Exploring How Youth Use TikTok for Mental Health Information in British Columbia: Semistructured Interview Study With Youth.

BACKGROUND: TikTok (ByteDance) experienced a surge in popularity during the COVID-19 pandemic as a way for people to interact with others, share experiences and thoughts related to the pandemic, and cope with ongoing mental health challenges. However, few studies have explored how youth use TikTok to learn about mental health. OBJECTIVE: This study aims to understand how youth used TikTok during the COVID-19 pandemic to learn about mental health and mental health support. METHODS: Semistructured interviews were conducted with 21 youths (aged 12-24 years) living in British Columbia, Canada, who had accessed TikTok for mental health information during the COVID-19 pandemic. Interviews were audio-recorded, transcribed verbatim, coded, and analyzed using an inductive, data-driven approach. RESULTS: A total of 3 overarching themes were identified describing youth's experiences. The first theme centered on how TikTok gave youth easy access to mental health information and support, which was particularly helpful during the COVID-19 pandemic to curb the effects of social isolation and the additional challenges of accessing mental health services. The second theme described how the platform provided youth with connection, as it gave youth a safe space to talk about mental health and allowed them to feel seen by others going through similar experiences. This helped normalize and destigmatize conversations about mental health and brought awareness to various mental health conditions. Finally, the last theme focused on how this information led to action, such as trying different coping strategies, discussing mental health with peers and family, accessing mental health services, and advocating for themselves during medical appointments. Across the 3 themes, youth expressed having to be mindful of bias and misinformation, highlighting the barriers to identifying and reporting misinformation and providing individualized advice on the platform. CONCLUSIONS: Findings suggest that TikTok can be a useful tool to increase mental health awareness, reduce stigma, and encourage youth to learn and address their mental health challenges while providing a source of peer connection and support. Simultaneously, TikTok can adversely impact mental health through repetitive exposure to mentally distressing content and misleading diagnosis and treatment information. Regulations against harmful content are needed to mitigate these risks and make TikTok safer for youth. Efforts should also be made to increase media and health literacy among youth so that they can better assess the information they consume online.

#Bartender: portrayals of popular alcohol influencer's videos on TikTok©.

BACKGROUND: Despite widespread use of the short-video social media platform TikTok©, limited research investigates how alcohol is portrayed on the platform. Previous research suggests that a driver of alcohol content on TikTok©, in part, comes from bartenders demonstrating how to make drinks. This study aims to explore the characterizing patterns of how bartender influencers on TikTok© feature and incorporate alcohol in their videos. METHODS: We identified the global top 15 most followed bartenders on TikTok© in 2021 (cumulative 29.7 million subscribers) and the videos they posted in November and December 2021, the period just before Christmas and New Year, when alcohol tends to be more marketed than in other periods. The videos were coded based on five criteria: (1) the presence of alcohol or not; (2) alcohol categories; (3); alcohol brand(s) if visible; (4) the presence of candies and other sweet products; (5) presence of cues that refer to young people's interests. RESULTS: In total, we identified 345 videos, which received 270,325,600 views in total, with an average of 18,021,707 views per video. Among these 345 videos, 92% (n = 317) displayed alcohol in their cocktail recipes (249,275,600 views, with an average of 786,358 views). The most common types of alcohol present in videos were liquor, vodka, rum, and whiskey, all of which are high-ABV beverages. 73% (n = 230) displayed or mentioned an alcohol brand. 17% (n = 55) associated alcohol with sweet products such as different types of candy (53,957,900 views, with an average of 981,053 views per video). 13% (n = 43) contained cues appealing to young people (e.g., cartoons, characters) (15,763,300 views, with an average of 366,588 views per video). CONCLUSIONS: Our findings suggest a large presence of positively framed alcohol content posted by popular bartenders on TikTok©. As exposure to digital marketing is related to an increase in alcohol consumption, particularly among young people, regulations are needed to protect the public from alcohol-related harms.

The portrayal of organ donation on TikTok: A content analysis of popular English-language TikTok videos.

