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Shah NA, Li Z, McMann T, Calac AJ, Le N, Nali MC, Cuomo RE, Mackey TK. Identification and Characterization of Synthetic Nicotine Product Promotion and Sales on Instagram Using Natural Language Processing. Nicotine Tob Res 2024; 26:580-588. [PMID: 37947271 DOI: 10.1093/ntr/ntad222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/01/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION There has been a rapid proliferation of synthetic nicotine products in recent years, despite newly established regulatory authority and limited research into its health risks. Previous research has implicated social media platforms as an avenue for nicotine product unregulated sales. Yet, little is known about synthetic nicotine product content on social media. We utilized natural language processing to characterize the sales of synthetic nicotine products on Instagram. METHODS We collected Instagram posts by querying Instagram hashtags (eg, "#tobaccofreenicotine) related to synthetic nicotine. Using Bidirectional Encoder Representations from Transformers, collected posts were categorized into thematically related topic clusters. Posts within topic clusters relevant to study aims were then manually annotated for variables related to promotion and selling (eg, cost discussion, contact information for offline sales). RESULTS A total of 7425 unique posts were collected with 2219 posts identified as related to promotion and selling of synthetic nicotine products. Nicotine pouches (52.9%, n = 1174), electronic nicotine delivery systems (30.6%, n = 679), and flavored e-liquids (14.1%, n = 313) were most commonly promoted. About 16.1% (n = 345) of posts contained embedded hyperlinks and 5.8% (n = 129) provided contact information for purported offline transactions. Only 17.6% (n = 391) of posts contained synthetic nicotine-specific health warnings. CONCLUSIONS In the United States, synthetic nicotine products can only be legally marketed if they have received premarket authorization from the Food and Drug Administration (FDA). Despite these prohibitions, Instagram appears to be a hub for potentially unregulated sales of synthetic and "tobacco-free" products. Efforts are needed by platforms and regulators to enhance content moderation and prevent unregulated online sales of existing and emerging synthetic nicotine products. IMPLICATIONS There is limited clinical understanding of synthetic nicotine's unique health risks and how these novel products are changing over time due to regulatory oversight. Despite synthetic nicotine-specific regulatory measures, such as the requirement for premarket authorization and FDA warning letters issued to unauthorized sellers, access to and promotion of synthetic nicotine is widely occurring on Instagram, a platform with over 2 billion users and one that is popular among youth and young adults. Activities include direct-to-consumer sales from questionable sources, inadequate health warning disclosure, and exposure with limited age restrictions, all conditions necessary for the sale of various tobacco products. Notably, the number of these Instagram posts increased in response to the announcement of new FDA regulations. In response, more robust online monitoring, content moderation, and proactive enforcement are needed from platforms who should work collaboratively with regulators to identify, report, and remove content in clear violation of platform policies and federal laws. Regulatory implementation and enforcement should prioritize digital platforms as conduits for unregulated access to synthetic nicotine products and other future novel and emerging tobacco products.
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Affiliation(s)
- Neal A Shah
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
| | - Zhuoran Li
- San Diego Supercomputer Center, University of California, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
| | - Tiana McMann
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
- Global Health Program Department of Anthropology, University of California, San Diego, La Jolla, CA, USA
| | - Alec J Calac
- Global Health Policy and Data Institute, San Diego, CA, USA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| | - Nicolette Le
- Global Health Program Department of Anthropology, University of California, San Diego, La Jolla, CA, USA
| | - Matthew C Nali
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
| | - Raphael E Cuomo
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
| | - Tim K Mackey
- San Diego Supercomputer Center, University of California, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
- Global Health Program Department of Anthropology, University of California, San Diego, La Jolla, CA, USA
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van Niekerk L, Topp SM, Pasternak N, Mackey TK, Garcia P, Binagwaho A, Aslanyan G. Podcasts as a tool to disrupt knowledge hierarchies and silos to decolonize global health. Nat Med 2024:10.1038/s41591-024-02859-1. [PMID: 38443688 DOI: 10.1038/s41591-024-02859-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
| | | | | | - Tim K Mackey
- University of California San Diego, La Jolla, CA, USA
| | | | | | - Garry Aslanyan
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland
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Haupt MR, Cuomo R, Cui M, Mackey TK. Is This Safe? Examining Safety Assessments of Illicit Drug Purchasing on Social Media Using Conjoint Analysis. Subst Use Misuse 2024; 59:999-1011. [PMID: 38319039 PMCID: PMC11019931 DOI: 10.1080/10826084.2024.2310507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background: Illicit substance sales facilitated by social media platforms are a growing public health issue given recent increases in overdose deaths, including an alarming rise in cases of fentanyl poisoning. However, little is known about how online users evaluate what features of social media posts convey safety, which can influence their intent to source illicit substances. Objectives: This study adapts conjoint analysis which assessed how attributes of social media posts (i.e., features) influence safety evaluations of mock posts selling illicit substances. 440 participants were recruited online for self-reporting use or purchase of controlled substances or prescription medicines recreationally. The following attributes were tested: drug packaging, drug offerings, profile photo of seller, payment info provided, and use of emojis. Results: Packaging was ranked the most important attribute (Average Importance =43.68, Offering=14.94, Profile=13.86, Payment=14.11, Emoji=13.41), with posts that displayed drugs in pill bottles assessed as the most safe. Attribute levels for advertising multiple drugs, having a blank profile photo, including payment information, and including emojis also ranked higher in perceived safety. Rankings were consistent across tested demographic factors (i.e., gender, age, and income). Survey results show that online pharmacies were most likely to be perceived as safe for purchasing drugs and medications. Additionally, those who were younger in age, had higher income, and identified as female were more likely to purchase from a greater number of platforms. Conclusions: These findings can assist in developing more precise content moderation for platforms seeking to address this ongoing threat to public safety.
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Affiliation(s)
- Michael Robert Haupt
- Department of Cognitive Science, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
- Global Health Policy & Data Institute, San Diego, CA USA
| | - Raphael Cuomo
- Global Health Policy & Data Institute, San Diego, CA USA
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA USA
| | - Manying Cui
- Global Health Policy & Data Institute, San Diego, CA USA
| | - Tim K. Mackey
- Global Health Policy & Data Institute, San Diego, CA USA
- Global Health Program, Department of Anthropology, University of California, San Diego, CA USA
- S-3 Research LLC, San Diego, CA USA
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Cuomo RE, Purushothaman VL, Mackey TK, Yang JW. Rates of adverse events and related risk factors following e-cigarette use. J Public Health (Oxf) 2024:fdad281. [PMID: 38282109 DOI: 10.1093/pubmed/fdad281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/21/2023] [Accepted: 12/12/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND E-cigarettes have emerged as popular products, especially for younger populations. However, concerns regarding health effects exist and there is a notable gap in understanding the prevalence and nature of adverse events. This study aims to examine the rate of adverse events in individuals who use e-cigarettes in a large sample. METHODS A cross-sectional survey was conducted with a sample of 4695 current and former e-cigarette users with a median age of 34 years. The survey collected data on e-cigarette use, adverse events experienced, product characteristics, related behaviors, sociodemographic factors and presence of medical comorbidities. Statistical analyses were conducted using Pearson's chi-squared tests and logistic regression. RESULTS A total of 78.9% of respondents reported experiencing an adverse event within 6 h of using a vaping device, with the most common events being headache, anxiety and coughing. Product characteristics and related behaviors significantly influenced the risk of adverse events. There were also sociodemographic disparities, with Hispanic respondents and those with at least college-level education reporting higher rates of adverse events. CONCLUSIONS Our study found a high rate of adverse events among e-cigarette users. We identified that certain e-cigarette product characteristics, behaviors and medical comorbidities significantly increased the risk of these events.
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Affiliation(s)
- Raphael E Cuomo
- School of Medicine, University of California, San Diego, San Diego, CA 92093, USA
| | | | - Tim K Mackey
- San Diego Supercomputer Center, San Diego, CA 92093, USA
| | - Joshua W Yang
- Department of Public Health, California State University, Fullerton, CA 92831, USA
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Kasahara A, Mitchell J, Yang J, Cuomo RE, McMann TJ, Mackey TK. Digital technologies used in clinical trial recruitment and enrollment including application to trial diversity and inclusion: A systematic review. Digit Health 2024; 10:20552076241242390. [PMID: 38559578 PMCID: PMC10981266 DOI: 10.1177/20552076241242390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Background Many clinical trials fail because of poor recruitment and enrollment which can directly impact the success of biomedical and clinical research outcomes. Options to leverage digital technology for improving clinical trial management are expansive, with potential benefits for improving access to clinical trials, encouraging trial diversity and inclusion, and potential cost-savings through enhanced efficiency. Objectives This systematic review has two key aims: (1) identify and describe the digital technologies applied in clinical trial recruitment and enrollment and (2) evaluate evidence of these technologies addressing the recruitment and enrollment of racial and ethnic minority groups. Methods We conducted a cross-disciplinary review of articles from PubMed, IEEE Xplore, and ACM Digital Library, published in English between January 2012 and July 2022, using MeSH terms and keywords for digital health, clinical trials, and recruitment and enrollment. Articles unrelated to technology in the recruitment/enrollment process or those discussing recruitment/enrollment without technology aspects were excluded. Results The review returned 614 results, with 21 articles (four reviews and 17 original research articles) deemed suitable for inclusion after screening and full-text review. To address the first objective, various digital technologies were identified and characterized, which included articles with more than one technology subcategory including (a) multimedia presentations (19%, n = 4); (b) mobile applications (14%, n = 3); (c) social media platforms (29%, n = 6); (d) machine learning and computer algorithms (19%, n = 4); (e) e-consenting (24%, n = 5); (f) blockchain (5%, n = 1); (g) web-based programs (24%, n = 5); and (h) virtual messaging (24%, n = 5). Additionally, subthemes, including specific diseases or conditions addressed, privacy and regulatory concerns, cost/benefit analyses, and ethnic and minority recruitment considerations, were identified and discussed. Limited research was found to support a particular technology's effectiveness in racial and ethnic minority recruitment and enrollment. Conclusion Results from this review illustrate that several types of technology are currently being explored and utilized in clinical trial recruitment and enrollment stages. However, evidence supporting the use of digital technologies is varied and requires further research and evaluation to identify the most valuable opportunities for encouraging diversity in clinical trial recruitment and enrollment practices.
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Affiliation(s)
- Amy Kasahara
- Rady School of Management, University of California San Diego, La Jolla, CA, USA
- Department of Public Health, University of California Irvine, Irvine, CA, USA
| | - Jennifer Mitchell
- Rady School of Management, University of California San Diego, La Jolla, CA, USA
- Occupational Therapy, California State University Dominguez Hills, Carson, CA, USA
| | - Joshua Yang
- Department of Public Health, California State University Fullerton, Fullerton, CA, USA
| | - Raphael E. Cuomo
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
- Department of Anesthesiology, University of California San Diego – School of Medicine, San Diego, CA, USA
| | - Tiana J. McMann
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
- Global Health Program, Department of Anthropology, University of California San Diego, San Diego, CA, USA
| | - Tim K. Mackey
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
- Global Health Program, Department of Anthropology, University of California San Diego, San Diego, CA, USA
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Haupt MR, Chiu M, Chang J, Li Z, Cuomo R, Mackey TK. Detecting nuance in conspiracy discourse: Advancing methods in infodemiology and communication science with machine learning and qualitative content coding. PLoS One 2023; 18:e0295414. [PMID: 38117843 PMCID: PMC10732406 DOI: 10.1371/journal.pone.0295414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023] Open
Abstract
The spread of misinformation and conspiracies has been an ongoing issue since the early stages of the internet era, resulting in the emergence of the field of infodemiology (i.e., information epidemiology), which investigates the transmission of health-related information. Due to the high volume of online misinformation in recent years, there is a need to continue advancing methodologies in order to effectively identify narratives and themes. While machine learning models can be used to detect misinformation and conspiracies, these models are limited in their generalizability to other datasets and misinformation phenomenon, and are often unable to detect implicit meanings in text that require contextual knowledge. To rapidly detect evolving conspiracist narratives within high volume online discourse while identifying nuanced themes requiring the comprehension of subtext, this study describes a hybrid methodology that combines natural language processing (i.e., topic modeling and sentiment analysis) with qualitative content coding approaches to characterize conspiracy discourse related to 5G wireless technology and COVID-19 on Twitter (currently known as 'X'). Discourse that focused on correcting 5G conspiracies was also analyzed for comparison. Sentiment analysis shows that conspiracy-related discourse was more likely to use language that was analytic, combative, past-oriented, referenced social status, and expressed negative emotions. Corrections discourse was more likely to use words reflecting cognitive processes, prosocial relations, health-related consequences, and future-oriented language. Inductive coding characterized conspiracist narratives related to global elites, anti-vax sentiment, medical authorities, religious figures, and false correlations between technology advancements and disease outbreaks. Further, the corrections discourse did not address many of the narratives prevalent in conspiracy conversations. This paper aims to further bridge the gap between computational and qualitative methodologies by demonstrating how both approaches can be used in tandem to emphasize the positive aspects of each methodology while minimizing their respective drawbacks.
