Leveraging Big Data to Improve Health Awareness Campaigns: A Novel Evaluation of the Great American Smokeout

Mapping obesity and diabetes' representation on Twitter: the case of Italy

One of the main functions of public health is to monitor population health to identify health problems and priorities. Social media is increasingly being used to promote it. This study aims to investigate the field of diabetes and obesity and related tweets in the context of health and disease. The database extracted using academic APIs (Application Programming Interfaces) allowed the study to be run with content analysis and sentiment analysis techniques. These two analysis techniques are some of the tools of choice for the intended objectives. Content analysis facilitated the representation of a concept and a connection between two or more concepts, such as diabetes and obesity, on a purely text-based social platform such as Twitter. Sentiment analysis therefore allowed us to explore the emotional aspect related to the collected data related to the representation of such concepts. The results show a variety of representations connected to the two concepts and their correlations. From them it was possible to produce some clusters of elementary contexts and structure narrative and representational dimensions of the investigated concepts. The use of sentiment analysis and content analysis and cluster output to represent complex contexts such as diabetes and obesity for a social media community could increase knowledge of how virtual platforms impact fragile categories, facilitating concrete spillovers into public health strategies.

Using Baidu Index Data to Improve Chickenpox Surveillance in Yunnan, China: Infodemiology Study

BACKGROUND

Chickenpox is an old but easily neglected infectious disease. Although chickenpox is preventable by vaccines, vaccine breakthroughs often occur, and the chickenpox epidemic is on the rise. Chickenpox is not included in the list of regulated communicable diseases that must be reported and controlled by public and health departments; therefore, it is crucial to rapidly identify and report varicella outbreaks during the early stages. The Baidu index (BDI) can supplement the traditional surveillance system for infectious diseases, such as brucellosis and dengue, in China. The number of reported chickenpox cases and internet search data also showed a similar trend. BDI can be a useful tool to display the outbreak of infectious diseases.

OBJECTIVE

This study aimed to develop an efficient disease surveillance method that uses BDI to assist in traditional surveillance.

METHODS

Chickenpox incidence data (weekly from January 2017 to June 2021) reported by the Yunnan Province Center for Disease Control and Prevention were obtained to evaluate the relationship between the incidence of chickenpox and BDI. We applied a support vector machine regression (SVR) model and a multiple regression prediction model with BDI to predict the incidence of chickenpox. In addition, we used the SVR model to predict the number of chickenpox cases from June 2021 to the first week of April 2022.

RESULTS

The analysis showed that there was a close correlation between the weekly number of newly diagnosed cases and the BDI. In the search terms we collected, the highest Spearman correlation coefficient was 0.747. Most BDI search terms, such as "chickenpox," "chickenpox treatment," "treatment of chickenpox," "chickenpox symptoms," and "chickenpox virus," trend consistently. Some BDI search terms, such as "chickenpox pictures," "symptoms of chickenpox," "chickenpox vaccine," and "is chickenpox vaccine necessary," appeared earlier than the trend of "chickenpox virus." The 2 models were compared, the SVR model performed better in all the applied measurements: fitting effect, R²=0.9108, root mean square error (RMSE)=96.2995, and mean absolute error (MAE)=73.3988; and prediction effect, R²=0.548, RMSE=189.1807, and MAE=147.5412. In addition, we applied the SVR model to predict the number of reported cases weekly in Yunnan from June 2021 to April 2022 using the same period of the BDI. The results showed that the fluctuation of the time series from July 2021 to April 2022 was similar to that of the last year and a half with no change in the level of prevention and control.

CONCLUSIONS

These findings indicated that the BDI in Yunnan Province can predict the incidence of chickenpox in the same period. Thus, the BDI is a useful tool for monitoring the chickenpox epidemic and for complementing traditional monitoring systems.

Trends in public interest in child abuse in the United States: An infodemiology study of Google Trends from 2004 to 2022

INTRODUCTION

More than 1 in 7 children in the United States experience abuse annually with rates remaining consistent over the past 2 decades. During this timeframe, several high-profile cases of child abuse and neglect were publicized in national media in addition to multiple investigations uncovering Indigenous children dying from abuse at Indian Boarding Schools. Increased media attention among other public health and medical topics has been linked to increased public interest, thus, our objective was to investigate trends in public interest from 2004 to 2022.

METHODS

To assess trends in public interest, we extracted monthly relative search interest in child abuse from Google Trends. We constructed linear regression to determine the long-term trajectory of interest, and also compared the slope of the trend to other topics, such as domestic violence. Further, we compared mean relative search interest (RSI) from Child Abuse Awareness Month (April) to other months via t-test. Lastly, we assess by-state correlations of RSI and number of children abused.

RESULTS

Since 2004, search interest in child abuse has significantly declined in the United States-more than other related search terms. Child Abuse Awareness Month showed spikes in RSI which were greater than other months. By-state correlations of RSI and abuse were moderate to weak.

CONCLUSION

Despite heavy media attention covering stories of child abuse during the past 2 decades, search interest in child abuse has significantly declined. This trend may be related to aversion to secondary traumatic stress as news broadcasts often include stories of violence-of which child abuse stories may be most provoking. Following journalism guidance from the Centers for Disease Control and Prevention, reporting with focus on resiliency and prevention, rather than the individuals who perpetrated the crime, may provide more community support and increased public interest.

Are social networks effective in promoting healthy behaviors? A systematic review of evaluations of public health campaigns broadcast on Twitter

Introduction

While public health campaigns disseminated through Twitter have multiple theoretical advantages over other strategies (e.g., a high potential reach and low economic cost), the effectiveness of social networks as facilitators of attitudinal and behavioral changes in the population seems to remain weakly supported. Therefore, this systematic review was aimed to analyze the degree of impact of healthy behavior-related campaigns as documented in scientific literature.

Methods

Strictly following the PRISMA methodology, a total of 109 indexed articles were obtained, of which only 18 articles met the inclusion criteria. In addition to accessing the literature available on WOS, Scopus, BVS, Medline, Cochrane Library and PubMed, the quality of the existing studies was assessed through the Critical Appraisal Skills Programme (CASP) protocol.

Results

The results of this systematic review revealed a small number of evaluations of the effectiveness of social campaigns disseminated on Twitter, although the quality of these studies was considerably good. Most of the research used statistics and metrics for evaluation, with residual use of other measurement methodologies. However, their effectiveness and impact on public health-related behaviors remain arguable, in view of the existence of marked tendencies to: (i) not evaluate these campaigns; (ii) evaluate them through excessively brief, ambiguous, or potentially biased indicators; and (iii) not carry out systematic follow-ups over time.

Discussion

Although there is no strong evidence of the suitability of Twitter as a suitable medium for raising public health awareness on behavioral health affairs, the actual limitations identified in this review would help to optimize this paradigm and enhance the quality, reach, and effectiveness of such communication strategies.

Potential of UK and US newspapers for shaping patients' knowledge and perceptions about antidiabetic medicines: a content analysis

Background

Information about how newspapers portray antidiabetic medicines to readers is lacking. This study investigated the reporting on antidiabetic medicines in the most widely circulated newspapers published in the United Kingdom (UK) and the United States (US) over a 10-year period.