Objective: TikTok is one of the most popular social media platforms and plays a role in shaping public perceptions. This research examined how organ donation was portrayed on the platform. Methods: We built a dataset of the most popular English-language TikTok videos that used the hashtags #organdonor or #organdonation. We then performed content analysis on the 400 most viewed videos after limiting data set inclusion to one video per user account. Results: The finalized videos (N = 313) had generated nearly 80 million views and 10 million likes. Featuring both donors (56.2%) and recipients (44.1%), videos shared experiences that celebrated and lamented lost donor lives (41.8%) while also celebrating transplantation successes (31.3%). Very few videos included public solicitation (2.9%). Common video traits included detailing medical procedures (45.4%), presenting honor walks (10.9%), and displaying donors and recipients connecting or wanting to connect (16.9%). Videos mostly had a positive (74.1%) versus negative (10.2%) leaning tone. Conclusion: Far from superficially glamorizing organ donation/transplantation processes and procedures, popular English-language TikTok videos depicted what we perceived as highly emotional and expository experiences. While the videos likely offered learning and cathartic opportunities for individuals and communities, they also highlight some tensions between personal anecdotes and data/research. Findings from this research can inform public outreach efforts as well as policies related to protecting anonymity and celebrating donors with honor walks. Indeed, given TikTok's increasing popularity and influence, it could be a valuable tool to meaningfully learn from, and engage with, patient and donor communities.

Vaccine related crowdfunding on a 'Freedom Fundraising' platform.

INTRODUCTION: Donation-based crowdfunding was heavily used during the COVID-19 pandemic. While most of these campaigns were uncontroversial, others spread misinformation or undermined public health. In response, mainstream crowdfunding platforms like GoFundMe restricted what campaigns they would host. This led some campaigns to shift to lesser-known and less restrictive crowdfunding platforms. While research on health-related misinformation on mainstream crowdfunding platforms is increasing, less is known about crowdfunding on less restrictive platforms like GiveSendGo. The aim of this study is to review vaccine-related crowdfunding campaigns on the GiveSendGo platform to better understand: 1) how vaccines are portrayed on GiveSendGo; and 2) how successful these campaigns have been at attracting financial support. METHODS: We searched the GiveSendGo crowdfunding platform for campaigns including "vaccine" or "vaccination". This process yielded 907 unique results which were then scraped for their campaign text and fundraising data. The authors reviewed these campaigns for fundraisers whose aims related to vaccines for humans and assigned campaigns as being for 1) Accessing vaccines; 2) creating Spaces for the unvaccinated; 3) helping Unvaccinated Individuals); 4) Advocacy about vaccines; 5) supporting Anti-Mandate actions; and 6) responding to Vaccine Injuries. FINDINGS: We identified 765 crowdfunding campaigns that raised $6,814,817 and requested $838,578,249. Anti-Mandate campaigns were most common, followed by Unvaccinated Individuals, Vaccine Injuries, Advocacy, Access, and Spaces. Only Access campaigns took a positive or neutral view toward vaccines. Themes of freedom and religion cut across campaign types with campaigns critical of vaccines invoking bodily autonomy and religious freedom as justifying their fundraisers. DISCUSSION: Very few of these fundraisers met their goals. With the exception of Access campaigns, they frequently contained highly polarizing language advocating against public health mandates, misinformation about vaccine safety, and language from bioethics and reproductive choice advocates. Restrictions on vaccine-related campaigns on the GoFundMe platform likely drove campaign creation on GiveSendGo.

TikTok and #OccupationalTherapy: Cross-sectional Study.

BACKGROUND: Medical providers use the short-form video social media platform TikTok to share information related to their scope of practice and insights about their professions. Videos under the hashtag #occupationaltherapy on TikTok have over 100 million views, but there is no evidence investigating how occupational therapy information and knowledge are shared on the platform. OBJECTIVE: The purpose of this cross-sectional study is to describe TikTok content with the hashtag #occupationaltherapy and investigate how occupational therapy is portrayed. METHODS: We performed a content analysis on the top 500 TikTok videos under the hashtag #occupationaltherapy. We analyzed occupational therapy content themes (occupational therapy intervention, education, student training, universal design, and humor), practice settings (pediatrics, generalists, dementia, hand therapy, neurology, occupational therapy students, older adults, mental health, and unknown), and sentiments (positive, negative, and neutral). RESULTS: The videos in our sample (n=500) received 175,862,994 views. The 2 most prevalent content areas were education (n=210) and occupational therapy interventions (n=146). The overall sentiment of the videos was positive (n=302). The most frequently observed practice settings in the videos were pediatrics (n=131) and generalists (n=129). Most videos did not state that it was occupational therapy (n=222) or misused the hashtag (n=131). CONCLUSIONS: TikTok has the potential for occupational therapists to share innovations, build communities of practice, and engage in collaborative efforts to share information about occupational therapists' unique roles with diverse populations. Future research is needed to monitor the quality of information and debunk inaccuracies.