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Affiliation(s)
- Michael Robert Haupt
- Department of Cognitive Science, University of California San Diego, La Jolla, California, United States of America
- Global Health Policy & Data Institute, San Diego, California, United States of America
| | - Michelle Chiu
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Joseline Chang
- Rady School of Management, University of California San Diego, La Jolla, California, United States of America
| | - Zoe Li
- Global Health Policy & Data Institute, San Diego, California, United States of America
- S-3 Research, San Diego, California, United States of America
| | - Raphael Cuomo
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, California, United States of America
| | - Tim K. Mackey
- S-3 Research, San Diego, California, United States of America
- Global Health Program, Department of Anthropology, University of California, San Diego, California, United States of America
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Xu Q, McMann TJ, Li J, Wenzel C, Mackey TK. Characterization of COVID-19 vaccine clinical trial discussions on the social question-and-answer site Quora. Trials 2023; 24:790. [PMID: 38053216 DOI: 10.1186/s13063-023-07837-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/27/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION Throughout the COVID-19 pandemic, underserved populations, such as racial and ethnic minorities, were disproportionately impacted by illness, hospitalization, and death. Equity in clinical trials means that the participants in clinical trials represent the people who are most likely to have the health condition and need the treatment that the trial is testing. Infodemiology approaches examining user conversations on social media platforms have the potential to elucidate specific barriers and challenges related to clinical trial participation, including among racial and ethnic minority populations. MATERIALS AND METHODS The study retrospectively collected and analyzed user question and answer posts from Quora in October 2021 using an inductive content coding approach. We also examined user's publicly available profile metadata to identify racial and ethnic minority users to capture their experiences, attitudes, topics, and discussions of barriers to COVID-19 vaccine trials. RESULTS A total of 1073 questions and 7479 answers were collected. A total of 763 questions and 2548 answers were identified as related to COVID-19 vaccine clinical trials. The majority of these online interactions focused on asking questions and sharing knowledge and opinions about COVID-19 vaccine trials, including major topics related to: (a) interpreting whether clinical trial results could be trusted; (b) questions about vaccine efficacy and safety; (c) understanding trial design, regulatory considerations, and vaccine platforms; and (d) questions about trial enrollment, length, and adequate representation. Additionally, four major barriers discussed included: (i) disagreement from users regarding whether clinical trials require representation from different racial and ethnic minorities; (ii) concerns regarding the safety of trials when participating; (iii) lack of knowledge on how to participate in a trial; and (iv) questions of whether participants could withdraw from a trial to access an approved COVID-19 vaccine. CONCLUSIONS Our study found active user discussions related to COVID-19 vaccine clinical trials on Quora, including those specific to minority health topics and those posted by a smaller group of self-identified racial and ethnic minority online users. Results from this study can help identify barriers to participation among the general public and underrepresented groups while also supporting the design of future outreach strategies to help with recruitment and inclusive trial participation.
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Affiliation(s)
- Qing Xu
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, LLC, San Diego, CA, USA
| | - Tiana J McMann
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, LLC, San Diego, CA, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, CA, USA
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, LLC, San Diego, CA, USA
| | | | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, CA, USA.
- S-3 Research, LLC, San Diego, CA, USA.
- Global Health Program, Department of Anthropology, University of California, San Diego, CA, USA.
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Affiliation(s)
- Alec J Calac
- School of Medicine, University of California, San Diego, La Jolla
| | - Tiana McMann
- Global Health Policy and Data Institute, San Diego, California
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, California
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Cuomo RE, Mackey TK, Purushothaman V. Tobacco/nicotine dependence as a risk factor for substance use disorders and related mental health conditions among cancer patients. Psychooncology 2023; 32:1395-1400. [PMID: 37409875 DOI: 10.1002/pon.6190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/26/2023] [Accepted: 06/27/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Cancer patients often face multiple comorbidities and are at risk for various mental health conditions and substance use disorders. Tobacco/nicotine dependence (TND) is a known risk factor for poor health outcomes and has been associated with psychiatric disorders including substance use disorder. However, the specific relationship between TND and the risk of substance use disorder and mental health conditions among cancer patients remains underexplored. This study aimed to assess the association between TND and the risk of comorbid conditions among cancer patients. METHODS Data were obtained from a database of electronic health records for patients from the University of California health system. The odds for every condition among cancer patients with TND were calculated and compared with those for cancer patients without TND. ORs were adjusted for gender, ethnicity, and race. RESULTS Three thousand seven hundred and ninety-one cancer patients with TND had 252,619 total conditions, and 51,711 cancer patients without TND had 2,310,880 conditions. After adjusting for confounders, the condition for which TND most exacerbated risk was psychoactive substance-induced organic anxiety disorder (OR = 16.3, p < 0.001). This appeared consistent with the second, third, and fifth most-exacerbated conditions: stimulant use disorder (OR = 12.8, p < 0.001), cocaine induced mental disorder (OR = 11.0, p < 0.001), and cocaine use disorder (OR = 11.0, p < 0.001). Different conditions exacerbated by TND include acute alcoholic intoxication (OR = 11.4, p < 0.001), opioid use disorder (OR = 7.6, p < 0.001), schizoaffective disorder (OR = 7.4, p < 0.001), and cannabis use disorder (OR = 6.3, p < 0.001). CONCLUSIONS Our findings reveal a strong association between TND and an increased risk of substance use disorder and mental health conditions among cancer patients. Specifically, cancer patients with TND were at an elevated risk for psychoactive substance-induced organic anxiety disorder, stimulant use disorder, and cocaine-related disorders. Additionally, TND was associated with an increased risk of acute alcoholic intoxication, opioid use disorder, schizoaffective disorder, and cannabis use disorder. These findings underscore the need for comprehensive screening and interventions to address TND and comorbid conditions among cancer patients.
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Affiliation(s)
- Raphael E Cuomo
- University of California, San Diego, School of Medicine, San Diego, California, USA
- Global Health Policy and Data Institute, San Diego, California, USA
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, California, USA
- San Diego Supercomputer Center, San Diego, California, USA
- Department of Anthropology, University of California, San Diego, San Diego, California, USA
- S-3 Research, San Diego, California, USA
| | - Vidya Purushothaman
- Global Health Policy and Data Institute, San Diego, California, USA
- San Diego Supercomputer Center, San Diego, California, USA
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Nali MC, Purushothaman V, Li Z, Cuomo R, Mackey TK. Assessing the Impact of the Massachusetts Temporary Flavor Ban on Licensed Tobacco Retailers. Tob Use Insights 2023; 16:1179173X231192821. [PMID: 37533795 PMCID: PMC10392200 DOI: 10.1177/1179173x231192821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction In 2019, the state of Massachusetts signed into law the first statewide sales restrictions of flavored ENDS/tobacco products for both physical and online shops in response to a previous executive order to curb E-Cigarette, or Vaping Product, Use Associated Lung Injury (EVALI) cases that were surging throughout the nation. Methodology This study obtained licensure data from the Massachusetts Department of Revenue, to observe the changes in retail licensure comparing the pre ban (October 2018-August 2019) and post ban periods (October 2020- August 2021). A series of linear regression tests were conducted on both periods using census tract data to explore potential associations with sociodemographic covariates, including median age, median household income, and population proportion by gender, age, and race/ethnicity groups. Results Analysis of the Massachusetts post-ban period (October 2020-August 2021) found that new tobacco retail licenses issued decreased by 52.9% (n = 968) when compared to the pre-ban period (October 2018-August 2019) of 1831. A significant positive association was discovered between change in new retailer count and proportion male population (2.48 ± 1.05, P = .018) as well as proportion Hispanic population (1.19 ± .25, P < .001) at the census tract level. Conclusion/Discussion Our analysis indicates that, following the temporary MA flavor sales ban, the total number of licenses decreased, though decreases were more pronounced for new licenses when compared to continuing licenses. Higher increases in new tobacco retailer density were significantly associated with concentration of male and Hispanic populations.
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Affiliation(s)
- Matthew C Nali
- Global Health Program, Department of Anthropology, University of California, San Diego, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
| | - Vidya Purushothaman
- Global Health Policy and Data Institute, San Diego, CA, USA
- San Diego Supercomputer Center, University of California, San Diego, CA, USA
| | - Zhuoran Li
- S-3 Research, San Diego, CA, USA
- San Diego Supercomputer Center, University of California, San Diego, CA, USA
| | - Raphael Cuomo
- Global Health Policy and Data Institute, San Diego, CA, USA
- Department of Anesthesiology and Division of Infectious Disease and Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Tim K Mackey
- Global Health Program, Department of Anthropology, University of California, San Diego, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
- San Diego Supercomputer Center, University of California, San Diego, CA, USA
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Nali MC, McMann TJ, Purushothaman V, Li Z, Cuomo RE, Liang BA, Mackey TK. Assessing Characteristics and Compliance of Online Delta-8 Tetrahydrocannabinol Product Sellers. Cannabis Cannabinoid Res 2023. [PMID: 37200462 DOI: 10.1089/can.2022.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Introduction: The debate over the legal status of many cannabis- and hemp-derived products, including delta-8 tetrahydrocannabinol (THC), is in question. Although low concentrations of delta-8 THC are legal at the Federal level, many states have implemented their own regulations to both allow and restrict its use and sale. Of concern, sellers with unknown legal credentials have appeared online and are actively selling this product. Materials and Methods: We characterized the marketing, sale, and compliance of online delta-8 THC sellers using (1) data collected from the Twitter Application Programming Interface with delta-8 THC-related keywords; (2) unsupervised topic modeling using the Biterm Topic Model to identify clusters of tweets involved in marketing and selling; (3) inductive coding to identify marketing and selling characteristics; and (4) web forensics and simulated shopping to determine compliance with state restrictions for delta-8 THC sales. Results: In total, 110 unique hyperlinks associated with 7085 tweets that included marketing and selling activity for delta-8 THC were collected. From these links, we conducted simulated purchasing in January 2021 to identify compliant and noncompliant websites. Among the vendors, age verification was not found in over half of websites (59, 53.63%); 60 (54.55%) did not report a physical address; and 74 (65.45%) sold delta-8 products direct-to-consumer. Sixty-seven (90.54%) of detected vendors shipped delta-8 products to addresses in states that prohibit sales. Forty-three (64.18%) of Internet Protocol addresses were located within the United States; all others were international. Conclusion: Our analysis suggests that online storefronts are illegally selling and shipping cannabinoid derivatives to U.S. consumers. Further research is needed to understand downstream health and regulatory impacts from this unregulated access.
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Affiliation(s)
- Matthew C Nali
- Department of Anesthesiology, University of California, San Diego, School of Medicine, San Diego, California, USA
- Global Health Policy and Data Institute, San Diego, California, USA
- S-3 Research, San Diego, California, USA
| | - Tiana J McMann
- Global Health Policy and Data Institute, San Diego, California, USA
- S-3 Research, San Diego, California, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, California, USA
| | - Vidya Purushothaman
- Global Health Policy and Data Institute, San Diego, California, USA
- San Diego Supercomputer Center, University of California, San Diego, La Jolla, California, USA
| | - Zhuoran Li
- Global Health Policy and Data Institute, San Diego, California, USA
- S-3 Research, San Diego, California, USA
- San Diego Supercomputer Center, University of California, San Diego, La Jolla, California, USA
| | - Raphael E Cuomo
- Department of Anesthesiology, University of California, San Diego, School of Medicine, San Diego, California, USA
- Global Health Policy and Data Institute, San Diego, California, USA
| | - Bryan A Liang
- Global Health Policy and Data Institute, San Diego, California, USA
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, California, USA
- S-3 Research, San Diego, California, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, California, USA
- San Diego Supercomputer Center, University of California, San Diego, La Jolla, California, USA
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12
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Larsen MZ, Haupt MR, McMann T, Cuomo RE, Mackey TK. The Influence of News Consumption Habits and Dispositional Traits on Trust in Medical Scientists. Int J Environ Res Public Health 2023; 20:ijerph20105842. [PMID: 37239568 DOI: 10.3390/ijerph20105842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Public trust in medical institutions is essential for ensuring compliance with medical directives. However, the politicization of public health issues and the polarized nature of major news outlets suggest that partisanship and news consumption habits can influence medical trust. This study employed a survey with 858 participants and used regression analysis to assesses how news consumption habits and information assessment traits (IATs) influence trust in medical scientists. IATs included were conscientiousness, openness, need for cognitive closure (NFCC), and cognitive reflective thinking (CRT). News sources were classified on the basis of factuality and political bias. Initially, readership of liberally biased news was positively associated with medical trust (p < 0.05). However, this association disappeared when controlling for the news source's factuality (p = 0.28), while CRT (p < 0.05) was positively associated with medical trust. When controlling for conservatively biased news sources, factuality of the news source (p < 0.05) and NFCC (p < 0.05) were positively associated with medical trust. While partisan media bias may influence medical trust, these results suggest that those who have higher abilities to assess information and who prefer more credible news sources have a greater trust in medical scientists.