Methods

The Nexis UK database was used to identify and select relevant articles. Systematic content analysis of the articles which met the inclusion criteria (articles of any format that contained reference to antidiabetic medicines) within the highest circulated newspapers in the UK and US between 2009 and 2018 was conducted. Inter-rater reliability of coding was established using a 10% sample of the identified articles.

Results

A total of 560 (369 UK and 191 US) relevant newspaper articles were retrieved. In the UK, the number of relevant articles showed a slightly increasing trend over the study period, while in the US, article numbers declined over the study period. Safety/risk of antidiabetic medicines was the most frequent theme covered by the articles (34.6%). Over one-third of the newspaper articles were written from a clinical perspective (37.7%). Insulin was the most commonly discussed class of antidiabetic medicine (23.1%). Control of blood sugar levels (53.1%) and side effects/toxicity (92.7%) were the most frequently reported benefit and risk of antidiabetic medicines, respectively. The most frequently reported organ systems harmed by antidiabetic medicines were the cardiovascular, endocrine and gastrointestinal systems. The UK newspapers were more likely to report the benefits of antidiabetic medicines (p = 0.005), while the US articles were more likely to report on harms/risks (p = 0.001). The majority of relevant articles (91.8%) were judged as having a balanced judgement, while 8.2% of the articles were rated as exaggerated.

Conclusions

This study has revealed that antidiabetic medicines are indeed reported on by UK and US newspapers. As media portrayal has the potential to negatively or positively influence patients’ views of their medication for diabetes, healthcare professionals should check on patients’ beliefs and knowledge about their medication and proactively provide objective and balanced information (including promotion of medication adherence).

COVID-19 and Tweets About Quitting Cigarette Smoking: Topic Model Analysis of Twitter Posts 2018-2020

Background

The risk of infection and severity of illness by SARS-CoV-2 infection is elevated for people who smoke cigarettes and may motivate quitting. Organic public conversations on Twitter about quitting smoking could provide insight into quitting motivations or behaviors associated with the pandemic.

Objective

This study explored key topics of conversation about quitting cigarette smoking and examined their trajectory during 2018-2020.

Methods

Topic model analysis with latent Dirichlet allocation (LDA) identified themes in US tweets with the term “quit smoking.” The model was trained on posts from 2018 and was then applied to tweets posted in 2019 and 2020. Analysis of variance and follow-up pairwise tests were used to compare the daily frequency of tweets within and across years by quarter.

Results

The mean numbers of daily tweets on quitting smoking in 2018, 2019, and 2020 were 133 (SD 36.2), 145 (SD 69.4), and 127 (SD 32.6), respectively. Six topics were extracted: (1) need to quit, (2) personal experiences, (3) electronic cigarettes (e-cigarettes), (4) advice/success, (5) quitting as a component of general health behavior change, and (6) clinics/services. Overall, the pandemic was not associated with changes in posts about quitting; instead, New Year’s resolutions and the 2019 e-cigarette or vaping use–associated lung injury (EVALI) epidemic were more plausible explanations for observed changes within and across years. Fewer second-quarter posts in 2020 for the topic e-cigarettes may reflect lower pandemic-related quitting interest, whereas fourth-quarter increases in 2020 for other topics pointed to a late-year upswing.

Conclusions

Twitter posts suggest that the pandemic did not generate greater interest in quitting smoking, but possibly a decrease in motivation when the rate of infections was increasing in the second quarter of 2020. Public health authorities may wish to craft messages for specific Twitter audiences (eg, using hashtags) to motivate quitting during pandemics.

Relationship between internet research data of oral neoplasms and public health programs in the European Union

BACKGROUND

Tobacco and alcohol are the main risk factors for oral squamous cell carcinoma, the low survival rate of which is a public health problem. European-wide health policies (a prevention campaign, tobacco packaging) have been put in place to inform the population of the risks associated with consumption. Due to the increase in smoking among women, the incidence of this disease remains high. The identification of internet research data on the population could help to measure the impact of and better position these preventive measures. The objective was to analyze a potential temporal association between public health programs and interest in oral cancers on the internet in the European Union (EU).

METHODS

A search of data from Google ©, Wikipedia © and Twitter © users in 28 European countries relating to oral cancer between 2004 and 2019 was completed. Bibliometric analysis of press and scientific articles over the same period was also performed. The association between these data and the introduction of public health programs in Europe was studied.

RESULTS

There was a temporal association between changes in tobacco packaging and a significant increase in internet searches for oral cancer in seven countries. Unlike national policies and ad campaigns, the European awareness program Make Sense has had no influence on internet research. There was an asymmetric correlation in internet searches between publications on oral cancer from scientific articles or "traditional" media (weak association) and those from internet media such as Twitter © or Wikipedia © (strong association).

CONCLUSION

Our work highlights seven areas around which oral cancer awareness in Europe could be refocused, such as a change in the communication of health warnings on cigarette packs, the establishment of a more explicit campaign name regarding oral cancer, the involvement of public figures and associations in initiatives to be organized at the local level and the strengthening of awareness of the dangers of tobacco in the development of oral cancer.

#MeToo and Google Inquiries Into Sexual Violence: A Hashtag Campaign Can Sustain Information Seeking

The #MeToo Movement has brought new attention to sexual harassment and assault. While the movement originates with activist Tarana Burke, actor Alyssa Milano used the phrase on Twitter in October 2017 in response to multiple sexual harassment allegations against Hollywood producer Harvey Weinstein. Within 24 hours, 53,000 people tweeted comments and/or shared personal experiences of sexual violence. The study objective was to measure how information seeking via Google searches for sexual harassment and assault changed following Milano's tweet and whether this change was sustained in spite of celebrity scandals. Weekly Google search inquiries in the United States were downloaded for the terms metoo, sexual assault, sexual harassment, sexual abuse, and rape for January 1, 2017 to July 15, 2018. Seven related news events about perpetrator accusations were considered. Results showed that searches for metoo increased dramatically after the Weinstein accusation and stayed high during subsequent accusations. A small decrease in searches followed, but the number remained very high relative to baseline (the period before the Weinstein accusation). Searches for sexual assault and sexual harassment increased substantially immediately following the Weinstein accusation, stayed high during subsequent accusations, and saw a decline after the accusation of Matt Lauer (talk show host; last event considered). We estimated a 40% to 70% reduction in searches 6 months after the Lauer accusation, though the increase in searches relative to baseline remained statistically significant. For sexual abuse and rape, the number of searches returned close to baseline by 6 months. It appears that the #MeToo movement sparked greater information seeking that was sustained beyond the associated events. Given its recent ubiquitous use in the media and public life, hashtag activism such as #MeToo can be used to draw further attention to the next steps in addressing sexual assault and harassment, moving public web inquiries from information seeking to action.

Internet Interest in Colon Cancer Following the Death of Chadwick Boseman: Infoveillance Study

Background

Compared with White Americans, Black Americans have higher colon cancer mortality rates but lower up-to-date screening rates. Chadwick Boseman was a prominent Black American actor who died of colon cancer on August 28, 2020. As announcements of celebrity diagnoses often result in increased awareness, Boseman’s death may have resulted in greater interest in colon cancer on the internet, particularly among Black Americans.

