 30-day period after the campaign (March 23, 2018 to April 21, 2018). A cost analysis of the ad campaign was also performed. Results: The ad campaign generated 3011 clicks and 4.5 million impressions in total. In addition, the campaign received 1311 website users during the 30-day period of the ad campaign as compared to 241 users during the 30-day period after the ad campaign (P<.001). Return visitor (17.7% vs 27.8%) and nonbounce (19.5% vs 39.8%) user rates as well as session duration (42 vs 102 seconds) and page views per session (1.4 vs 2.1) were lower during the ad campaign than after the campaign (P<.01 for all). The 30-day period of the ad campaign included 9 sessions with conversions initiated by an ad click. Paid and display ads accounted for 63% of the site traffic during the ad campaign, most of which came from mobile phone users. Desktops were the most-common device used after the ad campaign acquired the website via direct and organic searches primarily (92%). The estimated cost per session with one or more conversions was Can $54.69 and cost per conversion was Can $32.81. Conclusions: A Google Ads campaign designed to direct men to the Headstrong website increased the number of user visits by more than five-fold. However, engagement by users responding to the ad campaign was substantially lower than that by users who visited the website via other acquisition methods, possibly reflecting the nonspecific online targeting of men by the ad campaign. General targeting of men online to promote men’s mental health appears to have limited value. %M 30545812 %R 10.2196/12428 %U http://mental.jmir.org/2018/4/e12428/ %U https://doi.org/10.2196/12428 %U http://www.ncbi.nlm.nih.gov/pubmed/30545812 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e10911 %T Creating Engaging Health Promotion Campaigns on Social Media: Observations and Lessons From Fitbit and Garmin %A Edney,Sarah %A Bogomolova,Svetlana %A Ryan,Jillian %A Olds,Tim %A Sanders,Ilea %A Maher,Carol %+ Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, 5000, Australia, 61 +61402371792, sarah.edney@mymail.unisa.edu.au %K social media %K engagement %K physical activity %D 2018 %7 10.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The popularity and reach of social media make it an ideal delivery platform for interventions targeting health behaviors, such as physical inactivity. Research has identified a dose-response relationship whereby greater engagement and exposure are positively associated with intervention effects, hence enhancing engagement will maximize the potential of these interventions. Objective: This study examined the social media activity of successful commercial activity tracker brands to understand which creative elements (message content and design) they use in their communication to their audience, which social media platforms attract the most engagement, and which creative elements prompted the most engagement. Methods: Posts (n=509) made by Fitbit and Garmin on Facebook, Twitter, and Instagram over a 3-month period were coded for the presence of creative elements. User engagement regarding the total number of likes, comments, or shares per post was recorded. Negative binomial regression analyses were used to identify creative elements associated with higher engagement. Results: Engagement on Instagram was 30-200 times higher than on Facebook, or Twitter. Fitbit and Garmin tended to use different creative elements from one another. A higher engagement was achieved by posts featuring an image of the product, highlighting new product features and with themes of self-improvement (P<.01). Conclusions: Findings suggest that Instagram may be a particularly promising platform for delivering engaging health messaging. Health messages which incorporate inspirational imagery and focus on a tangible product appear to achieve the highest engagement. Fitbit and Garmin employed difference creative elements, which is likely to reflect differences in their target markets. This underscores the importance of market segmentation in health messaging campaigns. %M 30530449 %R 10.2196/10911 %U https://www.jmir.org/2018/12/e10911/ %U https://doi.org/10.2196/10911 %U http://www.ncbi.nlm.nih.gov/pubmed/30530449 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 4 %P e10827 %T Dynamics of Health Agency Response and Public Engagement in Public Health Emergency: A Case Study of CDC Tweeting Patterns During the 2016 Zika Epidemic %A Chen,Shi %A Xu,Qian %A Buchenberger,John %A Bagavathi,Arunkumar %A Fair,Gabriel %A Shaikh,Samira %A Krishnan,Siddharth %+ Department of Public Health Sciences, University of North Carolina at Charlotte, 9021 University City Boulevard, Charlotte, NC, 28223, United States, 1 8148800738, schen56@uncc.edu %K Centers for Disease Control and Prevention %K public engagement %K Twitter %K time series analysis %K Zika epidemic %K social media %K twitter %K infodemiology %K infoveillance %D 2018 %7 22.11.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media have been increasingly adopted by health agencies to disseminate information, interact with the public, and understand public opinion. Among them, the Centers for Disease Control and Prevention (CDC) is one of the first US government health agencies to adopt social media during health emergencies and crisis. It had been active on Twitter during the 2016 Zika epidemic that caused 5168 domestic noncongenital cases in the United States. Objective: The aim of this study was to quantify the temporal variabilities in CDC’s tweeting activities throughout the Zika epidemic, public engagement defined as retweeting and replying, and Zika case counts. It then compares the patterns of these 3 datasets to identify possible discrepancy among domestic Zika case counts, CDC’s response on Twitter, and public engagement in this topic. Methods: All of the CDC-initiated tweets published in 2016 with corresponding retweets and replies were collected from 67 CDC–associated Twitter accounts. Both univariate and multivariate time series analyses were performed in each quarter of 2016 for domestic Zika case counts, CDC tweeting activities, and public engagement in the CDC-initiated tweets. Results: CDC sent out >84.0% (5130/6104) of its Zika tweets in the first quarter of 2016 when Zika case counts were low in the 50 US states and territories (only 560/5168, 10.8% cases and 662/38,885, 1.70% cases, respectively). While Zika case counts increased dramatically in the second and third quarters, CDC efforts on Twitter substantially decreased. The time series of public engagement in the CDC-initiated tweets generally differed among quarters and from that of original CDC tweets based on autoregressive integrated moving average model results. Both original CDC tweets and public engagement had the highest mutual information with Zika case counts in the second quarter. Furthermore, public engagement in the original CDC tweets was substantially correlated with and preceded actual Zika case counts. Conclusions: Considerable discrepancies existed among CDC’s original tweets regarding Zika, public engagement in these tweets, and actual Zika epidemic. The patterns of these discrepancies also varied between different quarters in 2016. CDC was much more active in the early warning of Zika, especially in the first quarter of 2016. Public engagement in CDC’s original tweets served as a more prominent predictor of actual Zika epidemic than the number of CDC’s original tweets later in the year. %M 30467106 %R 10.2196/10827 %U http://publichealth.jmir.org/2018/4/e10827/ %U https://doi.org/10.2196/10827 %U http://www.ncbi.nlm.nih.gov/pubmed/30467106 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 4 %P e10262 %T How Twitter Can Support the HIV/AIDS Response to Achieve the 2030 Eradication Goal: In-Depth Thematic Analysis of World AIDS Day Tweets %A Odlum,Michelle %A Yoon,Sunmoo %A Broadwell,Peter %A Brewer,Russell %A Kuang,Da %+ Columbia University Medical Center, 560 W 168th Street, New York, NY, 10032, United States, 1 347 806 2090, mlo12@columbia.edu %K community %K human rights %K social network %K infodemiology %K infoveillence %K Twitter %D 2018 %7 22.11.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: HIV/AIDS is a tremendous public health crisis, with a call for its eradication by 2030. A human rights response through civil society engagement is critical to support and sustain HIV eradication efforts. However, ongoing civil engagement is a challenge. Objective: This study aimed to demonstrate the use of Twitter data to assess public sentiment in support of civil society engagement. Methods: Tweets were collected during World AIDS Days 2014 and 2015. A total of 39,940 unique tweets (>10 billion users) in 2014 and 78,215 unique tweets (>33 billion users) in 2015 were analyzed. Response frequencies were aggregated using natural language processing. Hierarchical rank-2 nonnegative matrix factorization algorithm generated a hierarchy of tweets into binary trees. Tweet hierarchy clusters were thematically organized by the Joint United Nations Programme on HIV/AIDS core action principles and categorized under HIV/AIDS Prevention, Treatment or Care, or Support. Results: Topics tweeted 35 times or more were visualized. Results show a decrease in 2015 in the frequency of tweets associated with the fight to end HIV/AIDS, the recognition of women, and to achieve an AIDS-free generation. Moreover, an increase in tweets was associated with an integrative approach to the HIV/AIDS response. Hierarchical thematic differences in 2015 included no prevention discussion and the recognition of the pandemic’s impact and discrimination. In addition, a decrease was observed in motivation to fast track the pandemic’s end and combat HIV/AIDS. Conclusions: The human rights–based response to HIV/AIDS eradication is critical. Findings demonstrate the usefulness of Twitter as a low-cost method to assess public sentiment for enhanced knowledge, increased hope, and revitalized expectations for HIV/AIDS eradication. %M 30467102 %R 10.2196/10262 %U http://publichealth.jmir.org/2018/4/e10262/ %U https://doi.org/10.2196/10262 %U http://www.ncbi.nlm.nih.gov/pubmed/30467102 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e10513 %T Automated Identification of Hookahs (Waterpipes) on Instagram: An Application in Feature Extraction Using Convolutional Neural Network and Support Vector Machine Classification %A Zhang,Youshan %A Allem,Jon-Patrick %A Unger,Jennifer Beth %A Boley Cruz,Tess %+ Keck School of Medicine of USC, 2001 N Soto Street, 3rd Floor Mail, Los Angeles, CA, 90032, United States, 1 8586030812, allem@usc.edu %K convolutional neural network %K feature extraction %K image classification %K Instagram %K social media %K support vector machine %D 2018 %7 21.11.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Instagram, with millions of posts per day, can be used to inform public health surveillance targets and policies. However, current research relying on image-based data often relies on hand coding of images, which is time-consuming and costly, ultimately limiting the scope of the study. Current best practices in automated image classification (eg, support vector machine (SVM), backpropagation neural network, and artificial neural network) are limited in their capacity to accurately distinguish between objects within images. Objective: This study aimed to demonstrate how a convolutional neural network (CNN) can be used to extract unique features within an image and how SVM can then be used to classify the image. Methods: Images of waterpipes or hookah (an emerging tobacco product possessing similar harms to that of cigarettes) were collected from Instagram and used in the analyses (N=840). A CNN was used to extract unique features from images identified to contain waterpipes. An SVM classifier was built to distinguish between images with and without waterpipes. Methods for image classification were then compared to show how a CNN+SVM classifier could improve accuracy. Results: As the number of validated training images increased, the total number of extracted features increased. In addition, as the number of features learned by the SVM classifier increased, the average level of accuracy increased. Overall, 99.5% (418/420) of images classified were correctly identified as either hookah or nonhookah images. This level of accuracy was an improvement over earlier methods that used SVM, CNN, or bag-of-features alone. Conclusions: A CNN extracts more features of images, allowing an SVM classifier to be better informed, resulting in higher accuracy compared with methods that extract fewer features. Future research can use this method to grow the scope of image-based studies. The methods presented here might help detect increases in the popularity of certain tobacco products over time on social media. By taking images of waterpipes from Instagram, we place our methods in a context that can be utilized to inform health researchers analyzing social media to understand user experience with emerging tobacco products and inform public health surveillance targets and policies. %M 30452385 %R 10.2196/10513 %U http://www.jmir.org/2018/11/e10513/ %U https://doi.org/10.2196/10513 %U http://www.ncbi.nlm.nih.gov/pubmed/30452385 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e15 %T Health Information Discrepancies Between Internet Media and Scientific Papers Reporting on Omega-3 Supplement Research: Comparative Analysis %A Nault,Daryl %A Beccia,Ariel %A Ito,Haruka %A Kashdan,Sarah %A Senders,Angela %+ Helfgott Research Institute, School of Research and Graduate Studies, National University of Natural Medicine, 049 SW Porter Street, Portland, OR, 97201, United States, 1 971 704 1172, dnault@muih.edu %K consumer health information %K health literacy %K health communication %K health promotion %K evidence-based practice %K dietary supplements %K omega-3 fatty acids %K journalism %D 2018 %7 01.10.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Dietary supplements are the most used complementary and alternative health modality in the United States, and omega-3 supplements continue to be the most popularly used nonvitamin or nonmineral supplements by adults. Users of dietary supplements report that they obtain health guidance from internet media resources, but there is question as to whether or not these resources provide the necessary evidence to guide health decisions. Current evidence suggests that there is a mistranslation occurring somewhere between researchers and the media. Objective: The aim of this study was to conduct a comparative cross-sectional analysis to identify areas of discordance created when science is translated from the laboratory to Web-based news media. Methods: A Google news search provided our convenience sample of 40 omega-3 supplement–based media reports stratified by the years 2009 to 2012. Media reports (n=17) were compared with the corresponding scientific papers for content. Report and scientific paper content were extracted using commonly accepted reporting guideline domains, and domains were then compared for detecting underlying omissions or mistranslations in reporting. Mean scores for all of the scientific papers and media reports were assessed for each domain. Results: Scientific papers (n=14) generally maintained a mean close to complete for each reporting domain. The only domain where there was not a significant difference between media and scientific reporting match was within the objectives domain (χ21= 0.8, P=.36). Media reports (n=17) more frequently reported potential caveats and warnings for consumers with a mean domain for caveat reporting of 0.88, with possible scores falling between 0 and 1. Conclusions: There are inherent differences in the intended audience, structure, and goals in scientific and media communications. These differences should be explored further, and consumers should be made aware of them. Additional considerations for balanced reporting and reader accessibility are also necessary to take into account and are explored further in this analysis. %M 30274960 %R 10.2196/ijmr.8981 %U http://www.i-jmr.org/2018/2/e15/ %U https://doi.org/10.2196/ijmr.8981 %U http://www.ncbi.nlm.nih.gov/pubmed/30274960 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 9 %P e10244 %T Discordance Between Human Papillomavirus Twitter Images and Disparities in Human Papillomavirus Risk and Disease in the United States: Mixed-Methods Analysis %A Lama,Yuki %A Chen,Tao %A Dredze,Mark %A Jamison,Amelia %A Quinn,Sandra Crouse %A Broniatowski,David A %+ Center for Language and Speech Processing, Johns Hopkins University, Hackerman Hall 226, 3400 North Charles Street, Baltimore, MD, 21218, United States, 1 410 516 4237, tchen77@jhu.edu %K disparities %K health communication %K HPV vaccines %K image tweet %K public health communication %K social media %K Twitter %K visual communication %D 2018 %7 14.09.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Racial and ethnic minorities are disproportionately affected by human papillomavirus (HPV)-related cancer, many of which could have been prevented with vaccination. Yet, the initiation and completion rates of HPV vaccination remain low among these populations. Given the importance of social media platforms for health communication, we examined US-based HPV images on Twitter. We explored inconsistencies between the demographics represented in HPV images and the populations that experience the greatest burden of HPV-related disease. Objective: The objective of our study was to observe whether HPV images on Twitter reflect the actual burden of disease by select demographics and determine to what extent Twitter accounts utilized images that reflect the burden of disease in their health communication messages. Methods: We identified 456 image tweets about HPV that contained faces posted by US users between November 11, 2014 and August 8, 2016. We identified images containing at least one human face and utilized Face++ software to automatically extract the gender, age, and race of each face. We manually annotated the source accounts of these tweets into 3 types as follows: government (38/298, 12.8%), organizations (161/298, 54.0%), and individual (99/298, 33.2%) and topics (news, health, and other) to examine how images varied by message source. Results: Findings reflected the racial demographics of the US population but not the disease burden (795/1219, 65.22% white faces; 140/1219, 11.48% black faces; 71/1219, 5.82% Asian faces; and 213/1219, 17.47% racially ambiguous faces). Gender disparities were evident in the image faces; 71.70% (874/1219) represented female faces, whereas only 27.89% (340/1219) represented male faces. Among the 11-26 years age group recommended to receive HPV vaccine, HPV images contained more female-only faces (214/616, 34.3%) than males (37/616, 6.0%); the remainder of images included both male and female faces (365/616, 59.3%). Gender and racial disparities were present across different image sources. Faces from government sources were more likely to depict females (n=44) compared with males (n=16). Of male faces, 80% (12/15) of youth and 100% (1/1) of adults were white. News organization sources depicted high proportions of white faces (28/38, 97% of female youth and 12/12, 100% of adult males). Face++ identified fewer faces compared with manual annotation because of limitations with detecting multiple, small, or blurry faces. Nonetheless, Face++ achieved a high degree of accuracy with respect to gender, race, and age compared with manual annotation. Conclusions: This study reveals critical differences between the demographics reflected in HPV images and the actual burden of disease. Racial minorities are less likely to appear in HPV images despite higher rates of HPV incidence. Health communication efforts need to represent populations at risk better if we seek to reduce disparities in HPV infection. %M 30217792 %R 10.2196/10244 %U http://www.jmir.org/2018/9/e10244/ %U https://doi.org/10.2196/10244 %U http://www.ncbi.nlm.nih.gov/pubmed/30217792 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10435 %T Sudden Infant Death Syndrome and Safe Sleep on Twitter: Analysis of Influences and Themes to Guide Health Promotion Efforts %A Pretorius,Kelly A %A Mackert,Michael %A Wilcox,Gary B %+ School of Nursing, The University of Texas at Austin, 1710 Red River Street, Austin, TX, 78701, United States, 1 512 471 7913, kpretorius@utexas.edu %K sudden infant death %K sudden unexpected infant death %K accidental suffocation in a sleeping environment %K infant mortality %K safe sleep %K sleep environment %K social media %K Twitter %K health communication %K public health %D 2018 %7 07.09.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In the United States, sudden infant death syndrome (SIDS) is the leading cause of death in infants aged 1 month to 1 year. Approximately 3500 infants die from SIDS and sleep-related reasons on a yearly basis. Unintentional sleep-related deaths and bed sharing, a known risk factor for SIDS, are on the rise. Furthermore, ethnic disparities exist among those most affected by SIDS. Despite public health campaigns, infant mortality persists. Given the popularity of social media, understanding social media conversations around SIDS and safe sleep may assist the medical and public health communities with information needed to spread, reinforce, or counteract false information regarding SIDS and safe sleep. Objective: The objective of our study was to investigate the social media conversation around SIDS and safe sleep to understand the possible influences and guide health promotion efforts and public health research as well as enable health professionals to engage in directed communication regarding this topic. Methods: We used textual analytics to identify topics and extract meanings contained in unstructured textual data. Twitter messages were captured during September, October, and November in 2017. Tweets and retweets were collected using NUVI software in conjunction with Twitter’s search API using the keywords: “sids,” “infant death syndrome,” “sudden infant death syndrome,” and “safe sleep.” This returned a total of 41,358 messages, which were analyzed using text mining and social media monitoring software. Results: Multiple themes were identified, including recommendations for safe sleep to prevent SIDS, safe sleep devices, the potential causes of SIDS, and how breastfeeding reduces SIDS. Compared with September and November, more personal and specific stories of infant loss were demonstrated in October (Pregnancy and Infant Loss Awareness Month). The top influencers were news organizations, universities, and health-related organizations. Conclusions: We identified valuable topics discussed and shared on Twitter regarding SIDS and safe sleep. The study results highlight the contradicting information a subset of the population is exposed to regarding SIDS and the continued controversy over vaccines. In addition, this analysis emphasizes the lack of public health organizations’ presence on Twitter compared with the influence of universities and news media organizations. The results also demonstrate the prevalence of safe sleep products that are embedded in safe sleep messaging. These findings can assist providers in speaking about relevant topics when engaging in conversations about the prevention of SIDS and the promotion of safe sleep. Furthermore, public health agencies and advocates should utilize social media and Twitter to better communicate accurate health information as well as continue to combat the spread of false information. %M 31518314 %R 10.2196/10435 %U http://pediatrics.jmir.org/2018/2/e10435/ %U https://doi.org/10.2196/10435 %U http://www.ncbi.nlm.nih.gov/pubmed/31518314 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 8 %P e11375 %T Empowering With PrEP (E-PrEP), a Peer-Led Social Media–Based Intervention to Facilitate HIV Preexposure Prophylaxis Adoption Among Young Black and Latinx Gay and Bisexual Men: Protocol for a Cluster Randomized Controlled Trial %A Patel,Viraj V %A Ginsburg,Zoë %A Golub,Sarit A %A Horvath,Keith J %A Rios,Nataly %A Mayer,Kenneth H %A Kim,Ryung S %A Arnsten,Julia H %+ Division of General Internal Medicine, Department of Medicine, Montefiore Health System / Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, United States, 1 718 920 5256, vpatel@montefiore.org %K pre-exposure prophylaxis %K HIV %K social media interventions %K HIV prevention %K social network intervention %K social media %K social networking %K telemedicine %D 2018 %7 28.08.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young black and Latinx, gay, bisexual, and other men who have sex with men (YBLGBM, aged 18-29 years) have among the highest rates of new HIV infections in the United States and are not consistently reached by existing prevention interventions. Preexposure prophylaxis (PrEP), an oral antiretroviral regimen taken daily by HIV-uninfected individuals to prevent HIV acquisition, is highly efficacious in reducing HIV acquisition and could help stop the HIV epidemic in YBLGBM. Use of social media (eg, Facebook, Twitter, online dating sites) is ubiquitous among young people, providing an efficient avenue to engage YBLGBM to facilitate PrEP adoption. Objective: Our overall goal was to develop and pilot test a theoretically grounded, social media–based, peer-led intervention to increase PrEP uptake in YBLGBM. We used diffusion of innovation and information-motivation-behavioral skills frameworks to (1) identify potential factors associated with interest in and adoption of PrEP among YBLGBM; (2) develop Empowering with PrEP (E-PrEP), a social media–based, peer-led intervention to increase PrEP uptake in YBLGBM; and (3) pilot test the feasibility and acceptability of E-PrEP, and determine its preliminary efficacy for increasing adoption of PrEP by YBLGBM. We describe the development and protocol for E-PrEP. Methods: Using a participatory research approach, we partnered with YBLGBM intervention development partners to develop a social media–based behavioral intervention to facilitate PrEP uptake, which involved an online messaging campaign disseminated by YBLGBM peer leaders to their existing online networks. We designed the 6-week campaign to provide education about PrEP, increase motivation to use PrEP, and facilitate access to PrEP. We then conducted a cluster-randomized trial of E-PrEP compared with an attention-matched general health control condition (E-Health) among YBLGBM aged 18 to 29 years to assess E-PrEP’s feasibility, acceptability, preliminary efficacy for increasing self-reported intention to use PrEP, PrEP uptake, and impact on knowledge and attitudes about PrEP at 12-week follow-up (6 weeks after the end of the online campaign). Results: From October 2016 to March 2017, we developed, pretested, and refined E-PrEP with 6 YBLGBM intervention development partners. From May to June 2017, we recruited, enrolled, and randomly assigned 10 peer leaders (n=5 for each condition). The 10 peer leaders then recruited and enrolled 152 participants from their existing online networks (range 3-33 per peer leader), during June and July 2017. Intervention follow-up was completed after 12 weeks, in November 2017, with analyses underway. Conclusions: We hypothesize that, compared with E-Health, participants randomly assigned to E-PrEP will be more likely to express intention to use PrEP and greater PrEP uptake, and will also show changes in potential mediators of PrEP uptake (knowledge, attitudes, stigma, and access). A Web-based biobehavioral intervention model such as E-PrEP could be rapidly scaled even with limited resources and have significant population-level impact. Trial Registration: ClinicalTrials.gov NCT03213366; https://clinicaltrials.gov/ct2/show/NCT03213366 (Archived by WebCite at http://www.webcitation.org/71onSdcXY) Registered Report Identifier: RR1-10.2196/11375 %M 30154071 %R 10.2196/11375 %U http://www.researchprotocols.org/2018/8/e11375/ %U https://doi.org/10.2196/11375 %U http://www.ncbi.nlm.nih.gov/pubmed/30154071 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e229 %T Misleading Claims About Tobacco Products in YouTube Videos: Experimental Effects of Misinformation on Unhealthy Attitudes %A Albarracin,Dolores %A Romer,Daniel %A Jones,Christopher %A Hall Jamieson,Kathleen %A Jamieson,Patrick %+ University of Illinois at Urbana Champaign, 603 E Daniel Street, Champaign, IL, 61822, United States, 1 2178402383, dalbarra@illinois.edu %K health communication %K tobacco %D 2018 %7 29.