Living in an online world: Social media experiences of adolescents and young adults with cancer.

BACKGROUND: Despite widespread use, little is known about how adolescents and young adults (AYA) with cancer use social media (SM). This research characterized use and self-reported SM experiences among AYA with cancer. PROCEDURE: AYA, aged 12-26 years, receiving cancer care completed a mixed-methods survey regarding SM experiences. Clinical information was obtained from the electronic medical record. Data were analyzed with descriptive statistics, t tests, and qualitative content analysis. RESULTS: Thirty-nine AYA with average age 16 (SD = 3.2) years participated. Most were Caucasian (92%) males (54%). Participants had leukemia/lymphoma (56%), solid tumors (33%), and brain tumors (10%). Nearly all (97%) used SM, with YouTube, Snapchat, and Instagram being the most popular. AYA self-reported lower SM use than their smartphone data indicated (2.8 hours/day, SD = 1.2 vs 3.4 hours/day, SD = 1.3; P < 0.001). Participants used SM to obtain information about their cancer (45%), post about cancer (47%), and read about others' cancer experience (50%). One-third made a friend with cancer through SM (32%). Qualitative results indicated that AYA had positive cancer-related SM experiences, including feelings of support (54%), community (27%), distraction (8%), and inspiration (8%). Most denied negative experiences (78%); however, 17% reported cyberbullying related to cancer. CONCLUSIONS: AYA with cancer avidly use SM, noting it provides a sense of support and community. However, one-sixth reported cancer-related cyberbullying. AYA oncology providers have an opportunity to enhance positive and blunt negative SM interactions by addressing and guiding SM use in AYA patients.

E-Cigarette-Related Nicotine Misinformation on Social Media.

Background. Twitter provides an opportunity to examine misperceptions about nicotine and addiction as they pertain to electronic nicotine delivery systems (ENDS). The purpose of this study was to systematically examine a sample of ENDS-related tweets that presented information about nicotine or addiction for the presence of potential misinformation.Methods. A total of 10.1 million ENDS-related tweets were obtained from April 2018 through March 2019 and were filtered for unique tweets containing keywords for nicotine and addiction. A subsample (n = 3,116) were human coded for type of account (individual, group, commercial, or news) and presence of potential misinformation.Results. Of tweets that presented ENDS-related nicotine or addiction information (n = 904), 41.7% (n = 377) contained potential misinformation coded as anti-vaping exaggeration, pro-vaping exaggeration, nicotine is not addictive or is never harmful, or unproven health benefits.Conclusions. Anti-vaping exaggeration tweets distorted or embellished claims about ENDS nicotine and addiction; pro-vaping exaggeration tweets misinterpreted results from scientific studies. Misinformation that nicotine is not addictive or is never harmful or has unproven health benefits appeared less but are potentially problematic. ENDS-related messaging should be designed to be easily understood by the public and monitored to detect the spread of misinterpretation or misinformation on social media.

Patient-centered Communication Behaviors on Primetime Television.

Previous research suggests that television programming may influence viewers' health-related knowledge, perceptions, and behaviors but has yet to examine patient-provider interactions on the most popular primetime television programs. We aimed to characterize the frequency and nature of patient-centered communication (PCC) behaviors on these programs, as cultivation and social cognitive theories suggest that these depictions may influence viewers' expectations of real-life health-care experiences. We examined 203 patient-provider interactions across 84 episodes of 22 primetime television programs-both medical and non-medical-that aired during the spring of 2016 and spring of 2017. Each interaction was analyzed for the presence of 21 optimal PCC behaviors. This study found that the most frequently observed PCC behaviors focused on the provider making good eye contact and displaying good manners. However, PCC behaviors related to managing patient uncertainty and self-management were rare. Overall, providers in medical programs were significantly more likely to exhibit certain PCC behaviors, such as asking a patient questions, having good manners, and self-disclosing personal information, compared to providers in non-medical programs. Implications of these findings include the potential for such depictions to influence patient expectations of real-life experiences and health outcomes. Future research is needed to examine these potential influences.