Advertising Alternative Cancer Treatments and Approaches on Meta Social Media Platforms: Content Analysis.

BACKGROUND: Alternative cancer treatment is associated with a greater risk of death than cancer patients undergoing conventional treatments. Anecdotal evidence suggests cancer patients view paid advertisements promoting alternative cancer treatment on social media, but the extent and nature of this advertising remain unknown. This context suggests an urgent need to investigate alternative cancer treatment advertising on social media. OBJECTIVE: This study aimed to systematically analyze the advertising activities of prominent alternative cancer treatment practitioners on Meta platforms, including Facebook, Instagram, Messenger, and Audience Network. We specifically sought to determine (1) whether paid advertising for alternative cancer treatment occurs on Meta social media platforms, (2) the strategies and messages of alternative cancer providers to reach and appeal to prospective patients, and (3) how the efficacy of alternative treatments is portrayed. METHODS: Between December 6, 2021, and December 12, 2021, we collected active advertisements from alternative cancer clinics using the Meta Ad Library. The information collected included identification number, URL, active/inactive status, dates launched/ran, advertiser page name, and a screenshot (image) or recording (video) of the advertisement. We then conducted a content analysis to determine how alternative cancer providers communicate the claimed benefits of their services and evaluated how they portrayed alternative cancer treatment efficacy. RESULTS: We identified 310 paid advertisements from 11 alternative cancer clinics on Meta (Facebook, Instagram, or Messenger) marketing alternative treatment approaches, care, and interventions. Alternative cancer providers appealed to prospective patients through eight strategies: (1) advertiser representation as a legitimate medical provider (n=289, 93.2%); (2) appealing to persons with limited treatments options (n=203, 65.5%); (3) client testimonials (n=168, 54.2%); (4) promoting holistic approaches (n=121, 39%); (5) promoting messages of care (n=81, 26.1%); (6) rhetoric related to science and research (n=72, 23.2%); (7) rhetoric pertaining to the latest technology (n=63, 20.3%); and (8) focusing treatment on cancer origins and cause (n=43, 13.9%). Overall, 25.8% (n=80) of advertisements included a direct statement claiming provider treatment can cure cancer or prolong life. CONCLUSIONS: Our results provide evidence alternative cancer providers are using Meta advertising products to market scientifically unsupported cancer treatments. Advertisements regularly referenced "alternative" and "natural" treatment approaches to cancer. Imagery and text content that emulated evidence-based medical providers created the impression that the offered treatments were effective medical options for cancer. Advertisements exploited the hope of patients with terminal and poor prognoses by sharing testimonials of past patients who allegedly were cured or had their lives prolonged. We recommend that Meta introduce a mandatory, human-led authorization process that is not reliant upon artificial intelligence for medical-related advertisers before giving advertising permissions. Further research should focus on the conflict of interest between social media platforms advertising products and public health.

The Paradoxical Relationship Between Health Promotion and the Social Media Industry.

Mounting evidence suggests that problematic adolescent social media use is associated with poor mental health. To respond to increased adolescent mental health concerns, health promoters increasingly rely on social media initiatives to promote their resources, programs, and services. This creates a paradoxical situation where social-media-linked adverse mental health outcomes are addressed using the same tools and platforms that can contribute to the development of such issues. It also highlights several areas of needed critical assessment in health promotion usage of social media platform features and products, such as addictive platform design, targeted marketing tools, data collection practices, impacts on underserved groups, and conflicts of interest. To advance subsequent action on these tensions, we offer three recommendations for health promoters that build upon existing scholarship and initiatives, including adapting ethical guidelines for health promoters using social media, adopting conflicts of interest policies, and promoting interdisciplinary scholarship.

Back to our roots or sowing new seeds: thinking anew on the paradigms of health, harm and disease.

Health, harms and disease are intimately linked, and their promotion and distribution are determined by the social, political and physical worlds in which people live. Yet, the popular narrative on health is still dominated by a biological model that focuses on a disease-causing 'pathogen' or 'agent' that leads to pathology which is diagnosable and amenable to intervention at the individual level via measures delivered through the health care and public health systems. This model generally rests on understanding populations as a collection of individuals, with the pattern of disease seen as the sum of a series of risk factors acting on each of them. Too little attention is paid to the ways in which health, harm, disease, causation and risk are conceptualized and used as guiding concepts in research, policy debates and other fora. We often overlook the distribution of health and the regulatory regimes, norms, values and rights that promote or undermine health. By challenging our ways of thinking about health, harms and disease, we can start to appreciate with greater depth the ways in which health can be threatened and what should be seen as harmful, and conversely, opportunities for moving our systems towards promoting and protecting health.