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Recent content analyses of YouTube postings reveal a proliferation of user generated videos with misleading statements about the health consequences of various types of nontraditional tobacco use (eg, electronic cigarettes; e-cigarettes). Objective: This research was aimed at obtaining evidence about the potential effects of YouTube postings about tobacco products on viewers' attitudes toward these products. Methods: A sample of young adults recruited online (N=350) viewed one of four highly viewed YouTube videos containing misleading health statements about chewing tobacco, e-cigarettes, hookahs, and pipe smoking, as well as a control YouTube video unrelated to tobacco products. Results: The videos about e-cigarettes and hookahs led to more positive attitudes toward the featured products than did control videos. However, these effects did not fully translate into attitudes toward combustive cigarette smoking, although the pipe video led to more positive attitudes toward combustive smoking than did the chewing and the hookah videos, and the e-cigarette video led to more positive attitudes toward combustive cigarette smoking than did the chewing video. Conclusions: This research revealed young people’s reactions to misleading claims about tobacco products featured in popular YouTube videos. Policy implications are discussed. %M 29959113 %R 10.2196/jmir.9959 %U http://www.jmir.org/2018/6/e229/ %U https://doi.org/10.2196/jmir.9959 %U http://www.ncbi.nlm.nih.gov/pubmed/29959113 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e10150 %T #Healthy Selfies: Exploration of Health Topics on Instagram %A Muralidhara,Sachin %A Paul,Michael J %+ Department of Information Science, University of Colorado Boulder, 315 UCB, Boulder, CO, 80309, United States, 1 303 735 7581, mpaul@colorado.edu %K social media %K Instagram %K image sharing %K topic modeling %K computer vision %K public health %D 2018 %7 29.06.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media provides a complementary source of information for public health surveillance. The dominate data source for this type of monitoring is the microblogging platform Twitter, which is convenient due to the free availability of public data. Less is known about the utility of other social media platforms, despite their popularity. Objective: This work aims to characterize the health topics that are prominently discussed in the image-sharing platform Instagram, as a step toward understanding how this data might be used for public health research. Methods: The study uses a topic modeling approach to discover topics in a dataset of 96,426 Instagram posts containing hashtags related to health. We use a polylingual topic model, initially developed for datasets in different natural languages, to model different modalities of data: hashtags, caption words, and image tags automatically extracted using a computer vision tool. Results: We identified 47 health-related topics in the data (kappa=.77), covering ten broad categories: acute illness, alternative medicine, chronic illness and pain, diet, exercise, health care & medicine, mental health, musculoskeletal health and dermatology, sleep, and substance use. The most prevalent topics were related to diet (8,293/96,426; 8.6% of posts) and exercise (7,328/96,426; 7.6% of posts). Conclusions: A large and diverse set of health topics are discussed in Instagram. The extracted image tags were generally too coarse and noisy to be used for identifying posts but were in some cases accurate for identifying images relevant to studying diet and substance use. Instagram shows potential as a source of public health information, though limitations in data collection and metadata availability may limit its use in comparison to platforms like Twitter. %M 29959106 %R 10.2196/10150 %U http://publichealth.jmir.org/2018/2/e10150/ %U https://doi.org/10.2196/10150 %U http://www.ncbi.nlm.nih.gov/pubmed/29959106 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e219 %T Young People’s Experiences of Viewing the Fitspiration Social Media Trend: Qualitative Study %A Easton,Stephanie %A Morton,Katherine %A Tappy,Zara %A Francis,Daniella %A Dennison,Laura %+ Academic Unit of Psychology, University of Southampton, Shackleton Building, University Road, Southampton,, United Kingdom, 44 2380595000 ext 7657, L.K.Dennison@soton.ac.uk %K Social media %K Fitspiration %K behaviour %K health %K body image %K self-esteem %K eating disorders %K qualitative research %K focus groups %K interviews %D 2018 %7 18.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media use has become ubiquitous in the lives of many people, especially young adults. A popular recent trend emerging on social media is that of posting and following ‘Fitspirational’ content - material that purports to motivate and showcase healthy lifestyle habits, particularly relating to exercise and diet. There is very limited existing literature on how engaging with this type of content influences people’s psychological and physical heath. Initial studies have focused on concerns over potential negative effects on psychological wellbeing including body image, self-esteem and eating disorders. Objective: We aimed to address a gap in the literature for exploratory research on this topic from the perspective of users. We used a qualitative approach to explore how people experience viewing Fitspiration on social media including why and how they engage with this material and how they perceive that it affects their thoughts, emotions, behaviour and health. Methods: We recruited 20 young adults (14 females, 6 males, aged 18-25) who self-declared themselves to be Fitspiration followers to participate in either focus groups or individual interviews. We asked detailed, open-ended questions about their motivations for following Fitspiration, experiences of viewing this content and its perceived impact. We used inductive thematic analysis to derive themes that represented common and salient features of the data set. Results: Four main themes were developed: 1) A tool with the potential to support healthy living, 2) Unrealistic, untrustworthy content, 3) Negative effects on emotional wellbeing, and 4) Vulnerability and protective factors. Following Fitspirational posts on social media can provide young people with knowledge and motivation that may support healthy lifestyle behaviours. However, a range of harms also appeared to arise from Fitspiration viewing ranging from minor annoyances and frustrations to more meaningful negative effects on psychological & physical health. These negative effects seemed to persist despite individuals acknowledging that the material can be unrealistic, and believing that they are personally equipped to minimise harms to themselves. Conclusions: This study suggests that Fitspiration on social media can be attractive and compelling for young people but appears to bring about negative as well as positive effects. Future research should aim to confirm the scale and intensity of positive and negative effects and investigate ways of harnessing desirable outcomes and minimising undesirable outcomes. %M 29914859 %R 10.2196/jmir.9156 %U http://www.jmir.org/2018/6/e219/ %U https://doi.org/10.2196/jmir.9156 %U http://www.ncbi.nlm.nih.gov/pubmed/29914859 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10227 %T What People “Like”: Analysis of Social Media Strategies Used by Food Industry Brands, Lifestyle Brands, and Health Promotion Organizations on Facebook and Instagram %A Klassen,Karen Michelle %A Borleis,Emily S %A Brennan,Linda %A Reid,Mike %A McCaffrey,Tracy A %A Lim,Megan SC %+ Monash University, 264 Ferntree Gully Road, Level 1, Notting Hill, 3168, Australia, 61 399024270, tracy.mccaffrey@monash.edu %K nutrition %K social media %K Facebook %K Instagram %K health promotion %D 2018 %7 14.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Health campaigns have struggled to gain traction with young adults using social media, even though more than 80% of young adults are using social media at least once per day. Many food industry and lifestyle brands have been successful in achieving high levels of user engagement and promoting their messages; therefore, there may be lessons to be learned by examining the successful strategies commercial brands employ. Objective: This study aims to identify and quantify social media strategies used by the food industry and lifestyle brands, and health promotion organizations across the social networking sites Facebook and Instagram. Methods: The six most engaging posts from the 10 most popular food industry and lifestyle brands and six health promotion organizations were included in this study. A coding framework was developed to categorize social media strategies, and engagement metrics were collected. Exploratory linear regression models were used to examine associations between strategies used and interactions on Facebook and Instagram. Results: Posts from Facebook (143/227, 63.0%) and Instagram (84/227, 37.0%) were included. Photos (64%) and videos (34%) were used to enhance most posts. Different strategies were most effective for Facebook and Instagram. Strategies associated with higher Facebook interactions included links to purchasable items (beta=0.81, 95% CI 0.50 to 1.13, P<.001) featuring body image messages compared with food content (beta=1.96, 95% CI 1.29 to 2.64, P<.001), and where the content induced positive emotions (beta=0.31, 95% CI 0.04 to 0.57, P=.02). Facebook interactions were negatively associated with using pop culture (beta=–0.67, 95% CI –0.99 to –0.34, P<.001), storytelling (beta=–0.86, 95% CI –1.29 to –0.43, P<.001) or visually appealing graphics (beta=–0.53, 95% CI –0.78 to –0.28, P<.001) in their posts compared with other strategies. Posting relatable content was negatively associated with interactions on Facebook (beta=–0.29, 95% CI –0.53 to –0.06, P=.01), but positively associated on Instagram (beta=0.50, 95% CI 0.05 to 0.95, P=.03). Instagram interactions were negatively associated with weight loss (beta=–1.45, 95% CI –2.69 to –0.21, P=.02) and other content (beta=–0.81, 95% CI –1.57 to –.06, P=.04) compared with food content. Conclusions: Health promotion professionals and organizations can improve engagement using positive messaging and tailoring posts appropriate for different social media channels. %M 29903694 %R 10.2196/10227 %U http://www.jmir.org/2018/6/e10227/ %U https://doi.org/10.2196/10227 %U http://www.ncbi.nlm.nih.gov/pubmed/29903694 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e203 %T Using Social Media to Target Cancer Prevention in Young Adults: Viewpoint %A Sarkar,Urmimala %A Le,Gem M %A Lyles,Courtney R %A Ramo,Danielle %A Linos,Eleni %A Bibbins-Domingo,Kirsten %+ Center for Vulnerable Populations, Division of General Internal Medicine, University of California, San Francisco, Building 10, 3rd Floor, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 415 206 4273, urmimala.sarkar@ucsf.edu %K cancer %K prevention & control %K young adult %K behavior %K social media %D 2018 %7 05.06.2018 %9 Viewpoint %J J Med Internet Res %G English %X Focusing on primary cancer prevention can reduce its incidence. Changing health behaviors is critical to cancer prevention. Modifiable cancer risk factors include lifestyle behaviors related to vaccination, physical activity, weight control and maintenance, alcohol consumption, and tobacco use. These health habits are often formed in young adulthood, a life stage which currently intersects with the growing population of digital natives whose childhood occurred in the internet era. Social media is a critical communication medium to reach this population of digital natives. Using a life course perspective, the purpose of this viewpoint paper is to describe the current landscape of nascent research using social media to target cancer prevention efforts in young adults and propose future directions to strengthen the scientific knowledge supporting social media strategies to promote cancer prevention behaviors. Leveraging social media as a health promotion tool is a promising strategy to impact modifiable behavioral risk factors for cancer and warrants further research on developing effective communication strategies in young adults to prevent cancer in the future generations. %R 10.2196/jmir.8882 %U http://www.jmir.org/2018/6/e203/ %U https://doi.org/10.2196/jmir.8882 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e54 %T Junk Food Marketing on Instagram: Content Analysis %A Vassallo,Amy Jo %A Kelly,Bridget %A Zhang,Lelin %A Wang,Zhiyong %A Young,Sarah %A Freeman,Becky %+ Prevention Research Collaboration, School of Public Health, Charles Perkins Centre, The University of Sydney, Level 6 (D17), Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia, 61 2 8627 4449, amy.vassallo@sydney.edu.au %K food and beverage %K advertisements %K social media %D 2018 %7 05.06.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Omnipresent marketing of processed foods is a key driver of dietary choices and brand loyalty. Market data indicate a shift in food marketing expenditures to digital media, including social media. These platforms have greater potential to influence young people, given their unique peer-to-peer transmission and youths’ susceptibility to social pressures. Objective: The aim of this study was to investigate the frequency of images and videos posted by the most popular, energy-dense, nutrient-poor food and beverage brands on Instagram and the marketing strategies used in these images, including any healthy choice claims. Methods: A content analysis of 15 accounts was conducted, using 12 months of Instagram posts from March 15, 2015, to March 15, 2016. A pre-established hierarchical coding guide was used to identify the primary marketing strategy of each post. Results: Each brand used 6 to 11 different marketing strategies in their Instagram accounts; however, they often adhered to an overall theme such as athleticism or relatable consumers. There was a high level of branding, although not necessarily product information on all accounts, and there were very few health claims. Conclusions: Brands are using social media platforms such as Instagram to market their products to a growing number of consumers, using a high frequency of targeted and curated posts that manipulate consumer emotions rather than present information about their products. Policy action is needed that better reflects the current media environment. Public health bodies also need to engage with emerging media platforms and develop compelling social counter-marketing campaigns. %R 10.2196/publichealth.9594 %U http://publichealth.jmir.org/2018/2/e54/ %U https://doi.org/10.2196/publichealth.9594 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e205 %T Increasing Interest of Mass Communication Media and the General Public in the Distribution of Tweets About Mental Disorders: Observational Study %A Alvarez-Mon,Miguel Angel %A Asunsolo del Barco,Angel %A Lahera,Guillermo %A Quintero,Javier %A Ferre,Francisco %A Pereira-Sanchez,Victor %A Ortuño,Felipe %A Alvarez-Mon,Melchor %+ Department of Psychiatry, Clinica Universidad de Navarra, University of Navarra, Avda Pio XII, 36, Pamplona, 31008, Spain, 34 948255400, malvarezdem@unav.es %K Twitter %K social media %K psychiatry %K mental health %D 2018 %7 28.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The contents of traditional communication media and new internet social media reflect the interests of society. However, certain barriers and a lack of attention towards mental disorders have been previously observed. Objective: The objective of this study is to measure the relevance of influential American mainstream media outlets for the distribution of psychiatric information and the interest generated in these topics among their Twitter followers. Methods: We investigated tweets generated about mental health conditions and diseases among 15 mainstream general communication media outlets in the United States of America between January 2007 and December 2016. Our study strategy focused on identifying several psychiatric terms of primary interest. The number of retweets generated from the selected tweets was also investigated. As a control, we examined tweets generated about the main causes of death in the United States of America, the main chronic neurological degenerative diseases, and HIV. Results: In total, 13,119 tweets about mental health disorders sent by the American mainstream media outlets were analyzed. The results showed a heterogeneous distribution but preferential accumulation for a select number of conditions. Suicide and gender dysphoria accounted for half of the number of tweets sent. Variability in the number of tweets related to each control disease was also found (5998). The number of tweets sent regarding each different psychiatric or organic disease analyzed was significantly correlated with the number of retweets generated by followers (1,030,974 and 424,813 responses to mental health disorders and organic diseases, respectively). However, the probability of a tweet being retweeted differed significantly among the conditions and diseases analyzed. Furthermore, the retweeted to tweet ratio was significantly higher for psychiatric diseases than for the control diseases (odds ratio 1.11, CI 1.07-1.14; P<.001). Conclusions: American mainstream media outlets and the general public demonstrate a preferential interest for psychiatric diseases on Twitter. The heterogeneous weights given by the media outlets analyzed to the different mental health disorders and conditions are reflected in the responses of Twitter followers. %R 10.2196/jmir.9582 %U http://www.jmir.org/2018/5/e205/ %U https://doi.org/10.2196/jmir.9582 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e44 %T The Development of a Social Networking–Based Relatedness Intervention Among Young, First-Time Blood Donors: Pilot Study %A Frye,Victoria %A Duffy,Louisa %A France,Janis L %A Kessler,Debra A %A Rebosa,Mark %A Shaz,Beth H %A Carlson,Bruce W %A France,Christopher R %+ Ohio University, Department of Psychology, 251 Porter Hall, Ohio University, Athens, OH, 45701, United States, 1 740 593 1079, France@ohio.edu %K blood donation %K social media intervention %K donor identity %K internal motivation %D 2018 %7 26.04.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Increasing repeat blood donation behavior is a critical public health goal. According to self-determination theory, the process of developing internal motivation to give blood and an associated self-identity as a blood donor may be promoted by feelings of “relatedness” or a connection to other donors, which may be enhanced through social relations and interactions. Objective: The purpose of this report it to describe the development and pilot testing of a social networking-based (Facebook) intervention condition designed to increase feelings of relatedness via virtual social interaction and support. Methods: To develop the intervention condition content, images, text, polls, and video content were assembled. Ohio University college students (N=127) rated the content (82 images/text) presented by computer in random order using a scale of one to five on various dimensions of relatedness. Mean ratings were calculated and analyses of variance were conducted to assess associations among the dimensions. Based on these results, the relatedness intervention was adapted and evaluated for feasibility, acceptability, and preliminary efficacy among 24 first-time donors, aged 18 to 24 years, in a 30-day pilot trial. Paired t-tests were conducted to examine change over time in relatedness and connectedness. Results: The intervention condition that was developed was acceptable and feasible. Results of the uncontrolled, preintervention, and postintervention evaluation revealed that feelings of individual-level relatedness increased significantly after the intervention. Conclusions: By promoting first-time blood donor relatedness, our goal is to enhance internal motivation for donating and the integration of the blood donor identity, thus increasing the likelihood of future repeat donation. Trial Registration: ClinicalTrials.gov NCT02717338; https://clinicaltrials.gov/ct2/show/NCT02717338 (Archived by WebCite at http://www.webcitation.org/6ymHRBCwu) %M 29699961 %R 10.2196/publichealth.8972 %U http://publichealth.jmir.org/2018/2/e44/ %U https://doi.org/10.2196/publichealth.8972 %U http://www.ncbi.nlm.nih.gov/pubmed/29699961 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e41 %T Using Social Media to Generate and Collect Primary Data: The #ShowsWorkplaceCompassion Twitter Research Campaign %A Clyne,Wendy %A Pezaro,Sally %A Deeny,Karen %A Kneafsey,Rosie %+ Hope for the Community, Community Interest Company, The Enterprise Hub, Whitefriars Street, Coventry, CV1 2DS, United Kingdom, 44 24 7765 9542, wendy.clyne@h4c.org.uk %K work engagement %K health personnel %K empathy %K attitude of health personnel %D 2018 %7 23.04.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Compassion is a core value embedded in the concept of quality in healthcare. The need for compassion toward healthcare staff in the workplace, for their own health and well-being and also to enable staff to deliver compassionate care for patients, is increasingly understood. However, we do not currently know how healthcare staff understand and characterize compassion toward themselves as opposed to patients. Objective: The aim of this study was to use social media for the generation and collection of primary data to gain understanding of the concept of workplace compassion. Methods: Tweets that contained the hashtag #ShowsWorkplaceCompassion were collected from Twitter and analyzed. The study took place between April 21 and May 21, 2016. Participants were self-selecting users of the social media service Twitter. The study was promoted by a number of routes: the National Health Service (NHS) England website, the personal Twitter accounts of the research team, internal NHS England communications, and via social media sharing. Participants were asked to contribute their views about what activities, actions, policies, philosophies or approaches demonstrate workplace compassion in healthcare using the hashtag #ShowsWorkplaceCompassion. All tweets including the research hashtag #ShowsWorkplaceCompassion were extracted from Twitter and studied using content analysis. Data concerning the frequency, nature, origin, and location of Web-based engagement with the research campaign were collected using Bitly (Bitly, Inc, USA) and Symplur (Symplur LLC, USA) software. Results: A total of 260 tweets were analyzed. Of the 251 statements within the tweets that were coded, 37.8% (95/251) of the statements concerned Leadership and Management aspects of workplace compassion, 29.5% (74/251) were grouped under the theme related to Values and Culture, 17.5% (44/251) of the statements related to Personalized Policies and Procedures that support workplace compassion, and 15.2% (38/251) of the statements concerned Activities and Actions that show workplace compassion. Content analysis showed that small acts of kindness, an embedded organizational culture of caring for one another, and recognition of the emotional and physical impact of healthcare work were the most frequently mentioned characteristics of workplace compassion in healthcare. Conclusions: This study presents a new and innovative research approach using Twitter. Although previous research has analyzed the nature and pattern of tweets retrospectively, this study used Twitter to both recruit participants and collect primary data. %M 29685866 %R 10.2196/publichealth.7686 %U http://publichealth.jmir.org/2018/2/e41/ %U https://doi.org/10.2196/publichealth.7686 %U http://www.ncbi.nlm.nih.gov/pubmed/29685866 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e38 %T Predictors of Facebook User Engagement With Health-Related Content for Gay, Bisexual, and Other Men Who Have Sex With Men: Content Analysis %A Card,Kiffer George %A Lachowsky,Nathan %A Hawkins,Blake W %A Jollimore,Jody %A Baharuddin,Fahmy %A Hogg,Robert S %+ Faculty of Health Science, Simon Fraser University, c/o Faculty of Health Sciences, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada, 1 7789884269, kiffercard@gmail.com %K social media %K health promotion %K gay and bisexual men %K user engagement %D 2018 %7 06.04.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media is used by community-based organizations (CBOs) to promote the well-being of gay and bisexual men (GBM). However, few studies have quantified which factors facilitate the diffusion of health content tailored for sexual minorities. Objective: The aim of this study was to identify post characteristics that can be leveraged to optimize the health promotion efforts of CBOs on Facebook. Methods: The Facebook application programming interface was used to collect 5 years’ of posts shared across 10 Facebook pages administered by Vancouver-based CBOs promoting GBM health. Network analysis assessed basic indicators of network structure. Content analyses were conducted using informatics-based approaches. Hierarchical negative binomial regression of post engagement data was used to identify meaningful covariates of engagement. Results: In total, 14,071 posts were shared and 21,537 users engaged with these posts. Most users (n=13,315) engaged only once. There was moderate correlation between the number of posts and the number of CBOs users engaged with (r=.53, P<.001). Higher user engagement was positively associated with positive sentiment, sharing multimedia, and posting about pre-exposure prophylaxis, stigma, and mental health. Engagement was negatively associated with asking questions, posting about dating, and sharing posts during or after work (versus before). Conclusions: Results highlight the existence of a core group of Facebook users who facilitate diffusion. Factors associated with greater user engagement present CBOs with a number of strategies for improving the diffusion of health content. %M 29625953 %R 10.2196/publichealth.8145 %U http://publichealth.jmir.org/2018/2/e38/ %U https://doi.org/10.2196/publichealth.8145 %U http://www.ncbi.nlm.nih.gov/pubmed/29625953 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e27 %T Youth Mental Health Services Utilization Rates After a Large-Scale Social Media Campaign: Population-Based Interrupted Time-Series Analysis %A Booth,Richard G %A Allen,Britney N %A Bray Jenkyn,Krista M %A Li,Lihua %A Shariff,Salimah Z %+ Arthur Labatt Family School of Nursing, Western University, 1151 Richmond Street, FNB2333, London, ON, N6A 5B9, Canada, 1 5196612111 ext 86571, rbooth5@uwo.ca %K mental health %K youth %K adolescent %K social media %K population health %K mass media %D 2018 %7 06.04.