Objective

This study aims to quantify the impact of Chadwick Boseman’s death on web-based search interest in colon cancer and determine whether there was an increase in interest in regions of the United States with a greater proportion of Black Americans.

Methods

We conducted an infoveillance study using Google Trends (GT) and Wikipedia pageview analysis. Using an autoregressive integrated moving average algorithm, we forecasted the weekly relative search volume (RSV) for GT search topics and terms related to colon cancer that would have been expected had his death not occurred and compared it with observed RSV data. This analysis was also conducted for the number of page views on the Wikipedia page for colorectal cancer. We then delineated GT RSV data for the term colon cancer for states and metropolitan areas in the United States and determined how the RSV values for these regions correlated with the percentage of Black Americans in that region. Differences in these correlations before and after Boseman’s death were compared to determine whether there was a shift in the racial demographics of the individuals conducting the searches.

Results

The observed RSVs for the topics colorectal cancer and colon cancer screening increased by 598% and 707%, respectively, and were on average 121% (95% CI 72%-193%) and 256% (95% CI 35%-814%) greater than expected during the first 3 months following Boseman’s death. Daily Wikipedia page view volume during the 2 months following Boseman’s death was on average 1979% (95% CI 1375%-2894%) greater than expected, and it was estimated that this represented 547,354 (95% CI 497,708-585,167) excess Wikipedia page views. Before Boseman’s death, there were negative correlations between the percentage of Black Americans living in a state or metropolitan area and the RSV for colon cancer in that area (r=−0.18 and r=−0.05, respectively). However, in the 2 weeks following his death, there were positive correlations between the RSV for colon cancer and the percentage of Black Americans per state and per metropolitan area (r=0.73 and r=0.33, respectively). These changes persisted for 4 months and were all statistically significant (P<.001).

Conclusions

There was a significant increase in web-based activity related to colon cancer following Chadwick Boseman’s death, particularly in areas with a higher proportion of Black Americans. This reflects a heightened public awareness that can be leveraged to further educate the public.

Using Search Engine Data to Explore Interest in PrEP and HIV Testing in the United States

We used Google search data from January 1, 2014 to January 1, 2019 to explore public awareness of pre-exposure prophylaxis (PrEP) and HIV testing in the United States. Using two search strings, one for PrEP and one for HIV testing, we compared search volume to state HIV prevalence and new HIV diagnoses. We also used Google News to identify news events related to short-term spikes in search volume. Controlling for poverty, education, and internet access, a one-unit increase in a state's HIV prevalence rate was associated with a 3% increase in PrEP search volume (aPR = 1.03 [1.034, 1.037], P < 0.0001) and HIV testing search volume (aPR = 1.03 [1.030, 1.032], P < 0.0001). Short-term search volume spikes also coincided with celebrity news and pharmaceutical company advertising. We demonstrate that search engine data can be a powerful tool for understanding HIV knowledge-seeking and can provide key insight to the events that drive public interest about HIV online.

The value of health awareness days, weeks and months: A systematic review

OBJECTIVE

The aim of this systematic review was to analyze the value of awareness days, weeks, and months as found in peer-reviewed research and highlight any related trends.

METHODS

A systematic review was conducted across four electronic databases for articles published between 1970 and July 2020. The researchers reviewed articles which included awareness days, weeks, or months in the title or abstract and extracted articles which used quantitative analysis to assess the impact of such campaigns.

RESULTS

The 73 included articles were separated into categories based on outcome measure(s) with 12 articles included in more than one category. Of the 31 articles which examined online activity outcomes, the vast majority reported the awareness day, week, or month in question positively correlated with increased activity. Of the 14 articles focused on knowledge outcomes, those which focused on specific day, week, or month sub-interventions with targeted populations had relatively greater success. The 29 studies that examined the impact of awareness days, weeks, and months on health outcomes reported mixed results. Another twelve studies provided treatment insights based on convenience sample research conducted during awareness days, weeks, and months. The majority of articles across all outcome categories did not examine costs.

CONCLUSION

Although online activity seemed to generally increase during the awareness days, weeks, and months studied, the relationship between this increase and improved health behaviors and outcomes remains unclear. In addition, there is a paucity of research pertaining to the cost and cost effectiveness of such campaigns. Future research in this area needs to focus more on health outcome impacts and include an examination of cost effectiveness when possible.

News coverage of the E-cigarette, or Vaping, product use Associated Lung Injury (EVALI) outbreak and internet searches for vaping cessation

BACKGROUND

In the latter half of 2019, an outbreak of pulmonary disease in the USA resulted in 2807 hospitalisations and 68 deaths, as of 18 February 2020. Given the severity of the outbreak, we assessed whether articles during the outbreak era more frequently warned about the dangers of vaping and whether internet searches for vaping cessation increased.

METHODS

Using Tobacco Watcher, a media monitoring platform that automatically identifies and categorises news articles from sources across the globe, we obtained all articles that (a) discussed the outbreak and (b) primarily warned about the dangers of vaping. We obtained internet search trends originating from the USA that mentioned 'quit' or 'stop' and 'e cig(s),' 'ecig(s),' 'e-cig(s),' 'e cigarette(s),' 'e-cigarette(s),' 'electronic cigarette(s),' 'vape(s),' 'vaping' or 'vaper(s)' from Google Trends (eg, 'how do I quit vaping?'). All data were obtained from 1 January 2014 to 18 February 2020 and ARIMA models were used with historical trends to forecast the ratio of observed to expected search volumes during the outbreak era.

RESULTS

News of the vaping-induced pulmonary disease outbreak was first reported on 25 July 2019 with 195 articles, culminating in 44 512 articles by 18 February 2020. On average, news articles warning about the dangers of vaping were 130% (95% prediction interval (PI): -15 to 417) and searches for vaping cessation were 76% (95% PI: 28 to 182) higher than expected levels for the days during the period when the sources of the outbreak were unknown (25 July to 27 September 2019). News and searches stabilised just after the US Centers for Disease Control and Prevention reported that a primary source of the outbreak was an additive used in marijuana vapes on 27 September 2019. In sum, there were 12 286 articles archived in Tobacco Watcher primarily warning about the dangers of vaping and 1 025 000 cessation searches following the outbreak.

CONCLUSION

The vaping-induced pulmonary disease outbreak spawned increased coverage about the dangers of vaping and internet searches for vaping cessation. Resources and strategies that respond to this elevated interest should become a priority among public health leaders.

'Dr. Google, I have a stomach ache' - seasonal variations in abdominal pain: a 4-year retrospective data analysis from Google Ads keywords planner

BACKGROUND

Internet traffic may reflect the prevalence of real-world ailments. The aim of this study was to analyse queries associated with abdominal pain and to investigate seasonal frequency and trends of searches in Poland.

METHODS

We analysed mean search volume from March 2015 to February 2019 of keywords associated with 'abdominal pain' in the Polish language generated from the Google Ads Planner. Keywords were categorised by location, feature or type of pain, concurrent symptoms, frequency and patient groups, etc. We compared differences in search volumes across seasons and years.