Newspaper Coverage of COVID-19 Vaccination Requirement for Organ Transplant.

This qualitative study summarizes newspaper reporting on views supporting or opposing policies requiring COVID-19 vaccination for organ transplant candidates in the US, the UK, and Canada.

Using Data From a Short Video Social Media Platform to Identify Emergent Monkeypox Conspiracy Theories.

This qualitative study investigates emergent conspiracy theories about monkeypox collected from content and metadata posted by users of a social media video app.

"It cannot be boring!": Developing a measure of function for young adults accessing integrated youth services.

BACKGROUND: In Canada, the prevalence of mental health challenges is highest in young people aged 12-24. Mental health challenges frequently cause marked functional impairment. Despite this, we are unaware of any existing conceptualization and/or measures of function that has been developed from the perspective of young people. The objective of this paper is to develop a conceptual and measurement model, including a preliminary set of items, for an outcome measure of function for young adults accessing mental health services. METHODS: We conducted this study in three phases. In phase 1, we conducted three focus groups to conceptualize function as a construct from the perspective of young adults. In phase 2, we co-designed a set of items with youth (n = 4) to capture the construct. In phase 3, we invited young people (n = 12) accessing mental health services to complete workbooks and participate in one of two focus groups to evaluate whether items were clear, captured function comprehensively, and were relevant. We transcribed and compiled all data to eliminate, refine and generate new items. RESULTS: In phase 1, a conceptual model of function was developed with three main themes: basic needs, roles and responsibilities, and social connections. In phase 2, 97 candidate items were developed, and in phase 3, a candidate pool of 50 items resulted for psychometric testing. CONCLUSION: This youth-centred conceptualization of function and preliminary item bank has the potential to advance person-centred care, outcomes, and experiences for youth seeking mental health services.

Implementing integrated-youth services virtually in British Columbia during the COVID-19 pandemic.

Objective: During the COVID-19 pandemic, Foundry responded to support youth across the province of British Columbia (BC), Canada, by creating a virtual platform to deliver integrated services to youth. In this paper, we report on the development of Foundry Virtual services, initial evaluation results and lessons learnt for others implementing virtual services. Methods and analysis: In April 2020, Foundry launched its virtual services, providing young people and their caregivers from across BC with drop-in counselling services via chat, voice or video calls. Foundry consulted with youth and caregivers to implement, improve and add services. Using Foundry's quality improvement data tool, we document service utilisation, the demographic profile of young people accessing virtual services, and how young people rate the quality of services accessed. Findings: Since launching, 3846 unique youth accessed Foundry Virtual services over 8899 visits, totalling 11 943 services accessed. The predominant services accessed were walk in counselling (32.5%), mental health and substance use services (31.4%), youth peer support (17.2%) and group services (7.3%). Over 95% of youth reported that they would recommend virtual services to a friend. Conclusion: In response to our early findings, we provide three recommendations for other implementers. First, engage the audience in which you intend to serve at every phase of the project. Second, invest in the needs of staff to ensure they are prepared and supported to deliver services. Last, imbed a learning health system to allow for the resources culture of continuous learning improvement that allows for rapid course adjustments and shared learning opportunities.

Analyzing natural herd immunity media discourse in the United Kingdom and the United States.

Natural herd immunity, where community-acquired infections in low-risk populations are used to protect high risk populations from infection-has seen high profile support in some quarters, including through the Great Barrington Declaration. However, this approach has been widely criticized as ineffective and misinformed. In this study, we examine media discourse around natural herd immunity in the United States (US) and United Kingdom (UK) to better understand how this approach was promoted. Country-specific news media publications between March 11, 2020 and January 31, 2021 were searched for references to herd immunity. News articles focused on herd immunity and including a stakeholder quote about herd immunity were collected, resulting in 400 UK and 144 US articles. Stakeholder comments were then coded by name, organization, organization type, and concept agreement or disagreement. Government figures and a small but vocal coalition of academics played a central role in promoting natural herd immunity in the news media whereas critics were largely drawn from academia and public health. These groups clashed on whether: natural herd immunity is an appropriate and effective pandemic response; the consequences of a lockdown are worse than those of promoting herd immunity; high-risk populations could be adequately protected; and if healthcare resources would be adequate under a herd immunity strategy. False balance in news media coverage of natural herd immunity as a pandemic response legitimized this approach and potentially undermined more widely accepted mitigation approaches. The ability to protect high risk populations while building herd immunity was a central but poorly supported pillar of this approach. The presentation of herd immunity in news media underscores the need for greater appreciation of potential harm of media representations that contain false balance.