Waterpipe tobacco use in college and non-college young adults in the USA.

BACKGROUND: Waterpipe tobacco smoking (WTS or 'hookah') is common among adolescents and college students in the USA. However, there has not yet been a large-scale, nationally representative study independently examining WTS among young adults who are not in college. OBJECTIVE: This study sought to examine associations between attitudes, normative beliefs, certain socio-demographic factors and current WTS among young adults not in college and compare them to young adults in college. METHODS: A total of 3131 US adults ages 18-30 completed an online survey about WTS behaviour, attitudes, normative beliefs and relevant socio-demographic factors. Multivariable logistic regression was used to examine independent associations between these variables and current WTS stratified by student status. RESULTS: Ever WTS was reported by 29% of young adults not in college and by 35% of those in college, and current use rates were 3 and 7%, respectively. Multivariable models demonstrated that positive attitudes and perceived peer acceptability of WTS were significantly associated with increased current WTS for both young adults not in college [adjusted odds ratio (AOR) = 2.72; 95% CI: 2.00-3.71 and AOR = 2.02; 95% CI: 1.50-2.71, respectively] and young adults in college (AOR = 3.37; 95% CI: 2.48-4.58 and AOR = 2.05; 95% CI: 1.49-2.83, respectively). The magnitude of these associations was not significantly different when comparing individuals in college and not in college. CONCLUSIONS: Among young adults, WTS is common in non-college-based populations as well as in college-based populations. Therefore, prevention programming should extend to all young adults, not only to those in college.

The association between valence of social media experiences and depressive symptoms.

BACKGROUND: Social media (SM) may confer emotional benefits via connection with others. However, epidemiologic studies suggest that overall SM is paradoxically associated with increased depressive symptoms. To better understand these findings, we examined the association between positive and negative experiences on SM and depressive symptoms. METHODS: We conducted a cross-sectional survey of 1,179 full-time students at the University of West Virginia, aged 18 to 30, in August 2016. Independent variables were self-reported positive and negative experiences on SM. The dependent variable was depressive symptoms as measured using the Patient-Reported Outcomes Measurement Information System. We used multivariable logistic regression to assess associations between SM experiences and depressive symptoms controlling for sociodemographic factors including age, sex, race/ethnicity, education, relationship status, and living situation. RESULTS: Of the 1,179 participants, 62% were female, 28% were non-White, and 51% were single. After controlling for covariates, each 10% increase in positive experiences on SM was associated with a 4% decrease in odds of depressive symptoms, but this was not statistically significant (adjusted odds ratio [AOR] = 0.96; 95% confidence interval [CI] = 0.91-1.002). However, each 10% increase in negative experiences was associated with a 20% increase in odds of depressive symptoms (AOR = 1.20; 95% CI = 1.11-1.31). When both independent variables were included in the same model, the association between negative experiences and depressive symptoms remained significant (AOR = 1.19, 95% CI = 1.10-1.30). CONCLUSIONS: Negative experiences online may have higher potency than positive ones because of negativity bias. Future research should examine temporality to determine if it is also possible that individuals with depressive symptomatology are inclined toward negative interactions.

Comparison of toxicant load from waterpipe and cigarette tobacco smoking among young adults in the USA.