RESULTS

Overall, 24,673,430 queries were associated with abdominal pain in the period analysed. The number of searches associated with abdominal pain in winter increased by ~30% compared with queries searched in summer. There were significantly more searches related to abdominal pain located in the epigastric, umbilical, hypogastrium, left lumbar, left iliac and right iliac regions combined with vomiting or fever, and acute or burning sensation in cold months. We did not observe any specific patterns of pain in the right lumbar or left hypochondrium region, co-presence of flatulence, acute, cramping or persistent/chronic or strong abdominal pain.

CONCLUSION

Internet queries associated with abdominal pain and related factors have increased in the past 4 years and present a seasonal pattern. Google Ads may be a valuable tool to assess the prevalence of complaints in under-researched regions. The observed trends in queries related to abdominal pain merely reflect the scale of the problem. The reported pattern should be verified in epidemiological studies.

Infodemiology and Infoveillance: Scoping Review

Background

Web-based sources are increasingly employed in the analysis, detection, and forecasting of diseases and epidemics, and in predicting human behavior toward several health topics. This use of the internet has come to be known as infodemiology, a concept introduced by Gunther Eysenbach. Infodemiology and infoveillance studies use web-based data and have become an integral part of health informatics research over the past decade.

Objective

The aim of this paper is to provide a scoping review of the state-of-the-art in infodemiology along with the background and history of the concept, to identify sources and health categories and topics, to elaborate on the validity of the employed methods, and to discuss the gaps identified in current research.

Methods

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to extract the publications that fall under the umbrella of infodemiology and infoveillance from the JMIR, PubMed, and Scopus databases. A total of 338 documents were extracted for assessment.

Results

Of the 338 studies, the vast majority (n=282, 83.4%) were published with JMIR Publications. The Journal of Medical Internet Research features almost half of the publications (n=168, 49.7%), and JMIR Public Health and Surveillance has more than one-fifth of the examined studies (n=74, 21.9%). The interest in the subject has been increasing every year, with 2018 featuring more than one-fourth of the total publications (n=89, 26.3%), and the publications in 2017 and 2018 combined accounted for more than half (n=171, 50.6%) of the total number of publications in the last decade. The most popular source was Twitter with 45.0% (n=152), followed by Google with 24.6% (n=83), websites and platforms with 13.9% (n=47), blogs and forums with 10.1% (n=34), Facebook with 8.9% (n=30), and other search engines with 5.6% (n=19). As for the subjects examined, conditions and diseases with 17.2% (n=58) and epidemics and outbreaks with 15.7% (n=53) were the most popular categories identified in this review, followed by health care (n=39, 11.5%), drugs (n=40, 10.4%), and smoking and alcohol (n=29, 8.6%).

Conclusions

The field of infodemiology is becoming increasingly popular, employing innovative methods and approaches for health assessment. The use of web-based sources, which provide us with information that would not be accessible otherwise and tackles the issues arising from the time-consuming traditional methods, shows that infodemiology plays an important role in health informatics research.

Search trends and prediction of human brucellosis using Baidu index data from 2011 to 2018 in China

Reporting on brucellosis, a relatively rare infectious disease caused by Brucella, is often delayed or incomplete in traditional disease surveillance systems in China. Internet search engine data related to brucellosis can provide an economical and efficient complement to a conventional surveillance system because people tend to seek brucellosis-related health information from Baidu, the largest search engine in China. In this study, brucellosis incidence data reported by the CDC of China and Baidu index data were gathered to evaluate the relationship between them. We applied an autoregressive integrated moving average (ARIMA) model and an ARIMA model with Baidu search index data as the external variable (ARIMAX) to predict the incidence of brucellosis. The two models based on brucellosis incidence data were then compared, and the ARIMAX model performed better in all the measurements we applied. Our results illustrate that Baidu index data can enhance the traditional surveillance system to monitor and predict brucellosis epidemics in China.

Analysis of Answers to Queries among Anonymous Users with Gastroenterological Problems on an Internet Forum

Internet forums are an attractive source of health-related information. We aimed to investigate threads in the gastroenterological section of a popular Polish medical forum for anonymous users. We characterised the following aspects in threads: the main problem of the original poster, declared ailments and rationale of the responses (rational, neutral, harmful or not related to the problem of the original poster). We analysed over 2717 forum threads initiated in the years 2010–2018. Users mostly asked for diagnosis of the problem [1814 (66.8%)], treatment [1056 (38.9%)] and diagnostic interpretation [308 (11.3%)]. The most commonly declared symptoms were abdominal pain [1046 (38.5%)], diarrhea [454 (16.7%)] and bloating [354 (13.0%)]. Alarm symptoms were mentioned in 309 (11.4%) threads. From the total 3550 responses, 1257 (35.4%) were assessed as rational, 693 (19.5%) as neutral, 157 (4.4%) as harmful and 1440 (40.6%) as not related to the user’s problem. The original poster’s declaration of blood in stool, dyspepsia, pain in the abdominal right lower quadrant, weight loss or inflammatory bowel disease was positively related to obtaining at least one potentially harmful response. Advice from anonymous users on Internet forums may be irrational and disregards alarm symptoms, which can delay the diagnosis of life-threatening diseases.

"Dr. Google, I am in Pain"-Global Internet Searches Associated with Pain: A Retrospective Analysis of Google Trends Data

We aimed to rank the most common locations of pain among Google users globally and locally and analyze secular and seasonal trends in pain-related searches in the years 2004–2019. We used data generated by Google Trends (GT) to identify and analyze global interest in topics (n = 24) related to locations of pain and how these progressed over time. We analyzed secular trends and time series decomposition to identify seasonal variations. We also calculated the interest in all topics with reference to the relative search volume (RSV) of “Abdominal pain”. Google users were most commonly interested in “Headache” (1.30 [times more frequently than “Abdominal pain”]), “Abdominal pain” (1.00), and “Back pain” (0.84). “Headache” was the most frequent search term in n = 41 countries, while “Abdominal pain” was the most frequent term in n = 27 countries. The interest in all pain-related topics except “Dyspareunia” increased over time. The sharpest increase was observed for “Abdominal pain” (5.67 RSV/year), and “Toothache” (5.52 RSV/year). Most of the topics revealed seasonal variations. Among pain-related topics, “Headache,” “Abdominal pain,” and “Back pain” interested most Google users. GT is a novel tool that allows retrospective investigation of complaints among Internet users.

Big Data, Computational Social Science, and Health Communication: A Review and Agenda for Advancing Theory

Contemporary research on health communication has been marked by the presence of big data and computational social science (CSS) techniques. The relative novelty of these approaches makes it worthwhile to consider their status and potential for advancing health communication scholarship. This essay offers an introduction focusing on how big data and CSS techniques are being employed to study health communication and their utility for theory development. Key trends in this body of research are summarized, including the use of big data and CSS for examining public perceptions of health conditions or events, investigating network-related dimensions of health phenomena, and illness monitoring. The implications of big data and CSS for health communication theory are also evaluated. Opportunities presented by big data and CSS to help extend existing theories and build new communication theories are discussed.

