News Coverage of the COVID-19 Pandemic on Social Media and the Public's Negative Emotions: Computational Study.

BACKGROUND: Social media has become an increasingly popular and critical tool for users to digest diverse information and express their perceptions and attitudes. While most studies endeavor to delineate the emotional responses of social media users, there is limited research exploring the factors associated with the emergence of emotions, particularly negative ones, during news consumption. OBJECTIVE: We aim to first depict the web coverage by news organizations on social media and then explore the crucial elements of news coverage that trigger the public's negative emotions. Our findings can act as a reference for responsible parties and news organizations in times of crisis. METHODS: We collected 23,705 Facebook posts with 1,019,317 comments from the public pages of representative news organizations in Hong Kong. We used text mining techniques, such as topic models and Bidirectional Encoder Representations from Transformers, to analyze news components and public reactions. Beyond descriptive analysis, we used regression models to shed light on how news coverage on social media is associated with the public's negative emotional responses. RESULTS: Our results suggest that occurrences of issues regarding pandemic situations, antipandemic measures, and supportive actions are likely to reduce the public's negative emotions, while comments on the posts mentioning the central government and the Government of Hong Kong reveal more negativeness. Negative and neutral media tones can alleviate the rage and interact with the subjects and issues in the news to affect users' negative emotions. Post length is found to have a curvilinear relationship with users' negative emotions. CONCLUSIONS: This study sheds light on the impacts of various components of news coverage (issues, subjects, media tone, and length) on social media on the public's negative emotions (anger, fear, and sadness). Our comprehensive analysis provides a reference framework for efficient crisis communication for similar pandemics at present or in the future. This research, although first extending the analysis between the components of news coverage and negative user emotions to the scenario of social media, echoes previous studies drawn from traditional media and its derivatives, such as web newspapers. Although the era of COVID-19 pandemic gradually brings down the curtain, the commonality of this research and previous studies also contributes to establishing a clearer territory in the field of health crises.

Mediating effect of depression and acute stress between exposure to Israel-Gaza war media coverage and insomnia: a multinational study from five arab countries.

BACKGROUND: In the context of persistent wars and conflicts worldwide, the impact of acute, excessive and constant exposure to media coverage of such events on mental health outcomes becomes a serious problem for public health, and requires therefore urgent investigation to inform an effective prevention and management response. The objective of the present study was to test the hypothesis that war-related media exposure is directly and indirectly associated with insomnia through depression and perceived stress among adults from the general population of different Arab countries. METHODS: A cross-sectional study was carried-out two weeks after the beginning of Israel-Gaza war on the 7th of October 2023. An anonymous online survey and a snowball sampling method were adopted to collect data. A sample of 2635 general population adults (mean age of 23.98 ± 7.55 years, 73.1% females) took part of this study. RESULTS: The results of the mediation analysis showed that, after adjusting over potential confounders, depression and perceived stress fully mediated the association between war media exposure and insomnia; higher war media exposure was significantly associated with higher depression (Beta = 0.13; p < .001) and perceived stress (Beta = 0.07; p < .001), whereas higher depression (Beta = 0.43; p < .001) and perceived stress (Beta = 0.31; p < .001) were significantly associated with higher insomnia. It is of note that war media exposure was not significantly and directly associated with insomnia (Beta = - 0.01; p = .178 and Beta = 0.02; p = .098 respectively). CONCLUSION: The present study is the first to provide evidence that more time spent viewing the horrors of war is significantly associated with insomnia. In addition, symptoms of stress and depression were present as early as two weeks following the beginning of the war, and played a significant role in mediating the association between war media coverage and insomnia. These findings suggest that timely screening for, and management of depression and stress symptoms in clinical and preventive programs might be beneficial for community adults who have been heavily and indirectly exposed to war through media, and present with insomnia.

Media exposure to climate change information and pro-environmental behavior: the role of climate change risk judgment.