OBJECTIVES: To form population-level comparisons of total smoke volume, tar, carbon monoxide and nicotine consumed from waterpipe tobacco smoking (WTS) and cigarette smoking using data from a nationally representative sample of smokers and non-smokers aged 18-30 years. METHODS: In March and April 2013, we surveyed a nationally representative sample of 3254 US young adults to assess the frequency and volume of WTS and cigarette smoking. We used Monte Carlo analyses with 5000 repetitions to estimate the proportions of toxicants originating from WTS and cigarette smoking. Analyses incorporated survey weights and used recent meta-analytic data to estimate toxicant exposures associated with WTS and cigarette smoking. RESULTS: Compared with the additive estimates of WTS and cigarette smoking combined, 54.9% (95% CI 37.5% to 72.2%) of smoke volume was attributed to WTS. The proportions of tar attributable to WTS was 20.8% (95% CI 6.5% to 35.2%), carbon monoxide 10.3% (95% CI 3.3% to 17.3%) and nicotine 2.4% (95% CI 0.9% to 3.8%). CONCLUSIONS: WTS accounted for over half of the tobacco smoke volume consumed among young US adult waterpipe and cigarette smokers. Toxicant exposures to tar, carbon monoxide and nicotine were lower, but still substantial, for WTS alone compared with WTS and cigarette smoking. Public health and policy interventions to reduce harm from tobacco smoking in young US adults should explicitly address WTS toxicant exposures.

Use of fictional medical television in health sciences education: a systematic review.

While medical television programs are popular among health profession trainees, it is not clear to what extent these programs affect their knowledge, perceptions, and/or behaviors. Therefore, we conducted a systematic review of research evaluating associations between program exposure and outcomes. We conducted systematic literature searches in Pubmed, CINAHL, and PsycINFO. Selected studies were required to be scholarly research, involve exposure to fictionalized medical television programming by health professional students, and assess associations between exposure and outcomes. Studies were classified according to quality and factors related to population, exposure, and outcomes. Of 3541 studies identified, 13 met selection criteria. Six studies involved undergraduate medical students, one involved nursing students, two involved both medical and nursing students, two involved medical residents, one involved medical students, residents and attending physicians, and one involved graduate epidemiology students. Mean study quality according to the MERSQI was 8.27. The most commonly assessed television programs were ER and Grey's Anatomy (six each). Five studies assessed regular viewing habits, and found that fictional medical programs are popular among students and that students recall health topics from episodes. The eight studies that assessed the association with outcomes when using clips as educational tools reported high satisfaction and increased knowledge of the presented health topics. While relatively few published studies have explored influences of fictional medical television on health professional students, those conducted suggest that students often view these television programs independently and that integration of this programming into medical education is feasible and acceptable.

Exposure to fictional medical television and health: a systematic review.

Fictional medical television programs have long been a staple of television programming, and they remain popular today. We aimed to examine published literature assessing the influence of medical television programs on health outcomes. We conducted systematic literature searches in PubMed, PsychINFO and CINAHL. Selected studies had to be scholarly research, to involve exposure to fictionalized medical television programming, and to assess associations between exposures and outcomes. Of 3541 unique studies identified, nineteen met selection criteria. The most commonly studied programs were ER (73%), Grey's Anatomy (58%) and House M.D. (37%). Outcomes included knowledge, perceptions and behaviors related to topics as diverse as organ donation, cancer screening, sexually transmitted infections, and heart disease. Viewing fictional medical television programs had a negative influence on viewers' health-related knowledge, perceptions and/or behavior in 11% of studies, a positive influence in 32% of studies, and mixed influence in 58%. While most studies (58%) were characterized as having fair quality in terms of rigor of study design, 21% were classified as good and 21% were classified as poor. As such, medical television can affect health education and outcomes. Future work should utilize randomization, more longitudinal assessments, and more direct assessments of health education and behavioral outcomes.

The association between social media use and sleep disturbance among young adults.

INTRODUCTION: Many factors contribute to sleep disturbance among young adults. Social media (SM) use is increasing rapidly, and little is known regarding its association with sleep disturbance. METHODS: In 2014 we assessed a nationally representative sample of 1788 U.S. young adults ages 19-32. SM volume and frequency were assessed by self-reported minutes per day spent on SM (volume) and visits per week (frequency) using items adapted from the Pew Internet Research Questionnaire. We assessed sleep disturbance using the brief Patient-Reported Outcomes Measurement Information System (PROMIS®) sleep disturbance measure. Analyses performed in Pittsburgh utilized chi-square tests and ordered logistic regression using sample weights in order to estimate effects for the total U.S. RESULTS: In models that adjusted for all sociodemographic covariates, participants with higher SM use volume and frequency had significantly greater odds of having sleep disturbance. For example, compared with those in the lowest quartile of SM use per day, those in the highest quartile had an AOR of 1.95 (95% CI=1.37-2.79) for sleep disturbance. Similarly, compared with those in the lowest quartile of SM use frequency per week, those in the highest quartile had an AOR of 2.92 (95% CI=1.97-4.32) for sleep disturbance. All associations demonstrated a significant linear trend. DISCUSSION: The strong association between SM use and sleep disturbance has important clinical implications for the health and well-being of young adults. Future work should aim to assess directionality and to better understand the influence of contextual factors associated with SM use.

