"Better Than Any DARE Program": Qualitative Analysis of Adolescent Reactions to EVALI Television Storylines.

Introduction. Research suggests that awareness of e-cigarette, or vaping, product-use associated lung injury (EVALI) among adolescents is associated with increased harm perception of e-cigarettes. The depiction of EVALI on three primetime medical dramas offers an opportunity to examine the use of these storylines for tobacco prevention education. Methods. We conducted four focus groups with seventh- and eighth-grade students at an urban middle school. Participants viewed three clips of scenes followed by a facilitated discussion as to the influence of the clips on knowledge and perceptions of e-cigarettes and the use of clips for tobacco prevention education. Two research assistants double-coded notes from the focus groups using a qualitative content analysis approach. Results. Our final sample included 78 adolescents; we obtained self-reported demographic information for 75. The majority of participants were 13 to 14 years of age (82.7%) and identified as cisgender female (52.0%) and Black (52.0%). No participants had knowledge of EVALI prior to viewing the clips. Comments made both during and after watching suggest the clips may have reinforced knowledge and perceptions of harm; participants stated that the clips could be a useful intervention tool. Viewing the clips also generated unprompted discussion about flavored products, tobacco advertising, other television programs, and marijuana. Conclusions. Clips featuring the depiction of EVALI on medical dramas may be an effective tool for raising awareness of e-cigarette use-related harms. These results offer a promising first step for future collaborative research between public health, adolescents, and schools to develop tobacco prevention education utilizing these clips.

Viewer Reactions to EVALI Storylines on Popular Medical Dramas: A Thematic Analysis of Twitter Messages.

Previous research has found an association between awareness of e-cigarette, or vaping, product-use associated lung injury (EVALI) and lower intention to use e-cigarettes among young people. This study utilized Twitter data to evaluate if the January 2020 depiction of EVALI on New Amsterdam, Chicago Med, and Grey's Anatomy-three popular primetime medical dramas-could be a potential innovative avenue to raise awareness of EVALI. We obtained tweets containing e-cigarette-related search strings from 1/21/2020 to 02/18/2020 and filtered these with storyline-specific keywords, resulting in 1,493 tweets for qualitative coding by two trained human coders. Content codes were informed by prior research, theories of narrative influence, and e-cigarette related outcomes. Of 641 (42.9%) relevant tweets, the most frequent content codes were perceived realism (n = 292, 45.6%) and negative response (n = 264, 41.2%). A common theme among these tweets was that storylines were unrealistic because none of the characters with EVALI used THC-containing products. Approximately 12% of tweets (n = 78) mentioned e-cigarette knowledge and 28 (4.4%) mentioned behavior, including quitting e-cigarettes because of viewing the storylines. Implications for health communication research utilizing social media data and maximizing the achievement of positive health-related outcomes for storylines depicting current health topics are discussed.

Characterizing the Influence of Television Health Entertainment Narratives in Lay Populations: A Scoping Review.

OBJECTIVE: To conduct a scoping review of published literature examining the influence of health storylines from fictional television programs on viewers. DATA SOURCE: We performed literature searches in Medline, PsycINFO, and Mass Media Complete in October 2021, and examined bibliographies of included articles and conducted forward searching using Web of Science with included articles. STUDY INCLUSION AND EXCLUSION CRITERIA: Selected studies were required to be original research published in English, involve exposure to fictional television programming by individuals not in the medical field, and assess associations between exposure and health-related outcomes. DATA EXTRACTION: Article screening and data abstraction were performed by two independent researchers using DistillerSR (Cohen's κ range: .73-1.00). DATA SYNTHESIS: We analyzed and qualitatively described the data using methods of scoping reviews described by PRISMA-ScR. RESULTS: Of 5,537 unique records identified, 165 met inclusion criteria. The most frequently studied program was ER (n = 22, 13.3%). Most studies had adult participants (n = 116, 70.3%) and used quantitative methods (n = 136, 82.4%). The most frequently examined health topics were sexual behavior (n = 28, 17.0%) and mental health (n = 28, 17.0%). Exposure had a positive influence on viewers' health-related outcomes in 28.5% (n = 47) of studies. CONCLUSION: Health storylines on fictional television influence viewers. Future research could address gaps identified in this review to further elucidate the influence of this programming on health promotion and disease prevention.