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Affiliation(s)
- Meng Zhen Larsen
- Global Health Policy and Data Institute, San Diego, CA 92123, USA
- S-3 Research LLC, San Diego, CA 92123, USA
| | - Michael R Haupt
- Global Health Policy and Data Institute, San Diego, CA 92123, USA
- Department of Cognitive Science, University of California, San Diego, CA 92093, USA
| | - Tiana McMann
- Global Health Policy and Data Institute, San Diego, CA 92123, USA
- S-3 Research LLC, San Diego, CA 92123, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, CA 92093, USA
| | - Raphael E Cuomo
- Global Health Policy and Data Institute, San Diego, CA 92123, USA
- Department of Anesthesiology, School of Medicine, University of California, San Diego, CA 94720, USA
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, CA 92123, USA
- S-3 Research LLC, San Diego, CA 92123, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, CA 92093, USA
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13
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Liang BA, Maroulis J, Mackey TK. Liability Before Diagnosis: Failure to Admit in a Stroke Case. Stroke 2023; 54:e171-e174. [PMID: 36861475 DOI: 10.1161/strokeaha.122.038790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Bryan A Liang
- Global Health Policy and Data Institute, University of California, San Diego (B.A.L., J.M., T.K.M.)
| | - James Maroulis
- Global Health Policy and Data Institute, University of California, San Diego (B.A.L., J.M., T.K.M.).,Global Health Program, Department of Anthropology, University of California, San Diego (J.M., T.K.M.)
| | - Tim K Mackey
- Global Health Policy and Data Institute, University of California, San Diego (B.A.L., J.M., T.K.M.).,Global Health Program, Department of Anthropology, University of California, San Diego (J.M., T.K.M.)
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14
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Affiliation(s)
- Bryan A Liang
- Global Health Policy and Data Institute (B.A.L., J.M., T.K.M.), University of California, San Diego
| | - James Maroulis
- Global Health Policy and Data Institute (B.A.L., J.M., T.K.M.), University of California, San Diego.,Global Health Program, Department of Anthropology (J.M., T.K.M.), University of California, San Diego
| | - Tim K Mackey
- Global Health Policy and Data Institute (B.A.L., J.M., T.K.M.), University of California, San Diego.,Global Health Program, Department of Anthropology (J.M., T.K.M.), University of California, San Diego
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15
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Lee J, Moroso M, Mackey TK. Unblocking recognition: A token system for acknowledging academic contribution. Front Blockchain 2023. [DOI: 10.3389/fbloc.2023.1136641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Here we present a blockchain-backed token recognition system to reward the contributions that academics make to the scientific ecosystem. Recognition is important in science but current methods, systems and incentives are limited. Specifically, the traditional focus on narrow publication metrics means diverse contributions are not captured, while bias toward senior, established scientists is common. To tackle this challenge, we explore the potential of harnessing blockchain’s collaborative, decentralised and trust-brokering properties to develop a token reward system for use by research funders. Academics would be awarded tokens for undertaking common but vital tasks such as peer review, sitting on funding committees and submitting reports. These tokens would not be tradable or specifically monetisable but would serve as a validated record of scientific contribution. They would have value in professional recruitment and job placement, support grant and award applications, and inform performance appraisals and file reviews. Coordination and cooperation across multiple funding agencies in developing the platform would provide an opportunity to aggregate and standardise recognition, given academics often work with several funders. This system’s goals are to expand recognition metrics, promote efficiencies, improve the robustness of professional assessments and enable cross-funder collaboration, thereby optimising research processes and practices in a decentralised and democratised manner.
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16
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Purushothaman V, Cuomo RE, Li J, Mackey TK. Examining the association between California tobacco licensed retail density and public support or opposition to state anti-tobacco legislation. Tob Prev Cessat 2023; 9:02. [PMID: 36721705 PMCID: PMC9853904 DOI: 10.18332/tpc/156460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The state of California has enacted progressive anti-tobacco policies, including Proposition 56 in 2016. In response, the alternative and emerging tobacco product (ATP) industry has increased its political activity. This study explores the association between the proportion of people voting against Proposition 56 and tobacco/ATP retail density. METHODS We conducted a retrospective analysis using data on licensed California tobacco retailers, which were then cross-referenced for categorization using Yelp. Proportion voting against Proposition 56 was obtained from the Secretary of State's website. A series of linear regression tests were performed between population-normalized retailer density and voting proportion at the county level before and after adjusting for covariates such as age, gender, race/ethnicity and median household income. RESULTS The total number of licensed tobacco retailers increased by 29.31% from 2015 to 2019. Association between proportion voting against Proposition 56 and retail density was significant during voting and during periods of policy implementation and post-implementation (2016-2018) for non-specialized tobacco retailers. For specialized/ATP retailers, significance was only detected during the post-implementation period (2018-2019) after normalization. Proportion voting against Proposition 56 was also a significant predictor of increase in total number of non-specific (β=0.48, p=0.008) as well as specialized tobacco and/or ATP retail storefronts (β=0.21, p=0.001) from 2016 to 2018. CONCLUSIONS This study provides initial evidence of the association between tobacco retail density and voting patterns for anti-tobacco policy. Future research should examine the role of tobacco retail density on variation in local support for state tobacco control initiatives, including tailoring outreach to specific voting census blocks in communities with heavy retail presence.
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Affiliation(s)
- Vidya Purushothaman
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, United States,Global Health Policy and Data Institute, San Diego, United States
| | - Raphael E. Cuomo
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, United States,Global Health Policy and Data Institute, San Diego, United States
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, United States,S-3 Research LLC, San Diego, United States
| | - Tim K. Mackey
- Global Health Policy and Data Institute, San Diego, United States,S-3 Research LLC, San Diego, United States,Global Health Program, Department of Anthropology, University of California, San Diego, United States
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17
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Honcharov V, Li J, Sierra M, Rivadeneira NA, Olazo K, Nguyen TT, Mackey TK, Sarkar U. Public Figure Vaccination Rhetoric and Vaccine Hesitancy: Retrospective Twitter Analysis. JMIR Infodemiology 2023; 3:e40575. [PMID: 37113377 PMCID: PMC10039410 DOI: 10.2196/40575] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 04/29/2023]
Abstract
Background Social media has emerged as a critical mass communication tool, with both health information and misinformation now spread widely on the web. Prior to the COVID-19 pandemic, some public figures promulgated anti-vaccine attitudes, which spread widely on social media platforms. Although anti-vaccine sentiment has pervaded social media throughout the COVID-19 pandemic, it is unclear to what extent interest in public figures is generating anti-vaccine discourse. Objective We examined Twitter messages that included anti-vaccination hashtags and mentions of public figures to assess the connection between interest in these individuals and the possible spread of anti-vaccine messages. Methods We used a data set of COVID-19-related Twitter posts collected from the public streaming application programming interface from March to October 2020 and filtered it for anti-vaccination hashtags "antivaxxing," "antivaxx," "antivaxxers," "antivax," "anti-vaxxer," "discredit," "undermine," "confidence," and "immune." Next, we applied the Biterm Topic model (BTM) to output topic clusters associated with the entire corpus. Topic clusters were manually screened by examining the top 10 posts most highly correlated in each of the 20 clusters, from which we identified 5 clusters most relevant to public figures and vaccination attitudes. We extracted all messages from these clusters and conducted inductive content analysis to characterize the discourse. Results Our keyword search yielded 118,971 Twitter posts after duplicates were removed, and subsequently, we applied BTM to parse these data into 20 clusters. After removing retweets, we manually screened the top 10 tweets associated with each cluster (200 messages) to identify clusters associated with public figures. Extraction of these clusters yielded 768 posts for inductive analysis. Most messages were either pro-vaccination (n=329, 43%) or neutral about vaccination (n=425, 55%), with only 2% (14/768) including anti-vaccination messages. Three main themes emerged: (1) anti-vaccination accusation, in which the message accused the public figure of holding anti-vaccination beliefs; (2) using "anti-vax" as an epithet; and (3) stating or implying the negative public health impact of anti-vaccination discourse. Conclusions Most discussions surrounding public figures in common hashtags labelled as "anti-vax" did not reflect anti-vaccination beliefs. We observed that public figures with known anti-vaccination beliefs face scorn and ridicule on Twitter. Accusing public figures of anti-vaccination attitudes is a means of insulting and discrediting the public figure rather than discrediting vaccines. The majority of posts in our sample condemned public figures expressing anti-vax beliefs by undermining their influence, insulting them, or expressing concerns over public health ramifications. This points to a complex information ecosystem, where anti-vax sentiment may not reside in common anti-vax-related keywords or hashtags, necessitating further assessment of the influence that public figures have on this discourse.
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Affiliation(s)
- Vlad Honcharov
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center University of California San Francisco San Francisco, CA United States
- Center for Vulnerable Populations University of California San Francisco San Francisco, CA United States
| | - Jiawei Li
- S-3 Research LLC San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
| | - Maribel Sierra
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center University of California San Francisco San Francisco, CA United States
- Center for Vulnerable Populations University of California San Francisco San Francisco, CA United States
| | - Natalie A Rivadeneira
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center University of California San Francisco San Francisco, CA United States
- Center for Vulnerable Populations University of California San Francisco San Francisco, CA United States
| | - Kristan Olazo
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center University of California San Francisco San Francisco, CA United States
- Center for Vulnerable Populations University of California San Francisco San Francisco, CA United States
| | - Thu T Nguyen
- Department of Family and Community Medicine University of California San Francisco San Francisco, CA United States
- Department of Epidemiology & Biostatistics University of Maryland School of Public Health College Park, MD United States
| | - Tim K Mackey
- S-3 Research LLC San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
- Global Health Program Department of Anthropology University of California San Diego La Jolla, CA United States
| | - Urmimala Sarkar
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center University of California San Francisco San Francisco, CA United States
- Center for Vulnerable Populations University of California San Francisco San Francisco, CA United States
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18
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Calac AJ, McMann T, Cai M, Li J, Cuomo R, Mackey TK. Exploring substance use disorder discussions in Native American communities: a retrospective Twitter infodemiology study. Harm Reduct J 2022; 19:141. [PMID: 36517902 PMCID: PMC9753320 DOI: 10.1186/s12954-022-00728-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The opioid epidemic has had a devastating impact on youth from American Indian and Alaska Native (AI/AN) Tribes and Villages, which also experience disparate suicide rates. The use of publicly available social media data originating from AI/AN communities may enhance public health response time to substance use disorder (SUD)-related overdose and augment Tribal public health surveillance systems, but these concepts have yet to be adequately explored. The goal of this exploratory analysis was to identify primary and secondary accounts of overdose and characterize relevant contextual factors in the AI/AN population on social media. METHODS The Twitter application programming interface was queried for all Tweets containing geocoded data between March 2014 and June 2020 and filtered for the keyword ['overdose']. This sample of Tweets (n = 146,236) was then restricted to those geolocated from US Tribal lands (n = 619). Tweets were manually annotated for primary or secondary accounts of overdose as well as suicidal ideation, substance(s) used, stigma of drug use, and community-wide incidents. RESULTS We collected a total of 146,235 tweets that were geocoded and contained the word 'overdose,' of which 9.5% were posted on Tribal lands (n = 619). 9.4% of these tweets (n = 58) met our study inclusion criteria and were mainly posted from Oklahoma (n = 26, 45%) and North Carolina (n = 13, 22.4%). Most Tweets (n = 41, 71%) described a primary account of an overdose and were mostly posted from 2014 to 2015. Less than half of the Tweets (n = 27, 46.5%) referenced a specific substance. Those substances mentioned included alcohol, marijuana, methamphetamine, heroin, laundry softener, cocaine, K2-Spice (synthetic cannabinoid), codeine, morphine, Nyquil, and Xanax. DISCUSSION Though exploratory, our study identified SUD-related content self-reported by AI/AN communities on Twitter, especially in Oklahoma and North Carolina. These results may assist in the future design and detection of infodemiology trends and early warning signs that can better facilitate intervention specific to the ongoing Tribal opioid epidemic. While all data were collected from the public domain, additional care should be given to individual and community privacy.
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Affiliation(s)
- Alec J Calac
- UC San Diego School of Medicine, La Jolla, CA, USA
- UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science, La Jolla, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
| | - Tiana McMann
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
| | - Mingxiang Cai
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
| | - Raphael Cuomo
- UC San Diego School of Medicine, La Jolla, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, CA, USA.
- Department of Anthropology, UC San Diego, La Jolla, CA, USA.
- S-3 Research, San Diego, CA, USA.
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19
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Xu Q, McMann T, Godinez H, Nali MC, Li J, Cai M, Merenda C, Lee C, Araojo R, Mackey TK. Impact of COVID-19 on HIV Prevention Access: A Multi-platform Social Media Infodemiology Study. AIDS Behav 2022; 27:1886-1896. [PMID: 36471205 PMCID: PMC9734820 DOI: 10.1007/s10461-022-03922-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
This study seeks to identify and characterize key barriers associated with PrEP therapy as self-reported by users on social media platforms. We used data mining and unsupervised machine learning approaches to collect and analyze COVID-19 and PrEP-related posts from three social media platforms including Twitter, Reddit, and Instagram. Predominant themes detected by unsupervised machine learning and manual annotation included users expressing uncertainty about PrEP treatment adherence due to COVID-19, challenges related to accessibility of clinics, concerns about PrEP costs and insurance coverage, perceived lower HIV risk leading to lack of adherence, and misinformation about PrEP use for COVID-19 prevention.