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the uptake of mass media campaigns, their overall impact remains unclear. Since 2011, a Canadian telecommunications company has operated an annual, large-scale mental health advocacy campaign (Bell Let’s Talk) focused on mental health awareness and stigma reduction. In February 2012, the campaign began to explicitly leverage the social media platform Twitter and incented participation from the public by promising donations of Can $0.05 for each interaction with a campaign-specific username (@Bell_LetsTalk). Objective: The intent of the study was to examine the impact of this 2012 campaign on youth outpatient mental health services in the province of Ontario, Canada. Methods: Monthly outpatient mental health visits (primary health care and psychiatric services) were obtained for the Ontario youth aged 10 to 24 years (approximately 5.66 million visits) from January 1, 2006 to December 31, 2015. Interrupted time series, autoregressive integrated moving average modeling was implemented to evaluate the impact of the campaign on rates of monthly outpatient mental health visits. A lagged intervention date of April 1, 2012 was selected to account for the delay required for a patient to schedule and attend a mental health–related physician visit. Results: The inclusion of Twitter into the 2012 Bell Let’s Talk campaign was temporally associated with an increase in outpatient mental health utilization for both males and females. Within primary health care environments, female adolescents aged 10 to 17 years experienced a monthly increase in the mental health visit rate from 10.2/1000 in April 2006 to 14.1/1000 in April 2015 (slope change of 0.094 following campaign, P<.001), whereas males of the same age cohort experienced a monthly increase from 9.7/1000 to 9.8/1000 (slope change of 0.052 following campaign, P<.001). Outpatient psychiatric services visit rates also increased for both male and female adolescents aged 10 to 17 years post campaign (slope change of 0.005, P=.02; slope change of 0.003, P=.005, respectively). For young adults aged 18 to 24 years, females who used primary health care experienced the most significant increases in mental health visit rates from 26.5/1000 in April 2006 to 29.2/1000 in April 2015 (slope change of 0.17 following campaign, P<.001). Conclusions: The 2012 Bell Let’s Talk campaign was temporally associated with an increase in the rate of mental health visits among Ontarian youth. Furthermore, there appears to be an upward trend of youth mental health utilization in the province of Ontario, especially noticeable in females who accessed primary health care services. %M 29625954 %R 10.2196/mental.8808 %U http://mental.jmir.org/2018/2/e27/ %U https://doi.org/10.2196/mental.8808 %U http://www.ncbi.nlm.nih.gov/pubmed/29625954 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e130 %T Vaccine Images on Twitter: Analysis of What Images are Shared %A Chen,Tao %A Dredze,Mark %+ Center for Language and Speech Processing, Johns Hopkins University, Hackerman Hall 226, 3400 North Charles Street, Baltimore, MD, 21218, United States, 1 410 516 4237, tchen77@jhu.edu %K vaccine %K visual communication %K image tweet %K Twitter %K retweet prediction %K social media %D 2018 %7 03.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Visual imagery plays a key role in health communication; however, there is little understanding of what aspects of vaccine-related images make them effective communication aids. Twitter, a popular venue for discussions related to vaccination, provides numerous images that are shared with tweets. Objective: The objectives of this study were to understand how images are used in vaccine-related tweets and provide guidance with respect to the characteristics of vaccine-related images that correlate with the higher likelihood of being retweeted. Methods: We collected more than one million vaccine image messages from Twitter and characterized various properties of these images using automated image analytics. We fit a logistic regression model to predict whether or not a vaccine image tweet was retweeted, thus identifying characteristics that correlate with a higher likelihood of being shared. For comparison, we built similar models for the sharing of vaccine news on Facebook and for general image tweets. Results: Most vaccine-related images are duplicates (125,916/237,478; 53.02%) or taken from other sources, not necessarily created by the author of the tweet. Almost half of the images contain embedded text, and many include images of people and syringes. The visual content is highly correlated with a tweet’s textual topics. Vaccine image tweets are twice as likely to be shared as nonimage tweets. The sentiment of an image and the objects shown in the image were the predictive factors in determining whether an image was retweeted. Conclusions: We are the first to study vaccine images on Twitter. Our findings suggest future directions for the study and use of vaccine imagery and may inform communication strategies around vaccination. Furthermore, our study demonstrates an effective study methodology for image analysis. %M 29615386 %R 10.2196/jmir.8221 %U http://www.jmir.org/2018/4/e130/ %U https://doi.org/10.2196/jmir.8221 %U http://www.ncbi.nlm.nih.gov/pubmed/29615386 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e33 %T Contents, Followers, and Retweets of the Centers for Disease Control and Prevention’s Office of Advanced Molecular Detection (@CDC_AMD) Twitter Profile: Cross-Sectional Study %A Fung,Isaac Chun-Hai %A Jackson,Ashley M %A Mullican,Lindsay A %A Blankenship,Elizabeth B %A Goff,Mary Elizabeth %A Guinn,Amy J %A Saroha,Nitin %A Tse,Zion Tsz Ho %+ Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA, 30460, United States, 1 9124785079, cfung@georgiasouthern.edu %K communications media %K health communication %K social media %D 2018 %7 02.04.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Office of Advanced Molecular Detection (OAMD), Centers for Disease Control and Prevention (CDC), manages a Twitter profile (@CDC_AMD). To our knowledge, no prior study has analyzed a CDC Twitter handle’s entire contents and all followers. Objective: This study aimed to describe the contents and followers of the Twitter profile @CDC_AMD and to assess if attaching photos or videos to tweets posted by @CDC_AMD would increase retweet frequency. Methods: Data of @CDC_AMD were retrieved on November 21, 2016. All followers (N=809) were manually categorized. All tweets (N=768) were manually coded for contents and whether photos or videos were attached. Retweet count for each tweet was recorded. Negative binomial regression models were applied to both the original and the retweet corpora. Results: Among the 809 followers, 26.0% (210/809) were individual health professionals, 11.6% (94/809) nongovernmental organizations, 3.3% (27/809) government agencies’ accounts, 3.3% (27/809) accounts of media organizations and journalists, and 0.9% (7/809) academic journals, with 54.9% (444/809) categorized as miscellaneous. A total of 46.9% (360/768) of @CDC_AMD’s tweets referred to the Office’s website and their current research; 17.6% (135/768) referred to their scientists’ publications. Moreover, 80% (69/86) of tweets retweeted by @CDC_AMD fell into the miscellaneous category. In addition, 43.4% (333/768) of the tweets contained photos or videos, whereas the remaining 56.6% (435/768) did not. Attaching photos or videos to original @CDC_AMD tweets increases the number of retweets by 37% (probability ratio=1.37, 95% CI 1.13-1.67, P=.002). Content topics did not explain or modify this association. Conclusions: This study confirms CDC health communicators’ experience that original tweets created by @CDC_AMD Twitter profile sharing images or videos (or their links) received more retweets. The current policy of attaching images to tweets should be encouraged. %M 29610112 %R 10.2196/publichealth.8737 %U http://publichealth.jmir.org/2018/2/e33/ %U https://doi.org/10.2196/publichealth.8737 %U http://www.ncbi.nlm.nih.gov/pubmed/29610112 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e32 %T Does Eating Chicken Feet With Pickled Peppers Cause Avian Influenza? Observational Case Study on Chinese Social Media During the Avian Influenza A (H7N9) Outbreak %A Chen,Bin %A Shao,Jian %A Liu,Kui %A Cai,Gaofeng %A Jiang,Zhenggang %A Huang,Yuru %A Gu,Hua %A Jiang,Jianmin %+ Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng Rd, Binjiang District, Hangzhou, 310051, China, 86 87115183, jmjiang@cdc.zj.cn %K social media %K misinformation %K infodemiology %K avian influenza A %K disease outbreak %D 2018 %7 29.03.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: A hot topic on the relationship between a popular avian-origin food and avian influenza occurred on social media during the outbreak of the emerging avian influenza A (H7N9). The misinformation generated from this topic had caused great confusion and public concern. Objective: Our goals were to analyze the trend and contents of the relevant posts during the outbreak. We also aimed to understand the characteristics of the misinformation and to provide suggestions to reduce public misconception on social media during the emerging disease outbreak. Methods: The original microblog posts were collected from China’s Sina Weibo and Tencent Weibo using a combination of keywords between April 1, 2013 and June 2, 2013. We analyzed the weekly and daily trend of the relevant posts. Content analyses were applied to categorize the posts into 4 types with unified sorting criteria. The posts’ characteristics and geographic locations were also analyzed in each category. We conducted further analysis on the top 5 most popular misleading posts. Results: A total of 1680 original microblog posts on the topic were retrieved and 341 (20.30%) of these posts were categorized as misleading messages. The number of relevant posts had not increased much during the first 2 weeks but rose to a high level in the next 2 weeks after the sudden increase in number of reported cases at the beginning of week 3. The posts under “misleading messages” occurred and increased from the beginning of week 3, but their daily posting number decreased when the daily number of posts under “refuting messages” outnumbered them. The microbloggers of the misleading posts had the lowest mean rank of followers and previous posts, but their posts had a highest mean rank of posts. The proportion of “misleading messages” in places with no reported cases was significantly higher than that in the epidemic areas (23.6% vs 13.8%). The popular misleading posts appeared to be short and consisted of personal narratives, which were easily disseminated on social media. Conclusions: Our findings suggested the importance of responding to common questions and misconceptions on social media platforms from the beginning of disease outbreaks. Authorities need to release clear and reliable information related to the popular topics early on. The microbloggers posting correct information should be empowered and their posts could be promoted to clarify false information. Equal importance should be attached to clarify misinformation in both the outbreak and nonoutbreak areas. %M 29599109 %R 10.2196/publichealth.8198 %U http://publichealth.jmir.org/2018/1/e32/ %U https://doi.org/10.2196/publichealth.8198 %U http://www.ncbi.nlm.nih.gov/pubmed/29599109 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e27 %T Influence of Flavors on the Propagation of E-Cigarette–Related Information: Social Media Study %A Zhou,Jiaqi %A Zhang,Qingpeng %A Zeng,Daniel Dajun %A Tsui,Kwok Leung %+ Department of Systems Engineering and Engineering Management, City University of Hong Kong, P6606, 6/F, Academic 1, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon Tong, 00001, China (Hong Kong), 852 34424727, qingpeng.zhang@cityu.edu.hk %K e-cigarettes %K flavors %K social media %K information propagation %K social networks %K electronic nicotine delivery systems %K flavoring agents %K information dissemination %K social networking %D 2018 %7 23.03.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Modeling the influence of e-cigarette flavors on information propagation could provide quantitative policy decision support concerning smoking initiation and contagion, as well as e-cigarette regulations. Objective: The objective of this study was to characterize the influence of flavors on e-cigarette–related information propagation on social media. Methods: We collected a comprehensive dataset of e-cigarette–related discussions from public Pages on Facebook. We identified 11 categories of flavors based on commonly used categorizations. Each post’s frequency of being shared served as a proxy measure of information propagation. We evaluated a set of regression models and chose the hurdle negative binomial model to characterize the influence of different flavors and nonflavor control variables on e-cigarette–related information propagation. Results: We found that 5 flavors (sweet, dessert & bakery, fruits, herbs & spices, and tobacco) had significantly negative influences on e-cigarette–related information propagation, indicating the users’ tendency not to share posts related to these flavors. We did not find a positive significance of any flavors, which is contradictory to previous research. In addition, we found that a set of nonflavor–related factors were associated with information propagation. Conclusions: Mentions of flavors in posts did not enhance the popularity of e-cigarette–related information. Certain flavors could even have reduced the popularity of information, indicating users’ lack of interest in flavors. Promoting e-cigarette–related information with mention of flavors is not an effective marketing approach. This study implies the potential concern of users about flavorings and suggests a need to regulate the use of flavorings in e-cigarettes. %M 29572202 %R 10.2196/publichealth.7998 %U http://publichealth.jmir.org/2018/1/e27/ %U https://doi.org/10.2196/publichealth.7998 %U http://www.ncbi.nlm.nih.gov/pubmed/29572202 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e52 %T Implementation of Digital Awareness Strategies to Engage Patients and Providers in a Lung Cancer Screening Program: Retrospective Study %A Jessup,Dana L %A Glover IV,McKinley %A Daye,Dania %A Banzi,Lynda %A Jones,Philip %A Choy,Garry %A Shepard,Jo-Anne O %A Flores,Efrén J %+ Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, United States, 1 617 724 5246, ejflores@mgh.harvard.edu %K lung neoplasms %K diagnostic imaging %K social media %K patient participation %K search engine %D 2018 %7 15.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Lung cancer is the leading cause of cancer-related deaths in the United States. Despite mandated insurance coverage for eligible patients, lung cancer screening rates remain low. Digital platforms, including social media, provide a potentially valuable tool to enhance health promotion and patient engagement related to lung cancer screening (LCS). Objective: The aim was to assess the effectiveness of LCS digital awareness campaigns on utilization of low-dose computed tomography (LDCT) and visits to institutional online educational content. Methods: A pay-per-click campaign utilizing Google and Facebook targeted adults aged 55 years and older and caregivers aged 18 years and older (eg, spouses, adult children) with LCS content during a 20-week intervention period from May to September 2016. A concurrent pay-per-click campaign using LinkedIn and Twitter targeted health care providers with LCS content. Geographic target radius was within 60 miles of an academic medical center. Social media data included aggregate demographics and click-through rates (CTRs). Primary outcome measures were visits to institutional Web pages and scheduled LDCT exams. Study period was 20 weeks before, during, and after the digital awareness campaigns. Results: Weekly visits to the institutional LCS Web pages were significantly higher during the digital awareness campaigns compared to the 20-week period prior to implementation (mean 823.9, SD 905.8 vs mean 51, SD 22.3, P=.001). The patient digital awareness campaign surpassed industry standard CTRs on Google (5.85%, 1108/18,955 vs 1.8%) and Facebook (2.59%, 47,750/1,846,070 vs 0.8%). The provider digital awareness campaign surpassed industry standard CTR on LinkedIn (1.1%, 630/57,079 vs 0.3%) but not Twitter (0.19%, 1139/587,133 vs 0.25%). Mean scheduled LDCT exam volumes per week before, during, and after the digital awareness campaigns were 17.4 (SD 7.5), 20.4 (SD 5.4), and 26.2 (SD 6.4), respectively, with the difference between the mean number of scheduled exams after the digital awareness campaigns and the number of exams scheduled before and after the digital awareness campaigns being statistically significant (P<.001). Conclusions: Implementation of the LCS digital awareness campaigns was associated with increased visits to institutional educational Web pages and scheduled LDCT exams. Digital platforms are an important tool to enhance health promotion activities and engagement with patients and providers. %M 29449199 %R 10.2196/jmir.8932 %U http://www.jmir.org/2018/2/e52/ %U https://doi.org/10.2196/jmir.8932 %U http://www.ncbi.nlm.nih.gov/pubmed/29449199 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e14 %T Influencing the Conversation About Masculinity and Suicide: Evaluation of the Man Up Multimedia Campaign Using Twitter Data %A Schlichthorst,Marisa %A King,Kylie %A Turnure,Jackie %A Sukunesan,Suku %A Phelps,Andrea %A Pirkis,Jane %+ Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, 3010, Australia, 61 390353508, marisa.schlichthorst@unimelb.edu.au %K mental health %K suicide %K masculinity %K men’s health %D 2018 %7 15.02.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: It has been suggested that some dominant aspects of traditional masculinity are contributing to the high suicide rates among Australian men. We developed a three-episode documentary called Man Up, which explores the complex relationship between masculinity and suicide and encourages men to question socially imposed rules about what it means to be a man and asks them to open up, express difficult emotions, and seek help if and when needed. We ran a three-phase social media campaign alongside the documentary using 5 channels (Twitter, Facebook, Instagram, YouTube, and Tumblr). Objective: This study aimed to examine the extent to which the Man Up Twitter campaign influenced the social media conversation about masculinity and suicide. Methods: We used Twitter insights data to assess the reach of and engagement with the campaign (using metrics on followers, likes, retweets, and impressions) and to determine the highest and lowest performing tweets in the campaign (using an aggregated performance measure of reactions). We used original content tweets to determine whether the campaign increased the volume of relevant Twitter conversations (aggregating the number of tweets for selected campaign hashtags over time), and we used a subset of these data to gain insight into the main content themes with respect to audience engagement. Results: The campaign generated a strong following that was engaged with the content of the campaign; over its whole duration, the campaign earned approximately 5000 likes and 2500 retweets and gained around 1,022,000 impressions. The highest performing tweets posted by the host included video footage and occurred during the most active period of the campaign (around the screening of the documentary). The volume of conversations in relation to commonly used hashtags (#MANUP, #ABCMANUP, #LISTENUP, and #SPEAKUP) grew in direct relation to the campaign activities, achieving strongest growth during the 3 weeks when the documentary was aired. Strongest engagement was found with content related to help-seeking, masculinity, and expressing emotions. A number of followers tweeted personal stories that revealed overwhelmingly positive perceptions of the content of the documentary and strongly endorsed its messages. Conclusions: The Man Up Twitter campaign triggered conversations about masculinity and suicide that otherwise may not have happened. For some, this may have been game-changing in terms of shifting attitudes toward expressing emotions and reaching out to others for help. The campaign was particularly effective in disseminating information and promoting conversations in real time, an advantage that it had over more traditional health promotion campaigns. This sort of approach could well be adapted to other areas of mental (and physical) health promotion campaigns to increase their reach and effectiveness. %M 29449203 %R 10.2196/mental.9120 %U http://mental.jmir.org/2018/1/e14/ %U https://doi.org/10.2196/mental.9120 %U http://www.ncbi.nlm.nih.gov/pubmed/29449203 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e8 %T Trust in Health Information Sources: Survey Analysis of Variation by Sociodemographic and Tobacco Use Status in Oklahoma %A Brown-Johnson,Cati G %A Boeckman,Lindsay M %A White,Ashley H %A Burbank,Andrea D %A Paulson,Sjonna %A Beebe,Laura A %+ Evaluation Sciences Unit, Division of Primary Care and Population Health, Stanford School of Medicine, Medical School Office Building, x216, 1265 Welch Rd, Mail Code 5475, Stanford, CA, 94305, United States, 1 6507363394, catibj@stanford.edu %K tobacco use cessation %K health communication %K trust %K social media %K health care providers %K electronic cigarettes %K mass media %K radio %K television %K Oklahoma %D 2018 %7 12.02.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Modern technology (ie, websites and social media) has significantly changed social mores in health information access and delivery. Although mass media campaigns for health intervention have proven effective and cost-effective in changing health behavior at a population scale, this is best studied in traditional media sources (ie, radio and television). Digital health interventions are options that use short message service/text messaging, social media, and internet technology. Although exposure to these products is becoming ubiquitous, electronic health information is novel, incompletely disseminated, and frequently inaccurate, which decreases public trust. Previous research has shown that audience trust in health care providers significantly moderates health outcomes, demographics significantly influence audience trust in electronic media, and preexisting health behaviors such as smoking status significantly moderate audience receptivity to traditional mass media. Therefore, modern health educators must assess audience trust in all sources, both media (traditional and digital) and interpersonal, to balance pros and cons before structuring multicomponent community health interventions. Objective: We aimed to explore current trust and moderators of trust in health information sources given recent changes in digital health information access and delivery to inform design of future health interventions in Oklahoma. Methods: We conducted phone surveys of a cross-sectional sample of 1001 Oklahoma adults (age 18-65 years) in spring 2015 to assess trust in seven media sources: traditional (television and radio), electronic (online and social media), and interpersonal (providers, insurers, and family/friends). We also gathered information on known moderators of trust (sociodemographics and tobacco use status). We modeled log odds of a participant rating a source as “trustworthy” (SAS PROC SURVEYLOGISTIC), with subanalysis for confounders (sociodemographics and tobacco use). Results: Oklahomans showed the highest trust in interpersonal sources: 81% (808/994) reported providers were trustworthy, 55% (550/999) for friends and family, and 48% (485/998) for health insurers. For media sources, 24% of participants (232/989) rated the internet as trustworthy, followed by 21% of participants for television (225/998), 18% for radio (199/988), and only 11% for social media (110/991). Despite this low self-reported trust in social media, 40% (406/991) of participants reported using social media for tobacco-related health information. Trust in health providers did not vary by subpopulation, but sociodemographic variables (gender, income, and education) and tobacco use status significantly moderated trust in other sources. Women were on the whole more trusting than men, trust in media decreased with income, and trust in friends and family decreased with education. Conclusions: Health education interventions should incorporate digital media, particularly when targeting low-income populations. Utilizing health care providers in social media settings could leverage high-trust and low-cost features of providers and social media, respectively. %M 29434015 %R 10.2196/publichealth.6260 %U http://publichealth.jmir.org/2018/1/e8/ %U https://doi.org/10.2196/publichealth.6260 %U http://www.ncbi.nlm.nih.gov/pubmed/29434015 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 1 %P e2 %T A Social Media-Based Acute Alcohol Consumption Behavior (NekNomination): Case Series in Italian Emergency Departments %A Barbieri,Stefania %A Feltracco,Paolo %A Lucchetta,Vittorio %A Gaudio,Rosa Maria %A Tredese,Alberto %A Bergamini,Mauro %A Vettore,Gianna %A Pietrantonio,Vincenzo %A Avato,Francesco Maria %A Donato,Daniele %A Boemo,Deris Gianni %A Nesoti,Maria Vittoria %A Snenghi,Rossella %+ Department of Urgent and Emergency Care, University of Padova, Via Giustiniani 2, Padova,, Italy, 39 3479812611, stefibarbieri118@gmail.com %K alcohol drinking %K drinking behavior %K underage drinking %K binge drinking %K alcoholic intoxication %K adolescent %K neknomination %K binge drinking %K alcoholic games %K social network %D 2018 %7 31.01.