Heartburn-Related Internet Searches and Trends of Interest across Six Western Countries: A Four-Year Retrospective Analysis Using Google Ads Keyword Planner

The internet is becoming the main source of health-related information. We aimed to investigate data regarding heartburn-related searches made by Google users from Australia, Canada, Germany, Poland, the United Kingdom, and the United States. We retrospectively analyzed data from Google Ads Keywords Planner. We extracted search volumes of keywords associated with “heartburn” for June 2015 to May 2019. The data were generated in the respective primary language. The number of searches per 1000 Google-user years was as follows: 177.4 (Australia), 178.1 (Canada), 123.8 (Germany), 199.7 (Poland), 152.5 (United Kingdom), and 194.5 (United States). The users were particularly interested in treatment (19.0 to 41.3%), diet (4.8 to 10.7%), symptoms (2.6 to 13.1%), and causes (3.7 to 10.0%). In all countries except Germany, the number of heartburn-related queries significantly increased over the analyzed period. For Canada, Germany, Poland, and the United Kingdom, query numbers were significantly lowest in summer; there was no significant seasonal trend for Australia and the United States. The number of heartburn-related queries has increased over the past four years, and a seasonal pattern may exist in certain regions. The trends in heartburn-related searches may reflect the scale of the complaint, and should be verified through future epidemiological studies.

Monitoring Tobacco Brand Websites to Understand Marketing Strategies Aimed at Tobacco Product Users and Potential Users

Introduction

Limited information exists about strategies and methods used on brand marketing websites to transmit pro-tobacco messages to tobacco users and potential users. This study compared age verification methods, themes, interactive activities and links to social media across tobacco brand websites.

Methods

This study examined 12 tobacco brand websites representing four tobacco product categories: cigarettes, cigar/cigarillos, smokeless tobacco, and e-cigarettes. Website content was analyzed by tobacco product category and data from all website visits (n = 699) were analyzed. Adult smokers (n = 32) coded websites during a one-year period, indicating whether or not they observed any of 53 marketing themes, seven interactive activities, or five external links to social media sites.

Results

Most (58%) websites required online registration before entering, however e-cigarette websites used click-through age verification. Compared to cigarette sites, cigar/cigarillo sites were more likely to feature themes related to "party" lifestyle, and e-cigarette websites were much more likely to feature themes related to harm reduction. Cigarette sites featured greater levels of interactive content compared to other tobacco products. Compared to cigarette sites, cigar/cigarillo sites were more likely to feature activities related to events and music. Compared to cigarette sites, both cigar and e-cigarette sites were more likely to direct visitors to external social media sites.

Conclusion

Marketing methods and strategies normalize tobacco use by providing website visitors with positive themes combined with interactive content, and is an area of future research. Moreover, all tobacco products under federal regulatory authority should be required to use more stringent age verification gates.

Implications

Findings indicate that the Food and Drug Administration (FDA) should require brand websites of all tobacco products under its regulatory authority use more stringent age verification gates by requiring all visitors be at least 18 years of age and register online prior to entry. This is important given that marketing strategies may encourage experimentation with tobacco or deter quit attempts among website visitors. Future research should examine the use of interactive activities and social media on a wide variety of tobacco brand websites as interactive content is associated with more active information processing.

Evaluating the impact of health awareness events on Google search frequency

Over two hundred health awareness events take place in the United States in order to educate the public about various diseases. It would be informative and instructive for the organizations to know the impact of these events, although such information could be difficult to measure. We investigated whether 46 selected events attract the public attention by increasing the search frequencies of certain keywords. Internet search data from 2004 to 2017 were downloaded from Google Trend (GT). Three statistical methods including Transfer Function Noise modeling, Wilcoxon Rank Sum test, and Binomial inference were conducted. Our study showed that 10 health awareness events resulted in increased search frequencies in the event months, and 28 events did not, with the rest being classified as unclear.

Investigating an Issue-Attention-Action Cycle: A Case Study on the Chronology of Media Attention, Public Attention, and Actual Vaccination Behavior during the 2019 Measles Outbreak in Austria

The present study investigated the chronology of media attention, public attention, and actual vaccinations during a recent measles outbreak in Austria. The analysis indicated that initial news coverage about the measles outbreak (the first wave of media attention) sparked public attention and led to additional heavy news coverage about measles (the second wave of media attention). The observed patterns of public and media attention reflect typical issue-attention cycles, as revealed by previous research. As a supplement to previous studies, the present study links media and public attention with a consecutive increase in the number of vaccinations, thereby supporting the notion of an issue-attention-action cycle. Additional curve-fitting analyses showed that the day-by-day variations in media and public attention resembled sharp, short-term "spotlight effects," whereas consequences on vaccination behavior represented a broader, long-term "echo effect." Above and beyond the theoretical contributions, we discuss practical implications: Surveilling the development of media and public attention in the immediate aftermath of a measles outbreak may be a cost-effective strategy to predict future patient load, thereby helping to effectively allocate resources for vaccination programs. A thorough understanding of the issue-attention-action cycle contributes to this aim.

Caribbean Wellness Day: promoting a region-wide day of action

In response to the epidemic of non-communicable diseases (NCDs) in the Caribbean, the Heads of Government of the Caribbean Community (CARICOM) issued the 2007 Port-of-Spain Declaration, “Uniting to Stop the Epidemic of Chronic Non-communicable Diseases” and declared the second Saturday in September to be “Caribbean Wellness Day” (CWD). CWD is a call-to-action for engaging the population of the Member States in confronting NCDs and their risk factors.

This report reviews the genesis, implementation, and institutionalization of CWD in CARICOM and beyond. The study used quantitative and qualitative methods, including 29 surveys, 7 in-depth interviews, and analysis of media content. Data was provided by NCD focal points at the Ministry of Health in 15 CARICOM countries, as well as by 7 non-governmental and 4 private organizations.

Branding materials were well received and locally adapted; much of CWD media content originated from organization websites and were not community-based. Events typically focused on physical activity and health screenings and were attended by up to 3 000 participants. Though most were held in city centers, some CWD activities have involved rural and indigenous populations.

CWD has become a catalyst for multisectoral engagement and health promotion activities. Inspired by CWD, PAHO initiated “Wellness Week in the Americas,” which includes CWD and promotes its tenets across the Region of the Americas. As CWD further develops, consideration should be given to reliable, adequate, and sustainable financing; to measuring and evaluating its impact on NCDs; and to widening its reach to include those outside of city centers.

How Twitter Can Support the HIV/AIDS Response to Achieve the 2030 Eradication Goal: In-Depth Thematic Analysis of World AIDS Day Tweets

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.