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Affiliation(s)
- Qing Xu
- S-3 Research LLC, San Diego, CA USA ,Global Health Policy and Data Institute, Sang Diego, CA USA
| | - Tiana McMann
- S-3 Research LLC, San Diego, CA USA ,Global Health Policy and Data Institute, Sang Diego, CA USA ,Global Health Program, Department of Anthropology, University of California, San Diego, San Diego, CA USA
| | | | - Matthew C. Nali
- S-3 Research LLC, San Diego, CA USA ,Global Health Policy and Data Institute, Sang Diego, CA USA ,Global Health Program, Department of Anthropology, University of California, San Diego, San Diego, CA USA
| | | | | | - Christine Merenda
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration, Silver Spring, MD USA
| | - Christine Lee
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration, Silver Spring, MD USA
| | - Richardae Araojo
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration, Silver Spring, MD USA
| | - Tim K. Mackey
- S-3 Research LLC, San Diego, CA USA ,Global Health Policy and Data Institute, Sang Diego, CA USA ,Global Health Program, Department of Anthropology, University of California, San Diego, San Diego, CA USA
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20
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Purushothaman V, Cuomo RE, Leas E, Li J, Strong D, Mackey TK. Longitudinal analysis of tobacco and vape retail density in California. Tob Induc Dis 2022; 20:87. [PMID: 36317059 PMCID: PMC9574848 DOI: 10.18332/tid/153506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Tobacco retailer density may be associated with greater youth initiation and reduced success during quit attempts; however, the extent to which tobacco retailer density has changed overtime across multiple categories of retailers has not been reported. METHODS Data on licensed tobacco retailers within California from 2015–2019 were obtained from the California Department of Tax and Fee Administration. Store type was categorized by automated cross-referencing with Yelp. Geolocations were aggregated at county level for analyzing longitudinal trends in changes in tobacco retail density including demographic characteristics. RESULTS The number of active CA tobacco retailer licenses increased from 19825 in 2015 to 25635 in 2019. The highest percent increase in tobacco retailer licenses (9.1%) was observed in 2017. The number of specialized tobacco stores was highest in Los Angeles, San Diego, and Riverside counties. We observed a significant increase in the number of active licenses for non-specialized and specialized tobacco stores, both overall and after controlling for the size of populations within each region. Time was a statistically significant predictor for the number of active licenses for only non-specialized stores, after adjusting for covariates. Regional volume of retailers was positively associated with higher proportion of women, lower median household income, and higher proportion of Hispanic residents. CONCLUSIONS Monitoring the changes in tobacco retail density and associated sociodemographic factors over time can help to identify communities at higher risk for tobacco and nicotine product exposure and access, and its associated health disparities.
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Affiliation(s)
- Vidya Purushothaman
- Department of Anthropology, University of California San Diego, San Diego, United States,Global Health Policy and Data Institute, San Diego, United States
| | - Raphael E. Cuomo
- Department of Anthropology, University of California San Diego, San Diego, United States,Global Health Policy and Data Institute, San Diego, United States,Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, United States
| | - Eric Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, United States
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, United States,S-3 Research, San Diego, United States
| | - David Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, United States
| | - Tim K. Mackey
- Department of Anthropology, University of California San Diego, San Diego, United States,Global Health Policy and Data Institute, San Diego, United States,S-3 Research, San Diego, United States
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21
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Mamudu HM, Nwabueze CA, Yang JS, Mackey TK, Ahuja M, Smith A, Weierbach FM, McNabb M, Minnick C, Jones A. Social media and use of electronic nicotine delivery systems among school-going adolescents in a rural distressed Appalachian community. Prev Med Rep 2022; 29:101953. [PMID: 36161107 PMCID: PMC9501989 DOI: 10.1016/j.pmedr.2022.101953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/28/2022] Open
Abstract
Social media use to discuss ENDS among youth in distressed areas is understudied. Nearly 1 in 3 and 1 in 8 of youth were ever and current ENDS users, respectively. Nearly 1 in 5 of the youth reported using social media to talk about ENDS. Social media increased current and ever ENDS use by 4 and 3 times, respectively. Social media engagement may lead to ENDS uptake among youth in distressed areas.
Electronic nicotine delivery systems (ENDS) are the most used tobacco products among middle and high schoolers in the United States (U.S.). Familial relations and access play a major role in uptake among adolescents; yet the role of social media in this phenomenon in the context of communities impacted by tobacco-related health disparities is understudied. In Spring 2019, data were collected from adolescents in 8th and 9th grades in a school located in a rural distressed county in Tennessee to assess social media’s role in ENDS uptake. Descriptive and multivariable statistical analyses were performed to delineate factors associated with ENDS use. Of a total of 399 respondents, 12.5 % reported current ENDS use and 22.1 % indicated having ever discussed ENDS on social media. Closed messaging platforms (Snapchat) and video platforms (Facebook/Instagram/You Tube) were the most reported form of social media used (8.31 % and 8.31 % respectively). Social media use was positively associated with both ever ENDS use (odds ratio [OR] = 2.9) and current ENDS use (OR = 3.98). Parental advice against ENDS use was positively associated with ever ENDS use. In conclusion, social media use was positively associated with both ever and current ENDS use, and Snapchat was the most popular platform among this population of students. The results indicate that youth social media engagement may lead to exposure that can influence ENDS uptake. Future studies are needed to further examine these associations among distressed communities.
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Affiliation(s)
- H M Mamudu
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
- College of Public Health, East Tennessee State University, Johnson, City, TN, USA
| | - C A Nwabueze
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
| | - J S Yang
- Department of Public Health, California State University, Fullerton, KHS 161 A, 800 N. State College Blvd, Fullerton, CA, 92831, USA
| | - T K Mackey
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, USA
| | - M Ahuja
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
- College of Public Health, East Tennessee State University, Johnson, City, TN, USA
| | - A Smith
- College of Public Health, East Tennessee State University, Johnson, City, TN, USA
| | - F M Weierbach
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
- College of Nursing, East Tennessee State University, Johnson City, TN, USA
| | - M McNabb
- Northeast Regional Office of Tennessee Department of Health, Johnson City, TN, USA
| | - C Minnick
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
- College of Public Health, East Tennessee State University, Johnson, City, TN, USA
| | - A Jones
- Department of Sociology & Department of Epidemiology, Milken School Institute of Public Health, The George Washington University, Washington, DC, USA
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22
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Cuomo RE, Li Z, Purushothaman V, Basavapatna-Shankar C, Nali M, Mackey TK. Predictors of Time to Coronavirus Disease 2019 Infection in the National Basketball Association: A Retrospective Case-Control Study. Clin Infect Dis 2022; 76:144-147. [PMID: 36097339 PMCID: PMC9494406 DOI: 10.1093/cid/ciac746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 01/11/2023] Open
Abstract
A case-control study was conducted between 1 December 2021 and 31 January 2022 to identify factors, which increase risk for coronavirus disease 2019 (COVID-19) among athletes in the National Basketball Association (NBA). Behavioral factors and stadium attendance significantly decreased time to COVID-19 infection, but local COVID-19 rates were not associated in a multivariable model.
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Affiliation(s)
- Raphael E Cuomo
- Address for Correspondence: Raphael E. Cuomo, PhD School of Medicine University of California San Diego 8950 Villa La Jolla Drive, A203 San Diego, CA 92037
| | - Zhuoran Li
- Global Health Policy and Data Institute, San Diego, CA, USA,San Diego Supercomputer Center, San Diego, CA, USA,S-3 Research LLC, San Diego, CA, USA
| | - Vidya Purushothaman
- Global Health Policy and Data Institute, San Diego, CA, USA,San Diego Supercomputer Center, San Diego, CA, USA
| | | | - Matthew Nali
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA,Global Health Policy and Data Institute, San Diego, CA, USA,S-3 Research LLC, San Diego, CA, USA
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, CA, USA,San Diego Supercomputer Center, San Diego, CA, USA,S-3 Research LLC, San Diego, CA, USA,Global Health Program, Department of Anthropology, University of California, San Diego, CA, USA
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Yang JS, Kotzias V, Crosbie E, Mackey TK. COVID-19 and a Window of Opportunity: Guiding Principles for a Health-Promoting Trade Agenda. Int J Health Policy Manag 2022; 11:1604-1607. [PMID: 33327688 PMCID: PMC9808361 DOI: 10.34172/ijhpm.2020.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/25/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Joshua S. Yang
- California State University, Fullerton, Fullerton, CA, USA
| | - Virginia Kotzias
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Tim K. Mackey
- Department of Anesthesiology, Division of Infectious Disease and Global Public Health, School of Medicine, University of California, San Diego, San Diego, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
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Saeed G, Kohler JC, Cuomo RE, Mackey TK. A systematic review of digital technology and innovation and its potential to address anti-corruption, transparency, and accountability in the pharmaceutical supply chain. Expert Opin Drug Saf 2022; 21:1061-1088. [PMID: 35714366 DOI: 10.1080/14740338.2022.2091543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The urgent need to acquire medical supplies amidst the COVID-19 pandemic has led to bypassing of controls that govern the global pharmaceutical supply chain, increasing the risk of corruption. Hence, promoting anti-corruption, transparency, and accountability (ACTA) in supply chain and procurement has never been more important. The adoption of digital tools, if designed and implemented appropriately, can reduce the risks of corruption. AREAS COVERED Following PRISMA guidelines, we conducted an interdisciplinary systematic review of health/medicine, humanities/social sciences, engineering, and computer science literature, with the aims of identifying technologies used for pharmaceutical supply chain and procurement optimization and reviewing whether they address ACTA mechanisms to strengthen pharmaceutical governance. Our review identified four distinct categories of digital solutions: e-procurement and open contracting; track-and-trace technology; anti-counterfeiting technology; and blockchain technology. EXPERT OPINION Findings demonstrate an increase in research of technologies to improve pharmaceutical supply chain and procurement functions; however, most technologies are not being leveraged to directly address ACTA or global health outcomes. Some blockchain and RFID technologies incorporated ACTA mechanisms and mentioned specific policy/governance frameworks, but more purposeful linkage is needed. Findings point to the need for targeted policy development and governance to activate these innovative technologies to improve global health .
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Affiliation(s)
- Gul Saeed
- Accountability and Transparency in the Pharmaceutical Sector, WHO Collaborating Centre for Governance, Toronto, ON, Canada
| | - Jillian C Kohler
- Accountability and Transparency in the Pharmaceutical Sector, WHO Collaborating Centre for Governance, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Raphael E Cuomo
- Global Health Policy and Data Institute, San Diego, CA, USA.,Department of Anesthesiology, University of California, San Diego - School of Medicine, La Jolla, CA, USA
| | - Tim K Mackey
- Accountability and Transparency in the Pharmaceutical Sector, WHO Collaborating Centre for Governance, Toronto, ON, Canada.,Global Health Policy and Data Institute, San Diego, CA, USA.,Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, USA
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Yang JS, Faruqui A, Sou A, Mackey TK. Non-compliance with university tobacco-free policies: A qualitative exploration. Tob Prev Cessat 2022; 8:14. [PMID: 35515713 PMCID: PMC8988849 DOI: 10.18332/tpc/146713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Though university smoke-free and tobacco-free campus policies have been proliferating across the US, compliance and enforcement remain challenges. This study examined perceptions and behaviors of employees and students who used tobacco products on tobacco-free campuses, to better understand policy non-compliance. METHODS Students (n=56) and employees (n=20) from two tobacco-free 4-year public universities in Southern California who self-reported using tobacco products on campus participated in focus groups, stratified by university and student or employee (faculty and staff) status, to discuss attitudes toward campus tobacco policies and on-campus smoking. Focus group discussions were transcribed and analyzed after structured coding and subcoding. RESULTS Participants were generally aware that smoking and vaping were not allowed on campus, though few could correctly identify their campus as tobacco-free. Attitudes toward the policy varied by subgroup and by campus, with students and employees at different universities expressing varying levels of support. Non-compliance was a unique interaction of individual, institutional, and interpersonal factors including a desire to smoke or vape to reduce stress, lack of formal enforcement or penalty for violating the policy, and efforts to smoke or vape in ways that reduce harm to others as a way of rationalizing non-compliance. CONCLUSIONS Attitudes toward university tobacco-free policies are campus- and constituency-specific, with similarities in individual, institutional, and interpersonal factors underlying non-compliance. Interventions to increase compliance should address individual, institutional, and interpersonal influences on non-compliance through efforts tailored to specific campus constituencies based on their particular knowledge and attitudes towards tobacco-free policies.
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Affiliation(s)
- Joshua S. Yang
- Department of Public Health, California State University, Fullerton, United States
| | - Afsana Faruqui
- Department of Public Health, California State University, Fullerton, United States
| | - Angela Sou
- Department of Public Health, California State University, Fullerton, United States
| | - Tim K. Mackey
- Department of Anthropology, University of California, San Diego, United States
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Nali MC, Purushothaman V, Li J, Mackey TK. Characterizing California licensure status and tobacco user experience with adverse events using Yelp data. Prev Med Rep 2022; 26:101720. [PMID: 35141123 PMCID: PMC8814643 DOI: 10.1016/j.pmedr.2022.101720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 11/28/2022] Open
Abstract
Yelp is an online business listing platform to rate tobacco/vaping goods retailers. CA licensed tobacco/vape stores data was cross-referenced with Yelp listings. We identified Yelp tobacco/vape listings not licensed in California’s database. Identified counterfeit/expired product selling, adverse events, underage selling. Results identify unauthorized tobacco/vape stores and customer safety issues.