BACKGROUND: The aim of this study was to examine the relationships between exposure to climate change information in traditional and modern media, cognitive and emotional aspects of climate change risk judgment, and pro-environmental behavior (PEB). METHOD: A cross-sectional online study was conducted on a quota sample of 1,075 participants (51.9% women) aged 18-79 years. Participants self-reported their exposure to climate change-related information in traditional (e.g. television) and modern media (e.g. social networks), cognitive assessment of climate change risk, level of worry about climate change, and the frequency of PEB. RESULTS: Structural equation modeling showed a good fit for the parallel mediation model, involving cognitive risk judgment and worry as mediators between exposure to climate change information in traditional and modern media and PEB. Exposure to climate change information in traditional media had indirect effect on PEB through heightened worry, but not cognitive risk judgment. In contrast, exposure to climate change information in modern media had no indirect effect on PEB. CONCLUSION: Since the link between exposure to climate change information in traditional media and PEB has been shown to be mediated by climate change worry, it is important to enhance the coverage of climate change in traditional media in Croatia, taking care to offer solutions to reduce possible negative impact on people's well-being.

Media reporting of violence against children in the Eastern Mediterranean Region during the early days of COVID-19 pandemic.

Background: Violence against children constitutes a significant public health problem globally. Aim: To document and compare media reports of violence against children before and during COVID-19, and measures taken by countries to address such violence. Methods: This comparative review covered news reports of violence against children from 1 January to 30 June of 2019 and 2020 in the WHO Eastern Mediterranean Region countries. A total of 823 articles published in Arabic and English, covering incidents, initiatives, opinions and views on all types of violence among children under 18 years of age were sourced using search engines and platforms and reviewed. News on incidents was analysed quantitatively while news on initiatives and opinions was analysed qualitatively. Results: Some 40.3% of the news reports was on incidents, followed by interviews or opinions (31.5%) and initiatives (28.2%). There were 1129 reports of violence against children from 1 January to 30 June of 2019 and 1880 for the same period in 2020. Reports of physical violence increased from 34% in 2019 to 40% in 2020, while reports of sexual violence decreased from 45% in 2019 to 37% in 2020. Views and opinion reports showed 0.4-1.1% alignment with the 7 INSPIRE strategies. Conclusion: The COVID-19 pandemic affected the incidence and reporting of violence against children across the region. It is essential to provide accurate and sensitive media coverage for incidences of violence against children so that survivors and at-risk children can receive adequate support and ensure that communities can tackle it appropriately.

"Death Is a Possibility for Those without Shelter": A Thematic Analysis of News Coverage on Homelessness and the 2021 Heat Dome in Canada.

Among the most vulnerable to the health-harming effects of heat are people experiencing homelessness. However, during the 2021 Heat Dome, the deadliest extreme heat event (EHE) recorded in Canada to date, people experiencing homelessness represented the smallest proportion of decedents (n = 3, 0.5%)-despite the impacted region (British Columbia) having some of the highest rates of homelessness in the country. Thus, we sought to explore the 2021 Heat Dome as a media-based case study to identify potential actions or targeted strategies that were initiated by community support agencies, individuals and groups, and communicated in the news during this EHE that may have aided in the protection of this group or helped minimize the mortality impacts. Using media articles collated for a more extensive investigation into the effects of the 2021 Heat Dome (n = 2909), we identified a subset which included content on people experiencing homelessness in Canada (n = 274, 9%). These articles were thematically analysed using NVivo. Three main themes were identified: (i) public warnings issued during the 2021 Heat Dome directly addressed people experiencing homelessness, (ii) community support services explicitly targeting this population were activated during the heat event, and (iii) challenges and barriers faced by people experiencing homelessness during extreme heat were communicated. These findings suggest that mass-media messaging and dedicated on-the-ground initiatives led by various organizations explicitly initiated to support individuals experiencing homelessness during the 2021 Heat Dome may have assisted in limiting the harmful impacts of the heat on this community.

Prevalence, Reach of Anti-smokeless Tobacco Messages and Quit Attempts by Product Type: A Secondary Data Analysis from the Global Adult Tobacco Survey (GATS - 2016-17).