Next generation media monitoring: Global coverage of electronic nicotine delivery systems (electronic cigarettes) on Bing, Google and Twitter, 2013-2018

News media monitoring is an important scientific tool. By treating news reporters as data collectors and their reports as qualitative accounts of a fast changing public health landscape, researchers can glean many valuable insights. Yet, there have been surprisingly few innovations in public health media monitoring, with nearly all studies relying on labor-intensive content analyses limited to a small number of media reports. We propose to advance this subfield by using scalable machine learning. In potentially the largest contemporary public health media monitoring study to date, we systematically characterize global news reports surrounding electronic cigarettes or electronic nicotine delivery systems (ENDS) using natural language processing techniques. News reports including ENDS terms (e.g., "electronic cigarettes") from over 100,000 sources (all sources archived on Google News or Bing News, as well as all news articles shared on Twitter) were monitored for 1 January 2013 through 31 July 2018. The geographic and subject (e.g., prevalence, bans, quitting, warnings, marketing, prices, age, flavor and industry) foci of news articles, their popularity among readers who share news on social media, and the sentiment behind news articles were assessed algorithmically. Globally there were 86,872 ENDS news reports with coverage increasing from 8 (standard deviation [SD] = 8) stories per day in 2013 to 75 (SD = 56) stories per day during 2018. The focus of ENDS news spanned 148 nations, with the plurality focusing on the United States (34% of all news). Potentially overlooked hotspots of ENDS media activity included China, Egypt, Russia, Ukraine, and Paraguay. The most common subject was warnings about ENDS (18%), followed by bans on using ENDS (13%) and ENDS prices (9%). Flavor and age restrictions were the least covered news subjects (~1% each). Among different subject foci, reports on quitting cigarettes using ENDS had the highest probability of scoring in the top three deciles of popularity rankings. Moreover, ENDS news on quitting and prices had a more positive sentiment on average than news with other subject foci. Public health leaders can use these trends to stay abreast of how ENDS are portrayed in the media, and potentially how the public perceives ENDS. Because our analytical strategies are updated in near real time, we aim to make media monitoring part of standard practice to support evidence-based tobacco control in the future.

Health Care Apps Reported in Newspapers: Content Analysis

BACKGROUND

Newspapers are considered one of the most viewed and influential media sources in both the United Kingdom and United States. However, information about how newspapers portray health care apps to the readers has been lacking.

OBJECTIVE

This study investigated the reporting on health care apps in newspapers published in the United Kingdom and United States.

METHODS

The Nexis UK database was used to identify and select relevant articles. Systematic content analysis of the articles that met the inclusion criteria (articles of any format that contained reference to health care apps or medical apps) within the highest circulated newspapers in the United Kingdom and United States over a period of 10 years (2006-2015) was conducted. Interrater reliability of coding was established using a 10% sample of the chosen articles.

RESULTS

A total of 220 (151 UK and 69 US) relevant newspaper articles were retrieved. Health care apps were most frequently reported on in the Daily Mail and The Guardian (UK newspapers) and in the New York Times and the Washington Post (US newspapers). An exponential rise in published scientific articles (PubMed) on health care-related apps was noted during the study period. A total of 26.4% (58/220) and 19.1% (42/220) of the retrieved newspaper articles appeared in the features and main news sections, respectively. General information about health care apps was the main theme coved by the newspapers (45.9%, 101/220). Most of the articles represented a societal point of view (72.3%, 159/220). The main focus of the articles was on general health matters (48.2%, 106/220) and specific disease matters (36.8%, 81/220). Diabetes was the most frequently mentioned disease in the articles. A high proportion (91.4%, 201/220) of the articles mentioned benefits of using health care apps mainly for personalized care, whereas 24.1% (53/220) of the articles commented on related risks such as anxiety and confidentiality issues. Almost half (45.9%, 101/220) of the articles mentioned potential facilitators to the use of apps; less than 10% (16/220) discussed barriers. Most of the articles (83.6%, 184/220) were judged as having balanced judgment on the present topic and more than half (60.0%, 132/220) of the articles were judged to be of generally low quality.

CONCLUSIONS

Health care apps were not widely reported in newspaper articles in the United Kingdom and United States over the study period; however, there appeared to be much more recent interest. Characteristically, the articles focused more frequently on societal impact and on general health rather than on disease-specific apps.

Diurnal Variations of Depression-Related Health Information Seeking: Case Study in Finland Using Google Trends Data

BACKGROUND

Some of the temporal variations and clock-like rhythms that govern several different health-related behaviors can be traced in near real-time with the help of search engine data. This is especially useful when studying phenomena where little or no traditional data exist. One specific area where traditional data are incomplete is the study of diurnal mood variations, or daily changes in individuals' overall mood state in relation to depression-like symptoms.

OBJECTIVE

The objective of this exploratory study was to analyze diurnal variations for interest in depression on the Web to discover hourly patterns of depression interest and help seeking.

METHODS

Hourly query volume data for 6 depression-related queries in Finland were downloaded from Google Trends in March 2017. A continuous wavelet transform (CWT) was applied to the hourly data to focus on the diurnal variation. Longer term trends and noise were also eliminated from the data to extract the diurnal variation for each query term. An analysis of variance was conducted to determine the statistical differences between the distributions of each hour. Data were also trichotomized and analyzed in 3 time blocks to make comparisons between different time periods during the day.

RESULTS

Search volumes for all depression-related query terms showed a unimodal regular pattern during the 24 hours of the day. All queries feature clear peaks during the nighttime hours around 11 PM to 4 AM and troughs between 5 AM and 10 PM. In the means of the CWT-reconstructed data, the differences in nighttime and daytime interest are evident, with a difference of 37.3 percentage points (pp) for the term "Depression," 33.5 pp for "Masennustesti," 30.6 pp for "Masennus," 12.8 pp for "Depression test," 12.0 pp for "Masennus testi," and 11.8 pp for "Masennus oireet." The trichotomization showed peaks in the first time block (00.00 AM-7.59 AM) for all 6 terms. The search volumes then decreased significantly during the second time block (8.00 AM-3.59 PM) for the terms "Masennus oireet" (P<.001), "Masennus" (P=.001), "Depression" (P=.005), and "Depression test" (P=.004). Higher search volumes for the terms "Masennus" (P=.14), "Masennustesti" (P=.07), and "Depression test" (P=.10) were present between the second and third time blocks.

CONCLUSIONS

Help seeking for depression has clear diurnal patterns, with significant rise in depression-related query volumes toward the evening and night. Thus, search engine query data support the notion of the evening-worse pattern in diurnal mood variation. Information on the timely nature of depression-related interest on an hourly level could improve the chances for early intervention, which is beneficial for positive health outcomes.

The Charlie Sheen Effect on Rapid In-home Human Immunodeficiency Virus Test Sales

One in eight of the 1.2 million Americans living with human immunodeficiency virus (HIV) are unaware of their positive status, and untested individuals are responsible for most new infections. As a result, testing is the most cost-effective HIV prevention strategy and must be accelerated when opportunities are presented. Web searches for HIV spiked around actor Charlie Sheen's HIV-positive disclosure. However, it is unknown whether Sheen's disclosure impacted offline behaviors like HIV testing. The goal of this study was to determine if Sheen's HIV disclosure was a record-setting HIV prevention event and determine if Web searches presage increases in testing allowing for rapid detection and reaction in the future. Sales of OraQuick rapid in-home HIV test kits in the USA were monitored weekly from April 12, 2014, to April 16, 2016, alongside Web searches including the terms "test," "tests," or "testing" and "HIV" as accessed from Google Trends. Changes in OraQuick sales around Sheen's disclosure and prediction models using Web searches were assessed. OraQuick sales rose 95% (95% CI, 75-117; p < 0.001) of the week of Sheen's disclosure and remained elevated for 4 more weeks (p < 0.05). In total, there were 8225 more sales than expected around Sheen's disclosure, surpassing World AIDS Day by a factor of about 7. Moreover, Web searches mirrored OraQuick sales trends (r = 0.79), demonstrating their ability to presage increases in testing. The "Charlie Sheen effect" represents an important opportunity for a public health response, and in the future, Web searches can be used to detect and act on more opportunities to foster prevention behaviors.