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: NekNomination, also known as NekNominate, Neck and Nominate, or Neck Nomination, is a social network–based drinking game which is thought to have originated in Australia and spread all over the world between 2013 and 2014. Individuals record videos of themselves while rapidly drinking excessive quantities of alcoholic drinks (necking) and then nominate friends to outdo them within 24 hours; the videos are then posted on social media such as Facebook or YouTube. The consequences of this drinking game have been very dangerous; at least 5 people under age 30 years have died after drinking deadly cocktails, and many others have suffered from alcohol intoxication. Objective: The goal of the research is to evaluate data about clinically important acute alcohol intoxication among teenagers and young adults and inform and educate the general public, especially parents, teachers, and health workers, about the spreading craze of dangerous Internet-related behavior among today’s teenagers and young people up to the age of 23 years. Methods: Patients aged 15 to 23 years with acute alcohol intoxication who came to the emergency department (ED) of 2 major hospitals in Italy from January 1, 2011, to June 30, 2014, were included in this study. Data were retrieved from prehospital and intrahospital medical records and included personal information, methods of intoxication, triage color code, date and time of access to the ED, any relevant signs and symptoms, blood alcohol concentration, and diagnosis at discharge. Results: A total of 450 young patients (male 277/450, 61.5%, female 173/450, 38.5%; age 15 to 16 years 15/450, 3.3%, age 17 to 18 years 184/450, 40.9%, age 19 to 23 years 251/450, 55.8%) were recruited. The causes of intoxication were happy hour, binge drinking, NekNominate, eyeballing, other alcoholic games, or a mix of them. Happy hour was found to be more common among the older patients, whereas NekNominate accounted for almost half of the youngest group of hospitalizations. Eyeballing occurred in 1.6% (7/450) of cases; binge drinking and other alcoholic games caused 23.3% (105/450) and 23.8% (107/450) of hospitalizations, respectively. On admission, 44.2% (199/450) of patients were assigned a red or yellow color code requiring immediate medical attention; about 14% of them required additional medical assistance (after being in the ED) or hospitalization, some in semi-intensive care units. Conclusions: Our study shows that the increased numbers of hospitalizations due to alcohol intoxication in the adolescent age group, as a consequence of NekNominate or other drinking games, is alarming and represents a serious public health issue. The potential markers of improper use of social networks must be clearly identified, including categories at risk of alcohol abuse, in order to develop intervention and prevention strategies in terms of education and awareness, which may help in averting potentially fatal episodes. %M 29386170 %R 10.2196/ijmr.6573 %U http://www.i-jmr.org/2018/1/e2/ %U https://doi.org/10.2196/ijmr.6573 %U http://www.ncbi.nlm.nih.gov/pubmed/29386170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e7 %T Identifying Opinion Leaders to Promote Organ Donation on Social Media: Network Study %A Shi,Jingyuan %A Salmon,Charles T %+ Department of Communication Studies, Hong Kong Baptist University, 5 Hereford Road, Communication and Visual Arts Building, Kowloon Tong, Hong Kong,, China (Hong Kong), 852 34118137, jolieshi@hkbu.edu.hk %K social media %K health promotion %K organ donation %K opinion leaders %K social network analysis %D 2018 %7 09.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: In the recent years, social networking sites (SNSs, also called social media) have been adopted in organ donation campaigns, and recruiting opinion leaders for such campaigns has been found effective in promoting behavioral changes. Objective: The aim of this paper was to focus on the dissemination of organ donation tweets on Weibo, the Chinese equivalent of Twitter, and to examine the opinion leadership in the retweet network of popular organ donation messages using social network analysis. It also aimed to investigate how personal and social attributes contribute to a user’s opinion leadership on the topic of organ donation. Methods: All messages about organ donation posted on Weibo from January 1, 2015 to December 31, 2015 were extracted using Python Web crawler. A retweet network with 505,047 nodes and 545,312 edges of the popular messages (n=206) was constructed and analyzed. The local and global opinion leaderships were measured using network metrics, and the roles of personal attributes, professional knowledge, and social positions in obtaining the opinion leadership were examined using general linear model. Results: The findings revealed that personal attributes, professional knowledge, and social positions predicted individual’s local opinion leadership in the retweet network of popular organ donation messages. Alternatively, personal attributes and social positions, but not professional knowledge, were significantly associated with global opinion leadership. Conclusions: The findings of this study indicate that health campaign designers may recruit peer leaders in SNS organ donation promotions to facilitate information sharing among the target audience. Users who are unverified, active, well connected, and experienced with information and communications technology (ICT) will accelerate the sharing of organ donation messages in the global environment. Medical professionals such as organ transplant surgeons who can wield a great amount of influence on their direct connections could also effectively participate in promoting organ donation on social media. %M 29317384 %R 10.2196/jmir.7643 %U http://www.jmir.org/2018/1/e7/ %U https://doi.org/10.2196/jmir.7643 %U http://www.ncbi.nlm.nih.gov/pubmed/29317384 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e1 %T Social Media Impact of the Food and Drug Administration's Drug Safety Communication Messaging About Zolpidem: Mixed-Methods Analysis %A Sinha,Michael S %A Freifeld,Clark C %A Brownstein,John S %A Donneyong,Macarius M %A Rausch,Paula %A Lappin,Brian M %A Zhou,Esther H %A Dal Pan,Gerald J %A Pawar,Ajinkya M %A Hwang,Thomas J %A Avorn,Jerry %A Kesselheim,Aaron S %+ Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, United States, 1 617 278 0930, akesselheim@partners.org %K Food and Drug Administration %K drug safety communications %K surveillance %K epidemiology %K social media %K Twitter %K Facebook %K Google Trends %D 2018 %7 05.01.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Food and Drug Administration (FDA) issues drug safety communications (DSCs) to health care professionals, patients, and the public when safety issues emerge related to FDA-approved drug products. These safety messages are disseminated through social media to ensure broad uptake. Objective: The objective of this study was to assess the social media dissemination of 2 DSCs released in 2013 for the sleep aid zolpidem. Methods: We used the MedWatcher Social program and the DataSift historic query tool to aggregate Twitter and Facebook posts from October 1, 2012 through August 31, 2013, a period beginning approximately 3 months before the first DSC and ending 3 months after the second. Posts were categorized as (1) junk, (2) mention, and (3) adverse event (AE) based on a score between –0.2 (completely unrelated) to 1 (perfectly related). We also looked at Google Trends data and Wikipedia edits for the same time period. Google Trends search volume is scaled on a range of 0 to 100 and includes “Related queries” during the relevant time periods. An interrupted time series (ITS) analysis assessed the impact of DSCs on the counts of posts with specific mention of zolpidem-containing products. Chow tests for known structural breaks were conducted on data from Twitter, Facebook, and Google Trends. Finally, Wikipedia edits were pulled from the website’s editorial history, which lists all revisions to a given page and the editor’s identity. Results: In total, 174,286 Twitter posts and 59,641 Facebook posts met entry criteria. Of those, 16.63% (28,989/174,286) of Twitter posts and 25.91% (15,453/59,641) of Facebook posts were labeled as junk and excluded. AEs and mentions represented 9.21% (16,051/174,286) and 74.16% (129,246/174,286) of Twitter posts and 5.11% (3,050/59,641) and 68.98% (41,138/59,641) of Facebook posts, respectively. Total daily counts of posts about zolpidem-containing products increased on Twitter and Facebook on the day of the first DSC; Google searches increased on the week of the first DSC. ITS analyses demonstrated variability but pointed to an increase in interest around the first DSC. Chow tests were significant (P<.0001) for both DSCs on Facebook and Twitter, but only the first DSC on Google Trends. Wikipedia edits occurred soon after each DSC release, citing news articles rather than the DSC itself and presenting content that needed subsequent revisions for accuracy. Conclusions: Social media offers challenges and opportunities for dissemination of the DSC messages. The FDA could consider strategies for more actively disseminating DSC safety information through social media platforms, particularly when announcements require updating. The FDA may also benefit from directly contributing content to websites like Wikipedia that are frequently accessed for drug-related information. %M 29305342 %R 10.2196/publichealth.7823 %U http://publichealth.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/publichealth.7823 %U http://www.ncbi.nlm.nih.gov/pubmed/29305342 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e416 %T Estimating the Population Impact of a New Pediatric Influenza Vaccination Program in England Using Social Media Content %A Wagner,Moritz %A Lampos,Vasileios %A Yom-Tov,Elad %A Pebody,Richard %A Cox,Ingemar J %+ Public Health England, 61 Colindale Ave, London, NW9 5EQ, United Kingdom, 44 7539078912, moritz.wagner.16@ucl.ac.uk %K health intervention %K influenza %K vaccination %K social media %K Twitter %D 2017 %7 21.12.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The rollout of a new childhood live attenuated influenza vaccine program was launched in England in 2013, which consisted of a national campaign for all 2 and 3 year olds and several pilot locations offering the vaccine to primary school-age children (4-11 years of age) during the influenza season. The 2014/2015 influenza season saw the national program extended to include additional pilot regions, some of which offered the vaccine to secondary school children (11-13 years of age) as well. Objective: We utilized social media content to obtain a complementary assessment of the population impact of the programs that were launched in England during the 2013/2014 and 2014/2015 flu seasons. The overall community-wide impact on transmission in pilot areas was estimated for the different age groups that were targeted for vaccination. Methods: A previously developed statistical framework was applied, which consisted of a nonlinear regression model that was trained to infer influenza-like illness (ILI) rates from Twitter posts originating in pilot (school-age vaccinated) and control (unvaccinated) areas. The control areas were then used to estimate ILI rates in pilot areas, had the intervention not taken place. These predictions were compared with their corresponding Twitter-based ILI estimates. Results: Results suggest a reduction in ILI rates of 14% (1-25%) and 17% (2-30%) across all ages in only the primary school-age vaccine pilot areas during the 2013/2014 and 2014/2015 influenza seasons, respectively. No significant impact was observed in areas where two age cohorts of secondary school children were vaccinated. Conclusions: These findings corroborate independent assessments from traditional surveillance data, thereby supporting the ongoing rollout of the program to primary school-age children and providing evidence of the value of social media content as an additional syndromic surveillance tool. %M 29269339 %R 10.2196/jmir.8184 %U http://www.jmir.org/2017/12/e416/ %U https://doi.org/10.2196/jmir.8184 %U http://www.ncbi.nlm.nih.gov/pubmed/29269339 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e98 %T E-Cigarette Surveillance With Social Media Data: Social Bots, Emerging Topics, and Trends %A Allem,Jon-Patrick %A Ferrara,Emilio %A Uppu,Sree Priyanka %A Cruz,Tess Boley %A Unger,Jennifer B %+ Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA,, United States, 1 858 603 0812, allem@usc.edu %K electronic cigarettes %K vaping %K Twitter %K social media %K social bots %K electronic nicotine delivery system %K infoveillance %D 2017 %7 20.12.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As e-cigarette use rapidly increases in popularity, data from online social systems (Twitter, Instagram, Google Web Search) can be used to capture and describe the social and environmental context in which individuals use, perceive, and are marketed this tobacco product. Social media data may serve as a massive focus group where people organically discuss e-cigarettes unprimed by a researcher, without instrument bias, captured in near real time and at low costs. Objective: This study documents e-cigarette–related discussions on Twitter, describing themes of conversations and locations where Twitter users often discuss e-cigarettes, to identify priority areas for e-cigarette education campaigns. Additionally, this study demonstrates the importance of distinguishing between social bots and human users when attempting to understand public health–related behaviors and attitudes. Methods: E-cigarette–related posts on Twitter (N=6,185,153) were collected from December 24, 2016, to April 21, 2017. Techniques drawn from network science were used to determine discussions of e-cigarettes by describing which hashtags co-occur (concept clusters) in a Twitter network. Posts and metadata were used to describe where geographically e-cigarette–related discussions in the United States occurred. Machine learning models were used to distinguish between Twitter posts reflecting attitudes and behaviors of genuine human users from those of social bots. Odds ratios were computed from 2x2 contingency tables to detect if hashtags varied by source (social bot vs human user) using the Fisher exact test to determine statistical significance. Results: Clusters found in the corpus of hashtags from human users included behaviors (eg, #vaping), vaping identity (eg, #vapelife), and vaping community (eg, #vapenation). Additional clusters included products (eg, #eliquids), dual tobacco use (eg, #hookah), and polysubstance use (eg, #marijuana). Clusters found in the corpus of hashtags from social bots included health (eg, #health), smoking cessation (eg, #quitsmoking), and new products (eg, #ismog). Social bots were significantly more likely to post hashtags that referenced smoking cessation and new products compared to human users. The volume of tweets was highest in the Mid-Atlantic (eg, Pennsylvania, New Jersey, Maryland, and New York), followed by the West Coast and Southwest (eg, California, Arizona and Nevada). Conclusions: Social media data may be used to complement and extend the surveillance of health behaviors including tobacco product use. Public health researchers could harness these data and methods to identify new products or devices. Furthermore, findings from this study demonstrate the importance of distinguishing between Twitter posts from social bots and humans when attempting to understand attitudes and behaviors. Social bots may be used to perpetuate the idea that e-cigarettes are helpful in cessation and to promote new products as they enter the marketplace. %M 29263018 %R 10.2196/publichealth.8641 %U http://publichealth.jmir.org/2017/4/e98/ %U https://doi.org/10.2196/publichealth.8641 %U http://www.ncbi.nlm.nih.gov/pubmed/29263018 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e97 %T Characteristics of Articles About Human Papillomavirus Vaccination in Japanese Newspapers: Time-Series Analysis Study %A Ueda,Nao %A Yokouchi,Ryoki %A Onoda,Taro %A Ogihara,Atsushi %+ Graduate School of Human Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, 359-1192, Japan, 81 80 5082 3970, naaaaa0428@gmail.com %K papillomavirus vaccines %K immunization programs %K uterine cervical neoplasms %K newspapers as topic %K mass media %K data mining %K Japan %D 2017 %7 19.12.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Media coverage and reports have a major influence on individual vaccination and other health-related activities. People use the media to seek information and knowledge on health-related behaviors. They obtain health-related information from media such as television and newspapers, and they trust such information. While several studies have examined the relation between media coverage and individual health, there is a lack of studies that have analyzed media reports of health information. In particular, we have found no analyses related to cervical cancer (human papillomavirus [HPV]) vaccine. Objective: This study aimed to identify mentions of cervical cancer vaccine in Japan’s printed news media and to determine their characteristics. Methods: We used the archival databases of 2 Japanese newspapers, Yomiuri Shimbun (Yomidasu Rekishikan) and Asahi Shimbun (Kikuzo II Visual), for text mining. First, we created a database by extracting articles published between January 1, 2007, and December 31, 2014, that matched the terms “cervical cancer” AND “vaccination” in a keyword search. Then, we tallied the extracted articles based on the month of publication and number of characters in order to conduct a time-series analysis. Results: We extracted a total of 219 articles. Of these, 154 (70.3%) were positive and 51 (23.3%) were negative toward HPV vaccination. Of the 51 negative articles, 4 (7.8%) were published before June 2013, when routine vaccination was temporarily discontinued due to concerns regarding side effects, and 47 (92.2%) were published since then. The negative reports commonly cited side effects, although prior to June 2013, these issues were hardly mentioned. Although foreign media reports mentioned side effects before routine vaccination was temporarily discontinued, fewer articles mentioned side effects than recommendations for vaccination. Furthermore, on June 13, 2013, the World Health Organization’s advisory body Global Advisory Committee on Vaccine Safety issued a statement regarding the safety of HPV vaccines, but hardly any articles reported this statement. Rather, several articles were published about the side effects after June 2013. Conclusions: Since we consider media coverage to be a factor affecting human health behavior, the media should extensively report on the cost of not receiving cervical cancer vaccination, global trends concerning cervical cancer vaccination, and statements released by various agencies on the subject. %M 29258972 %R 10.2196/publichealth.8237 %U http://publichealth.jmir.org/2017/4/e97/ %U https://doi.org/10.2196/publichealth.8237 %U http://www.ncbi.nlm.nih.gov/pubmed/29258972 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e403 %T Media Consumption and Creation in Attitudes Toward and Knowledge of Inflammatory Bowel Disease: Web-Based Survey %A Groshek,Jacob %A Basil,Miles %A Guo,Ling %A Parker Ward,Sarah %A Farraye,Francis A %A Reich,Jason %+ Department of Emerging Media Studies, College of Communication, Boston University, Office 302D, 704 Commonwealth Ave., Boston, MA, 02215, United States, 1 617 353 6421, jgroshek@bu.edu %K inflammatory bowel disease %K social media %K health communication %K social stigma %D 2017 %7 08.12.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Inflammatory bowel disease (IBD) is a chronic gastrointestinal condition affecting over 5 million people globally and 1.6 million in the United States but currently lacks a precisely determined cause or cure. The range of symptoms IBD patients experience are often debilitating, and the societal stigmas associated with some such symptoms can further degrade their quality of life. Better understanding the nature of this public reproach then is a critical component for improving awareness campaigns and, ultimately, the experiences of IBD patients. Objective: The objective of this study was to explore and assess the public’s awareness and knowledge of IBD, as well as what relationship, if any, exists between the social stigma surrounding IBD, knowledge of the disease, and various media usage, including social media. Methods: Utilizing a Web-based opt-in platform, we surveyed a nationally representative sample (n=1200) with demographics mirroring those of the US Census figures across baseline parameters. Using constructed indices based on factor analysis, we were able to build reliable measures of personal characteristics, media behaviors, and perceptions and knowledge of IBD. Results: Among the American public, IBD is the most stigmatized of seven diseases, including genital herpes and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Additionally, IBD knowledge is generally low with 11.08% (133/1200) of the sample indicating no familiarity with the disease and 85.50% (1026/1200) of participants inaccurately answering two-thirds of the IBD index questions with which their knowledge was assessed. Increased knowledge of IBD is associated with lower levels of stigma. However, social media use is currently related to lower levels of IBD knowledge (P<.05). Furthermore, findings indicate that participants who most frequently engaged in producing social media content are less knowledgeable about IBD (P<.10), highlighting the potential for a dangerous cycle should they be contributing to a Web-based IBD dialogue. Conclusions: Greater efforts must be taken to stymie IBD misinformation across all media, but especially in social media channels, to increase IBD knowledge and reduce stigma surrounding IBD. These findings pave the way for further research qualitatively examining the pervasiveness of specific IBD messages found in today’s social media landscape and their impact on enacted stigmas so as to better equip providers and patient advocacy organizations with impactful communication solutions. %M 29222081 %R 10.2196/jmir.7624 %U http://www.jmir.org/2017/12/e403/ %U https://doi.org/10.2196/jmir.7624 %U http://www.ncbi.nlm.nih.gov/pubmed/29222081 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e54 %T Twitter and Public Health (Part 2): Qualitative Analysis of How Individual Health Professionals Outside Organizations Use Microblogging to Promote and Disseminate Health-Related Information %A Hart,Mark %A Stetten,Nichole %A Islam,Sabrina %A Pizarro,Katherine %+ Department of Behavioral Science and Community Health, University of Florida, 1225 Center Drive, HPNP Room 4144, PO Box 100175, Gainesville, FL, 32610, United States, 1 352 273 8545, kramtrah@phhp.ufl.edu %K Twitter %K social media %K public health %K technology transfer %K diffusion of innovation %D 2017 %7 04.10.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Twitter is the most popular form of microblogging that is being utilized in public health to engage audiences and to communicate health-related information. Although there is some research showing the various forms of Twitter use in public health, little is known about how individual public health professionals are using their personal Twitter accounts to disseminate health information. Objective: The purpose of this research was to categorize public health professionals’ tweets to evaluate how individual public health professionals are furthering the mission of public health. Methods: Twitter accounts held by public health professionals were identified, and researchers proceeded to record 6 months’ worth of each individual’s Twitter feed. During the 6-month period, a total of 15,236 tweets were collected and analyzed using the constant comparison method. Results: A total of 23 tweet categories among the 15,236 tweets were initially identified. Some of the most common topics among the 23 categories included the following: health nutrition (n=2008), conferences (n=815), Ebola (n=789), Affordable Care Act (ACA)/health care (n=627), and social justice (n=626). Each of these categories were then stratified into one of four themes: (1) informing and educating, (2) monitoring health statuses and trends, (3) social justice, and (4) professional development. Conclusions: Using Twitter, public health professionals are helping dispel misinformation through education and by translating technical research into lay terms, advocating for health inequalities, and using it as a means to promote professional development. %M 28978500 %R 10.2196/publichealth.6796 %U https://publichealth.jmir.org/2017/4/e54/ %U https://doi.org/10.2196/publichealth.6796 %U http://www.ncbi.nlm.nih.gov/pubmed/28978500 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 3 %P e49 %T The Use of Facebook Advertising for Communicating Public Health Messages: A Campaign Against Drinking During Pregnancy in New Zealand %A Parackal,Mathew %A Parackal,Sherly %A Eusebius,Shobhit %A Mather,Damien %+ Department of Marketing, University of Otago, Suite 6.35, Commerce Building, 60 Clyde Street, Dunedin, 9035, New Zealand, 64 34797696, mathew.parackal@otago.ac.nz %K social media %K health promotion %K alcohol %K pregnancy %K New Zealand %D 2017 %7 10.08.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media is gaining recognition as a platform for delivering public health messages. One area attracting attention from public health researchers and professionals is Facebook’s advertising channel. This channel is reported to have a broad reach and generate high user engagement with the disseminated campaign materials. However, to date, no study has examined the communication process via this channel which this study aimed to address. Objective: The specific objectives of the study were to (1) examine user engagement for a public health campaign based on the metadata provided by Facebook, (2) analyze comments generated by the campaign materials using text mining, and (3) investigate the relationship between the themes identified in the comments and the message and the sentiments prevalent in the themes that exhibited significant relationships. Methods: This study examined a New Zealand public health pilot campaign called “Don’t Know? Don’t Drink,” which warned against drinking alcohol during pregnancy. The campaign conveyed the warning through a video and three banner ads that were delivered as news feeds to women aged 18-30 years. Thematic analysis using text mining performed on the comments (n=819) identified four themes. Logistic regression was used to identify meaning-making themes that exhibited association with the message. Results: The users’ engagement was impressive with the video receiving 203,754 views. The combined likes and shares for the promotional materials (video and banner ads) amounted to 6125 and 300, respectively. The logistic regression analysis showed two meaning-making themes, namely, risk of pregnancy (P=.003) and alcohol and culture (P<.001) exhibited association with the message. The sentiment analysis carried out on the two themes revealed there were more negative than positive comments (47% vs 28%). Conclusions: The user engagement observed in this study was consistent with previous research. The numbers reported for views, likes, and shares may be seen as unique interactions over the fixed period of the campaign; however, survey research would be required to find out the true evaluative worth of these metadata. A close examination of the comments, employing text mining, revealed that the message was not accepted by a majority of the target segment. Self-identity and conformity theories may help to explain these observed reactions, albeit warrant further investigations. Although the comments were predominantly negative, they provide opportunities to engage back with the women. The one-way communication format followed in this campaign did not support any two-way engagement. Further investigation is warranted to establish whether using a two-way communication format would have improved the acceptability of such public health messages delivered via social media. The findings of this study caution using a one-way communication format to convey public health messages via Facebook’s advertising channel. %M 28798011 %R 10.2196/publichealth.7032 %U http://publichealth.jmir.org/2017/3/e49/ %U https://doi.org/10.2196/publichealth.7032 %U http://www.ncbi.nlm.nih.gov/pubmed/28798011 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e255 %T Images of Little Cigars and Cigarillos on Instagram Identified by the Hashtag #swisher: Thematic Analysis %A Allem,Jon-Patrick %A Escobedo,Patricia %A Chu,Kar-Hai %A Boley Cruz,Tess %A Unger,Jennifer B %+ Keck School of Medicine, University of Southern California, 2001 N Soto Street, 3rd Floor Mail, Los Angeles, CA,, United States, 1 858 603 0812, allem@usc.edu %K Instagram %K Swisher %K little cgars %K cigarillos %K social media %K blunts %K health behavior %K tobacco use %D 2017 %7 14.