COVID-19 Vaccine Hesitancy, Acceptance, and Promotion Among Healthcare Workers: A Mixed-Methods Analysis.

Even with vaccine mandates, COVID-19 vaccine hesitancy remains a concern among healthcare workers, in part due to their role in promoting vaccination among patients and communities. To examine COVID-19 vaccine hesitancy, acceptance, and promotion among healthcare workers, we conducted a mixed-methods analysis of (1) survey responses about COVID-19 vaccination and (2) Twitter messages (i.e., tweets) relevant to COVID-19 vaccination and healthcare. A total of 540 hospital employees completed the survey. Those that completed less than 80% of the survey or did not endorse employment at the hospital were excluded, resulting in a total of 511 valid responses; 93.2% reported receiving at least one dose of a COVID-19 vaccine. Approximately 1/3 of vaccinated individuals indicated they posted about receiving the vaccine on social media. Simultaneously, we analyzed a sample of 3845 tweets; 2299 (60%) were relevant to COVID-19 vaccination and 1863 (81%) were coded as authored by an individual. Of tweets authored by an individual, 6% (n = 106) were authored by a healthcare provider/health sciences student. Among relevant tweets, the most frequent code across all sentiment categories was related to the pharmaceutical industry (n = 529 tweets, 28%; n = 33, 31% of tweets authored by healthcare workers). Triangulation of results found themes including vaccine access, trust, and vaccine safety or negative health impacts. Results suggest that promoting the sharing of COVID-19 vaccine personal narratives on social media, combined with interventions targeting specific reasons for COVID-19 vaccine hesitancy and emphasizing freedom from fear once vaccinated could be effective at reducing COVID-19 vaccine hesitancy among this population.

#DoctorsSpeakUp: Lessons learned from a pro-vaccine Twitter event.

BACKGROUND: In response to growing anti-vaccine activism on social media, the #DoctorsSpeakUp event was designed to promote pro-vaccine advocacy. This study aimed to analyze Twitter content related to the event to determine (1) characteristics of the Twitter users who authored these tweets, (2) the proportion of tweets expressing pro-vaccine compared to anti-vaccine sentiment, and (3) the content of these tweets. METHODS: Data were collected using Twitter's Filtered Streams Interface, and included all publicly available tweets with the "#DoctorsSpeakUp" hashtag on March 5, 2020, the day of the event. Two independent coders assessed a 5% subsample of original tweets (n = 966) using a thematic content analysis approach. Cohen's κ ranged 0.71-1.00 for all categories. Chi-square and Fisher's exact tests were used to examine associations between tweet sentiment, type of account, and tweet content (personal narrative and/or statement about research or science). Accounts were analyzed for likelihood of being a bot (i.e. automated account) using Botometer. RESULTS: Of 847 (87.7%) relevant tweets, 244 (28.8%) were authored by a Twitter user that identified as a parent and 68 (8.0%) by a user that identified as a health professional. With regard to sentiment, 167 (19.7%) were coded as pro-vaccine and 668 (78.9%) were coded as anti-vaccine. Tweet sentiment was significantly associated with type of account (p < 0.001) and tweet content (p = 0.001). Of the 575 unique users in our dataset, 31 (5.4%) were classified as bots using Botometer. CONCLUSIONS: Our results suggest a highly coordinated response of devoted anti-vaccine antagonists in response to the #DoctorsSpeakUp event. These findings can be used to help vaccine advocates leverage social media more effectively to promote vaccines. Specifically, it would be valuable to ensure that pro-vaccine messages consider hashtag use and pre-develop messages that can be launched and promoted by pro-vaccine advocates.

Food Bank-Based Diabetes Prevention Intervention to Address Food Security, Dietary Intake, and Physical Activity in a Food-Insecure Cohort at High Risk for Diabetes.