Various tobacco vendors, including alternative tobacco product sellers, are listed on the popular crowdsourced business listing platform Yelp. Yelp is used to rate and choose tobacco, electronic nicotine delivery systems (ENDS) goods/services and includes self-reporting of user experiences with shops and products. We cross-referenced California Department of Tax and Fee Administration (CDTFA) licensed tobacco, vape, and head shop retail stores with publicly available Yelp business listings to identify licensed and unlicensed stores in California. We extracted metadata associated with store accounts and analyzed user comments and ratings for discussion of tobacco-related complaints and adverse events. We detected a total of 3,717 shops that were categorized as tobacco/vape/head shops on Yelp and by cross-referencing with CDTFA data, licensed businesses accounted for 49.5% (n = 1,841), licensed individual retailers 31.6% (n = 1,174), and suspected unlicensed storefronts 18.9% (n = 702). Businesses and individuals with a state tobacco retail license received a higher average rating from Yelp users (3.86 out of 5) compared to unlicensed shops (3.57) (p < 0.001). Additionally, 4,682 unique comments about licensed businesses, 1,535 unique comments about individual retailers, and 560 unique comments about unlicensed vendors were reviewed, with themes including discussion about defective and counterfeit products and adverse events including coughing, difficulty breathing and reports of hospitalization detected. In contrast, comments about licensed stores predominantly discussed customer service issues. Close to one-fifth of tobacco, vape and/or head shops reviewed on Yelp were not in CDTFA’s licensure database. Overall self-reported tobacco user experiences appeared to differ in content and severity based on whether an establishment was licensed. These results have the potential to identify unauthorized stores and adverse events associated with their tobacco and vaping products or services.
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Purushothaman V, McMann T, Nali M, Li Z, Cuomo R, Mackey TK. Content Analysis of Nicotine Poisoning (Nic Sick) Videos on TikTok: Retrospective Observational Infodemiology Study. J Med Internet Res 2022; 24:e34050. [PMID: 35353056 PMCID: PMC9008518 DOI: 10.2196/34050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 12/24/2022] Open
Abstract
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).
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Affiliation(s)
- Vidya Purushothaman
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anesthesiology and Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States
| | - Tiana McMann
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anthropology, University of California San Diego, La Jolla, CA, United States.,S-3 Research, San Diego, CA, United States
| | - Matthew Nali
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anesthesiology and Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States.,S-3 Research, San Diego, CA, United States
| | - Zhuoran Li
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anthropology, University of California San Diego, La Jolla, CA, United States.,S-3 Research, San Diego, CA, United States
| | - Raphael Cuomo
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anesthesiology and Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anthropology, University of California San Diego, La Jolla, CA, United States.,S-3 Research, San Diego, CA, United States
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Purushothaman V, McMann TJ, Li Z, Cuomo RE, Mackey TK. Content and trend analysis of user-generated nicotine
sickness tweets: A retrospective infoveillance study. Tob Induc Dis 2022; 20:30. [PMID: 35529325 PMCID: PMC8919180 DOI: 10.18332/tid/145941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Exposure to pro-tobacco and electronic nicotine delivery system (ENDS) social media content can lead to overconsumption, increasing the likelihood of nicotine poisoning. This study aims to examine trends and characteristics of nicotine sickness content on Twitter between 2018–2020. METHODS Tweets were collected retrospectively from the Twitter Academic Research Application Programming Interface (API) stream filtered for keywords: ‘nic sick’, ‘nicsick’, ‘vape sick’, ‘vapesick’ between 2018–2020. Collected tweets were manually annotated to identify suspected user-generated reports of nicotine sickness and related themes using an inductive coding approach. The Augmented Dickey-Fuller (ADF) test was used to assess stationarity in the monthly variation of the volume of tweets between 2018–2020. RESULTS A total of 5651 tweets contained nicotine sickness-related keywords and 18.29% (n=1034) tweets reported one or more suspected nicotine sickness symptoms of varied severity. These tweets were also grouped into five related categories including firsthand and secondhand reports of symptoms, intentional overconsumption of nicotine products, users expressing intention to quit after ‘nic sick’ symptoms, mention of nicotine product type/brand name that they consumed while ‘nic sick’, and users discussing symptoms associated with nicotine withdrawal following cessation attempts. The volume of tweets reporting suspected nicotine sickness appeared to increase throughout the study period, except between February and April 2020. Stationarity in the volume of ‘nicsick’ tweets between 2018–2020 was not statistically significant (ADF= -0.32, p=0.98) indicating a change in the volume of tweets. CONCLUSIONS Results point to the need for alternative forms of adverse event surveillance and reporting, to appropriately capture the growing health burden of vaping. Infoveillance approaches on social media platforms can help to assess the volume and characteristics of user-generated content discussing suspected nicotine poisoning, which may not be reported to poison control centers. Increasing volume of user-reported nicotine sickness and intentional overconsumption of nicotine in twitter posts represent a concerning trend associated with ENDS-related adverse events and poisoning.
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Affiliation(s)
- Vidya Purushothaman
- Global Health Policy and Data Institute, San Diego, United States
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, San Diego, United States
| | - Tiana J. McMann
- Global Health Policy and Data Institute, San Diego, United States
- Global Health Program, Department of Anthropology, University of California, San Diego, San Diego, United States
| | - Zhuoran Li
- Global Health Policy and Data Institute, San Diego, United States
- Global Health Program, Department of Anthropology, University of California, San Diego, San Diego, United States
- S-3 Research, San Diego, United States
| | - Raphael E. Cuomo
- Global Health Policy and Data Institute, San Diego, United States
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, San Diego, United States
| | - Tim K. Mackey
- Global Health Policy and Data Institute, San Diego, United States
- Global Health Program, Department of Anthropology, University of California, San Diego, San Diego, United States
- S-3 Research, San Diego, United States
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Cuomo RE, Mackey TK. Examining the association between international migration and colorectal cancer among multiple ancestry groups in the United States. Ethn Health 2022; 27:275-283. [PMID: 31679393 DOI: 10.1080/13557858.2019.1685652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 10/08/2019] [Indexed: 06/10/2023]
Abstract
Objectives: Prior research has not adequately examined the relationship between international migration and colorectal cancer (CRC) by cultural regions in the US. The purpose of this exploratory study was to determine how annual CRC incidence varied with US annual international migrant inflow in ten different regions, corresponding to dominant ancestry group.Design: County-level international migrant inflow and dominant ancestry type were obtained from the American Community Survey, and age-adjusted CRC incidence was obtained from the National Cancer Institute. A linear regression model was tested for each ancestry region to assess the relationship between migrant inflow and CRC incidence.Results: Higher international migrant inflow was associated with lower CRC incidence among counties where the dominant ancestry group was African American (p = 0.0207), British (p = 0.0212), Hispanic (p = 0.0001), and Native American (p = 0.0056).Conclusions: These findings suggest that US residents in certain ancestry groups are at higher risk for CRC.
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Affiliation(s)
| | - T K Mackey
- Global Health Policy Institute, San Diego, CA, USA
- Department of Anesthesiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
- Division of Global Public Health, School of Medicine, University of California, San Diego, San Diego, CA, USA
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Purushothaman V, Cuomo RE, Li J, Nali M, Mackey TK. Association of tobacco retailer count with smoking population versus vaping population in California (2019). Arch Public Health 2022; 80:42. [PMID: 35086563 PMCID: PMC8793220 DOI: 10.1186/s13690-022-00799-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/12/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Access to tobacco products, including vape products, from local brick-and-mortar stores influences the exposure, uptake, and use of these products in local communities. METHODS Licensed tobacco retailers in California were classified as specialized tobacco/vape stores or non-specialized stores by obtaining categories published on Yelp. California smoking and vaping prevalence data were obtained from the 500 cities project and ESRI community analyst tool respectively. A series of simple linear regression tests were performed, at the zip code level, between the retailer count in each store category and smoking/vaping population. The Getis-Ord Gi* and Anselin Local Moran's I statistics were used for characterization of tobacco retail density hotspots and cold spots. RESULTS The association between CA smoking/vaping population and number of tobacco retailers was statistically significant for all store categories. Variability in smoking population was best explained by variability in non-specialized storefronts(R2=0.84). Spatial variability in tobacco-only storefronts explained the least proportion of variability in the overall smoking population. Similar results were obtained specific to vaping population, although the proportion of population explained by variability in the number of non-specialized storefronts was comparatively lower(R2=0.80). CONCLUSIONS Localities with greater numbers of non-specialized tobacco retailers had higher rates of smoking/vaping populations, and this association was much stronger for localities with greater numbers of specialized retailers. Non-specialized storefronts may represent convenient access points for nicotine products, while specialized storefronts may represent critical access points for initiation. Hence, regulations that address the entirety of the tobacco/vaping retail environment by limiting widespread access from non-specialized stores and reducing appeal generated by specialized retailers should be incorporated in future tobacco regulatory science and policymaking.
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Affiliation(s)
- Vidya Purushothaman
- Department of Anesthesiology, San Diego School of Medicine, University of California, La Jolla, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
| | - Raphael E Cuomo
- Department of Anesthesiology, San Diego School of Medicine, University of California, La Jolla, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research LLC, San Diego, CA, USA
| | - Matthew Nali
- Department of Anesthesiology, San Diego School of Medicine, University of California, La Jolla, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research LLC, San Diego, CA, USA
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, CA, USA.
- S-3 Research LLC, San Diego, CA, USA.
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, USA.
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Shah N, Li J, Mackey TK. An unsupervised machine learning approach for the detection and characterization of illicit drug-dealing comments and interactions on Instagram. Subst Abus 2022; 43:273-277. [PMID: 34214410 PMCID: PMC9675406 DOI: 10.1080/08897077.2021.1941508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Growing use of social media has led to the emergence of virtual controlled substance and illicit drug marketplaces, prompting calls for action by government and law enforcement. Previous studies have analyzed Instagram drug selling via posts. However, comments made by users involving potential drug selling have not been analyzed. In this study, we use unsupervised machine learning to detect and classify prescription and illicit drug-related buying and selling interactions on Instagram. Methods: We used over 1,000 drug-related hashtags on Instagram to collect a total of 43,607 Instagram comments between February 1st, 2019 and May 31st, 2019 using data mining approaches in the Python programming language. We then used an unsupervised machine learning approach, the Biterm Topic Model (BTM), to thematically summarize Instagram comments into distinct topic groupings, which were then extracted and manually annotated to detect buying and selling comments. Results: We detected 5,589 comments from sellers, prospective buyers, and online pharmacies from 531 unique posts. The vast majority (99.7%) of comments originated from drug sellers and online pharmacies. Key themes from comments included providing contact information through encrypted third-party messaging platforms, drug availability, and price inquiry. Commonly offered drugs for sale included scheduled controlled substances such as Adderall and Xanax, as well as illicit hallucinogens and stimulants. Comments from prospective buyers of drugs most commonly included inquiries about price and availability. Conclusions: We detected prescription controlled substances and other illicit drug selling interactions via Instagram comments to posts. We observed that comments were primarily used by sellers offering drugs, and typically not by prospective buyers interacting with sellers. Further research is needed to characterize these "social" drug marketplace interactions on this and other popular social media platforms.
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Affiliation(s)
- Neal Shah
- Department of Healthcare Research and Policy, UC San Diego – Extension, San Diego, CA USA
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, CA USA,S-3 Research LLC, San Diego, CA USA
| | - Tim K. Mackey
- Department of Healthcare Research and Policy, UC San Diego – Extension, San Diego, CA USA,Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA USA
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McMann TJ, Calac A, Nali M, Cuomo R, Maroulis J, Mackey TK. Synthetic Cannabinoids in Prisons: Content Analysis of TikToks. JMIR Infodemiology 2022; 2:e37632. [PMID: 37113804 PMCID: PMC9987188 DOI: 10.2196/37632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 04/29/2023]
Abstract
Background Synthetic cannabinoids are a significant public health concern, especially among incarcerated populations due to increased reports of abuse. Recent news reports have highlighted the severe consequences of K2/Spice, a synthetic cannabinoid, among the prison population in the United States. Despite regulations against cell phone use, inmates use TikTok to post K2/Spice-related content. Objective This study aimed to examine TikTok posts for use and illicit distribution of psychoactive substances (eg, K2/Spice) among incarcerated populations. Methods The study collected TikTok videos associated with the #k2spice hashtag and used a data collection approach similar to snowball sampling. Inductive coding was used to conduct content analysis of video characteristics. Videos were manually annotated to generate binary classifications related to the use of K2/Spice as well as selling and buying activities associated with it. Statistical analysis was used to determine associations between a video's user engagement and an intent to buy or sell K2/Spice. Results A total of 89 TikTok videos with the hashtag #k2spice were manually coded, with 40% (n=36) identified as displaying the use, solicitation, or adverse effects of K2/Spice among the prison population. Of them, 44.44% (n=16) were in a prison-based setting documenting adverse effects including possible overdose. Videos with higher user engagement were positively correlated with comments indicating an intent to buy or sell K2/Spice. Conclusions K2/Spice is a drug subject to abuse among prison inmates in the United States, including depictions of its harmful effects being recorded and shared on TikTok. Lack of policy enforcement on TikTok and the need for better access to treatment services within the prison system may be exacerbating substance use among this highly vulnerable population. Minimizing the potential individual harm of this content on the incarcerated population should be a priority for social media platforms and the criminal justice system alike.