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Little cigar and cigarillo use is becoming more prevalent in the United States and elsewhere, with implications for public health. As little cigar and cigarillo use grows in popularity, big social media data (eg, Instagram, Google Web Search, Twitter) can be used to capture and document the context in which individuals use, and are marketed, these tobacco products. Big social media data may allow people to organically demonstrate how and why they use little cigars and cigarillos, unprimed by a researcher, without instrument bias and at low costs. Objective: This study characterized Swisher (the most popular brand of cigars in the United States, controlling over 75% of the market share) little cigar- and cigarillo-related posts on Instagram to inform the design of tobacco education campaigns and the development of future tobacco control efforts, and to demonstrate the utility in using big social media data in understanding health behaviors. Methods: We collected images from Instagram, an image-based social media app allowing users to capture, customize, and post photos on the Internet with over 400 million active users. Inclusion criteria for this study consisted of an Instagram post with the hashtag “#swisher”. We established rules for coding themes of images. Results: Of 1967 images collected, 486 (24.71%) were marijuana related, 348 (17.69%) were of tobacco products or promotional material, 324 (16.47%) showed individuals smoking, 225 (11.44%) were memes, and 584 (29.69%) were classified as other (eg, selfies, food, sexually explicit images). Of the marijuana-related images, 157/486 (32.3%) contained a Swisher wrapper, indicating that a Swisher product was used in blunt making, which involves hollowing out a cigar and refilling it with marijuana. Conclusions: Images from Instagram may be used to complement and extend the study of health behaviors including tobacco use. Images may be as valuable as, or more valuable than, words from other social media platforms alone. Posts on Instagram showing Swisher products, including blunt making, could add to the normalization of little cigar and cigarillo use and is an area of future research. Tobacco control researchers should design social media campaigns to combat smoking imagery found on popular sites such as Instagram. %M 28710057 %R 10.2196/jmir.7634 %U http://www.jmir.org/2017/7/e255/ %U https://doi.org/10.2196/jmir.7634 %U http://www.ncbi.nlm.nih.gov/pubmed/28710057 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e24 %T The Living the Example Social Media Substance Use Prevention Program: A Pilot Evaluation %A Evans,William %A Andrade,Elizabeth %A Goldmeer,Sandra %A Smith,Michelle %A Snider,Jeremy %A Girardo,Gunilla %+ Milken Institute School of Public Health, Department of Prevention and Community Health, The George Washington University, 950 New Hampshire Avenue, Washington, DC, 20052, United States, 1 2029943632, wdevans@gwu.edu %K substance use prevention %K peer-to-peer education %K social media %K adolescence %D 2017 %7 27.06.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adolescent substance use rates in rural areas of the United States, such as upstate New York, have risen substantially in recent years, calling for new intervention approaches in response to this trend. The Mentor Foundation USA conducts the Living the Example (LTE) campaign to engage youth in prevention using an experiential approach. As part of LTE, youth create their own prevention messages following a training curriculum in techniques for effective messaging and then share them via social media. This paper reports on a pilot evaluation of the LTE program. Objective: To conduct a pilot test of LTE in two rural high schools in upstate New York. We hypothesized that positive antidrug brand representations could be promoted using social media strategies to complement the Shattering the Myths (STM) in-person, event-based approach (hypothesis 1, H1), and that youth would respond positively and engage with prevention messages disseminated by their peers. We also hypothesized that exposure to the social media prevention messages would be associated with more positive substance use avoidance attitudes and beliefs, reductions in future use intentions, and decreased substance use at posttest (hypothesis 2, H2). Methods: We adapted a previously published curriculum created by the authors that focuses on branding, messaging, and social media for prevention. The curriculum consisted of five, one-hour sessions. It was delivered to participating youth in five sequential weeks after school at the two high schools in late October and early November 2016. We designed a pre- and posttest pilot implementation study to evaluate the effects of LTE on student uptake of the intervention and short-term substance use and related outcomes. Working at two high schools in upstate New York, we conducted a pilot feasibility evaluation of LTE with 9th-grade students (ie, freshmen) at these high schools. We administered a 125-item questionnaire online to capture data on media use; attitudes toward social media; next 30-day personal drug use intentions; personal reasons to use drugs; reasons participants believe their peers would use drugs; self-reported exposure to the LTE program; and receptivity to the LTE program, among those reporting exposure. We constructed multivariable logistic regression models to analyze the relationship between program receptivity and outcomes. First, in a cross-sectional logistic regression model, we regressed self-reported LTE message receipt on drug use intent and actions related to LTE messaging. Then, for analysis of participants with matched pre- and posttest responses, we used multilevel generalized estimating equation (GEE) techniques to model changes in behavior from baseline to follow-up. Results: Youth reported increased intentions to use marijuana (odds ratio [OR] 2.134, P=.02) between pre- and posttest. However, youth who reported exposure and receptivity to LTE reported a significant decrease in intentions (OR 0.239, P=.008). We observed a similar pattern for sedatives/sleeping pills—an increase in intentions overall (OR 1.886, P=.07), but a decrease among youth who reported exposure and receptivity to LTE (OR 0.210, P=.02). We saw the same pattern for use of any drug—an increase in reported intentions overall (OR 2.141, P=.02), but a decrease among youth who reported exposure and receptivity to LTE (OR 0.111, P=.004). Conclusions: We observed some evidence of significant LTE program effects. Social media may be an effective strategy for peer-to-peer substance use prevention in the future. These findings point both to the potential of LTE and the social media diffusion model and to the need for more research on a larger scale with an expanded youth population in the future. %M 28655704 %R 10.2196/mental.7839 %U http://mental.jmir.org/2017/2/e24/ %U https://doi.org/10.2196/mental.7839 %U http://www.ncbi.nlm.nih.gov/pubmed/28655704 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e193 %T Too Far to Care? Measuring Public Attention and Fear for Ebola Using Twitter %A van Lent,Liza GG %A Sungur,Hande %A Kunneman,Florian A %A van de Velde,Bob %A Das,Enny %+ Centre for Language Studies, Radboud University, PO Box 9103, Nijmegen, 6500 HD, Netherlands, 31 024 3612928, lizavanlent@gmail.com %K psychological theory %K epidemics %K fear %K distance perception %K social media %D 2017 %7 13.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: In 2014, the world was startled by a sudden outbreak of Ebola. Although Ebola infections and deaths occurred almost exclusively in Guinea, Sierra Leone, and Liberia, few potential Western cases, in particular, caused a great stir among the public in Western countries. Objective: This study builds on the construal level theory to examine the relationship between psychological distance to an epidemic and public attention and sentiment expressed on Twitter. Whereas previous research has shown the potential of social media to assess real-time public opinion and sentiment, generalizable insights that further the theory development lack. Methods: Epidemiological data (number of Ebola infections and fatalities) and media data (tweet volume and key events reported in the media) were collected for the 2014 Ebola outbreak, and Twitter content from the Netherlands was coded for (1) expressions of fear for self or fear for others and (2) psychological distance of the outbreak to the tweet source. Longitudinal relations were compared using vector error correction model (VECM) methodology. Results: Analyses based on 4500 tweets revealed that increases in public attention to Ebola co-occurred with severe world events related to the epidemic, but not all severe events evoked fear. As hypothesized, Web-based public attention and expressions of fear responded mainly to the psychological distance of the epidemic. A chi-square test showed a significant positive relation between proximity and fear: χ22=103.2 (P<.001). Public attention and fear for self in the Netherlands showed peaks when Ebola became spatially closer by crossing the Mediterranean Sea and Atlantic Ocean. Fear for others was mostly predicted by the social distance to the affected parties. Conclusions: Spatial and social distance are important predictors of public attention to worldwide crisis such as epidemics. These factors need to be taken into account when communicating about human tragedies. %M 28611015 %R 10.2196/jmir.7219 %U http://www.jmir.org/2017/6/e193/ %U https://doi.org/10.2196/jmir.7219 %U http://www.ncbi.nlm.nih.gov/pubmed/28611015 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 2 %P e34 %T Measuring Audience Engagement for Public Health Twitter Chats: Insights From #LiveFitNOLA %A Rabarison,Kristina M %A Croston,Merriah A %A Englar,Naomi K %A Bish,Connie L %A Flynn,Shelbi M %A Johnson,Carolyn C %+ Centers for Disease Control and Prevention, Division of Population Health, 4770 Buford Hwy NE MS F78, Atlanta, GA, 30341, United States, 1 770 488 5810, krabarison@cdc.gov %K social media %K Twitter %K Twitter chat %K public health, communication %K content analysis %K social network analysis %D 2017 %7 08.06.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 28596149 %R 10.2196/publichealth.7181 %U http://publichealth.jmir.org/2017/2/e34/ %U https://doi.org/10.2196/publichealth.7181 %U http://www.ncbi.nlm.nih.gov/pubmed/28596149 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 2 %P e33 %T Recruiting Young Gay and Bisexual Men for a Human Papillomavirus Vaccination Intervention Through Social Media: The Effects of Advertisement Content %A Reiter,Paul L %A Katz,Mira L %A Bauermeister,Jose A %A Shoben,Abigail B %A Paskett,Electra D %A McRee,Annie-Laurie %+ College of Medicine, Ohio State University, 1590 North High Street, Suite 525, Columbus, OH, 43201, United States, 1 614 366 4265, paul.reiter@osumc.edu %K HPV %K HPV vaccine %K gay and bisexual men %K social media %D 2017 %7 02.06.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 28576758 %R 10.2196/publichealth.7545 %U http://publichealth.jmir.org/2017/2/e33/ %U https://doi.org/10.2196/publichealth.7545 %U http://www.ncbi.nlm.nih.gov/pubmed/28576758 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 1 %P e14 %T Tweet for Behavior Change: Using Social Media for the Dissemination of Public Health Messages %A Gough,Aisling %A Hunter,Ruth F %A Ajao,Oluwaseun %A Jurek,Anna %A McKeown,Gary %A Hong,Jun %A Barrett,Eimear %A Ferguson,Marbeth %A McElwee,Gerry %A McCarthy,Miriam %A Kee,Frank %+ UKCRC Centre of Excellence in Public Health Northern Ireland, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Institute of Clinical Sciences, Block B, Belfast,, United Kingdom, 44 028 9097 8931, a.gough@qub.ac.uk %K social media %K Twitter %K awareness %K public heath %K skin cancer %K behavior change %K communication %D 2017 %7 23.03.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media public health campaigns have the advantage of tailored messaging at low cost and large reach, but little is known about what would determine their feasibility as tools for inducing attitude and behavior change. Objective: The aim of this study was to test the feasibility of designing, implementing, and evaluating a social media–enabled intervention for skin cancer prevention. Methods: A quasi-experimental feasibility study used social media (Twitter) to disseminate different message “frames” related to care in the sun and cancer prevention. Phase 1 utilized the Northern Ireland cancer charity’s Twitter platform (May 1 to July 14, 2015). Following a 2-week “washout” period, Phase 2 commenced (August 1 to September 30, 2015) using a bespoke Twitter platform. Phase 2 also included a Thunderclap, whereby users allowed their social media accounts to automatically post a bespoke message on their behalf. Message frames were categorized into 5 broad categories: humor, shock or disgust, informative, personal stories, and opportunistic. Seed users with a notable following were contacted to be “influencers” in retweeting campaign content. A pre- and postintervention Web-based survey recorded skin cancer prevention knowledge and attitudes in Northern Ireland (population 1.8 million). Results: There were a total of 417,678 tweet impressions, 11,213 engagements, and 1211 retweets related to our campaign. Shocking messages generated the greatest impressions (shock, n=2369; informative, n=2258; humorous, n=1458; story, n=1680), whereas humorous messages generated greater engagement (humorous, n=148; shock, n=147; story, n=117; informative, n=100) and greater engagement rates compared with story tweets. Informative messages, resulted in the greatest number of shares (informative, n=17; humorous, n=10; shock, n=9; story, n=7). The study findings included improved knowledge of skin cancer severity in a pre- and postintervention Web-based survey, with greater awareness that skin cancer is the most common form of cancer (preintervention: 28.4% [95/335] vs postintervention: 39.3% [168/428] answered “True”) and that melanoma is most serious (49.1% [165/336] vs 55.5% [238/429]). The results also show improved attitudes toward ultraviolet (UV) exposure and skin cancer with a reduction in agreement that respondents “like to tan” (60.5% [202/334] vs 55.6% [238/428]). Conclusions: Social media–disseminated public health messages reached more than 23% of the Northern Ireland population. A Web-based survey suggested that the campaign might have contributed to improved knowledge and attitudes toward skin cancer among the target population. Findings suggested that shocking and humorous messages generated greatest impressions and engagement, but information-based messages were likely to be shared most. The extent of behavioral change as a result of the campaign remains to be explored, however, the change of attitudes and knowledge is promising. Social media is an inexpensive, effective method for delivering public health messages. However, existing and traditional process evaluation methods may not be suitable for social media. %M 28336503 %R 10.2196/publichealth.6313 %U http://publichealth.jmir.org/2017/1/e14/ %U https://doi.org/10.2196/publichealth.6313 %U http://www.ncbi.nlm.nih.gov/pubmed/28336503 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e171 %T E-Cigarette Social Media Messages: A Text Mining Analysis of Marketing and Consumer Conversations on Twitter %A Lazard,Allison J %A Saffer,Adam J %A Wilcox,Gary B %A Chung,Arnold DongWoo %A Mackert,Michael S %A Bernhardt,Jay M %+ Center for Health Communication, Moody College of Communication, The University of Texas at Austin, CMB 3.120, Austin, TX, United States, 1 317 331 7807, lazard@unc.edu %K e-cigarettes %K social media %K tweet %K Internet %D 2016 %7 12.12.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As the use of electronic cigarettes (e-cigarettes) rises, social media likely influences public awareness and perception of this emerging tobacco product. Objective: This study examined the public conversation on Twitter to determine overarching themes and insights for trending topics from commercial and consumer users. Methods: Text mining uncovered key patterns and important topics for e-cigarettes on Twitter. SAS Text Miner 12.1 software (SAS Institute Inc) was used for descriptive text mining to reveal the primary topics from tweets collected from March 24, 2015, to July 3, 2015, using a Python script in conjunction with Twitter’s streaming application programming interface. A total of 18 keywords related to e-cigarettes were used and resulted in a total of 872,544 tweets that were sorted into overarching themes through a text topic node for tweets (126,127) and retweets (114,451) that represented more than 1% of the conversation. Results: While some of the final themes were marketing-focused, many topics represented diverse proponent and user conversations that included discussion of policies, personal experiences, and the differentiation of e-cigarettes from traditional tobacco, often by pointing to the lack of evidence for the harm or risks of e-cigarettes or taking the position that e-cigarettes should be promoted as smoking cessation devices. Conclusions: These findings reveal that unique, large-scale public conversations are occurring on Twitter alongside e-cigarette advertising and promotion. Proponents and users are turning to social media to share knowledge, experience, and questions about e-cigarette use. Future research should focus on these unique conversations to understand how they influence attitudes towards and use of e-cigarettes. %M 27956376 %R 10.2196/publichealth.6551 %U http://publichealth.jmir.org/2016/2/e171/ %U https://doi.org/10.2196/publichealth.6551 %U http://www.ncbi.nlm.nih.gov/pubmed/27956376 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 12 %P e318 %T Applying Multiple Data Collection Tools to Quantify Human Papillomavirus Vaccine Communication on Twitter %A Massey,Philip M %A Leader,Amy %A Yom-Tov,Elad %A Budenz,Alexandra %A Fisher,Kara %A Klassen,Ann C %+ Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St, Philadelphia, PA, 19104, United States, 1 267 359 6067, pmm85@drexel.edu %K HPV vaccine %K Twitter %K communication methods %K content analysis %K data mining %D 2016 %7 05.12.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. There are several vaccines that protect against strains of HPV most associated with cervical and other cancers. Thus, HPV vaccination has become an important component of adolescent preventive health care. As media evolves, more information about HPV vaccination is shifting to social media platforms such as Twitter. Health information consumed on social media may be especially influential for segments of society such as younger populations, as well as ethnic and racial minorities. Objective: The objectives of our study were to quantify HPV vaccine communication on Twitter, and to develop a novel methodology to improve the collection and analysis of Twitter data. Methods: We collected Twitter data using 10 keywords related to HPV vaccination from August 1, 2014 to July 31, 2015. Prospective data collection used the Twitter Search API and retrospective data collection used Twitter Firehose. Using a codebook to characterize tweet sentiment and content, we coded a subsample of tweets by hand to develop classification models to code the entire sample using machine learning procedures. We also documented the words in the 140-character tweet text most associated with each keyword. We used chi-square tests, analysis of variance, and nonparametric equality of medians to test for significant differences in tweet characteristic by sentiment. Results: A total of 193,379 English-language tweets were collected, classified, and analyzed. Associated words varied with each keyword, with more positive and preventive words associated with “HPV vaccine” and more negative words associated with name-brand vaccines. Positive sentiment was the largest type of sentiment in the sample, with 75,393 positive tweets (38.99% of the sample), followed by negative sentiment with 48,940 tweets (25.31% of the sample). Positive and neutral tweets constituted the largest percentage of tweets mentioning prevention or protection (20,425/75,393, 27.09% and 6477/25,110, 25.79%, respectively), compared with only 11.5% of negative tweets (5647/48,940; P<.001). Nearly one-half (22,726/48,940, 46.44%) of negative tweets mentioned side effects, compared with only 17.14% (12,921/75,393) of positive tweets and 15.08% of neutral tweets (3787/25,110; P<.001). Conclusions: Examining social media to detect health trends, as well as to communicate important health information, is a growing area of research in public health. Understanding the content and implications of conversations that form around HPV vaccination on social media can aid health organizations and health-focused Twitter users in creating a meaningful exchange of ideas and in having a significant impact on vaccine uptake. This area of research is inherently interdisciplinary, and this study supports this movement by applying public health, health communication, and data science approaches to extend methodologies across fields. %M 27919863 %R 10.2196/jmir.6670 %U http://www.jmir.org/2016/12/e318/ %U https://doi.org/10.2196/jmir.6670 %U http://www.ncbi.nlm.nih.gov/pubmed/27919863 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e228 %T Engaging Moms on Teen Indoor Tanning Through Social Media: Protocol of a Randomized Controlled Trial %A Pagoto,Sherry L %A Baker,Katie %A Griffith,Julia %A Oleski,Jessica L %A Palumbo,Ashley %A Walkosz,Barbara J %A Hillhouse,Joel %A Henry,Kimberly L %A Buller,David B %+ Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 856 2092, Sherry.Pagoto@umassmed.edu %K skin cancer %K indoor tanning %K melanoma %K Facebook %K social media %K health communication %D 2016 %7 29.11.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Indoor tanning elevates the risk for melanoma, which is now the most common cancer in US women aged 25-29. Public policies restricting access to indoor tanning by minors to reduce melanoma morbidity and mortality in teens are emerging. In the United States, the most common policy restricting indoor tanning in minors involves parents providing either written or in person consent for the minor to purchase a tanning visit. The effectiveness of this policy relies on parents being properly educated about the harms of indoor tanning to their children. Objective: This randomized controlled trial will test the efficacy of a Facebook-delivered health communication intervention targeting mothers of teenage girls. The intervention will use health communication and behavioral modification strategies to reduce mothers’ permissiveness regarding their teenage daughters’ use of indoor tanning relative to an attention-control condition with the ultimate goal of reducing indoor tanning in both daughters and mothers. Methods: The study is a 12-month randomized controlled trial comparing 2 conditions: an attention control Facebook private group where content will be relevant to teen health with 25% focused on prescription drug abuse, a topic unrelated to tanning; and the intervention condition will enter participants into a Facebook private group where 25% of the teen health content will be focused on indoor tanning. A cohort of 2000 mother-teen daughter dyads will be recruited to participate in this study. Only mothers will participate in the Facebook groups. Both mothers and daughters will complete measures at baseline, end of intervention (1-year) and 6 months post-intervention. Primary outcomes include mothers’ permissiveness regarding their teenage daughters’ use of indoor tanning, teenage daughters’ perception of their mothers’ permissiveness, and indoor tanning by both mothers and daughters. Results: The first dyad was enrolled on March 31, 2016, and we anticipate completing this study by October 2019. Conclusions: This trial will deliver social media content grounded in theory and will test it in a randomized design with state-of-the-art measures. This will contribute much needed insights on how to employ social media for health behavior change and disease prevention both for indoor tanning and other health risk behaviors and inform future social media efforts by public health and health care organizations. ClinicalTrial: Clinicaltrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807 (Archived by WebCite at http://www.webcitation.org/6mDMICcCE). %M 27899339 %R 10.2196/resprot.6624 %U http://www.researchprotocols.org/2016/4/e228/ %U https://doi.org/10.2196/resprot.6624 %U http://www.ncbi.nlm.nih.gov/pubmed/27899339 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e168 %T Estimating the Duration of Public Concern After the Fukushima Dai-ichi Nuclear Power Station Accident From the Occurrence of Radiation Exposure-Related Terms on Twitter: A Retrospective Data Analysis %A Nishimoto,Naoki %A Ota,Mizuki %A Yagahara,Ayako %A Ogasawara,Katsuhiko %+ Hokkaido University, Faculty of Health Science School, Kita 12 zyou Nishi 5 chome, Kita-ku, Sapporo, 060-0812, Japan, 81 11 706 3409, oga@hs.hokudai.ac.jp %K Twitter %K social media %K public concern %K nuclear power plants %K survival analysis %K Kaplan-Meier estimate %K infodemiology %K radiation %D 2016 %7 25.11.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: After the Fukushima Dai-ichi Nuclear Power Station accident in Japan on March 11, 2011, a large number of comments, both positive and negative, were posted on social media. Objective: The objective of this study was to clarify the characteristics of the trend in the number of tweets posted on Twitter, and to estimate how long public concern regarding the accident continued. We surveyed the attenuation period of the first term occurrence related to radiation exposure as a surrogate endpoint for the duration of concern. Methods: We retrieved 18,891,284 tweets from Twitter data between March 11, 2011 and March 10, 2012, containing 143 variables in Japanese. We selected radiation, radioactive, Sievert (Sv), Becquerel (Bq), and gray (Gy) as keywords to estimate the attenuation period of public concern regarding radiation exposure. These data, formatted as comma-separated values, were transferred into a Statistical Analysis System (SAS) dataset for analysis, and survival analysis methodology was followed using the SAS LIFETEST procedure. This study was approved by the institutional review board of Hokkaido University and informed consent was waived. Results: A Kaplan-Meier curve was used to show the rate of Twitter users posting a message after the accident that included one or more of the keywords. The term Sv occurred in tweets up to one year after the first tweet. Among the Twitter users studied, 75.32% (880,108/1,168,542) tweeted the word radioactive and 9.20% (107,522/1,168,542) tweeted the term Sv. The first reduction was observed within the first 7 days after March 11, 2011. The means and standard errors (SEs) of the duration from the first tweet on March 11, 2011 were 31.9 days (SE 0.096) for radioactive and 300.6 days (SE 0.181) for Sv. These keywords were still being used at the end of the study period. The mean attenuation period for radioactive was one month, and approximately one year for radiation and radiation units. The difference in mean duration between the keywords was attributed to the effect of mass media. Regularly posted messages, such as daily radiation dose reports, were relatively easy to detect from their time and formatted contents. The survival estimation indicated that public concern about the nuclear power plant accident remained after one year. Conclusions: Although the simple plot of the number of tweets did not show clear results, we estimated the mean attenuation period as approximately one month for the keyword radioactive, and found that the keywords were still being used in posts at the end of the study period. Further research is required to quantify the effect of other phrases in social media data. The results of this exploratory study should advance progress in influencing and quantifying the communication of risk. %M 27888168 %R 10.2196/publichealth.5384 %U http://publichealth.jmir.org/2016/2/e168/ %U https://doi.org/10.2196/publichealth.5384 %U http://www.ncbi.nlm.nih.gov/pubmed/27888168 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e166 %T “Mommy Blogs” and the Vaccination Exemption Narrative: Results From A Machine-Learning Approach for Story Aggregation on Parenting Social Media Sites %A Tangherlini,Timothy R %A Roychowdhury,Vwani %A Glenn,Beth %A Crespi,Catherine M %A Bandari,Roja %A Wadia,Akshay %A Falahi,Misagh %A Ebrahimzadeh,Ehsan %A Bastani,Roshan %+ Department of Electrical Engineering, University of California, Los Angeles, 56-125B Engineering IV Building, 420 Westwood Plaza (Box 951594), Los Angeles, CA, 90095-1594, United States, 1 310 206 4975, vwani@ee.ucla.edu %K vaccination %K social media %K machine learning %K personal narratives %K Internet %K health knowledge %K attitudes %K practice %D 2016 %7 22.11.