PURPOSE AND OBJECTIVES: Although food insecurity is associated with poor dietary intake and risk of chronic disease, few studies have demonstrated the effectiveness of diabetes prevention interventions delivered through food banks. Food banks serve vulnerable communities. The purpose of this pilot project was to assess the effectiveness of a food bank-delivered intervention aimed at improving food security and reducing risk factors for type 2 diabetes among at-risk clients. INTERVENTION APPROACH: We screened adult English- and Spanish-speaking food bank clients for type 2 diabetes risk at 12 community food distribution sites in Alameda County, California. Screening and enrollment for a pilot intervention took place from November 2017 to March 2018. Intervention components were delivered from November 2017 through March 2019. The intervention included monthly diabetes-appropriate food packages, text-based health education, and referrals to health care. EVALUATION METHODS: Food bank staff members administered surveys to participants at baseline, 6 months (midpoint), and 12 months (postintervention); participants self-reported all responses. Primary outcomes assessed were food security status, dietary intake, health-related behaviors, and body mass index (BMI). Information on demographic characteristics, food pantry access, health care use, and symptoms of depression was also collected. RESULTS: We screened 462 food bank clients for eligibility. Of the 299 who were eligible, 244 enrolled; 90.6% were female, 80.1% were Hispanic, and 49.1% had an annual household income less than $20,000. At baseline, 68.8% of participants had low or very low food security. At midpoint, participants had significant improvements in food security status, dietary intake, physical activity, health status, and depression scores. Mean BMI did not change. IMPLICATIONS FOR PUBLIC HEALTH: This intervention demonstrated that food banks can effectively screen clients at high risk for diabetes and improve household food security and other risk factors for diabetes. Food banks may be an important and strategic partner for health care systems or community-based organizations working to prevent diabetes in food-insecure populations.

It's not all about autism: The emerging landscape of anti-vaccination sentiment on Facebook.

BACKGROUND: Due in part to declining vaccination rates, in 2018 over 20 states reported at least one case of measles, and over 40,000 cases were confirmed in Europe. Anti-vaccine posts on social media may be facilitating anti-vaccination behaviour. This study aimed to systematically characterize (1) individuals known to publicly post anti-vaccination content on Facebook, (2) the information they convey, and (3) the spread of this content. METHODS: Our data set consisted of 197 individuals who posted anti-vaccination comments in response to a message promoting vaccination. We systematically analysed publicly-available content using quantitative coding, descriptive analysis, social network analysis, and an in-depth qualitative assessment. The final codebook consisted of 26 codes; Cohen's κ ranged 0.71-1.0 after double-coding. RESULTS: The majority (89%) of individuals identified as female. Among 136 individuals who divulged their location, 36 states and 8 other countries were represented. In a 2-mode network of individuals and topics, modularity analysis revealed 4 distinct sub-groups labelled as "trust," "alternatives," "safety," and "conspiracy." For example, a comment representative of "conspiracy" is that poliovirus does not exist and that pesticides caused clinical symptoms of polio. An example from the "alternatives" sub-group is that eating yogurt cures human papillomavirus. Deeper qualitative analysis of all 197 individuals' profiles found that these individuals also tended to post material against other health-related practices such as water fluoridation and circumcision. CONCLUSIONS: Social media outlets may facilitate anti-vaccination connections and organization by facilitating the diffusion of centuries old arguments and techniques. Arguments against vaccination are diverse but remain consistent within sub-groups of individuals. It would be valuable for health professionals to leverage social networks to deliver more effective, targeted messages to different constituencies.

We're working hard, but is it hardly working? Why process is critical in the delivery of worksite health promotion programs.

OBJECTIVE: To evaluate the relationship between the process and outcomes of worksite wellness committees (WWCs) implementing worksite health promotion programs at PPG Industries, Inc. METHODS: We developed two unique tools to understand how WWCs function and to assess their program implementation. We then analyzed survey data from 65 PPG worksites, measuring process and program implementation. RESULTS: Worksites that scored higher on the process indicator had more robust program implementation. CONCLUSIONS: The WWCs need increased attention from researchers and evaluators. Employers should consider administering worksite health promotion structural assessments to identify gaps in management support and program implementation that may influence program effectiveness.