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Affiliation(s)
- Tiana J McMann
- Global Health Program Department of Anthropology University of California San Diego La Jolla, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
- S-3 Research San Diego, CA United States
| | - Alec Calac
- Global Health Policy and Data Institute San Diego, CA United States
- Department of Anesthesiology University of California San Diego San Diego, CA United States
| | - Matthew Nali
- Global Health Policy and Data Institute San Diego, CA United States
- S-3 Research San Diego, CA United States
| | - Raphael Cuomo
- Global Health Policy and Data Institute San Diego, CA United States
- Department of Anesthesiology University of California San Diego San Diego, CA United States
| | - James Maroulis
- Global Health Policy and Data Institute San Diego, CA United States
| | - Tim K Mackey
- Global Health Program Department of Anthropology University of California San Diego La Jolla, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
- S-3 Research San Diego, CA United States
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Ahmed J, Modica de Mohac L, Mackey TK, Raimi-Abraham BT. A critical review on the availability of substandard and falsified medicines online: Incidence, challenges and perspectives. The Journal of Medicine Access 2022; 6:23992026221074548. [PMID: 36204527 PMCID: PMC9413502 DOI: 10.1177/23992026221074548] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022]
Abstract
Simultaneous expansion of the Internet and increased globalisation of the
pharmaceutical industry have meant medication can be accessed transnationally
from both legal and illicit sources. This has coincided with the rise of
substandard and falsified medicines (SFMs) online. These products fail to meet
regulatory or quality standards and/or are constituted with substandard
ingredients, causing undesired pharmacological effects, including possible
injury and death. This review aimed to identify original research studies that
examined characteristics of SFM online sales, attitudes towards purchasing
medicines online and strategies to address this drug safety challenge. Keywords
of ‘Substandard’ and ‘Falsified’/‘Counterfeit’ and ‘Medicines’/‘Drugs’ and
‘Online’/‘Internet’ were searched using Web of Knowledge and PubMed databases.
Resulting literature, which satisfied the study’s inclusion criteria, was
included in the review, and the findings from each paper were assessed. From an
initial 185 literature articles, 7 were eligible according to the inclusion
criteria to be reviewed. These articles identified studies testing SFMs
purchased online, surveys of attitudes and knowledge about SFMs online, and
website content analysis to detect illegal online sales. Challenges identified
were lack of knowledge and awareness among consumers and physicians, in addition
to the use of direct-to-consumer-advertising, via Internet platforms and social
media, providing easy access to SFMs. Despite this, medicine authentication
technology, website verification approaches and new detection methods were
identified as potential solutions specific to online SFM sales. To address
online sales of SFMs, more robust research, greater awareness/educational
programmes, analytical detection methods and more stringent online global
governance are required.
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Affiliation(s)
- Jamee Ahmed
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Science, King’s College London, London, UK
| | - Laura Modica de Mohac
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Science, King’s College London, London, UK
| | - Tim K Mackey
- Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, School of Medicine, UC San Diego, La Jolla, CA, USA
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Shah N, Nali M, Bardier C, Li J, Maroulis J, Cuomo R, Mackey TK. Applying topic modelling and qualitative content analysis to identify and characterise ENDS product promotion and sales on Instagram. Tob Control 2021:tobaccocontrol-2021-056937. [PMID: 34857646 DOI: 10.1136/tobaccocontrol-2021-056937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/16/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Increased public health and regulatory scrutiny concerning the youth vaping epidemic has led to greater attention to promotion and sales of vaping products on social media platforms. OBJECTIVES We used unsupervised machine learning to identify and characterise sale offers of electronic nicotine delivery systems (ENDS) and associated products on Instagram. We examined types of sellers, geographic ENDS location and use of age verification. METHODS Our methodology was composed of three phases: data collection, topic modelling and content analysis. We used data mining approaches to query hashtags related to ENDS product use among young adults to collect Instagram posts. For topic modelling, we applied an unsupervised machine learning approach to thematically categorise and identify topic clusters associated with selling activity. Content analysis was then used to characterise offers for sale of ENDS products. RESULTS From 70 725 posts, we identified 3331 engaged in sale of ENDS products. Posts originated from 20 different countries and were roughly split between individual (46.3%) and retail sellers (43.4%), with linked online sellers (8.8%) representing a smaller volume. ENDS products most frequently offered for sale were flavoured e-liquids (53.0%) and vaping devices (20.5%). Online sellers offering flavoured e-liquids were less likely to use age verification at point of purchase (29% vs 64%) compared with other products. CONCLUSIONS Instagram is a global venue for unregulated ENDS sales, including flavoured products, and access to websites lacking age verification. Such posts may violate Instagram's policies and US federal and state law, necessitating more robust review and enforcement to prevent ENDS uptake and access.
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Affiliation(s)
- Neal Shah
- Department of Healthcare Research and Policy, University of California San Diego, La Jolla, California, USA.,Global Health Policy and Data Institute, San Diego, California, USA
| | - Matthew Nali
- Global Health Policy and Data Institute, San Diego, California, USA.,Department of Anesthesiology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Cortni Bardier
- Global Health Policy and Data Institute, San Diego, California, USA.,Global Health Program, Department of Anthropology, University of California San Diego, La Jolla, California, USA
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, California, USA
| | - James Maroulis
- Global Health Program, Department of Anthropology, University of California San Diego, La Jolla, California, USA
| | - Raphael Cuomo
- Global Health Policy and Data Institute, San Diego, California, USA.,Department of Anesthesiology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Tim K Mackey
- Department of Healthcare Research and Policy, University of California San Diego, La Jolla, California, USA .,Global Health Policy and Data Institute, San Diego, California, USA.,Global Health Program, Department of Anthropology, University of California San Diego, La Jolla, California, USA
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Haupt MR, Xu Q, Yang J, Cai M, Mackey TK. Characterizing Vaping Industry Political Influence and Mobilization on Facebook: Social Network Analysis. J Med Internet Res 2021; 23:e28069. [PMID: 34714245 PMCID: PMC8590191 DOI: 10.2196/28069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/01/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Michael Robert Haupt
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, United States.,Global Health Policy and Data Institute, San Diego, CA, United States
| | - Qing Xu
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Healthcare Research and Policy, University of California, San Diego Extension, La Jolla, CA, United States.,S-3 Research, San Diego, CA, United States
| | - Joshua Yang
- Department of Public Health, California State University, Fullerton, CA, United States
| | - Mingxiang Cai
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Healthcare Research and Policy, University of California, San Diego Extension, La Jolla, CA, United States.,S-3 Research, San Diego, CA, United States
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, CA, United States.,S-3 Research, San Diego, CA, United States.,Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, United States
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Xu Q, Yang J, Haupt MR, Cai M, Nali MC, Mackey TK. Digital Surveillance to Identify California Alternative and Emerging Tobacco Industry Policy Influence and Mobilization on Facebook. Int J Environ Res Public Health 2021; 18:ijerph182111150. [PMID: 34769666 PMCID: PMC8583030 DOI: 10.3390/ijerph182111150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022]
Abstract
Growing popularity of electronic nicotine-delivery systems (ENDS) has coincided with a need to strengthen tobacco-control policy. In response, the ENDS industry has taken actions to mobilize against public health measures, including coordination on social media platforms. To explore this phenomenon, data mining was used to collect public posts on two Facebook public group pages: the California Consumer Advocates for Smoke Free Alternatives Association (CCASAA) and the community page of the Northern California Chapter of SFATA (NC-SFATA). Posts were manually annotated to characterize themes associated with industry political interference and user interaction. We collected 288 posts from the NC-SFATA and 411 posts from CCASAA. A total of 522 (74.7%) posts were categorized as a form of political interference, with 339 posts (64.9%) from CCASAA and 183 posts (35.1%) from NC-SFATA. We identified three different categories of policy interference-related posts: (1) providing updates on ENDS-related policy at the federal, state, and local levels; (2) sharing opinions about ENDS-related policies; (3) posts related to scientific information related to vaping; and (4) calls to action to mobilize against tobacco/ENDS policies. Our findings indicate that pro-tobacco social media communities on Facebook, driven by strategic activities of trade associations and their members, may act as focal points for anti-policy information dissemination, grass-roots mobilization, and industry coordination that needs further research.
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Affiliation(s)
- Qing Xu
- Global Health Policy and Data Institute, San Diego, CA 92121, USA; (Q.X.); (M.R.H.); (M.C.); (M.C.N.)
- S-3 Research, LLC, San Diego, CA 92121, USA
| | - Joshua Yang
- Department of Public Health, California State University, Fullerton, CA 92834, USA;
| | - Michael R. Haupt
- Global Health Policy and Data Institute, San Diego, CA 92121, USA; (Q.X.); (M.R.H.); (M.C.); (M.C.N.)
- Department of Cognitive Science, University of California, San Diego, CA 92093, USA
| | - Mingxiang Cai
- Global Health Policy and Data Institute, San Diego, CA 92121, USA; (Q.X.); (M.R.H.); (M.C.); (M.C.N.)
- S-3 Research, LLC, San Diego, CA 92121, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, CA 92093, USA
| | - Matthew C. Nali
- Global Health Policy and Data Institute, San Diego, CA 92121, USA; (Q.X.); (M.R.H.); (M.C.); (M.C.N.)
- S-3 Research, LLC, San Diego, CA 92121, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, CA 92093, USA
| | - Tim K. Mackey
- Global Health Policy and Data Institute, San Diego, CA 92121, USA; (Q.X.); (M.R.H.); (M.C.); (M.C.N.)
- S-3 Research, LLC, San Diego, CA 92121, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, CA 92093, USA
- Correspondence: ; Tel.: +1-(951)-491-4161
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Calac AJ, Bardier C, Cai M, Mackey TK. Examining Facebook Community Reaction to a COVID-19 Vaccine Trial on the Navajo Nation. Am J Public Health 2021; 111:1428-1430. [PMID: 34464193 DOI: 10.2105/ajph.2021.306202] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Alec J Calac
- All authors are with the University of California, San Diego, La Jolla. Alec Calac is also with the Joint Doctoral Program in Global Public Health, University of California, San Diego School of Medicine. Cortni Bardier, Mingxiang Cai, and Tim K. Mackey are also with the Global Health Policy and Data Institute, San Diego, CA
| | - Cortni Bardier
- All authors are with the University of California, San Diego, La Jolla. Alec Calac is also with the Joint Doctoral Program in Global Public Health, University of California, San Diego School of Medicine. Cortni Bardier, Mingxiang Cai, and Tim K. Mackey are also with the Global Health Policy and Data Institute, San Diego, CA
| | - Mingxiang Cai
- All authors are with the University of California, San Diego, La Jolla. Alec Calac is also with the Joint Doctoral Program in Global Public Health, University of California, San Diego School of Medicine. Cortni Bardier, Mingxiang Cai, and Tim K. Mackey are also with the Global Health Policy and Data Institute, San Diego, CA
| | - Tim K Mackey
- All authors are with the University of California, San Diego, La Jolla. Alec Calac is also with the Joint Doctoral Program in Global Public Health, University of California, San Diego School of Medicine. Cortni Bardier, Mingxiang Cai, and Tim K. Mackey are also with the Global Health Policy and Data Institute, San Diego, CA
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Bardier C, Yang JS, Li J, Mackey TK. Characterizing alternative and emerging tobacco product transition of use behavior on Twitter. BMC Res Notes 2021; 14:303. [PMID: 34372926 PMCID: PMC8351350 DOI: 10.1186/s13104-021-05719-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/28/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The objective of this study was to develop an inductive coding approach specific to characterizing user-generated social media conversations about transition of use of different tobacco and alternative and emerging tobacco products (ATPs). RESULTS A total of 40,206 tweets were collected from the Twitter public API stream that were geocoded from 2018 to 2019. Using data mining approaches, these tweets were then filtered for keywords associated with tobacco and ATP use behavior. This resulted in a subset of 5718 tweets, with 657 manually annotated and identified as associated with user-generated conversations about tobacco and ATP use behavior. The 657 tweets were coded into 9 parent codes: inquiry, interaction, observation, opinion, promote, reply, share knowledge, use characteristics, and transition of use behavior. The highest number of observations occurred under transition of use (43.38%, n = 285), followed by current use (39.27%, n = 258), opinions about use (0.07%, n = 46), and product promotion (0.06%, n = 37). Other codes had less than ten tweets that discussed these themes. Results provide early insights into how social media users discuss topics related to transition of use and their experiences with different and emerging tobacco product use behavior.
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Affiliation(s)
- Cortni Bardier
- Global Health Policy and Data Institute, San Diego, CA, USA
- Department of Anthropology, Global Health Program, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- S-3 Research LLC, San Diego, CA, USA
| | - Joshua S Yang
- Department of Public Health, California State University, Fullerton, Fullerton, CA, USA
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research LLC, San Diego, CA, USA
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, CA, USA.
- Department of Anthropology, Global Health Program, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
- S-3 Research LLC, San Diego, CA, USA.