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media offer an unprecedented opportunity to explore how people talk about health care at a very large scale. Numerous studies have shown the importance of websites with user forums for people seeking information related to health. Parents turn to some of these sites, colloquially referred to as “mommy blogs,” to share concerns about children’s health care, including vaccination. Although substantial work has considered the role of social media, particularly Twitter, in discussions of vaccination and other health care–related issues, there has been little work on describing the underlying structure of these discussions and the role of persuasive storytelling, particularly on sites with no limits on post length. Understanding the role of persuasive storytelling at Internet scale provides useful insight into how people discuss vaccinations, including exemption-seeking behavior, which has been tied to a recent diminution of herd immunity in some communities. Objective: To develop an automated and scalable machine-learning method for story aggregation on social media sites dedicated to discussions of parenting. We wanted to discover the aggregate narrative frameworks to which individuals, through their exchange of experiences and commentary, contribute over time in a particular topic domain. We also wanted to characterize temporal trends in these narrative frameworks on the sites over the study period. Methods: To ensure that our data capture long-term discussions and not short-term reactions to recent events, we developed a dataset of 1.99 million posts contributed by 40,056 users and viewed 20.12 million times indexed from 2 parenting sites over a period of 105 months. Using probabilistic methods, we determined the topics of discussion on these parenting sites. We developed a generative statistical-mechanical narrative model to automatically extract the underlying stories and story fragments from millions of posts. We aggregated the stories into an overarching narrative framework graph. In our model, stories were represented as network graphs with actants as nodes and their various relationships as edges. We estimated the latent stories circulating on these sites by modeling the posts as a sampling of the hidden narrative framework graph. Temporal trends were examined based on monthly user-poststatistics. Results: We discovered that discussions of exemption from vaccination requirements are highly represented. We found a strong narrative framework related to exemption seeking and a culture of distrust of government and medical institutions. Various posts reinforced part of the narrative framework graph in which parents, medical professionals, and religious institutions emerged as key nodes, and exemption seeking emerged as an important edge. In the aggregate story, parents used religion or belief to acquire exemptions to protect their children from vaccines that are required by schools or government institutions, but (allegedly) cause adverse reactions such as autism, pain, compromised immunity, and even death. Although parents joined and left the discussion forums over time, discussions and stories about exemptions were persistent and robust to these membership changes. Conclusions: Analyzing parent forums about health care using an automated analytic approach, such as the one presented here, allows the detection of widespread narrative frameworks that structure and inform discussions. In most vaccination stories from the sites we analyzed, it is taken for granted that vaccines and not vaccine preventable diseases (VPDs) pose a threat to children. Because vaccines are seen as a threat, parents focus on sharing successful strategies for avoiding them, with exemption being the foremost among these strategies. When new parents join such sites, they may be exposed to this endemic narrative framework in the threads they read and to which they contribute, which may influence their health care decision making. %M 27876690 %R 10.2196/publichealth.6586 %U http://publichealth.jmir.org/2016/2/e166/ %U https://doi.org/10.2196/publichealth.6586 %U http://www.ncbi.nlm.nih.gov/pubmed/27876690 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e124 %T Safe Sex Messages Within Dating and Entertainment Smartphone Apps: A Review %A Huang,Evelyn Tzu-Yen %A Williams,Henrietta %A Hocking,Jane S %A Lim,Megan SC %+ Austin Hospital, Austin Health, 145 Studley Road, Heidelberg, 3084, Australia, 61 3 9496 5000, drevelynhuang@gmail.com %K mobile apps %K sexual health %K STDs %K sexually transmitted diseases %K mobile health %K mHealth %D 2016 %7 08.11.2016 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Smartphone apps provide a new platform for entertainment, information distribution, and health promotion activities, as well as for dating and casual sexual encounters. Previous research has shown high acceptability of sexual health interventions via smartphone apps; however, sexual health promotion apps were infrequently downloaded and underused. Integrating sexual health promotion into established apps might be a more effective method. Objective: The objective of our study was to critically review popular sex-related apps and dating apps, in order to ascertain whether they contain any sexual health content. Methods: Part 1: In January 2015, we used the term “sexual” to search for free apps in the Apple iTunes store and Android Google Play store, and categorized the sexual health content of the 137 apps identified. Part 2: We used the term “dating” to search for free geosocial-networking apps in the Apple iTunes and Android Google Play stores. The apps were downloaded to test functionality and to determine whether they included sexual health content. Results: Part 1: Of the 137 apps identified, 15 (11.0%) had sexual health content and 15 (11.0%) contained messages about sexual assault or violence. The majority of the apps did not contain any sexual health content. Part 2: We reviewed 60 dating apps: 44 (73%) targeting heterosexual users, 9 (15%) targeting men who have sex with men (MSM), 3 (5%) targeting lesbian women, and 4 (7%) for group dating. Only 9 dating apps contained sexual health content, of which 7 targeted MSM. Conclusions: The majority of sex-related apps and dating apps contained no sexual health content that could educate users about and remind them of their sexual risks. Sexual health practitioners and public health departments will need to work with app developers to promote sexual health within existing popular apps. For those apps that already contain sexual health messages, further study to investigate the effectiveness of the content is needed. %M 27826133 %R 10.2196/mhealth.5760 %U http://mhealth.jmir.org/2016/4/e124/ %U https://doi.org/10.2196/mhealth.5760 %U http://www.ncbi.nlm.nih.gov/pubmed/27826133 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e156 %T Disease Monitoring and Health Campaign Evaluation Using Google Search Activities for HIV and AIDS, Stroke, Colorectal Cancer, and Marijuana Use in Canada: A Retrospective Observational Study %A Ling,Rebecca %A Lee,Joon %+ School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 31567, joon.lee@uwaterloo.ca %K public health informatics %K Internet %K information seeking behavior %D 2016 %7 12.10.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Infodemiology can offer practical and feasible health research applications through the practice of studying information available on the Web. Google Trends provides publicly accessible information regarding search behaviors in a population, which may be studied and used for health campaign evaluation and disease monitoring. Additional studies examining the use and effectiveness of Google Trends for these purposes remain warranted. Objective: The objective of our study was to explore the use of infodemiology in the context of health campaign evaluation and chronic disease monitoring. It was hypothesized that following a launch of a campaign, there would be an increase in information seeking behavior on the Web. Second, increasing and decreasing disease patterns in a population would be associated with search activity patterns. This study examined 4 different diseases: human immunodeficiency virus (HIV) infection, stroke, colorectal cancer, and marijuana use. Methods: Using Google Trends, relative search volume data were collected throughout the period of February 2004 to January 2015. Campaign information and disease statistics were obtained from governmental publications. Search activity trends were graphed and assessed with disease trends and the campaign interval. Pearson product correlation statistics and joinpoint methodology analyses were used to determine significance. Results: Disease patterns and online activity across all 4 diseases were significantly correlated: HIV infection (r=.36, P<.001), stroke (r=.40, P<.001), colorectal cancer (r= −.41, P<.001), and substance use (r=.64, P<.001). Visual inspection and the joinpoint analysis showed significant correlations for the campaigns on colorectal cancer and marijuana use in stimulating search activity. No significant correlations were observed for the campaigns on stroke and HIV regarding search activity. Conclusions: The use of infoveillance shows promise as an alternative and inexpensive solution to disease surveillance and health campaign evaluation. Further research is needed to understand Google Trends as a valid and reliable tool for health research. %M 27733330 %R 10.2196/publichealth.6504 %U http://publichealth.jmir.org/2016/2/e156/ %U https://doi.org/10.2196/publichealth.6504 %U http://www.ncbi.nlm.nih.gov/pubmed/27733330 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e115 %T Using Knowledge Translation to Craft “Sticky” Social Media Health Messages That Provoke Interest, Raise Awareness, Impart Knowledge, and Inspire Change %A Shibasaki,Sanchia %A Gardner,Karen %A Sibthorpe,Beverly %+ ThinkThrough Consultancy Services, P O Box 7083, Holland Park, 4121, Australia, 61 0447040224, sanchia.shibasaki@gmail.com %K knowledge translation %K social media %K Indigenous health %K health promotion %D 2016 %7 05.10.2016 %9 Short Paper %J JMIR Mhealth Uhealth %G English %X Background: In Australia, there is growing use of technology supported knowledge translation (KT) strategies such as social media and mobile apps in health promotion and in Indigenous health. However, little is known about how individuals use technologies and the evidence base for the impact of these health interventions on health behavior change is meager. Objective: The objective of our study was to examine how Facebook is used to promote health messages to Indigenous people and discuss how KT can support planning and implementing health messages to ensure chosen strategies are fit for the purpose and achieve impact. Methods: A desktop audit of health promotion campaigns on smoking prevention and cessation for Australian Indigenous people using Facebook was conducted. Results: Our audit identified 13 out of 21 eligible campaigns that used Facebook. Facebook pages with the highest number of likes (more than 5000) were linked to a website and to other social media applications and demonstrated stickiness characteristics by posting frequently (triggers and unexpected), recruiting sporting or public personalities to promote campaigns (social currency and public), recruiting Indigenous people from the local region (stories and emotion), and sharing stories and experiences based on real-life events (credible and practical value). Conclusions: KT planning may support campaigns to identify and select KT strategies that are best suited and well-aligned to the campaign’s goals, messages, and target audiences. KT planning can also help mitigate unforeseen and expected risks, reduce unwarranted costs and expenses, achieve goals, and limit the peer pressure of using strategies that may not be fit for purpose. One of the main challenges in using KT systems and processes involves coming to an adequate conceptualization of the KT process itself. %M 27707685 %R 10.2196/mhealth.5987 %U http://mhealth.jmir.org/2016/4/e115/ %U https://doi.org/10.2196/mhealth.5987 %U http://www.ncbi.nlm.nih.gov/pubmed/27707685 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e153 %T Chiropractic and Spinal Manipulation Therapy on Twitter: Case Study Examining the Presence of Critiques and Debates %A Marcon,Alessandro R %A Klostermann,Philip %A Caulfield,Timothy %+ Health Law Institute, Department of Law, University of Alberta, University Campus, NW, Edmonton, AB, T6G 2H5, Canada, 1 780 492 9575, caulfield@ualberta.ca %K spinal manipulation %K manipulation therapy %K chiropractic %K alternative medicine %K Twitter %K social media %K infodemiology %D 2016 %7 16.09.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Spinal manipulation therapy (SMT) is a popular though controversial practice. The debates surrounding efficacy and risk of SMT are only partially evident in popular discourse. Objective: This study aims to investigate the presence of critiques and debates surrounding efficacy and risk of SMT on the social media platform Twitter. The study examines whether there is presence of debate and whether critical information is being widely disseminated. Methods: An initial corpus of 31,339 tweets was compiled through Twitter’s Search Application Programming Interface using the query terms “chiropractic,” “chiropractor,” and “spinal manipulation therapy.” Tweets were collected for the month of December 2015. Post removal of tweets made by bots and spam, the corpus totaled 20,695 tweets, of which a sample (n=1267) was analyzed for skeptical or critical tweets. Additional criteria were also assessed. Results: There were 34 tweets explicitly containing skepticism or critique of SMT, representing 2.68% of the sample (n=1267). As such, there is a presence of 2.68% of tweets in the total corpus, 95% CI 0-6.58% displaying explicitly skeptical or critical perspectives of SMT. In addition, there are numerous tweets highlighting the health benefits of SMT for health issues such as attention deficit hyperactivity disorder (ADHD), immune system, and blood pressure that receive scant critical attention. The presence of tweets in the corpus highlighting the risks of “stroke” and “vertebral artery dissection” is also minute (0.1%). Conclusions: In the abundance of tweets substantiating and promoting chiropractic and SMT as sound health practices and valuable business endeavors, the debates surrounding the efficacy and risks of SMT on Twitter are almost completely absent. Although there are some critical voices of SMT proving to be influential, issues persist regarding how widely this information is being disseminated. %M 27637456 %R 10.2196/publichealth.5739 %U http://publichealth.jmir.org/2016/2/e153/ %U https://doi.org/10.2196/publichealth.5739 %U http://www.ncbi.nlm.nih.gov/pubmed/27637456 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 9 %P e235 %T Does Digital Video Advertising Increase Population-Level Reach of Multimedia Campaigns? Evidence From the 2013 Tips From Former Smokers Campaign %A Davis,Kevin C %A Shafer,Paul R %A Rodes,Robert %A Kim,Annice %A Hansen,Heather %A Patel,Deesha %A Coln,Caryn %A Beistle,Diane %+ Center for Health Policy Science and Tobacco Research, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, United States, 1 919 541 5801, kcdavis@rti.org %K social marketing %K smoking %K health campaigns %K digital advertising %K television advertising %D 2016 %7 14.09.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Federal and state public health agencies in the United States are increasingly using digital advertising and social media to promote messages from broader multimedia campaigns. However, little evidence exists on population-level campaign awareness and relative cost efficiencies of digital advertising in the context of a comprehensive public health education campaign. Objective: Our objective was to compare the impact of increased doses of digital video and television advertising from the 2013 Tips From Former Smokers (Tips) campaign on overall campaign awareness at the population level. We also compared the relative cost efficiencies across these media platforms. Methods: We used data from a large national online survey of approximately 15,000 US smokers conducted in 2013 immediately after the conclusion of the 2013 Tips campaign. These data were used to compare the effects of variation in media dose of digital video and television advertising on population-level awareness of the Tips campaign. We implemented higher doses of digital video among selected media markets and randomly selected other markets to receive similar higher doses of television ads. Multivariate logistic regressions estimated the odds of overall campaign awareness via digital or television format as a function of higher-dose media in each market area. All statistical tests used the .05 threshold for statistical significance and the .10 level for marginal nonsignificance. We used adjusted advertising costs for the additional doses of digital and television advertising to compare the cost efficiencies of digital and television advertising on the basis of costs per percentage point of population awareness generated. Results: Higher-dose digital video advertising was associated with 94% increased odds of awareness of any ad online relative to standard-dose markets (P<.001). Higher-dose digital advertising was associated with a marginally nonsignificant increase (46%) in overall campaign awareness regardless of media format (P=.09). Higher-dose television advertising was associated with 81% increased odds of overall ad awareness regardless of media format (P<.001). Increased doses of television advertising were also associated with significantly higher odds of awareness of any ad on television (P<.001) and online (P=.04). The adjusted cost of each additional percentage point of population-level reach generated by higher doses of advertising was approximately US $440,000 for digital advertising and US $1 million for television advertising. Conclusions: Television advertising generated relatively higher levels of overall campaign awareness. However, digital video was relatively more cost efficient for generating awareness. These results suggest that digital video may be used as a cost-efficient complement to traditional advertising modes (eg, television), but digital video should not replace television given the relatively smaller audience size of digital video viewers. %M 27627853 %R 10.2196/jmir.5683 %U http://www.jmir.org/2016/9/e235/ %U https://doi.org/10.2196/jmir.5683 %U http://www.ncbi.nlm.nih.gov/pubmed/27627853 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e232 %T Characterizing Twitter Discussions About HPV Vaccines Using Topic Modeling and Community Detection %A Surian,Didi %A Nguyen,Dat Quoc %A Kennedy,Georgina %A Johnson,Mark %A Coiera,Enrico %A Dunn,Adam G %+ Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, New South Wales, 2109, Australia, 61 +61298502455, didi.surian@mq.edu.au %K topic modelling %K graph algorithms analysis %K social media %K public health surveillance %D 2016 %7 29.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: In public health surveillance, measuring how information enters and spreads through online communities may help us understand geographical variation in decision making associated with poor health outcomes. Objective: Our aim was to evaluate the use of community structure and topic modeling methods as a process for characterizing the clustering of opinions about human papillomavirus (HPV) vaccines on Twitter. Methods: The study examined Twitter posts (tweets) collected between October 2013 and October 2015 about HPV vaccines. We tested Latent Dirichlet Allocation and Dirichlet Multinomial Mixture (DMM) models for inferring topics associated with tweets, and community agglomeration (Louvain) and the encoding of random walks (Infomap) methods to detect community structure of the users from their social connections. We examined the alignment between community structure and topics using several common clustering alignment measures and introduced a statistical measure of alignment based on the concentration of specific topics within a small number of communities. Visualizations of the topics and the alignment between topics and communities are presented to support the interpretation of the results in context of public health communication and identification of communities at risk of rejecting the safety and efficacy of HPV vaccines. Results: We analyzed 285,417 Twitter posts (tweets) about HPV vaccines from 101,519 users connected by 4,387,524 social connections. Examining the alignment between the community structure and the topics of tweets, the results indicated that the Louvain community detection algorithm together with DMM produced consistently higher alignment values and that alignments were generally higher when the number of topics was lower. After applying the Louvain method and DMM with 30 topics and grouping semantically similar topics in a hierarchy, we characterized 163,148 (57.16%) tweets as evidence and advocacy, and 6244 (2.19%) tweets describing personal experiences. Among the 4548 users who posted experiential tweets, 3449 users (75.84%) were found in communities where the majority of tweets were about evidence and advocacy. Conclusions: The use of community detection in concert with topic modeling appears to be a useful way to characterize Twitter communities for the purpose of opinion surveillance in public health applications. Our approach may help identify online communities at risk of being influenced by negative opinions about public health interventions such as HPV vaccines. %M 27573910 %R 10.2196/jmir.6045 %U http://www.jmir.org/2016/8/e232/ %U https://doi.org/10.2196/jmir.6045 %U http://www.ncbi.nlm.nih.gov/pubmed/27573910 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e211 %T Making Quality Health Websites a National Public Health Priority: Toward Quality Standards %A Devine,Theresa %A Broderick,Jordan %A Harris,Linda M %A Wu,Huijuan %A Hilfiker,Sandra Williams %+ CommunicateHealth, Inc., 26 Market St., Northampton, MA, 01060, United States, 1 413 582 0425, huijuan@communicatehealth.com %K online health information %K health literacy %K reliability %K usability %K measurement %D 2016 %7 02.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Most US adults have limited health literacy skills. They struggle to understand complex health information and services and to make informed health decisions. The Internet has quickly become one of the most popular places for people to search for information about their health, thereby making access to quality information on the Web a priority. However, there are no standardized criteria for evaluating Web-based health information. Every 10 years, the US Department of Health and Human Services' Office of Disease Prevention and Health Promotion (ODPHP) develops a set of measurable objectives for improving the health of the nation over the coming decade, known as Healthy People. There are two objectives in Healthy People 2020 related to website quality. The first is objective Health Communication and Health Information Technology (HC/HIT) 8.1: increase the proportion of health-related websites that meet 3 or more evaluation criteria for disclosing information that can be used to assess information reliability. The second is objective HC/HIT-8.2: increase the proportion of health-related websites that follow established usability principles. Objective: The ODPHP conducted a nationwide assessment of the quality of Web-based health information using the Healthy People 2020 objectives. The ODPHP aimed to establish (1) a standardized approach to defining and measuring the quality of health websites; (2) benchmarks for measurement; (3) baseline data points to capture the current status of website quality; and (4) targets to drive improvement. Methods: The ODPHP developed the National Quality Health Website Survey instrument to assess the quality of health-related websites. The ODPHP used this survey to review 100 top-ranked health-related websites in order to set baseline data points for these two objectives. The ODPHP then set targets to drive improvement by 2020. Results: This study reviewed 100 health-related websites. For objective HC/HIT-8.1, a total of 58 out of 100 (58.0%) websites met 3 or more out of 6 reliability criteria. For objective HC/HIT-8.2, a total of 42 out of 100 (42.0%) websites followed 10 or more out of 19 established usability principles. On the basis of these baseline data points, ODPHP set targets for the year 2020 that meet the minimal statistical significance—increasing objective HC/HIT-8.1 data point to 70.5% and objective HC/HIT-8.2 data point to 55.7%. Conclusions: This research is a critical first step in evaluating the quality of Web-based health information. The criteria proposed by ODPHP provide methods to assess website quality for professionals designing, developing, and managing health-related websites. The criteria, baseline data, and targets are valuable tools for driving quality improvement. %M 27485512 %R 10.2196/jmir.5999 %U http://www.jmir.org/2016/8/e211/ %U https://doi.org/10.2196/jmir.5999 %U http://www.ncbi.nlm.nih.gov/pubmed/27485512 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 1 %P e27 %T Facebook Advertising Across an Engagement Spectrum: A Case Example for Public Health Communication %A Platt,Tevah %A Platt,Jodyn %A Thiel,Daniel B %A Kardia,Sharon L. R %+ School of Public Health, Department of Epidemiology, University of Michigan, SPH 1, 1415 Washington Heights, #4600, Ann Arbor, MI, 48109, United States, 1 734 615 3412, tevah@umich.edu %K Internet %K facebook %K social media %K facebook advertising campaign %K social media engagement %K health communication %K social networking %K biobanking %K neonatal screening %K infant %K newborn screening %D 2016 %7 30.05.