ASSOCIATION BETWEEN SOCIAL MEDIA USE AND DEPRESSION AMONG U.S. YOUNG ADULTS.

BACKGROUND: Social media (SM) use is increasing among U.S. young adults, and its association with mental well-being remains unclear. This study assessed the association between SM use and depression in a nationally representative sample of young adults. METHODS: We surveyed 1,787 adults ages 19 to 32 about SM use and depression. Participants were recruited via random digit dialing and address-based sampling. SM use was assessed by self-reported total time per day spent on SM, visits per week, and a global frequency score based on the Pew Internet Research Questionnaire. Depression was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression Scale Short Form. Chi-squared tests and ordered logistic regressions were performed with sample weights. RESULTS: The weighted sample was 50.3% female and 57.5% White. Compared to those in the lowest quartile of total time per day spent on SM, participants in the highest quartile had significantly increased odds of depression (AOR = 1.66, 95% CI = 1.14-2.42) after controlling for all covariates. Compared with those in the lowest quartile, individuals in the highest quartile of SM site visits per week and those with a higher global frequency score had significantly increased odds of depression (AOR = 2.74, 95% CI = 1.86-4.04; AOR = 3.05, 95% CI = 2.03-4.59, respectively). All associations between independent variables and depression had strong, linear, dose-response trends. Results were robust to all sensitivity analyses. CONCLUSIONS: SM use was significantly associated with increased depression. Given the proliferation of SM, identifying the mechanisms and direction of this association is critical for informing interventions that address SM use and depression.

A randomized crossover study of web-based media literacy to prevent smoking.

Feasibly implemented Web-based smoking media literacy (SML) programs have been associated with improving SML skills among adolescents. However, prior evaluations have generally had weak experimental designs. We aimed to examine program efficacy using a more rigorous crossover design. Seventy-two ninth grade students completed a Web-based SML program based on health behavior theory and implemented using a two-group two-period crossover design. Students were randomly assigned by classroom to receive media literacy or control interventions in different sequences. They were assessed three times, at baseline (T0), an initial follow-up after the first intervention (T1) and a second follow-up after the second intervention (T2). Crossover analysis using analysis of variance demonstrated significant intervention coefficients, indicating that the SML condition was superior to control for the primary outcome of total SML (F = 11.99; P < 0.001) and for seven of the nine individual SML items. Results were consistent in sensitivity analyses conducted using non-parametric methods. There were changes in some exploratory theory-based outcomes including attitudes and normative beliefs but not others. In conclusion, while strength of the design of this study supports and extends prior findings around effectiveness of SML programs, influences on theory-based mediators of smoking should be further explored.

Social Media Use and Perceived Emotional Support Among US Young Adults.

Low emotional support is associated with poor health outcomes. Engagement with face-to-face social networks is one way of increasing emotional support. However, it is not yet known whether engagement with proliferating electronic social networks is similarly associated with increased emotional support. Thus, the purpose of this study was to assess associations between social media use and perceived emotional support in a large, nationally-representative sample. In October 2014, we collected data from 1796 U.S. adults ages 19-32. We assessed social media use using both total time spent and frequency of visits to each of the 11 most popular social media platforms. Our dependent variable was perceived emotional support as measured by the brief Patient-Reported Outcomes Measurement Information System (PROMIS) emotional support scale. A multivariable model including all sociodemographic covariates and accounting for survey weights demonstrated that, compared with the lowest quartile of time on social media, being in the highest quartile (spending two or more hours per day) was significantly associated with decreased odds of having higher perceived emotional support (AOR 0.62, 95 % CI 0.40, 0.94). However, compared with those in the lowest quartile, being in the highest quartile regarding frequency of social media use was not significantly associated with perceived emotional support (AOR 0.70, 95 % CI 0.45, 1.09). In conclusion, while the cross-sectional nature of these data hinder inference regarding directionality, it seems that heavy users of social media may actually feel less and not more emotional support.