Influencing the Conversation About Masculinity and Suicide: Evaluation of the Man Up Multimedia Campaign Using Twitter Data

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.

E-Cigarette Surveillance With Social Media Data: Social Bots, Emerging Topics, and Trends

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.

They're heating up: Internet search query trends reveal significant public interest in heat-not-burn tobacco products

Heat-not-burn tobacco products, battery powered devices that heat leaf tobacco to approximately 500 degrees Fahrenheit to produce an inhalable aerosol, are being introduced in markets around the world. Japan, where manufacturers have marketed several heat-not-burn brands since 2014, has been the focal national test market, with the intention of developing global marketing strategies. We used Google search query data to estimate, for the first time, the scale and growth potential of heat-not-burn tobacco products. Average monthly searches for heat-not-burn products rose 1,426% (95%CI: 746,3574) between their first (2015) and second (2016) complete years on the market and an additional 100% (95%CI: 60, 173) between the products second (2016) and third years on the market (Jan-Sep 2017). There are now between 5.9 and 7.5 million heat-not-burn related Google searches in Japan each month based on September 2017 estimates. Moreover, forecasts relying on the historical trends suggest heat-not-burn searches will increase an additional 32% (95%CI: -4 to 79) during 2018, compared to current estimates for 2017 (Jan-Sep), with continued growth thereafter expected. Contrasting heat-not-burn’s rise in Japan to electronic cigarettes’ rise in the United States we find searches for heat-not-burn eclipsed electronic cigarette searches during April 2016. Moreover, the change in average monthly queries for heat-not-burn in Japan between 2015 and 2017 was 399 (95% CI: 184, 1490) times larger than the change in average monthly queries for electronic cigarettes in the Unites States over the same time period, increasing by 2,956% (95% CI: 1729, 7304) compared to only 7% (95% CI: 3,13). Our findings are a clarion call for tobacco control leaders to ready themselves as heat-not-burn tobacco products will likely garner substantial interest as they are introduced into new markets. Public health practitioners should expand heat-not-burn tobacco product surveillance, adjust existing tobacco control strategies to account for heat-not-burn tobacco products, and preemptively study the health risks/benefits, popular perceptions, and health messaging around heat-not-burn tobacco products.

Global reaction to the recent outbreaks of Zika virus: Insights from a Big Data analysis

Objective

The recent spreading of Zika virus represents an emerging global health threat. As such, it is attracting public interest worldwide, generating a great amount of related Internet searches and social media interactions. The aim of this research was to understand Zika-related digital behavior throughout the epidemic spreading and to assess its consistence with real-world epidemiological data, using a behavioral informatics and analytics approach.

Methods

In this study, the global web-interest and reaction to the recently occurred outbreaks of the Zika Virus were analyzed in terms of tweets and Google Trends (GT), Google News, YouTube, and Wikipedia search queries. These data streams were mined from 1^st January 2004 to 31^st October 2016, with a focus on the period November 2015—October 2016. This analysis was complemented with the use of epidemiological data. Spearman’s correlation was performed to correlate all Zika-related data. Moreover, a multivariate regression was performed using Zika-related search queries as a dependent variable, and epidemiological data, number of inhabitants in 2015 and Human Development Index as predictor variables.

Results

Overall 3,864,395 tweets, 284,903 accesses to Wikipedia pages dedicated to the Zika virus were analyzed during the study period. All web-data sources showed that the main spike of researches and interactions occurred in February 2016 with a second peak in August 2016. All novel data streams-related activities increased markedly during the epidemic period with respect to pre-epidemic period when no web activity was detected. Correlations between data from all these web platforms resulted very high and statistically significant. The countries in which web searches were particularly concentrated are mainly from Central and South Americas. The majority of queries concerned the symptoms of the Zika virus, its vector of transmission, and its possible effect to babies, including microcephaly. No statistically significant correlation was found between novel data streams and global real-world epidemiological data. At country level, a correlation between the digital interest towards the Zika virus and Zika incidence rate or microcephaly cases has been detected.

Conclusions

An increasing public interest and reaction to the current Zika virus outbreak was documented by all web-data sources and a similar pattern of web reactions has been detected. The public opinion seems to be particularly worried by the alert of teratogenicity of the Zika virus. Stakeholders and health authorities could usefully exploited these internet tools for collecting the concerns of public opinion and reply to them, disseminating key information.

Characterizing Awareness of Schizophrenia Among Facebook Users by Leveraging Facebook Advertisement Estimates

Background

Schizophrenia is a rare but devastating condition, affecting about 1% of the world’s population and resulting in about 2% of the US health care expenditure. Major impediments to appropriate and timely care include misconceptions, high levels of stigma, and lack of public awareness. Facebook offers novel opportunities to understand public awareness and information access related to schizophrenia, and thus can complement survey-based approaches to assessing awareness that are limited in scale, robustness, and temporal and demographic granularity.

Objective

The aims of this study were to (1) construct an index that measured the awareness of different demographic groups around schizophrenia-related information on Facebook; (2) study how this index differed across demographic groups and how it correlated with complementary Web-based (Google Trends) and non–Web-based variables about population well-being (mental health indicators and infrastructure), and (3) examine the relationship of Facebook derived schizophrenia index with other types of online activity as well as offline health and mental health outcomes and indicators.

Methods

Data from Facebook’s advertising platform was programmatically collected to compute the proportion of users in a target demographic group with an interest related to schizophrenia. On consultation with a clinical expert, several topics were combined to obtain a single index measuring schizophrenia awareness. This index was then analyzed for differences across US states, gender, age, ethnic affinity, and education level. A statistical approach was developed to model a group’s awareness index based on the group’s characteristics.

Results

Overall, 1.03% of Facebook users in the United States have a schizophrenia-related interest. The schizophrenia awareness index (SAI) is higher for females than for males (1.06 vs 0.97, P<.001), and it is highest for the people who are aged 25-44 years (1.35 vs 1.03 for all ages, P<.001). The awareness index drops for higher education levels (0.68 for MA or PhD vs 1.92 for no high school degree, P<.001), and Hispanics have the highest level of interest (1.57 vs 1.03 for all ethnic affinities, P<.001). A regression model fit to predict a group’s interest level achieves an adjusted R²=0.55. We also observe a positive association between our SAI and mental health services (or institutions) per 100,000 residents in a US state (Pearson r=.238, P<.001), but a negative association with the state-level human development index (HDI) in United States (Pearson r=−.145, P<.001) and state-level volume of mental health issues in United States (Pearson r=−.145, P<.001).

Conclusions

Facebook’s advertising platform can be used to construct a plausible index of population-scale schizophrenia awareness. However, only estimates of awareness can be obtained, and the index provides no information on the quality of the information users receive online.