OBJECTIVE: India has the highest number of smokeless tobacco (SLT) products available in different forms, consumed in various ways. The current study aimed to understand the pattern of daily SLT use according to different product categories and whether Quit intention and Quit attempts vary by SLT type and exposure to media messages. METHODS: Data from Global Adult Tobacco Surveys (GATS), 2016-17, was used to find access to media messages and warning labels by SLT type. Quit attempt and Quit intention were calculated for each of the SLT types. Logistic regression analyses were employed to identify whether access to media messages, warning labels influenced, quit intention and attempts vary by SLT type. RESULTS: Khaini or tobacco lime mixture was the most common SLT type consumed by 37% of SLT users, whereas SLT users consuming more than one product accounted for 23% of SLT users. Exposure to media messages and warning labels was high among Gutkha/ paan masala tobacco users (74.7% and 81.2%) and low among oral tobacco (Mishri, Gul, Gudakhu) users (56.1% and 60.0%). Quit attempts and quit intention were high among Gutkha/ paan masala tobacco users (38.3% and 22.3%) and low among oral tobacco (Mishri, Gul, Gudakhu) users (25.3% and 13.6%). Users of Oral tobacco and khaini or tobacco-lime mixture were significantly less likely to attempt quitting (AOR 0.806(95%CI: 0.676-0.962), 0.839(95%CI: 0.736-0.956), and have quit intention (AOR 0.681(95%CI: 0.702-0.976), 0.733(95%CI: 0.627-0.857) compared to Gutkha/ paan masala with tobacco users. CONCLUSION: The reach of media messages and warning labels varies by SLT type. Quit intention and attempts vary by SLT type and access to media messages and warning labels. There is a need to re-strategise the tobacco control Information, Education and Communication (IEC) to reach out with effective messaging to the most unreached.

US Nationwide Multi-City Media Coverage of COVID-19 Responses: Community Structure Theory, Belief System, and a "Violated Way of Life".

Community structure analysis compared city characteristics and newspaper coverage of state/local government responses to COVID-19 in 25 major U.S. cities, sampling all 250+ word articles from 4/4/20 to 7/6/20. The resulting 588 articles were coded for "prominence" and "direction" (favorable/unfavorable/balanced-neutral coverage), then combined into each newspaper's composite "Media Vector" (range=0.3552 to -0.5197, or 0.8749). Twenty-one of 25 newspapers (84%) displayed unfavorable coverage of local COVID-19 responses. Pearson correlations and regression analysis confirmed a muscular "violated way of life" pattern, when a community perceives itself as threatened by a "biological threat or a threat to a cherished way of life." Political and belief system polarization (in particular percent Evangelical and percent voting Republican) were strongly associated with unfavorable coverage of local pandemic responses, compared to more favorable responses linked to percent voting Democratic or percent Catholic. Vulnerability (percent uninsured) was also linked to negative coverage. Conversely, two different measures of access to healthcare (percent municipal spending on health and welfare, and physicians/100,000) were significantly linked to favorable coverage of the same local government efforts. Community structure theory's grass roots "bottom up" expectations linking community demographics to variations in reporting on critical issues were robustly confirmed.

Sociocultural pressures and engagement with cosmetic products and procedures in adult women.

Previous studies have shown that cosmetic procedures and products that perpetuate Western hegemonic beauty standards among women have become increasingly popular, and pressures from sociocultural agents to utilize them are significant. However, little work has documented the relationship between perceived sociocultural pressures and use of cosmetic procedures and products among a larger age range of adult women. A community sample of 308 women aged 18-66, mean (SD) age of 35.7 (9.7), reported on the cosmetic procedures they had considered or used, as well as perceived pressures from the media, peers, romantic partners, and health and beauty professionals. Findings revealed that, among those investigated, the most frequently utilized products and procedures were supplements and hair removal. However, a significant minority reported considering more invasive procedures, including cosmetic surgery. Media was the predominant source of pressure, while partners were the least frequently endorsed. While pressure from professionals and peers had small-to-moderate associations with utilization of cosmetic products and procedures, pressure from partners had the largest association with their use. This work frames important future directions for examining the impact of sociocultural pressures on women's willingness to utilize cosmetic products and procedures that are sometimes underregulated and risky for physical and mental health.

A Comparative Content Analysis of the News Media Framing of Trans Homicide Between Trans Men and Trans Women in the U.S. from 2016 to 2022.

Recently, the media's coverage of trans homicides has increased in the U.S. Studies show that the news media's framing has been largely negative but has improved in recent times. Yet, research has mostly analyzed the news media's framing of victims who were trans women, thus limiting our understanding of this issue across different trans groups. The present study employs a mixed method approach to comparatively analyze articles (N = 124) published in online news media outlets of 15 trans men and 15 trans women murdered between 2016 and 2022. The findings indicate news media outlets used more positive and neutral frames than negative for both groups. However, when compared to trans women, trans men were delegitimized at higher rates. These findings highlight the ways that the police, news media, family, friends, and community members simultaneously contribute to the humanization and delegitimization of trans victims of homicide, demonstrating the importance of ensuring all information released about the victims correctly reflects who they were, or the cycle of delegitimization will continue. By studying how the news media frames trans homicide victims, we can look at how the media shapes cultural beliefs and ideologies about trans people, the role of language in reinforcing stereotypes, and the implications of these framings for trans people.