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Abstract
The most recent global refugee figures are staggering, with over 82.4 million people forcibly displaced and 26.4 million registered refugees. The ongoing conflict in Syria is a major contributor. After a decade of violence and destabilization, over 13.4 million Syrians have been displaced, including 6.7 million internally displaced persons and 6.7 million refugees registered in other countries. Beyond the immediate political and economic challenges, an essential component of any response to this humanitarian crisis must be health-related, including policies and interventions specific to mental health. This policy and practice review addresses refugee mental health in the context of the Syrian crisis, providing an update and overview of the current situation while exploring new initiatives in mental health research and global health policy that can help strengthen and expand services. Relevant global health policy frameworks are first briefly introduced, followed by a short summary of recent research on refugee mental health. We then provide an update on the current status of research, service provision, and health policy in the leading destinations for Syrians who have been forcibly displaced. This starts within Syria and then turns to Turkey, Lebanon, Jordan, and Germany. Finally, several general recommendations are discussed, including the pressing need for more data at each phase of migration, the expansion of integrated mental health services, and the explicit inclusion and prioritization of refugee mental health in national and global health policy.
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Affiliation(s)
- Kelso Cratsley
- Department of Philosophy & Religion, American University, Washington, DC, United States
| | | | - Tim K. Mackey
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, United States
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Yang JS, Sou A, Faruqui A, Mackey TK. A qualitative examination of e-cigarette use among California young adults during the EVALI outbreak. Prev Med Rep 2021; 24:101506. [PMID: 34401219 PMCID: PMC8351914 DOI: 10.1016/j.pmedr.2021.101506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/17/2022] Open
Abstract
The 2019 outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) increased awareness of potential health risks associated with vaping among the general public. Little is known, however, about how unfolding information regarding EVALI affected knowledge, attitudes, and behaviors among e-cigarette users, particularly among young adults. This study describes attitudinal and behavioral responses to EVALI among young adult e-cigarette users. In October and November 2019, seven focus groups were held with college-going young adult tobacco users from two four-year public universities in California. Focus groups included questions regarding knowledge of and reaction to EVALI news, and how the news affected product use. Text from current e-cigarette users was extracted to develop individual phenomenological textural-structural descriptions of e-cigarette use for 38 individuals which were used to create a composite experience of e-cigarette use in light of EVALI. Experiences indicated that e-cigarette users were aware of information regarding EVALI and received information from numerous sources. Information was filtered for legitimacy of EVALI claims and causes of EVALI. Risk rationalizations were developed to assess potential harm of continued e-cigarette use and provided reasoning for behavioral responses to EVALI. The emerging harm associated with EVALI prompted e-cigarette users to engage in a cognitive process resulting in employment of a range of rationalities to justify continued use. These results suggest how environmental, cognitive, and behavioral factors may interact as young adults negotiate e-cigarette-related harms.
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Affiliation(s)
- Joshua S. Yang
- Department of Public Health, California State University, Fullerton, 800
N. State College Boulevard, KHS 161-A, Fullerton, CA 92831, USA
- Corresponding author.
| | - Angela Sou
- Department of Public Health, California State University, Fullerton, 800
N. State College Boulevard, KHS 161-A, Fullerton, CA 92831, USA
| | - Afsana Faruqui
- Department of Public Health, California State University, Fullerton, 800
N. State College Boulevard, KHS 161-A, Fullerton, CA 92831, USA
| | - Tim K. Mackey
- Global Health Program, Department of Anthropology, University of
California, San Diego, 8950 Villa La Jolla Drive, A124, La Jolla, CA 92037,
USA
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Cuomo RE, Cai M, Shah N, Mackey TK. Physicians payment in the United States between 2014 and 2018: An analysis of the CMS Open Payments database. PLoS One 2021; 16:e0252656. [PMID: 34077460 PMCID: PMC8171935 DOI: 10.1371/journal.pone.0252656] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/20/2021] [Indexed: 11/18/2022] Open
Abstract
The Open Payments database reports payments made to physicians by industry. Given the potential for financial conflicts of interest relating to patient outcomes, further scrutiny of these data is valuable. Therefore, the objective of this study was to analyze physician-industry relationships by specialty type, payment type, geospatial trend, and longitudinal trend between 2014-2018. We conducted an observational, retrospective data analysis of payments from the Open Payments database for licensed United States physicians listed in the National Plan & Provider Enumeration System (NPPES). Datasets from 2013-2018 were joined using the Python programming language. Aggregation and sub-setting by characteristics of interest was done in R to calculate means and frequencies of reported general physician payments from industry across different specialties, locations, timeframes, and payment types. Normalization was applied for numbers of physicians or payments. Geospatial statistical hot spot analysis was conducted in ArcGIS. 51.73 million payment records were analyzed. In total, 50,047,930 payments were issued to 771,113 allopathic or osteopathic physicians, representing $8,702,631,264 transferred from industry to physicians over the five-year period between 2014 and 2018. The mean payment amount was $179, with a standard deviation of $12,685. Variability in physicians' financial relationships with industry were apparent across specialties, regions, time, and payment type. A limited match rate between records in the NPPES and Open Payments databases may have resulted in selection bias of trends related to physician characteristics. Further research is necessary, particularly in the context of changing industry payment trends and public perceptions of the appropriateness of these relationships.
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Affiliation(s)
- Raphael E. Cuomo
- Global Health Policy and Data Institute, San Diego, CA, United States of America
- Department of Anesthesiology, San Diego School of Medicine, University of California, San Diego, CA, United States of America
| | - Mingxiang Cai
- Global Health Policy and Data Institute, San Diego, CA, United States of America
- Department of Anthropology, Global Health Program, University of California, San Diego, CA, United States of America
- S-3 Research LLC, San Diego, CA, United States of America
| | - Neal Shah
- Global Health Policy and Data Institute, San Diego, CA, United States of America
- Department of Healthcare Research and Policy, San Diego—Extension, University of California, San Diego, CA, United States of America
| | - Tim K. Mackey
- Global Health Policy and Data Institute, San Diego, CA, United States of America
- Department of Anesthesiology, San Diego School of Medicine, University of California, San Diego, CA, United States of America
- S-3 Research LLC, San Diego, CA, United States of America
- Department of Healthcare Research and Policy, San Diego—Extension, University of California, San Diego, CA, United States of America
- Division of Infectious Disease and Global Public Health, Department of Medicine, San Diego School of Medicine, University of California, San Diego, CA, United States of America
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Purushothaman V, Li J, Mackey TK. Detecting Suicide and Self-Harm Discussions Among Opioid Substance Users on Instagram Using Machine Learning. Front Psychiatry 2021; 12:551296. [PMID: 34135778 PMCID: PMC8200460 DOI: 10.3389/fpsyt.2021.551296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Suicide and substance use disorder (SUD) pose serious public health challenges among young adults in the United States. Increasing social media use among these populations can be leveraged as an alternative method to detect characteristics of suicide-related topics and behavior among substance users. Objective: To detect and characterize suicide and self-harm related conversations co-occurring with SUD posts and comments on the popular social media platform Instagram. Methods: This study used big data and machine learning approaches to collect and classify Instagram posts containing 632 controlled substance-related hashtags. Posts were first classified for online drug diversion topics and then filtered to detect suicide and mental health discussions. Posts and comments were then manually annotated for SUD and mental health co-occurring themes. Associations between these characteristics were tested using the Chi-square test. Results: We detected 719 Instagram posts/comments that included user-generated discussions about suicide, substance use and/or mental health. Posts self-reporting SUD and mental health topics were also more likely to discuss suicide compared to those that did not discuss SUD and mental health topics, respectively (p < 0.001). Major themes observed included concurrent discussions of suicide ideation and attempts and low self-esteem. Conclusions: Our study results provide preliminary evidence of social media discussions about suicide and mental health among those with SUD. This co-occurrence represents a key health risk factor on a platform heavily utilized by young adults. Further studies are required to analyze specific patterns of suicide and self-harm ideations for the purposes of designing future suicide prevention campaigns through digital channels.
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Affiliation(s)
- Vidya Purushothaman
- Masters in Public Health Program, University of California, San Diego, San Diego, CA, United States
- Department of Anesthesiology, School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Jiawei Li
- Department of Healthcare Research and Policy, University of California San Diego - Extension, San Diego, CA, United States
| | - Tim K Mackey
- Department of Anesthesiology, School of Medicine, University of California, San Diego, San Diego, CA, United States
- Department of Healthcare Research and Policy, University of California San Diego - Extension, San Diego, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
- Division of Infectious Disease and Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, San Diego, CA, United States
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Cuomo RE, Yang JS, Purushothaman VL, Nali M, Li J, Mackey TK. A geospatial analysis of age disparities in resolute localities of tobacco and vaping-specific storefronts in California. Tob Prev Cessat 2021; 7:32. [PMID: 34017926 PMCID: PMC8114581 DOI: 10.18332/tpc/133933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/03/2021] [Accepted: 03/03/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Concomitant with the popularization of vaping, vape shops have dramatically proliferated over the past years. This study assesses whether vape storefronts in California are significantly associated with density of different age groups, and whether this differs between tobacco storefronts or non-specific tobacco retailers. METHODS Addresses for licensed tobacco retailers were obtained from the California Department of Tax and Fee Administration. Business names and addresses were used to obtain store categories cross-referenced from Yelp. Using a cross-sectional ecological design, stores categorized as ‘Vape Shop’ or ‘Tobacco Shop’ were geolocated and compared with age-related variables from the American Community Survey. Regression was conducted in R to determine relationships between age group concentration, in ventiles, and proportion of tracts with tobacco-specific or vape-specific stores. Geospatial visualization was conducted using ArcGIS. RESULTS We found 848 vape shops, 820 tobacco shops, 419 categorized as both, and 20320 retailers with neither category. Overall, 1800 tobacco and/or vape shops were categorized in 1557 of California’s 23194 census tracts. A positive linear association was found between ventiles of two age categories, 20–24 and 25–34 years, and proportion of tracts with vape-specific or tobacco-specific shops separately. CONCLUSIONS Positive associations were found for ages 20–34 years but not for other ages, suggesting vape shops are strategically located in areas populated by young adults. Location-based targeting increases access, thereby increasing proportion of tobacco users, and could be a critical factor in e-cigarette uptake and use. Further study to identify additional age-related demographic characteristics among clientele of tobacco storefronts is warranted.
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Affiliation(s)
- Raphael E Cuomo
- Global Health Policy and Data Institute, San Diego, United States.,Department of Healthcare Research and Policy, University of California, San Diego - Extension, San Diego, United States.,Department of Anesthesiology, School of Medicine, University of California, San Diego, United States
| | - Joshua S Yang
- Department of Public Health, California State University, Fullerton, United States
| | - Vidya L Purushothaman
- Global Health Policy and Data Institute, San Diego, United States.,Department of Anesthesiology, School of Medicine, University of California, San Diego, United States
| | - Matthew Nali
- Department of Anesthesiology, School of Medicine, University of California, San Diego, United States
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, United States
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, United States.,Department of Healthcare Research and Policy, University of California, San Diego - Extension, San Diego, United States.,Department of Anesthesiology, School of Medicine, University of California, San Diego, United States
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Miyachi K, Mackey TK. hOCBS: A privacy-preserving blockchain framework for healthcare data leveraging an on-chain and off-chain system design. Inf Process Manag 2021. [DOI: 10.1016/j.ipm.2021.102535] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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45
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Cuomo RE, Purushothaman V, Li J, Cai M, Mackey TK. A longitudinal and geospatial analysis of COVID-19 tweets during the early outbreak period in the United States. BMC Public Health 2021; 21:793. [PMID: 33894745 PMCID: PMC8067788 DOI: 10.1186/s12889-021-10827-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/09/2021] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Early reports of COVID-19 cases and deaths may not accurately convey community-level concern about the pandemic during early stages, particularly in the United States where testing capacity was initially limited. Social media interaction may elucidate public reaction and communication dynamics about COVID-19 in this critical period, during which communities may have formulated initial conceptions about the perceived severity of the pandemic. METHODS Tweets were collected from the Twitter public API stream filtered for keywords related to COVID-19. Using a pre-existing training set, a support vector machine (SVM) classifier was used to obtain a larger set of geocoded tweets with characteristics of user self-reporting COVID-19 symptoms, concerns, and experiences. We then assessed the longitudinal relationship between identified tweets and the number of officially reported COVID-19 cases using linear and exponential regression at the U.S. county level. Changes in tweets that included geospatial clustering were also assessed for the top five most populous U.S. cities. RESULTS From an initial dataset of 60 million tweets, we analyzed 459,937 tweets that contained COVID-19-related keywords that were also geolocated to U.S. counties. We observed an increasing number of tweets throughout the study period, although there was variation between city centers and residential areas. Tweets identified as COVID-19 symptoms or concerns appeared to be more predictive of active COVID-19 cases as temporal distance increased. CONCLUSION Results from this study suggest that social media communication dynamics during the early stages of a global pandemic may exhibit a number of geospatial-specific variations among different communities and that targeted pandemic communication is warranted. User engagement on COVID-19 topics may also be predictive of future confirmed case counts, though further studies to validate these findings are needed.
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Affiliation(s)
- Raphael E Cuomo
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
| | - Vidya Purushothaman
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research LLC, San Diego, CA, USA
| | - Mingxiang Cai
- S-3 Research LLC, San Diego, CA, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, USA
| | - Tim K Mackey
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA.