Why do people use electronic nicotine delivery systems (electronic cigarettes)? A content analysis of Twitter, 2012-2015

The reasons for using electronic nicotine delivery systems (ENDS) are poorly understood and are primarily documented by expensive cross-sectional surveys that use preconceived close-ended response options rather than allowing respondents to use their own words. We passively identify the reasons for using ENDS longitudinally from a content analysis of public postings on Twitter. All English language public tweets including several ENDS terms (e.g., “e-cigarette” or “vape”) were captured from the Twitter data stream during 2012 and 2015. After excluding spam, advertisements, and retweets, posts indicating a rationale for vaping were retained. The specific reasons for vaping were then inferred based on a supervised content analysis using annotators from Amazon’s Mechanical Turk. During 2012 quitting combustibles was the most cited reason for using ENDS with 43% (95%CI 39–48) of all reason-related tweets cited quitting combustibles, e.g., “I couldn’t quit till I tried ecigs,” eclipsing the second most cited reason by more than double. Other frequently cited reasons in 2012 included ENDS’s social image (21%; 95%CI 18–25), use indoors (14%; 95%CI 11–17), flavors (14%; 95%CI 11–17), safety relative to combustibles (9%; 95%CI 7–11), cost (3%; 95%CI 2–5) and favorable odor (2%; 95%CI 1–3). By 2015 the reasons for using ENDS cited on Twitter had shifted. Both quitting combustibles and use indoors significantly declined in mentions to 29% (95%CI 24–33) and 12% (95%CI 9–16), respectively. At the same time, social image increased to 37% (95%CI 32–43) and lack of odor increased to 5% (95%CI 2–5), the former leading all cited reasons in 2015. Our data suggest the reasons people vape are shifting away from cessation and toward social image. The data also show how the ENDS market is responsive to a changing policy landscape. For instance, smoking indoors was less frequently cited in 2015 as indoor smoking restrictions became more common. Because the data and analytic approach are scalable, adoption of our strategies in the field can inform follow-up survey-based surveillance (so the right questions are asked), interventions, and policies for ENDS.

"Mommy Blogs" and the Vaccination Exemption Narrative: Results From A Machine-Learning Approach for Story Aggregation on Parenting Social Media Sites

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.

Pokémon Go and Exposure to Mosquito-Borne Diseases: How Not to Catch 'Em All

Pokémon Go is a new game that encourages players to venture outdoors and interact with others in the pursuit of virtual Pokémon characters. With more time spent outdoors overall and in sometimes large congregations, Pokémon Go players could inadvertently elevate their risk of exposure to mosquito-borne diseases when playing in certain areas at certain times of year. Here, we make an initial assessment of the possible scope of this concern in the continental United States, which experiences its highest seasonal transmission of West Nile, Zika, and other viruses during summer and early fall. In particular, we propose that the times of day when many disease-relevant mosquito species are most likely to engage in blood feeding coincide with times of day when Pokémon Go activity is likely to be high, and we note that locations serving as hubs of Pokémon Go activity may in some cases overlap with areas where these mosquitoes are actively engaged in blood feeding. Although the risk of mosquito-borne diseases in the continental U.S. is low overall and is unlikely to be impacted significantly by Pokémon Go, it is nonetheless important for Pokémon Go players and others who spend time outdoors engaging in activities such as barbecues and gardening to be aware of these ongoing risks and to take appropriate preventative measures in light of the potential for outdoor activity to modify individual-level risk of exposure. As Pokémon Go and other augmented reality games become available in other parts of the world, similar risks should be assessed in a manner that is consistent with the local epidemiology of mosquito-borne diseases in those areas.

Leveraging Big Data for Exploring Occupational Diseases-Related Interest at the Level of Scientific Community, Media Coverage and Novel Data Streams: The Example of Silicosis as a Pilot Study

Objective

Silicosis is an untreatable but preventable occupational disease, caused by exposure to silica. It can progressively evolve to lung impairment, respiratory failure and death, even after exposure has ceased. However, little is known about occupational diseases-related interest at the level of scientific community, media coverage and web behavior. This article aims at filling in this gap of knowledge, taking the silicosis as a case study.

Methods

We investigated silicosis-related web-activities using Google Trends (GT) for capturing the Internet behavior worldwide in the years 2004–2015. GT-generated data were, then, compared with the silicosis-related scientific production (i.e., PubMed and Google Scholar), the media coverage (i.e., Google news), the Wikipedia traffic (i.e, Wikitrends) and the usage of new media (i.e., YouTube and Twitter).

Results

A peak in silicosis-related web searches was noticed in 2010–2011: interestingly, both scientific articles production and media coverage markedly increased after these years in a statistically significant way. The public interest and the level of the public engagement were witnessed by an increase in likes, comments, hashtags, and re-tweets. However, it was found that only a small fraction of the posted/uploaded material contained accurate scientific information.

Conclusions

GT could be useful to assess the reaction of the public and the level of public engagement both to novel risk-factors associated to occupational diseases, and possibly related changes in disease natural history, and to the effectiveness of preventive workplace practices and legislative measures adopted to improve occupational health. Further, occupational clinicians should become aware of the topics most frequently searched by patients and proactively address these concerns during the medical examination. Institutional bodies and organisms should be more present and active in digital tools and media to disseminate and communicate scientifically accurate information. This manuscript should be intended as preliminary, exploratory communication, paving the way for further studies.

Big Data Sensors of Organic Advocacy: The Case of Leonardo DiCaprio and Climate Change

The strategies that experts have used to share information about social causes have historically been top-down, meaning the most influential messages are believed to come from planned events and campaigns. However, more people are independently engaging with social causes today than ever before, in part because online platforms allow them to instantaneously seek, create, and share information. In some cases this “organic advocacy” may rival or even eclipse top-down strategies. Big data analytics make it possible to rapidly detect public engagement with social causes by analyzing the same platforms from which organic advocacy spreads. To demonstrate this claim we evaluated how Leonardo DiCaprio’s 2016 Oscar acceptance speech citing climate change motivated global English language news (Bloomberg Terminal news archives), social media (Twitter postings) and information seeking (Google searches) about climate change. Despite an insignificant increase in traditional news coverage (54%; 95%CI: -144 to 247), tweets including the terms “climate change” or “global warming” reached record highs, increasing 636% (95%CI: 573–699) with more than 250,000 tweets the day DiCaprio spoke. In practical terms the “DiCaprio effect” surpassed the daily average effect of the 2015 Conference of the Parties (COP) and the Earth Day effect by a factor of 3.2 and 5.3, respectively. At the same time, Google searches for “climate change” or “global warming” increased 261% (95%CI, 186–335) and 210% (95%CI 149–272) the day DiCaprio spoke and remained higher for 4 more days, representing 104,190 and 216,490 searches. This increase was 3.8 and 4.3 times larger than the increases observed during COP’s daily average or on Earth Day. Searches were closely linked to content from Dicaprio’s speech (e.g., “hottest year”), as unmentioned content did not have search increases (e.g., “electric car”). Because these data are freely available in real time our analytical strategy provides substantial lead time for experts to detect and participate in organic advocacy while an issue is salient. Our study demonstrates new opportunities to detect and aid agents of change and advances our understanding of communication in the 21st century media landscape.

Integration of advances in social media and mHealth technology are pivotal to successful cancer prevention and control

The successful prevention and treatment of cancer is dependent upon efficient and reliable communication between healthcare workers and patients. Advances in social media and mHealth platforms have provided new ways in which to enhance the sharing of cancer related information. Other benefits of embracing this technology include utilising its analytic capabilities which can process the vast quantity of information generated from genome exploration in a highly efficient manner. The aim of this review is to provide an overview of the rapidly evolving areas through which digital engagement is proving useful in the prevention and control of cancer.