Tobacco Imagery in Indian Over-the-Top (OTT) Media and Its Compliance With Existing Tobacco Laws: A Content Analysis.

INTRODUCTION: Over-the-top (OTT) media are internet-based content delivery systems offering media services to the viewers bypassing the traditional broadcasting platforms. The OTT media, with limited regulatory oversight, can serve as a source of exposure to tobacco-promoting content. AIMS AND METHODS: This study analyzed the depiction of tobacco imagery in Indian OTT programs and assessed their compliance with existing Indian tobacco control policies. We conducted a content analysis of 28 purposively sampled OTT exclusive programs (14 movies and 14 web series) in India. Breathe California method was used to code the OTT content for tobacco imagery. We assessed the prevalence of tobacco imagery, its duration per episode or program, product placements, and brand appearances. We also evaluated OTT programs adherence to existing tobacco control policies in India. RESULTS: Tobacco imagery was identified in all of the web series and most OTT-exclusive movies. On average the web series depicted seven incidents of tobacco imagery per episode, whereas there were close to 19 incidents of tobacco imagery per movie. Ten minutes of OTT programming (including movies and web series) had on average 8.40 s of tobacco imagery. None of the OTT programs studied fully complied with Indian tobacco control policies. CONCLUSIONS: Depiction of tobacco imagery in OTT exclusive programs is common in India. Streaming platforms need to comply with existing tobacco control policies. Furthermore, there is a need to strengthen these policies and strictly enforce them to ensure tobacco-free mass media. IMPLICATIONS: India has more than 267 million tobacco users and accounts for the largest share of smokeless tobacco use globally. OTT platforms are largely unregulated and are considered drivers for global tobacco use. This is one of the few studies examining tobacco imagery in Indian OTT content, reporting the gaps in tobacco control policies in India. This study documents the product placement of smokeless tobacco, duration of exposure to tobacco imagery, and empirically report the compliance of OTT platforms with Indian tobacco control policies. The study findings can aid in strengthening tobacco control policies in India.

Measuring dynamic media bias.

Ideological media bias is increasingly central to the study of politics. Yet, past literature often assumes that the ideological bias of any outlet, at least in the short term, is static and exogenous to the political process. We challenge this assumption. We use longitudinal data from the Stanford Cable News Analyzer (2010 to 2021), which reports the screen time of various political actors on cable news, and quantify the partisan leaning of those actors using their past campaign donation behavior. Using one instantiation of media bias-the mean ideology of political actors on a channel, i.e., visibility bias-we examine weekly, within-day, and program-level estimates of media bias. We find that media bias is highly dynamic even in the short term and that the heightened polarization between TV channels over time was mostly driven by the prime-time shows.

Framing South Asian politics: An analysis of Indian and Pakistani English print media discourses regarding Kartarpur corridor.

This paper aims to analyze the divergent perspectives of Indian and Pakistani English print media on opening the Kartarpur corridor. It is a four-kilometer-long cordoned-off strip from the Indo-Pak international border to the Gurdwara Darbar Sahib Kartarpur located in Pakistan. The basic purpose of establishing this corridor is to give easy access to the Indian Sikh community. The initiative was taken into account in August 2018, which resulted in the appearance of a vast quantity of contemplations in the national print media of both countries, especially until the opening of the corridor in November 2019. Print media plays a key role in building knowledge and framing the general public's opinion through interpreting an issue. The data were taken from Dawn, The News International (Pakistan), The Times of India, and Hindustan Times (India) from August 2018 to March 2020 using Lexus Nexus Library. The corpus analysis was carried out by applying the lexical study of Natural Language Processing (NLP) through its Latent Dirichlet Allocation (LDA) tool to find out the general patterns or topics in the print media of both countries. It was found that Pakistani print media terms the Kartarpur corridor as a sign of regional peace, religious tourism, mediation, and diplomatic efforts. In contrast, Indian print media focuses on apprehensions related to traveling modalities, pilgrimage facilities, and tensions between the two states.