Pre-emption strategies to block taxes on sugar-sweetened beverages: A framing analysis of Facebook advertising in support of Washington state initiative-1634.

ABSTRACTIn 2018, the sugar-sweetened beverage (SSB) industry introduced a ballot measure (I-1634) in Washington State of the United States to prevent further local taxes on groceries. The measure, which passed, is emblematic of new pre-emptive legislative strategies by the SSB industry to block soda taxes and conceal those strategies under the guise of preventing burdensome 'grocery taxes'. This paper uses qualitative framing analysis to examine a public archive of 1218 Facebook advertisements to understand how I-1634 proponents shaped public discourse and engaged in misinformation efforts online during the lead up to the passage of I-1634. Coding strategies identified 7 compelling and inter-related framing strategies used by the campaign. These included strategies that misinformed the public about the threat of grocery taxation and the economic impacts it would have on the region. Strategies to conceal the true intent of the ballot measure and the sponsors of the campaign were aided by Facebook's advertising platform, which does not moderate misinformation in advertising and allows advertisers to conceal their sponsors. We urge public health researchers and advocates to pay more attention to how Facebook and other social media platforms can be used by industries to target voters, misinform publics, and misconstrue industry support.

Measuring the Commercial Determinants of Health and Disease: A Proposed Framework.

The commercial determinants of health (CDoH) describe the adverse health effects associated with for-profit actors and their actions. Despite efforts to advance the definition, conceptualization, and empirical analyses of CDoH, the term's practical application to mitigate these effects requires the capacity to measure the influences of specific components of CDoH and the cumulative impacts of CDoH on the health and well-being of specific populations. Building on the Global Burden of Disease Study, we begin by conceptualizing CDoH as risk factor exposures that span agency and structural influences. We identify 6 components of these influences and propose an initial set of indicators and datasets to rank exposures as high, medium, or low. These are combined into a commercial determinants of health index (CDoHi) and illustrated by 3 countries. Although now a proof of concept, comparative analysis of CDoH exposures by population, over time and space, and their associated health outcomes will become possible with further development of indicators and datasets. Expansion of the CDoHi and application to varied populations groups will enable finer targeting of interventions to reduce health harms. The measurement of improvements to health and wellness from such interventions will, in turn, inform overall efforts to address the CDoH.

Powerful Allies and Weak Consensus: Towards a Deeper Understanding of how Health-Harming Industries Seek to Influence Global Health Governance Comment on "Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases".

Suzuki et al have identified commonalities in the policy positions adopted at a global forum by commercial sector actors and high-income countries (HICs), on the one hand, and non-governmental organizations (NGOs) and low- and middle-income countries (LMICs), on the other, in ways that may allow commercial sector actors to block or delay evidence-based policies through the creation of political controversy. The ability of industry actors to draw on the support of the most politically and economically powerful countries for their favoured policy agenda is an important contribution to understanding the dynamics of global health governance in the area of non-communicable diseases (NCDs) and beyond. Here we assess the relevance of this paper for the field of corporate actors' research and the potential avenues this opens up for further study. More specifically we emphasize the need for comparative, cross disciplinary research to examine the power of heath-harming industries and the relevance of these findings for decolonizing global health.

Defining Priorities for Action and Research on the Commercial Determinants of Health: A Conceptual Review.

In recent years, the concept of commercial determinants of health (CDoH) has attracted scholarly, public policy, and activist interest. To date, however, this new attention has failed to yield a clear and consistent definition, well-defined metrics for quantifying its impact, or coherent directions for research and intervention. By tracing the origins of this concept over 2 centuries of interactions between market forces and public health action and research, we propose an expanded framework and definition of CDoH. This conceptualization enables public health professionals and researchers to more fully realize the potential of the CDoH concept to yield insights that can be used to improve global and national health and reduce the stark health inequities within and between nations. It also widens the utility of CDoH from its main current use to study noncommunicable diseases to other health conditions such as infectious diseases, mental health conditions, injuries, and exposure to environmental threats. We suggest specific actions that public health professionals can take to transform the burgeoning interest in CDoH into meaningful improvements in health. (Am J Public Health. 2021;111(12):2202-2211. https://doi.org/10.2105/AJPH.2021.306491).