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The interpersonal, dialogic features of social networking sites have untapped potential for public health communication. We ran a Facebook advertising campaign to raise statewide awareness of Michigan’s newborn screening and biobanking programs. Objective: We ran a Facebook advertising campaign to stimulate public engagement on the complex and sensitive issue of Michigan’s newborn screening and biobank programs. Methods: We ran an 11-week, US $15,000 Facebook advertising campaign engaging Michigan Facebook users aged 18-64 years about the state’s newborn screening and population biobank programs, and we used a novel “engagement spectrum” framework to contextualize and evaluate engagement outcomes ranging from observation to multi-way conversation. Results: The campaign reached 1.88 million Facebook users, yielding a range of engagement outcomes across ad sets that varied by objective, content, budget, duration, and bid type. Ad sets yielded 9009 page likes (US $4125), 15,958 website clicks (US $5578), and 12,909 complete video views to 100% (US $3750). “Boosted posts” yielded 528 comments and 35,966 page post engagements (US $1500). Overall, the campaign led to 452 shares and 642 comments, including 176 discussing newborn screening and biobanking. Conclusions: Facebook advertising campaigns can efficiently reach large populations and achieve a range of engagement outcomes by diversifying ad types, bid types, and content. This campaign provided a population-based approach to communication that also increased transparency on a sensitive and complex topic by creating a forum for multi-way interaction. %M 27244774 %R 10.2196/publichealth.5623 %U http://publichealth.jmir.org/2016/1/e27/ %U https://doi.org/10.2196/publichealth.5623 %U http://www.ncbi.nlm.nih.gov/pubmed/27244774 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 1 %P e19 %T Medical Institutions and Twitter: A Novel Tool for Public Communication in Japan %A Sugawara,Yuya %A Narimatsu,Hiroto %A Tsuya,Atsushi %A Tanaka,Atsushi %A Fukao,Akira %+ Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan, 81 (0)45 520 2222, hiroto-narimatsu@umin.org %K social media %K Web 2.0 %K medical education %K consultation guidance %K advertisement %D 2016 %7 12.05.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Twitter is a free social networking and microblogging service on the Internet. Medical professionals and patients have started to use Twitter in medicine. Twitter use by medical institutions can interactively and efficiently provide public health information and education for laypeople. Objective: This study examined Twitter usage by medical institutions. Methods: We reviewed all Japanese user accounts in which the names of medical institutions were described in the user’s Twitter profile. We then classified medical institutions’ tweets by content. Results: We extracted 168 accounts for medical institutions with ≥500 followers. The medical specialties of those accounts were dentistry and oral surgery (n=73), dermatology (n=12), cosmetic surgery (n=10), internal medicine (n=10), ophthalmology (n=6), obstetrics and gynecology (n=5), plastic surgery (n=2), and others (n=50). Of these, 21 accounts tweeted medical knowledge and 45 accounts tweeted guidance about medical practice and consultation hours, including advertisements. In the dentistry and oral surgery accounts, individual behavior or thinking was the most frequent (22/71, 31%) content. On the other hand, consultation including advertisements was the most frequent (14/23, 61%) in cosmetic surgery, plastic surgery, and dermatology. Conclusions: Some medical specialties used Twitter for disseminating medical knowledge or guidance including advertisements. This indicates that Twitter potentially can be used for various purposes by different medical specialties. %M 27227154 %R 10.2196/publichealth.4831 %U http://publichealth.jmir.org/2016/1/e19/ %U https://doi.org/10.2196/publichealth.4831 %U http://www.ncbi.nlm.nih.gov/pubmed/27227154 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 1 %P e17 %T Leveraging Social Media to Promote Public Health Knowledge: Example of Cancer Awareness via Twitter %A Xu,Songhua %A Markson,Christopher %A Costello,Kaitlin L %A Xing,Cathleen Y %A Demissie,Kitaw %A Llanos,Adana AM %+ School of Public Health and Cancer Institute of New Jersey, Epidemiology, Rutgers University, 683 Hoes Lane West, Room 211, Piscataway, NJ, 08854, United States, 1 7322354017, Adana.Llanos@rutgers.edu %K awareness %K breast cancer %K colorectal cancer %K disparities %K lung cancer %K prostate cancer %K social media %K Twitter %D 2016 %7 28.04.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As social media becomes increasingly popular online venues for engaging in communication about public health issues, it is important to understand how users promote knowledge and awareness about specific topics. Objective: The aim of this study is to examine the frequency of discussion and differences by race and ethnicity of cancer-related topics among unique users via Twitter. Methods: Tweets were collected from April 1, 2014 through January 21, 2015 using the Twitter public streaming Application Programming Interface (API) to collect 1% of public tweets. Twitter users were classified into racial and ethnic groups using a new text mining approach applied to English-only tweets. Each ethnic group was then analyzed for frequency in cancer-related terms within user timelines, investigated for changes over time and across groups, and measured for statistical significance. Results: Observable usage patterns of the terms "cancer", "breast cancer", "prostate cancer", and "lung cancer" between Caucasian and African American groups were evident across the study period. We observed some variation in the frequency of term usage during months known to be labeled as cancer awareness months, particularly September, October, and November. Interestingly, we found that of the terms studied, "colorectal cancer" received the least Twitter attention. Conclusions: The findings of the study provide evidence that social media can serve as a very powerful and important tool in implementing and disseminating critical prevention, screening, and treatment messages to the community in real-time. The study also introduced and tested a new methodology of identifying race and ethnicity among users of the social media. Study findings highlight the potential benefits of social media as a tool in reducing racial and ethnic disparities. %M 27227152 %R 10.2196/publichealth.5205 %U http://publichealth.jmir.org/2016/1/e17/ %U https://doi.org/10.2196/publichealth.5205 %U http://www.ncbi.nlm.nih.gov/pubmed/27227152 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 1 %P e9 %T Understanding Digital Technology Access and Use Among New York State Residents to Enhance Dissemination of Health Information %A Manganello,Jennifer A %A Gerstner,Gena %A Pergolino,Kristen %A Graham,Yvonne %A Strogatz,David %+ Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, One University Place, #165, Rensselaer, NY, 12144, United States, 1 5184020304, jmanganello@albany.edu %K media %K New York %K Internet %K health information %K eHealth %D 2016 %7 18.04.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Many state and local health departments, as well as community organizations, have been using new technologies to disseminate health information to targeted populations. Yet little data exist that show access and use patterns, as well as preferences for receiving health information, at the state level. Objective: This study was designed to obtain information about media and technology use, and health information seeking patterns, from a sample of New York State (NYS) residents. Methods: A cross-sectional telephone survey (with mobile phones and landlines) was developed to assess media and technology access, use patterns, and preferences for receiving health information among a sample of 1350 residents in NYS. The survey used random digit dialing methodology. A weighted analysis was conducted utilizing Stata/SE software. Results: Data suggest that NYS residents have a high level of computer and Internet use; 82% have at least one working computer at home, and 85% use the Internet at least sometimes. Mobile phone use is also high; 90% indicated having a mobile phone, and of those 63% have a smartphone. When asked about preferences for receiving health information from an organization, many people preferred websites (49%); preferences for other sources varied by demographic characteristics. Conclusions: Findings suggest that the Internet and other technologies are viable ways to reach NYS residents, but agencies and organizations should still consider using traditional methods of communication in some cases, and determine appropriate channels based on the population of interest. %M 27227163 %R 10.2196/publichealth.4442 %U http://publichealth.jmir.org/2016/1/e9/ %U https://doi.org/10.2196/publichealth.4442 %U http://www.ncbi.nlm.nih.gov/pubmed/27227163 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e67 %T 100 Million Views of Electronic Cigarette YouTube Videos and Counting: Quantification, Content Evaluation, and Engagement Levels of Videos %A Huang,Jidong %A Kornfield,Rachel %A Emery,Sherry L %+ Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, United States, 1 312 355 0195, jhuang12@uic.edu %K electronic cigarettes %K electronic nicotine delivery systems %K ENDS %K tobacco products %K YouTube %K social media %D 2016 %7 18.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The video-sharing website, YouTube, has become an important avenue for product marketing, including tobacco products. It may also serve as an important medium for promoting electronic cigarettes, which have rapidly increased in popularity and are heavily marketed online. While a few studies have examined a limited subset of tobacco-related videos on YouTube, none has explored e-cigarette videos’ overall presence on the platform. Objective: To quantify e-cigarette-related videos on YouTube, assess their content, and characterize levels of engagement with those videos. Understanding promotion and discussion of e-cigarettes on YouTube may help clarify the platform’s impact on consumer attitudes and behaviors and inform regulations. Methods: Using an automated crawling procedure and keyword rules, e-cigarette-related videos posted on YouTube and their associated metadata were collected between July 1, 2012, and June 30, 2013. Metadata were analyzed to describe posting and viewing time trends, number of views, comments, and ratings. Metadata were content coded for mentions of health, safety, smoking cessation, promotional offers, Web addresses, product types, top-selling brands, or names of celebrity endorsers. Results: As of June 30, 2013, approximately 28,000 videos related to e-cigarettes were captured. Videos were posted by approximately 10,000 unique YouTube accounts, viewed more than 100 million times, rated over 380,000 times, and commented on more than 280,000 times. More than 2200 new videos were being uploaded every month by June 2013. The top 1% of most-viewed videos accounted for 44% of total views. Text fields for the majority of videos mentioned websites (70.11%); many referenced health (13.63%), safety (10.12%), smoking cessation (9.22%), or top e-cigarette brands (33.39%). The number of e-cigarette-related YouTube videos was projected to exceed 65,000 by the end of 2014, with approximately 190 million views. Conclusions: YouTube is a major information-sharing platform for electronic cigarettes. YouTube appears to be used unevenly for promotional purposes by e-cigarette brands, and our analyses indicated a high level of user engagement with a small subset of content. There is evidence that YouTube videos promote e-cigarettes as cigarette smoking cessation tools. Presence and reach of e-cigarette videos on YouTube warrants attention from public health professionals and policymakers. %M 26993213 %R 10.2196/jmir.4265 %U http://www.jmir.org/2016/3/e67/ %U https://doi.org/10.2196/jmir.4265 %U http://www.ncbi.nlm.nih.gov/pubmed/26993213 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e64 %T Does Digital Ad Exposure Influence Information-Seeking Behavior Online? Evidence From the 2012 Tips From Former Smokers National Tobacco Prevention Campaign %A Kim,Annice %A Hansen,Heather %A Duke,Jennifer %A Davis,Kevin %A Alexander,Robert %A Rowland,Amy %A Mitchko,Jane %+ RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, , United States, 1 919 316 3972, akim@rti.org %K tobacco cessation %K health %K Internet %K monitoring and evaluation %D 2016 %7 16.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Measuring the impact of online health campaigns is challenging. Ad click-through rates are traditionally used to measure campaign reach, but few Internet users ever click on ads. Alternatively, self-reported exposure to digital ads would be prone to recall bias. Furthermore, there may be latency effects whereby people do not click on ads when exposed but visit the promoted website or conduct campaign-related searches later. Online panels that unobtrusively collect panelists’ Web behavior data and link ad exposure to website visits and searches can more reliably assess the impact of digital ad exposure. From March to June 2012, the Centers for Disease Control and Prevention aired the national Tips From Former Smokers (Tips 2012) media campaign designed to encourage current smokers to quit. Advertisements ran across media channels, and the digital ads directed users to the Tips 2012 campaign website. Objective: Our aim was to examine whether exposure to Tips 2012 digital ads influenced information-seeking behaviors online. Methods: ComScore mined its panelists’ Web behavior data for unique codes that would indicate exposure to Tips 2012 ads, regardless of whether panelists clicked the ad or not. A total of 15,319 US adults were identified as having been exposed to a Tips 2012 campaign ad. An equal number of unexposed adults (N=15,319) were identified and matched on demographics and Internet use behavior to the exposed group. Panelists’ Web behavior data were mined for up to 4 weeks after initial Tips 2012 ad exposure to determine whether they visited the Tips 2012 campaign website or other cessation-related websites (eg, nicotine replacement therapy site) or conducted searches for campaign-related topics (eg, quit smoking). Results: The proportion of exposed adults visiting the Tips 2012 sites increased from 0.4% in Week 1 to 0.9% 4 weeks after ad exposure, and these rates were significantly higher than in the unexposed group (0.1% in Week 1 to 0.4% in Week 4, P<.001) across all weeks examined. The proportion of exposed panelists visiting other cessation websites increased from 0.2% in Week 1 to 0.3% 4 weeks after initial ad exposure, and these rates were significantly higher than in the unexposed group (0.0% in Week 1 to 0.2% in Week 4, P=.001 to P=.019) across all weeks examined. There were no significant differences in searches for campaign-related topics between the exposed and unexposed group during most of the weeks examined. Conclusions: These results suggest that online ad exposure is associated with confirmed visits to the Tips 2012 campaign sites and visits to other cessation websites and that these information-seeking behaviors occur up to several weeks after ad exposure. Web behavior data from online panels are useful for examining exposure and behavioral responses to digital campaign ads. %M 26983849 %R 10.2196/jmir.4299 %U http://www.jmir.org/2016/3/e64/ %U https://doi.org/10.2196/jmir.4299 %U http://www.ncbi.nlm.nih.gov/pubmed/26983849 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 1 %P e8 %T Gordie Howe’s “Miraculous Treatment”: Case Study of Twitter Users’ Reactions to a Sport Celebrity’s Stem Cell Treatment %A Du,Li %A Rachul,Christen %A Guo,Zhaochen %A Caulfield,Timothy %+ Health Law Institute, Law Centre, University of Alberta, 91 University Campus NW, Edmonton, AB, T6G 2H5, Canada, 1 780 492 9575, caulfield@ualberta.ca %K Gordie Howe %K stem cell treatment %K stem cell tourism %K social network %K Twitter %K infodemiology %K infoveillance %D 2016 %7 09.03.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Former Detroit Red Wing Gordie Howe received stem cell (SC) treatment in Mexico in December 2014 for a stroke he suffered in October 2014. The news about his positive response to the SC treatment prompted discussion on social networks like Twitter. Objective: This study aims to provide information about discussions that took place on Twitter regarding Howe’s SC treatment and SC treatment in general. In particular, this study examines whether tweets portrayed a positive or negative attitude towards Howe’s SC treatment, whether or not tweets mention that the treatment is unproven, and whether the tweets mention risks associated with the SC treatment. Methods: This is an infodemiology study, harnessing big data published on the Internet for public health research and analysis of public engagement. A corpus of 2783 tweets about Howe’s SC treatment was compiled using a program that collected English-language tweets from December 19, 2014 at 00:00 to February 7, 2015 at 00:00. A content analysis of the corpus was conducted using a coding framework developed through a two-stage process. Results: 78.87% (2195/2783) of tweets mentioned improvements to Howe’s health. Only one tweet explicitly mentioned that Howe’s SC treatment was unproven, and 3 tweets warned that direct-to-consumer SC treatments lacked scientific evidence. In addition, 10.31% (287/2783) of tweets mentioned challenges with SC treatment that have been raised by scientists and researchers, and 3.70% (103/2783) of tweets either defined Howe as a “stem cell tourist” or claimed that his treatment was part of “stem cell tourism”. In general, 71.79% (1998/2783) of tweets portrayed a positive attitude towards Howe’s SC treatment. Conclusions: Our study found the responses to Howe’s treatment on Twitter to be overwhelmingly positive. There was far less attention paid to the lack of scientific evidence regarding the efficacy of the treatment. Unbalanced and uncritical discussion on Twitter regarding SC treatments is another example of inaccurate representations of SC treatments that may create unrealistic expectations that will facilitate the market for unproven stem cell therapies. %M 27227162 %R 10.2196/publichealth.5264 %U http://publichealth.jmir.org/2016/1/e8/ %U https://doi.org/10.2196/publichealth.5264 %U http://www.ncbi.nlm.nih.gov/pubmed/27227162 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 1 %P e6 %T Considerations for Public Health Organizations Attempting to Implement a Social Media Presence: A Qualitative Study %A Hart,Mark %A Stetten,Nichole %A Castaneda,Gail %+ University of Florida, 1225 Center Drive, HPNP Room 4144, PO Box 100175, Gainesville, FL, 32610, United States, 1 352 273 8545, kramtrah@phhp.ufl.edu %K public health %K social networking sites %K professional development %K training centers %K Facebook %K Twitter %D 2016 %7 24.02.2016 %9 Notes from the Field %J JMIR Public Health Surveill %G English %X Background: In the past decade, social media has become an integral part of our everyday lives, but research on how this tool is used by public health workers and organizations is still developing. Budget cuts and staff reduction in county departments have required employees to take on more responsibilities. These reductions have caused a reduction in the time for training or collaborating with others in the field. To make up for the loss, many employees are seeking collaboration through social media sites but are unable to do so because state departments block these Internet sites. Objective: This study sought to highlight the key considerations and decision-making process for a public health organization deciding whether to implement a social media presence for their organization. Methods: Using 3 structured interviews, 15 stakeholders were questioned on their personal experience with social media, experience within the context of public health, and their thoughts on implementation for their center. Interviews were coded using constant comparative qualitative methods. Results: The following themes emerged from the interviews: (1) personal experience with technology and social networking sites, (2) use of social networking sites in public health, (3) use of social networking sites in work environments, (4) social networking sites access, (5) ways the Rural South Public Health Training Center could use social networking sites, and (6) perceived outcomes of social networking site usage for the Rural South Public Health Training Center (positive and negative). Conclusions: The collective voice of the center showed a positive perceived perception of social media implementation, with the benefits outweighing the risks. Despite the benefits, there is a cautious skepticism of the importance of social networking site use. %M 27227160 %R 10.2196/publichealth.5032 %U http://publichealth.jmir.org/2016/1/e6/ %U https://doi.org/10.2196/publichealth.5032 %U http://www.ncbi.nlm.nih.gov/pubmed/27227160 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 5 %N 1 %P e6 %T Can Seeding in the Clinic Reach a Wide Audience? A Proof of Concept Study on Spreading a Health Message About Juvenile Idiopathic Arthritis Using a Shareable Online Video %A Fay,Michaela %A Rapley,Tim %A Foster,Helen %A Pain,Clare %A Gerrand,Craig %+ Department of Orthopaedics, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, High Heaton, Newcastle Upon Tyne, NE7 7DN, United Kingdom, 44 1912137708, craig.gerrand@nuth.nhs.uk %K juvenile arthritis %K video-audio media %K patient education %K Internet %D 2016 %7 22.02.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: Shareable online video offers the potential for spreading a health message across online and real world social networks. Seeding a message in a clinical setting may be advantageous. Objective: To investigate the potential of an online video to spread a health message about juvenile idiopathic arthritis (JIA) when delivered or seeded in a clinical setting and investigate factors that influence sharing behavior. Methods: Multimethod proof of concept study. Concepts for two different styles of video were developed using focus groups and interviews and reviewed by an online market research panel. We compared dissemination of the two videos from two specialist pediatric rheumatology clinics in NHS Hospitals. Participants were 15 patients, family members, and clinical staff with knowledge of JIA at concept stage; 300 market research panel members in development stage; and 38 patients and their parents or guardians in the seeding stage. Newly diagnosed patients with JIA and/or parents or guardians were invited to view and share an online video with a health message about JIA across real-life and electronic social networks. Main outcome measures were viewing statistics, sharing behavior and patterns, and participant feedback. Results: Of 38 patients and/or their parents or guardians given links, 26 visited the video webpage and shared the link, 2 visited and did not share, and 10 did not visit. Most links were viewed and shared within a few days. A total of 3314 pageviews were recorded with a mean of 89.6 pageviews per link (range 0-1245). Links were accessed from 26 countries, with most viewers in the United Kingdom (82.5%). Mothers were the most active group of sharers. Conclusions: Distribution of a video link in a clinical setting may be an effective way to spread a health message. Parents or guardians of children with JIA are more likely to share a link than young people. Dissemination depends on a small number of active sharers, the content of the video, and the willingness of participants to share health information about themselves. Trial Registration: UK Clinical Research Network Study Portfolio ID (UKCRN): 13747; http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=13747 (Archived by WebCite at http://www.webcitation.org/6eeXlMmM6). %M 26903485 %R 10.2196/ijmr.4608 %U http://www.i-jmr.org/2016/1/e6/ %U https://doi.org/10.2196/ijmr.4608 %U http://www.ncbi.nlm.nih.gov/pubmed/26903485 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 2 %P e39 %T Association Between Media Dose, Ad Tagging, and Changes in Web Traffic for a National Tobacco Education Campaign: A Market-Level Longitudinal Study %A Shafer,Paul R %A Davis,Kevin C %A Patel,Deesha %A Rodes,Robert %A Beistle,Diane %+ Center for Health Policy Science and Tobacco Research, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, United States, 1 919 260 2711, pshafer@rti.org %K Internet %K advertising %K health communication %K smoking cessation %K public health %K tobacco control %D 2016 %7 17.02.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: In 2012, the US Centers for Disease Control and Prevention (CDC) launched Tips From Former Smokers (Tips), the first federally funded national tobacco education campaign. In 2013, a follow-up Tips campaign aired on national cable television networks, radio, and other channels, with supporting digital advertising to drive traffic to the Tips campaign website. Objective: The objective of this study was to use geographic and temporal variability in 2013 Tips campaign television media doses and ad tagging to evaluate changes in traffic to the campaign website in response to specific doses of campaign media. Methods: Linear regression models were used to estimate the dose-response relationship between weekly market-level television gross rating points (GRPs) and weekly Web traffic to the Tips campaign website. This relationship was measured using unique visitors, total visits, and page views as outcomes. Ad GRP effects were estimated separately for ads tagged with the Tips campaign website URL and 1-800-QUIT-NOW. Results: In the average media market, an increase of 100 television GRPs per week for ads tagged with the Tips campaign website URL was associated with an increase of 650 unique visitors (P<.001), 769 total visits (P<.001), and 1255 total page views (P<.001) per week. The associations between GRPs for ads tagged with 1-800-QUIT-NOW and each Web traffic measure were also statistically significant (P<.001), but smaller in magnitude. Conclusions: Based on these findings, we estimate that the 16-week 2013 Tips television campaign generated approximately 660,000 unique visitors, 900,000 total visits, and 1,390,000 page views for the Tips campaign website. These findings can help campaign planners forecast the likely impact of targeted advertising efforts on consumers’ use of campaign-specific websites. %M 26887959 %R 10.2196/jmir.5343 %U http://www.jmir.org/2016/2/e39/ %U https://doi.org/10.2196/jmir.5343 %U http://www.ncbi.nlm.nih.gov/pubmed/26887959 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 1 %P e5 %T Promoting a Hand Hygiene Program Using Social Media: An Observational Study %A Pan,Sung-Ching %A Sheng,Wang-Huei %A Tien,Kuei-Lien %A Chien,Kuang-Tse %A Chen,Yee-Chun %A Chang,Shawn-Chwen %+ National Taiwan University Hospital, No. 7, Chung-Shan S Road, Taipei, , Taiwan, 886 2 23123456, yeechunchen@gmail.com %K social media %K hand hygiene %K infection control %D 2016 %7 02.02.