Topical analysis of migration coverage during lockdown in India by mainstream print media.

Implementing countrywide lockdown measures in India, from March 2020 to May 2020 was a major step to deal with the COVID -19 pandemic crisis. The decision of country lockdown adversely affected the urban migrant population, and a large section of them was compelled to move out of the urban areas to their native places. The reverse migration garnered widespread media attention and coverage in electronic as well as print media. The present study focuses on the coverage of the issue by print media using descriptive natural language text mining. The study uses topic modelling, clustering, and sentiment analysis to examine the articles on migration issues during the lockdown period published in two leading English newspapers in India- The Times of India and The Hindu. The sentiment analysis results indicate that the majority of articles have neutral sentiment while very few articles show high negative or positive polarity. Descriptive topic modelling results show that transport, food security, special services, and employment with migration and migrants are the majorly covered topics after employing Bag of Words and TF-IDF models. Clustering is performed to group the article titles based on similar traits using agglomerative hierarchical clustering.

Effects of media stories of hope and recovery on suicidal ideation and help-seeking attitudes and intentions: systematic review and meta-analysis.

BACKGROUND: There is strong evidence that suicides increase after media stories about suicides by celebrities, particularly those that highlight the suicide method (the Werther effect). Much less is known about the Papageno effect-the protective effects of media stories of hope and recovery from suicidal crises. A synthesis of the retrievable evidence is lacking. We aim to summarise findings from randomised controlled trials about the effects of stories of hope and recovery on individuals with some degree of vulnerability to suicide. METHODS: For this systematic review and individual participant data meta-analysis, we searched PubMed (including MEDLINE), Scopus, Embase, PsycInfo, Web of Science, and Google Scholar published from inception to Sept 6, 2021, without language restrictions. We included trials that reported suicidal ideation (the primary outcome) or help-seeking attitudes or intentions (the secondary outcome) and tested a media narrative of hope and recovery. Studies were excluded if they did not feature a clearly positive story of hope and recovery, or had a control group exposed to suicide-related stimulus material. We contacted the lead or senior authors of all original studies to obtain participant-level data for this study. The primary analysis was restricted to individuals with some vulnerability to suicide. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomised trials. The study is registered with PROSPERO, number CRD42020221341. FINDINGS: Our search yielded 7347 records. 3920 records were screened by title and abstract, and 25 full-text records assessed for eligibility. There were eight eligible studies with 2350 participants for which individual participant data were sought. For suicidal ideation, six studies met the inclusion criteria for the primary analysis. Follow-up responses were available for 569 (90%) of 633 participants who were randomised with high vulnerability (345 [55%] allocated to the intervention group and 288 [45%] to the control group). The pooled standardised mean difference (SMD) indicated a small reduction in suicidal ideation of -0·22 (95% CI -0·39 to -0·04, p=0·017; six studies) in the intervention group. For help-seeking attitudes and intentions, four studies met the inclusion criteria and follow-up data were available for 362 (86%) of 420 participants (247 [59%] allocated to the intervention group and 173 [41%] to the control group). The pooled SMD showed no evidence of a difference between the groups (SMD=0·14, 95% CI -0·15 to 0·43, p=0·35; four studies). Low levels of cross-study heterogeneity effects were observed for both analyses (I2=5% [suicidal ideation] and I2=36% [help-seeking attitudes and intentions]). We found no evidence of publication bias. INTERPRETATION: Media narratives of hope and recovery from suicidal crises appear to have a beneficial effect on suicidal ideation in individuals with some vulnerability, but there is insufficient evidence regarding help-seeking attitudes and intentions. These findings provide new evidence about narratives for suicide prevention. FUNDING: None.

Personality Traits, Media Exposure, and Deterioration of Psychological Wellbeing in Japan During the COVID-19 Pandemic.

ABSTRACT: This study examined the associations among personality traits, media exposure regarding COVID-19, and deterioration of mental wellbeing among the public in Japan. We conducted a cross-sectional Web-based questionnaire survey among 8000 Japanese men and women aged 25 to 64 years. Approximately half of participants reported deterioration of mental wellbeing. Nearly 20% of participants reported "constant/excessive" exposure to media information regarding COVID-19. As compared with those with low "extraversion" and "less frequent" exposure to media information about COVID-19, those with high "extraversion" and "more frequent" media exposure reported significantly less deterioration of mental wellbeing. In addition, as compared with those with low "neuroticism" and media exposure, those with high "neuroticism" and "constant/excessive" exposure to COVID-19-related information significantly more frequently reported deterioration of mental wellbeing. Under the ongoing pandemic of COVID-19, measures for the promotion and maintenance of mental wellbeing should be implemented considering the interaction between personality traits and media exposure.