- Global Health Policy and Data Institute, San Diego, CA, USA.
- S-3 Research LLC, San Diego, CA, USA.
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Cuomo RE, Purushothaman VL, Li J, Bardier C, Nali M, Shah N, Obradovich N, Yang J, Mackey TK. Characterizing Self-Reported Tobacco, Vaping, and Marijuana-Related Tweets Geolocated for California College Campuses. Front Public Health 2021; 9:628812. [PMID: 33928062 PMCID: PMC8076505 DOI: 10.3389/fpubh.2021.628812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: College-aged youth are active on social media yet smoking-related social media engagement in these populations has not been thoroughly investigated. We sought to conduct an exploratory infoveillance study focused on geolocated data to characterize smoking-related tweets originating from California 4-year colleges on Twitter. Methods: Tweets from 2015 to 2019 with geospatial coordinates in CA college campuses containing smoking-related keywords were collected from the Twitter API stream and manually annotated for discussions about smoking product type, sentiment, and behavior. Results: Out of all tweets detected with smoking-related behavior, 46.7% related to tobacco use, 50.0% to marijuana, and 7.3% to vaping. Of these tweets, 46.1% reported first-person use or second-hand observation of smoking behavior. Out of 962 tweets with user sentiment, the majority (67.6%) were positive, ranging from 55.0% for California State University, Long Beach to 95.8% for California State University, Los Angeles. Discussion: We detected reporting of first- and second-hand smoking behavior on CA college campuses representing possible violation of campus smoking bans. The majority of tweets expressed positive sentiment about smoking behaviors, though there was appreciable variability between college campuses. This suggests that anti-smoking outreach should be tailored to the unique student populations of these college communities. Conclusion: Among tweets about smoking from California colleges, high levels of positive sentiment suggest that the campus climate may be less receptive to anti-smoking messages or adherence to campus smoking bans. Further research should investigate the degree to which this varies by campuses over time and following implementation of bans including validating using other sources of data.
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Affiliation(s)
- Raphael E. Cuomo
- Department of Anesthesiology, San Diego School of Medicine, University of California, San Diego, San Diego, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Vidya L. Purushothaman
- Department of Anesthesiology, San Diego School of Medicine, University of California, San Diego, San Diego, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Jiawei Li
- S-3 Research, San Diego, CA, United States
| | - Cortni Bardier
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Matthew Nali
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Neal Shah
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Nick Obradovich
- Center for Humans and Machines, Max Planck Institute for Human Development, Berlin, Germany
| | - Joshua Yang
- Department of Public Health, California State University, Fullerton, Fullerton, CA, United States
| | - Tim K. Mackey
- Department of Anesthesiology, San Diego School of Medicine, University of California, San Diego, San Diego, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research, San Diego, CA, United States
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Xu Q, Purushothaman V, Cuomo RE, Mackey TK. A bilingual systematic review of South Korean medical tourism: a need to rethink policy and priorities for public health? BMC Public Health 2021; 21:658. [PMID: 33823817 PMCID: PMC8023526 DOI: 10.1186/s12889-021-10642-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 03/17/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND In 2016, the "Act on Support for Overseas Expansion of Healthcare System and Attraction of International Patients" was enacted by the South Korean government in an attempt to accelerate growth of its medical tourism industry. However, only a few years after its implementation, the benefits are not well understood, nor have the positive or negative impacts of expanding Korea's medical tourism sector been properly evaluated. OBJECTIVE We aimed to systematically review and summarize existing literature describing South Korea's medical tourism policy and legislative history, while also assessing the impact of this domestic policy approach on the country's public health systems. METHODS A bilingual systematic literature review was conducted per PRISMA guidelines for all South Korean medical tourism legislative and policy literature using MeSH terms and other related keywords in two academic databases, PubMed and JSTOR. Published studies were included if they directly addressed South Korean medical tourism policy. To supplement results from the peer-review, the grey literature was also searched using Google search engine for relevant policy documents, information from government websites, and national statistics on medical tourism-related data. RESULTS This review included 14 peer-reviewed journal articles and 9 websites. The majority of literature focused on the legislative history of South Korea's pro-medical tourism policy, economic considerations associated with industry growth, and the specific experiences of medical tourists. There was a lack of studies, analytical or commentary-based, conducting in-depth analysis of the healthcare impact of these policies or comparing benefits and costs compared to other medical tourism destinations. Proponents of medical tourism continue to advocate the government for increased deregulation and investment in the sector. CONCLUSION This systematic review suggests that policy decisions may prioritize economic growth offered by medical tourism over negative effects on the healthcare workforce, access and equity, and its potential to undermine Universal Health Coverage. South Korea continues to examine ways to further amend the Act and grow this sector, but these actions should be taken with caution by critically examining how other countries have adapted their policymaking based on the real-world costs associated with medical tourism.
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Affiliation(s)
- Qing Xu
- Department of Healthcare Research and Policy, University of California, San Diego - Extension, San Diego, CA, USA.,Global Health Policy and Data Institute, San Diego, CA, USA.,S-3 Research LLC, San Diego, CA, USA
| | - Vidya Purushothaman
- Global Health Policy and Data Institute, San Diego, CA, USA.,Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, University of California, San Diego School of Medicine, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, USA
| | - Raphael E Cuomo
- Department of Healthcare Research and Policy, University of California, San Diego - Extension, San Diego, CA, USA.,Global Health Policy and Data Institute, San Diego, CA, USA.,Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, University of California, San Diego School of Medicine, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, USA
| | - Tim K Mackey
- Department of Healthcare Research and Policy, University of California, San Diego - Extension, San Diego, CA, USA. .,Global Health Policy and Data Institute, San Diego, CA, USA. .,S-3 Research LLC, San Diego, CA, USA. .,Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, University of California, San Diego School of Medicine, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, USA.
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Mackey TK, Purushothaman V, Haupt M, Nali MC, Li J. Application of unsupervised machine learning to identify and characterise hydroxychloroquine misinformation on Twitter. Lancet Digit Health 2021; 3:e72-e75. [PMID: 33509386 DOI: 10.1016/s2589-7500(20)30318-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/26/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Tim K Mackey
- Department of Anesthesiology and Division of Infectious Disease and Global Public Health, University of California, San Diego, San Diego, CA 92037, USA; Department of Healthcare Research and Policy, University of California, San Diego, San Diego, CA 92037, USA; Global Health Policy Institute, San Diego, CA, USA; S-3 Research, San Diego, CA, USA.
| | - Vidya Purushothaman
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA 92037, USA; Global Health Policy Institute, San Diego, CA, USA
| | - Michael Haupt
- Department of Cognitive Science, University of California, San Diego, San Diego, CA 92037, USA
| | - Matthew C Nali
- Department of Anesthesiology and Division of Infectious Disease and Global Public Health, University of California, San Diego, San Diego, CA 92037, USA; Global Health Policy Institute, San Diego, CA, USA; S-3 Research, San Diego, CA, USA
| | - Jiawei Li
- Department of Healthcare Research and Policy, University of California, San Diego, San Diego, CA 92037, USA; Global Health Policy Institute, San Diego, CA, USA; S-3 Research, San Diego, CA, USA
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Chavez J, Shah NA, Ruoss S, Cuomo RE, Ward SR, Mackey TK. Online marketing practices of regenerative medicine clinics in US-Mexico border region: a web surveillance study. Stem Cell Res Ther 2021; 12:189. [PMID: 33736697 PMCID: PMC7977255 DOI: 10.1186/s13287-021-02254-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The potential of regenerative medicine to improve human health has led to the rapid expansion of stem cell clinics throughout the world with varying levels of regulation and oversight. This has led to a market ripe for stem cell tourism, with Tijuana, Mexico, as a major destination. In this study, we characterize the online marketing, intervention details, pricing of services, and assess potential safety risks through web surveillance of regenerative medicine clinics marketing services in Tijuana. Methods We conducted structured online search queries from March to April 2019 using 296 search terms in English and Spanish on two search engines (Google and Bing) to identify websites engaged in direct-to-consumer advertising of regenerative medicine services. We performed content analysis to characterize three categories of interest: online presence, tokens of scientific legitimacy, and intervention details. Results Our structured online searches resulted in 110 unique websites located in Tijuana corresponding to 76 confirmed locations. These clinics’ online presence consisted of direct-to-consumer advertising mainly through a dedicated website (94.5%) or Facebook page (65.5%). The vast majority of these websites (99.1%) did not mention any affiliation to an academic institutions or other overt tokens of scientific legitimacy. Most clinics claimed autologous tissue was the source of treatments (67.3%) and generally did not specify route of administration. Additionally, of the Tijuana clinics identified, 13 claimed licensing, though only 1 matched with available licensing information. Conclusions Regenerative medicine clinics in Tijuana have a significant online presence using direct-to-consumer advertising to attract stem-cell tourism clientele in a bustling border region between Mexico and the USA. This study adds to existing literature evidencing the unregulated nature of online stem cell offerings and provides further evidence of the need for regulatory harmonization, particularly to address stem cell services being offered online across borders. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-021-02254-4.
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Affiliation(s)
- Javier Chavez
- Masters Program in Clinical Research, UC San Diego - School of Medicine, San Diego, CA, USA
| | - Neal A Shah
- Department of Healthcare Research and Policy, UC San Diego - Extension, 8950 Villa La Jolla Drive Suite A124, San Diego, CA, 92037, USA.,Global Health Policy and Data Institute, San Diego, CA, USA
| | - Severin Ruoss
- Department of Orthopaedic Surgery, UC San Diego - School of Medicine, San Diego, CA, USA
| | - Raphael E Cuomo
- Global Health Policy and Data Institute, San Diego, CA, USA.,Department of Anesthesiology and Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery and Department of Radiology, UC San Diego - School of Medicine, San Diego, CA, USA
| | - Tim K Mackey
- Department of Healthcare Research and Policy, UC San Diego - Extension, 8950 Villa La Jolla Drive Suite A124, San Diego, CA, 92037, USA. .,Global Health Policy and Data Institute, San Diego, CA, USA. .,Department of Anesthesiology and Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA. .,S-3 Research, LLC, San Diego, CA, USA.
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Cuomo RE, Cai M, Shah N, Li J, Chen WH, Obradovich N, Mackey TK. Characterising communities impacted by the 2015 Indiana HIV outbreak: A big data analysis of social media messages associated with HIV and substance abuse. Drug Alcohol Rev 2020; 39:908-913. [PMID: 32406155 PMCID: PMC8533051 DOI: 10.1111/dar.13091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 04/06/2020] [Accepted: 04/21/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND AIMS Infoveillance approaches (i.e. surveillance methods using online content) that leverage big data can provide new insights about infectious disease outbreaks and substance use disorder topics. We assessed social media messages about HIV, opioid use and injection drug use in order to understand how unstructured data can prepare public health practitioners for response to future outbreaks. DESIGN AND METHODS We conducted an retrospective analysis of Twitter messages during the 2015 HIV Indiana outbreak using machine learning, statistical and geospatial analysis to examine the transition between opioid prescription drug abuse to heroin injection use and finally HIV transmission risk, and to test possible associations with disease burden and demographic variables in Indiana and Marion County. Tweets from October 2014 to June 2015 were compared to disease burden at the county level for Indiana, and classification of census blocks by presence of relevant messages was done at the census block level for Marion County. Marion County was used as it exhibited the highest total count of Tweets. RESULTS 257 messages about substance abuse and HIV were significantly related to HIV rates (P < 0.001) and opioid-related hospitalisations (P = 0.037). Using 157 characteristics from the American Community Survey, a linear classifier was computed with an appreciable correlation (r = 0.49) to risk-related social media messages from Marion County. DISCUSSION AND CONCLUSIONS Communities appear to communicate online in response to disease burden. Classification produced an accurate equation to model census block risk based on census data, allowing for high-dimensional estimation of risk for blocks with sparse populations.
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Affiliation(s)
- Raphael E Cuomo
- Global Health Policy Institute, San Diego, USA
- Department of Healthcare Research and Policy, University of California, San Diego, USA
- Department of Anesthesiology, University of California, San Diego, USA
| | - Mingxiang Cai
- Global Health Policy Institute, San Diego, USA
- Department of Healthcare Research and Policy, University of California, San Diego, USA
- Department of Computer Science and Engineering, University of California, San Diego, USA
| | - Neal Shah
- Global Health Policy Institute, San Diego, USA
- Department of Healthcare Research and Policy, University of California, San Diego, USA
| | - Jiawei Li
- Global Health Policy Institute, San Diego, USA
- Department of Healthcare Research and Policy, University of California, San Diego, USA
| | - Wen-Hao Chen
- Global Health Policy Institute, San Diego, USA
- Department of Healthcare Research and Policy, University of California, San Diego, USA
- Department of Computer Science and Engineering, University of California, San Diego, USA
| | - Nick Obradovich
- Center for Humans and Machines, Max Planck Institute for Human Development, Berlin, Germany
| | - Tim K Mackey
- Global Health Policy Institute, San Diego, USA
- Department of Healthcare Research and Policy, University of California, San Diego, USA
- Department of Anesthesiology, University of California, San Diego, USA
- Division of Infectious Disease and Global Public Health, University of California, San Diego, USA
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