The influence of worksite health promotion program management and implementation structure variables on medical care costs at PPG Industries.

OBJECTIVE: To evaluate the relationship between critical factors for successful worksite health promotion programs such as management support and program implementation and health care costs at PPG Industries. METHODS: We analyzed survey data from 37 PPG worksites measuring management support and program implementation. We estimated the relationship between management and implementation scores in 2007 and subsequent health care costs in 2008 using ordinary least squares regression. RESULTS: High program implementation scores were associated with higher health care costs (P < 0.01) as were high management scores (P < 0.05). However, sites with a combination of high management and implementation scores had lower health care costs, while sites with low scores on these dimensions had higher cost trends. CONCLUSIONS: Employers should consider administering worksite health promotion structural assessments to identify gaps in management support and program implementation that may influence program effectiveness.

Online pediatric information seeking among mothers of young children: results from a qualitative study using focus groups.

BACKGROUND: Pre-natal and post-natal periods are times when many women actively seek health information from multiple sources, including the Internet. However, little is known about how pregnant women and mothers of young children seek and process online pediatric health information. OBJECTIVE: To explore why and where mothers of young children look for online health information and how they determine if the information they receive is trustworthy. METHODS: Focus groups were conducted in a Southeastern US city to provide an in-depth exploration of web-related behaviors and beliefs among mothers who work inside and outside of the home. Data from the focus groups were coded using deductive and inductive coding schemes and content was analyzed for the existence of themes. RESULTS: Twenty mothers of young children participated in four focus groups. Most participants sought information on the Internet during pregnancy and nearly all sought online information after their child was born, primarily to diagnose or treat pediatric conditions and to seek advice on parenting and development. Participants mainly used commercial information websites for health information and many expressed disdain for commercial product websites. Many also expressed concerns about the reliability of health information on the web and described strategies for determining how much they trust each website. CONCLUSIONS: Women appear to be high information seekers during pregnancy and the first few years following delivery, and this period represents an important window of time for providing online health information. Participants suggested that online information sources and motives for providing online information should be clear in order to increase perceptions of trust. Participants expressed preference for online clinical health information that is presented by clinical professionals, and online parenting advice that is presented from other parents.

Implementation and evaluation of a Web-based continuing education course in injury prevention and control.

Training in injury prevention and control represents a major deficit in the fields of health promotion and public health. Internet-based distance learning is an innovative method of offering continuing education to professionals, but this approach has not yet been widely researched or implemented with public health audiences. VINCENTweb involved the development and evaluation of a no-cost continuing education course on injury prevention and control presented exclusively on the World Wide Web. The course was evaluated using online surveys at baseline and follow-up. Participants, especially those with lower education levels, provided positive feedback about the course and reported high levels of learning and satisfaction. This article describes the development and evaluation of VINCENTweb and discusses the implications for developing future Internet-based courses in public health.

Perceived barriers to Internet-based health communication on human genetics.

The Internet has emerged as potential vehicle for distributing health communication to millions of individuals because it is interactive, user controlled, and offers breadth and depth of information. However, its widespread use by the public may be limited due to three overarching concerns: privacy and confidentiality, information accuracy and perceptions of credibility, including limited credibility of some government-sponsored web sites. To explore the potential of using the Internet, especially for delivering information on human genetics communication, 15 focus groups and one interview were conducted with African American and European American adult males and females in a southeastern town. We found that the participants recognized great potential in the Internet for health communication on human genetics, but they also voiced concerns about the credibility and accuracy of online information, lack of trust in many web sites, and fear of safeguarding privacy. Their concerns are summarized here, along with potential remedies health communicators could implement and should research further. The Internet cannot achieve its full potential for human genetics communication until the public's concerns are addressed and resolved.