Is Ignorance Bliss? Examining the Effect of News Media Exposure on Anxiety and Depression During the COVID-19 Pandemic.

ABSTRACT: There has been a widespread increase in affective disorders after the emergence of the COVID-19 pandemic. In the current study, we investigated the effects of exposure to and perceived accuracy of news media and demographic characteristics on anxiety and depressive symptoms. We conducted an online survey of US adults (N = 480) using hierarchical linear regression models to understand the predictive roles of duration and frequency of news media exposure, as well as the perceived accuracy of COVID-19 portrayal by the news media, on anxiety and depression. Increased exposure duration predicted greater anxiety, and decreased frequency of exposure and perceived overreaction in the news media coverage of COVID-19 were linked to greater anxiety and depression. Perceived accuracy moderated the relationship of exposure frequency to both affective outcomes. Accordingly, our data support the importance of adequate levels of accurate and trusted information to help mitigate the overall mental health burden of the pandemic.

When election expectations fail: Polarized perceptions of election legitimacy increase with accumulating evidence of election outcomes and with polarized media.

The present study, conducted immediately after the 2020 presidential election in the United States, examined whether Democrats' and Republicans' polarized assessments of election legitimacy increased over time. In a naturalistic survey experiment, people (N = 1,236) were randomly surveyed either during the week following Election Day, with votes cast but the outcome unknown, or during the following week, after President Joseph Biden was widely declared the winner. The design unconfounded the election outcome announcement from the vote itself, allowing more precise testing of predictions derived from cognitive dissonance theory. As predicted, perceived election legitimacy increased among Democrats, from the first to the second week following Election Day, as their expected Biden win was confirmed, whereas perceived election legitimacy decreased among Republicans as their expected President Trump win was disconfirmed. From the first to the second week following Election Day, Republicans reported stronger negative emotions and weaker positive emotions while Democrats reported stronger positive emotions and weaker negative emotions. The polarized perceptions of election legitimacy were correlated with the tendencies to trust and consume polarized media. Consumption of Fox News was associated with lowered perceptions of election legitimacy over time whereas consumption of other outlets was associated with higher perceptions of election legitimacy over time. Discussion centers on the role of the media in the experience of cognitive dissonance and the implications of polarized perceptions of election legitimacy for psychology, political science, and the future of democratic society.

Impact of a mass media campaign on presentations and ambulance use for acute coronary syndrome.

OBJECTIVE: Between 2009 and 2013, the National Heart Foundation of Australia ran mass media campaigns to improve Australian's awareness of acute coronary syndrome (ACS) symptoms and the need to call emergency medical services (EMS). This study examined the impact of this campaign on emergency department (ED) presentations and EMS use in Victoria, Australia. METHODS: The Victorian Department of Health and Human Services provided data for adult Victorian patients presenting to public hospitals with an ED diagnosis of ACS or unspecified chest pain (U-CP). We modelled changes in the incidence of ED presentations, and the association between the campaign period and (1) EMS arrival and (2) referred to ED by a general practitioner (GP). Models were adjusted for increasing population size, ACS subtype and demographics. RESULTS: Between 2003 and 2015, there were 124 632 eligible ED presentations with ACS and 536 148 with U-CP. In patients with ACS, the campaign period was associated with an increase in ED presentations (incidence rate ratio: 1.11; 95% CI 1.07 to 1.15), a decrease in presentations via a GP (adjusted OR (AOR): 0.77; 95% CI 0.70 to 0.86) and an increase in EMS use (AOR: 1.10; 95% CI 1.05 to 1.17). Similar, but smaller associations were seen in U-CP. CONCLUSIONS: The Warning Signs Campaign was associated with improvements in treatment seeking in patients with ACS-including increased EMS use. The increase in ACS ED presentations corresponds with a decrease in out-of-hospital cardiac arrest over this time. Future education needs to focus on improving EMS use in ACS patient groups where use remains low.