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hand hygiene is an important component in infection control to protect patient safety and reduce health care-associated infection. Objective: Our aim was to evaluate the efficacy of different social media on the promotion of a hand hygiene (HH) program. Methods: The observational study was conducted from May 5 to December 31, 2014, at a 2600-bed tertiary care hospital. A 3-minute video of an HH campaign in 8 languages was posted to YouTube. The Chinese version was promoted through three platforms: the hospital website, the hospital group email, and the Facebook site of a well-known Internet illustrator. The video traffic was analyzed via Google Analytics. HH compliance was measured in November 2013 and 2014. Results: There were 5252 views of the video, mainly of the Chinese-language version (3509/5252, 66.81%). The NTUH website had 24,000 subscribers, and 151 of them viewed the video (connection rate was 151/24,000, 0.63%). There were 9967 users of the hospital email group and the connection rate was 0.91% (91/9967). The connection rate was 6.17% (807/13,080) from Facebook, significantly higher than the other 2 venues (both P<.001). HH compliance sustained from 83.7% (473/565) in 2013 to 86.7% (589/679) in 2014 (P=.13) among all HCWs. Conclusions: Facebook had the highest connection rate in the HH video campaign. The use of novel social media such as Facebook should be considered for future programs that promote hand hygiene and other healthy behaviors. %M 27227159 %R 10.2196/publichealth.5101 %U http://publichealth.jmir.org/2016/1/e5/ %U https://doi.org/10.2196/publichealth.5101 %U http://www.ncbi.nlm.nih.gov/pubmed/27227159 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e24 %T Adapting Behavioral Interventions for Social Media Delivery %A Pagoto,Sherry %A Waring,Molly E %A May,Christine N %A Ding,Eric Y %A Kunz,Werner H %A Hayes,Rashelle %A Oleski,Jessica L %+ Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, S7-751, 55 Lake Ave N, Worcester, MA, 01655, United States, 1 508 856 2092, Sherry.Pagoto@umassmed.edu %K social media %K behavioral interventions %K health behavior %K online social networks %D 2016 %7 29.01.2016 %9 Tutorial %J J Med Internet Res %G English %X Patients are increasingly using online social networks (ie, social media) to connect with other patients and health care professionals—a trend called peer-to-peer health care. Because online social networks provide a means for health care professionals to communicate with patients, and for patients to communicate with each other, an opportunity exists to use social media as a modality to deliver behavioral interventions. Social media-delivered behavioral interventions have the potential to reduce the expense of behavioral interventions by eliminating visits, as well as increase our access to patients by becoming embedded in their social media feeds. Trials of online social network-delivered behavioral interventions have shown promise, but much is unknown about intervention development and methodology. In this paper, we discuss the process by which investigators can translate behavioral interventions for social media delivery. We present a model that describes the steps and decision points in this process, including the necessary training and reporting requirements. We also discuss issues pertinent to social media-delivered interventions, including cost, scalability, and privacy. Finally, we identify areas of research that are needed to optimize this emerging behavioral intervention modality. %M 26825969 %R 10.2196/jmir.5086 %U http://www.jmir.org/2016/1/e24/ %U https://doi.org/10.2196/jmir.5086 %U http://www.ncbi.nlm.nih.gov/pubmed/26825969 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 1 %P e1 %T The Measles Vaccination Narrative in Twitter: A Quantitative Analysis %A Radzikowski,Jacek %A Stefanidis,Anthony %A Jacobsen,Kathryn H %A Croitoru,Arie %A Crooks,Andrew %A Delamater,Paul L %+ Center for Geospatial Intelligence, Department of Geography and Geoinformation Science, George Mason University, 4400 University Drive, MS 6C3, Fairfax, VA, 22030, United States, 1 (703)9931212, astefani@gmu.edu %K social media %K health narrative %K geographic characteristics %K data analysis %K health informatics %K GIS (geographic information systems) %D 2016 %7 04.01.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The emergence of social media is providing an alternative avenue for information exchange and opinion formation on health-related issues. Collective discourse in such media leads to the formation of a complex narrative, conveying public views and perceptions. Objective: This paper presents a study of Twitter narrative regarding vaccination in the aftermath of the 2015 measles outbreak, both in terms of its cyber and physical characteristics. We aimed to contribute to the analysis of the data, as well as presenting a quantitative interdisciplinary approach to analyze such open-source data in the context of health narratives. Methods: We collected 669,136 tweets referring to vaccination from February 1 to March 9, 2015. These tweets were analyzed to identify key terms, connections among such terms, retweet patterns, the structure of the narrative, and connections to the geographical space. Results: The data analysis captures the anatomy of the themes and relations that make up the discussion about vaccination in Twitter. The results highlight the higher impact of stories contributed by news organizations compared to direct tweets by health organizations in communicating health-related information. They also capture the structure of the antivaccination narrative and its terms of reference. Analysis also revealed the relationship between community engagement in Twitter and state policies regarding child vaccination. Residents of Vermont and Oregon, the two states with the highest rates of non-medical exemption from school-entry vaccines nationwide, are leading the social media discussion in terms of participation. Conclusions: The interdisciplinary study of health-related debates in social media across the cyber-physical debate nexus leads to a greater understanding of public concerns, views, and responses to health-related issues. Further coalescing such capabilities shows promise towards advancing health communication, thus supporting the design of more effective strategies that take into account the complex and evolving public views of health issues. %M 27227144 %R 10.2196/publichealth.5059 %U http://publichealth.jmir.org/2016/1/e1/ %U https://doi.org/10.2196/publichealth.5059 %U http://www.ncbi.nlm.nih.gov/pubmed/27227144 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 2 %P e21 %T Agenda Setting for Health Promotion: Exploring an Adapted Model for the Social Media Era %A Albalawi,Yousef %A Sixsmith,Jane %+ Health Promotion Research Centre, National University of Ireland Galway, University Road, Galway, , Ireland, 353 83 1232203, y.albalawi@gmail.com %K agenda setting, health promotion, social media, Twitter, health communication, Saudi Arabia, road traffic accidents %D 2015 %7 25.11.2015 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The foundation of best practice in health promotion is a robust theoretical base that informs design, implementation, and evaluation of interventions that promote the public’s health. This study provides a novel contribution to health promotion through the adaptation of the agenda-setting approach in response to the contribution of social media. This exploration and proposed adaptation is derived from a study that examined the effectiveness of Twitter in influencing agenda setting among users in relation to road traffic accidents in Saudi Arabia. Objective: The proposed adaptations to the agenda-setting model to be explored reflect two levels of engagement: agenda setting within the social media sphere and the position of social media within classic agenda setting. This exploratory research aims to assess the veracity of the proposed adaptations on the basis of the hypotheses developed to test these two levels of engagement. Methods: To validate the hypotheses, we collected and analyzed data from two primary sources: Twitter activities and Saudi national newspapers. Keyword mentions served as indicators of agenda promotion; for Twitter, interactions were used to measure the process of agenda setting within the platform. The Twitter final dataset comprised 59,046 tweets and 38,066 users who contributed by tweeting, replying, or retweeting. Variables were collected for each tweet and user. In addition, 518 keyword mentions were recorded from six popular Saudi national newspapers. Results: The results showed significant ratification of the study hypotheses at both levels of engagement that framed the proposed adaptions. The results indicate that social media facilitates the contribution of individuals in influencing agendas (individual users accounted for 76.29%, 67.79%, and 96.16% of retweet impressions, total impressions, and amplification multipliers, respectively), a component missing from traditional constructions of agenda-setting models. The influence of organizations on agenda setting is also highlighted (in the data of user interactions, organizational accounts registered 17% and 14.74% as source and target of interactions, respectively). In addition, 13 striking similarities showed the relationship between newspapers and Twitter on the mentions trends line. Conclusions: The effective use of social media platforms in health promotion intervention programs requires new strategies that consider the limitations of traditional communication channels. Conducting research is vital to establishing a strong basis for modifying, designing, and developing new health promotion strategies and approaches. %M 27227139 %R 10.2196/publichealth.5014 %U http://publichealth.jmir.org/2015/2/e21/ %U https://doi.org/10.2196/publichealth.5014 %U http://www.ncbi.nlm.nih.gov/pubmed/27227139 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e248 %T Social Media and HIV: A Systematic Review of Uses of Social Media in HIV Communication %A Taggart,Tamara %A Grewe,Mary Elisabeth %A Conserve,Donaldson F %A Gliwa,Catherine %A Roman Isler,Malika %+ Department of Health Behavior, University of North Carolina at Chapel Hill, 135 Dauer Drive 302 Rosenau Hall, CB Number 7440, Chapel Hill, NC, 27599-7440, United States, 1 919 966 5771, ttaggart@email.unc.edu %K HIV %K social media %K communication %D 2015 %7 02.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media, including mobile technologies and social networking sites, are being used increasingly as part of human immunodeficiency virus (HIV) prevention and treatment efforts. As an important avenue for communication about HIV, social media use may continue to increase and become more widespread. Objective: The objective of this paper is to present a comprehensive systematic review of the current published literature on the design, users, benefits, and limitations of using social media to communicate about HIV prevention and treatment. Methods: This review paper used a systematic approach to survey all literature published before February 2014 using 7 electronic databases and a manual search. The inclusion criteria were (1) primary focus on communication/interaction about HIV/acquired immunodeficiency syndrome (AIDS), (2) discusses the use of social media to facilitate communication, (3) communication on the social media platform is between individuals or a group of individuals rather than the use of preset, automated responses from a platform, (4) published before February 19, 2014, and (5) all study designs. Results: The search identified 35 original research studies. Thirty studies had low or unclear risk of at least one of the bias items in the methodological quality assessment. Among the 8 social media platform types described, short message service text messaging was most commonly used. Platforms served multiple purposes including disseminating health information, conducting health promotion, sharing experiences, providing social support, and promoting medication adherence. Social media users were diverse in geographic location and race/ethnicity; studies commonly reported users aged 18-40 years and users with lower income. Although most studies did not specify whether use was anonymous, studies reported the importance of anonymity in social media use to communicate about HIV largely due to the stigma associated with HIV. The ability to share and receive information about HIV was the most commonly reported benefit of social media use and the most common challenges were related to technology. Measures of frequency of use, satisfaction, and effects of use varied across studies. Conclusions: Using social media to bridge communication among a diverse range of users, in various geographic and social contexts, may be leveraged through pre-existing platforms and with attention to the roles of anonymity and confidentiality in communication about HIV prevention and treatment. More robust research is needed to determine the effects of social media use on various health and social outcomes related to HIV. %M 26525289 %R 10.2196/jmir.4387 %U http://www.jmir.org/2015/11/e248/ %U https://doi.org/10.2196/jmir.4387 %U http://www.ncbi.nlm.nih.gov/pubmed/26525289 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 10 %P e233 %T The Potential Role of Social Media Platforms in Community Awareness of Antibiotic Use in the Gulf Cooperation Council States: Luxury or Necessity? %A Zowawi,Hosam Mamoon %A Abedalthagafi,Malak %A Mar,Florie A %A Almalki,Turki %A Kutbi,Abdullah H %A Harris-Brown,Tiffany %A Harbarth,Stephan %A Balkhy,Hanan H %A Paterson,David L %A Hasanain,Rihab Abdalazez %+ School of Public Health, Queensland University of Technology, Victoria Park Rd Kelvin Grove QLD 4059, QLD, , Australia, 61 7 3138 5879, Rihab.Hasanain@student.qut.edu.au %K social media %K antibiotics %K awareness %K health campaigns %K Gulf States %D 2015 %7 15.10.2015 %9 Viewpoint %J J Med Internet Res %G English %X The increasing emergence and spread of antimicrobial resistance (AMR) is a serious public health issue. Increasing the awareness of the general public about appropriate antibiotic use is a key factor for combating this issue. Several public media campaigns worldwide have been launched; however, such campaigns can be costly and the outcomes are variable and difficult to assess. Social media platforms, including Twitter, Facebook, and YouTube, are now frequently utilized to address health-related issues. In many geographical locations, such as the countries of the Gulf Cooperation Council (GCC) States (Saudi Arabia, United Arab Emirates, Kuwait, Oman, Qatar, and Bahrain), these platforms are becoming increasingly popular. The socioeconomic status of the GCC states and their reliable communication and networking infrastructure has allowed the penetration and scalability of these platforms in the region. This might explain why the Saudi Ministry of Health is using social media platforms alongside various other media platforms in a large-scale public awareness campaign to educate at-risk communities about the recently emerged Middle East respiratory syndrome coronavirus (MERS-CoV). This paper discusses the potential for using social media tools as cost-efficient and mass education platforms to raise awareness of appropriate antibiotic use in the general public and in the medical communities of the Arabian Peninsula. %M 26471079 %R 10.2196/jmir.3891 %U http://www.jmir.org/2015/10/e233/ %U https://doi.org/10.2196/jmir.3891 %U http://www.ncbi.nlm.nih.gov/pubmed/26471079 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 2 %P e11 %T Electronic Cigarette Marketing Online: a Multi-Site, Multi-Product Comparison %A Chu,Kar-Hai %A Sidhu,Anupreet K %A Valente,Thomas W %+ University of Southern California, Department of Preventive Medicine, 2001 North Soto Street, 3rd Floor, Los Angeles, CA, 90032, United States, 1 323 442 7244, karhaich@usc.edu %K electronic cigarettes %K content analysis %K social networking sites %K marketing %D 2015 %7 11.09.2015 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Electronic cigarette awareness and use has been increasing rapidly. E-cigarette brands have utilized social networking sites to promote their products, as the growth of the e-cigarette industry has paralleled that of Web 2.0. These online platforms are cost-effective and have unique technological features and user demographics that can be attractive for selective marketing. The popularity of multiple sites also poses a risk of exposure to social networks where e-cigarette brands might not have a presence. Objective: To examine the marketing strategies of leading e-cigarette brands on multiple social networking sites, and to identify how affordances of the digital media are used to their advantage. Secondary analyses include determining if any brands are benefitting from site demographics, and exploring cross-site diffusion of marketing content through multi-site users. Methods: We collected data from two e-cigarette brands from four social networking sites over approximately 2.5 years. Content analysis is used to search for themes, population targeting, marketing strategies, and cross-site spread of messages. Results: Twitter appeared to be the most frequently used social networking site for interacting directly with product users. Facebook supported informational broadcasts, such as announcements regarding political legislation. E-cigarette brands also differed in their approaches to their users, from informal conversations to direct product marketing. Conclusions: E-cigarette makers use different strategies to market their product and engage their users. There was no evidence of direct targeting of vulnerable populations, but the affordances of the different sites are exploited to best broadcast context-specific messages. We developed a viable method to study cross-site diffusion, although additional refinement is needed to account for how different types of digital media are used. %M 27227129 %R 10.2196/publichealth.4777 %U http://publichealth.jmir.org/2015/2/e11/ %U https://doi.org/10.2196/publichealth.4777 %U http://www.ncbi.nlm.nih.gov/pubmed/27227129 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e159 %T Scientific Versus Experiential Evidence: Discourse Analysis of the Chronic Cerebrospinal Venous Insufficiency Debate in a Multiple Sclerosis Forum %A Koschack,Janka %A Weibezahl,Lara %A Friede,Tim %A Himmel,Wolfgang %A Makedonski,Philip %A Grabowski,Jens %+ Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany, 49 5513914225, jkoscha@gwdg.de %K multiple sclerosis %K venous insufficiency %K Internet %K social media %K cognitive dissonance %K qualitative research %D 2015 %7 01.07.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The vascular hypothesis of multiple sclerosis (MS), called chronic cerebrospinal venous insufficiency (CCSVI), and its treatment (known as liberation therapy) was immediately rejected by experts but enthusiastically gripped by patients who shared their experiences with other patients worldwide by use of social media, such as patient online forums. Contradictions between scientific information and lay experiences may be a source of distress for MS patients, but we do not know how patients perceive and deal with these contradictions. Objective: We aimed to understand whether scientific and experiential knowledge were experienced as contradictory in MS patient online forums and, if so, how these contradictions were resolved and how patients tried to reconcile the CCSVI debate with their own illness history and experience. Methods: By using critical discourse analysis, we studied CCSVI-related posts in the patient online forum of the German MS Society in a chronological order from the first post mentioning CCSVI to the time point when saturation was reached. For that time period, a total of 117 CCSVI-related threads containing 1907 posts were identified. We analyzed the interaction and communication practices of and between individuals, looked for the relation between concrete subtopics to identify more abstract discourse strands, and tried to reveal discourse positions explaining how users took part in the CCSVI discussion. Results: There was an emotionally charged debate about CCSVI which could be generalized to 2 discourse strands: (1) the “downfall of the professional knowledge providers” and (2) the “rise of the nonprofessional treasure trove of experience.” The discourse strands indicated that the discussion moved away from the question whether scientific or experiential knowledge had more evidentiary value. Rather, the question whom to trust (ie, scientists, fellow sufferers, or no one at all) was of fundamental significance. Four discourse positions could be identified by arranging them into the dimensions “trust in evidence-based knowledge,” “trust in experience-based knowledge,” and “subjectivity” (ie, the emotional character of contributions manifested by the use of popular rhetoric that seemed to mask a deep personal involvement). Conclusions: By critical discourse analysis of the CCSVI discussion in a patient online forum, we reconstruct a lay discourse about the evidentiary value of knowledge. We detected evidence criteria in this lay discourse that are different from those in the expert discourse. But we should be cautious to interpret this dissociation as a sign of an intellectual incapability to understand scientific evidence or a naïve trust in experiential knowledge. Instead, it might be an indication of cognitive dissonance reduction to protect oneself against contradictory information. %M 26133525 %R 10.2196/jmir.4103 %U http://www.jmir.org/2015/7/e159/ %U https://doi.org/10.2196/jmir.4103 %U http://www.ncbi.nlm.nih.gov/pubmed/26133525 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 1 %P e2 %T The Digital Distribution of Public Health News Surrounding the Human Papillomavirus Vaccination: A Longitudinal Infodemiology Study %A Mahoney,L Meghan %A Tang,Tang %A Ji,Kai %A Ulrich-Schad,Jessica %+ West Chester University, 511 Main Hall, West Chester, PA, 19383, United States, 1 3022998475, mmahoney@wcupa.edu %K new media %K public health dissemination %K health communication %K social media %K HPV vaccination %K infodemiology %K infoveillance %D 2015 %7 18.03.2015 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: New media changes the dissemination of public health information and misinformation. During a guest appearance on the Today Show, US Representative Michele Bachmann claimed that human papillomavirus (HPV) vaccines could cause “mental retardation”. Objective: The purpose of this study is to explore how new media influences the type of public health information users access, as well as the impact to these platforms after a major controversy. Specifically, this study aims to examine the similarities and differences in the dissemination of news articles related to the HPV vaccination between Google News and Twitter, as well as how the content of news changed after Michele Bachmann’s controversial comment. Methods: This study used a purposive sampling to draw the first 100 news articles that appeared on Google News and the first 100 articles that appeared on Twitter from August 1-October 31, 2011. Article tone, source, topics, concerns, references, publication date, and interactive features were coded. The intercoder reliability had a total agreement of .90. Results: Results indicate that 44.0% of the articles (88/200) about the HPV vaccination had a positive tone, 32.5% (65/200) maintained a neutral tone, while 23.5% (47/200) presented a negative tone. Protection against diseases 82.0% (164/200), vaccine eligibility for females 75.5% (151/200), and side effects 59.0% (118/200) were the top three topics covered by these articles. Google News and Twitter articles significantly differed in article tone, source, topics, concerns covered, types of sources referenced in the article, and uses of interactive features. Most notably, topic focus changed from public health information towards political conversation after Bachmann’s comment. Before the comment, the HPV vaccine news talked more often about vaccine dosing (P<.001), duration (P=.005), vaccine eligibility for females (P=.03), and protection against diseases (P=.04) than did the later pieces. After the controversy, the news topic shifted towards politics (P=.01) and talked more about HPV vaccine eligibility for males (P=.01). Conclusions: This longitudinal infodemiology study suggests that new media influences public health communication, knowledge transaction, and poses potential problems in the amount of misinformation disseminated during public health campaigns. In addition, the study calls for more research to adopt an infodemiology approach to explore relationships between online information supply and public health decisions. %M 27227125 %R 10.2196/publichealth.3310 %U http://publichealth.jmir.org/2015/1/e2/ %U https://doi.org/10.2196/publichealth.3310 %U http://www.ncbi.nlm.nih.gov/pubmed/27227125 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 6 %P e181 %T Should Health Organizations Use Web 2.0 Media in Times of an Infectious Disease Crisis? An In-depth Qualitative Study of Citizens’ Information Behavior During an EHEC Outbreak %A van Velsen,Lex %A van Gemert-Pijnen,Julia E.W.C %A Beaujean,Desirée J.M.A %A Wentzel,Jobke %A van Steenbergen,Jim E %+ Center for eHealth Research and Disease Management, Department of Psychology, Health and Technology, University of Twente, P.O. box 217, Enschede, 7500 AE, Netherlands, 31 0534896054, l.s.vanvelsen@utwente.nl %K Disease Outbreaks %K Foodborne Diseases %K Health Communication %K Information Dissemination %K Information Seeking Behavior %K Social networking %D 2012 %7 20.12.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Web 2.0 media (eg, Facebook, Wikipedia) are considered very valuable for communicating with citizens in times of crisis. However, in the case of infectious disease outbreaks, their value has not been determined empirically. In order to be able to take full advantage of Web 2.0 media in such a situation, the link between these media, citizens’ information behavior, and citizens’ information needs has to be investigated. Objective: The goal of our study was to assess citizens’ Web 2.0 media use during an infectious disease outbreak and to determine which Web 2.0 medium is used for which goal. With this information, we wanted to formulate recommendations for health organizations that consider using Web 2.0 media as part of their communication strategy during an infectious disease outbreak. Methods: A total of 18 student participants kept an information diary for 4 weeks during the 2011 enterohemorrhagic E. coli (EHEC) outbreak in Germany. Of them, 9 lived at the epicenter of the outbreak and 9 of them at some distance. The diaries were supplemented by a qualitative pre-survey (demographics) and postsurvey (questioning their satisfaction with information provision during the outbreak). Results: The Internet appeared to be the most popular medium for passively receiving EHEC-related information, with news websites and websites of newspapers as the most consulted sources. Twitter was used for receiving information to a small degree, while Facebook played virtually no role. Participants indicated that they thought information posted on Twitter or Facebook was not reliable or was out of place. When actively seeking information, online newspapers and wikis were important sources. Several causes for (dis)satisfaction with information provision were uncovered: source credibility, contradicting messages, and a need for closure. Conclusions: During an infectious disease outbreak, our small sample of students did not see social media (like Facebook and Twitter) as suitable or reliable sources for communicating information, but primarily viewed them as a tool for communicating with friends. Wikis, however, did fill several information needs, especially when citizens are actively searching for information. For many, source credibility is an important asset of information usefulness. Finally, we provide several general recommendations for communicating with citizens during an infectious disease outbreak. %M 23257066 %R 10.2196/jmir.2123 %U http://www.jmir.org/2012/6/e181/ %U https://doi.org/10.2196/jmir.2123 %U http://www.ncbi.nlm.nih.gov/pubmed/23257066