Sex Differences in Hookah-Related Images Posted on Tumblr: A Content Analysis.

Hookah tobacco smoking is prevalent, widespread, and associated with large amounts of toxicants. Hookah tobacco smoking may be viewed differently by males and females. For example, females have been drawn to types of tobacco that are flavored, milder, and marketed as more social and exotic. Individuals often use the growing segment of anonymous social networking sites, such as Tumblr, to learn about potentially dangerous or harmful behaviors. We used a systematic process involving stratification by time of day, day of week, and search term to gather a sample of 140 Tumblr posts related to hookah tobacco smoking. After a structured codebook development process, 2 coders independently assessed all posts in their entirety, and all disagreements were easily adjudicated. When data on poster sex and age were available, we found that 77% of posts were posted by females and 35% were posted by individuals younger than 18. The most prominent features displayed in all posts were references to or images of hookahs themselves, sexuality, socializing, alcohol, hookah smoke, and tricks performed with hookah smoke. Compared with females, males more frequently posted images of hookahs and alcohol-related images or references. This information may help guide future research in this area and the development of targeted interventions to curb this behavior.

Water pipe steam stones: familiarity and use among US young adults.

INTRODUCTION: Water pipe tobacco smoking (WTS) is associated with substantial toxicant exposure. Water pipe steam stones (WSS) are marketed as a healthier alternative. The purpose of this study was to determine, in a nationally representative sample, young adults' familiarity with, perceptions regarding, and use of WSS. METHODS: A survey about WTS was completed by 3,253 members of an online nonvolunteer access panel. Four items specifically addressed WSS. RESULTS: Of the 228 individuals who had heard of WSS, 17% (n = 41) reported using them. Use was associated with ever (adjusted odds ratio [AOR] = 7.7, 95% confidence interval [CI] = 2.7-21.8) and current (AOR = 16.1, 95% CI = 5.1-51.5) WTS. Compared with those who thought that WSS had about the same harm as WTS, those who thought that WSS was "a lot less harmful" to a person's health had substantially higher odds of having tried WSS (AOR = 6.8, 95% CI = 2.0-23.1). CONCLUSIONS: Approximately 1 in 6 young adults who have heard of WSS used them. WSS use is associated with the perception of reduced harm.

Knowledge, attitudes, and normative beliefs as predictors of hookah smoking initiation: a longitudinal study of university students.

INTRODUCTION: While cross-sectional studies have shown that hookah tobacco smoking (HTS) is an increasingly popular behavior among university students, little is known about factors associated with initiation. This study sought to determine associations between knowledge, attitudes, and normative beliefs and initiation of HTS among university students. METHODS: Data were from a prospective longitudinal cohort study of 569 randomly selected first- and second-year university students. Online questionnaires that were developed in accordance with our composite theoretical model were completed in September 2010 and April 2011. RESULTS: About one-seventh (13%) of participants initiated HTS by follow-up. Positive attitudes and favorable normative beliefs were associated with increased adjusted odds of initiation (AOR = 4.12, 95% CI = 2.56, 6.59; and AOR = 2.01, 95% CI = 1.35, 2.99, respectively), while negative attitudes were associated with decreased adjusted odds (AOR = 0.62, 95% CI = 0.48, 0.80). Correct knowledge regarding toxicants associated with HTS was not significantly associated with initiation. CONCLUSIONS: While positive attitudes and favorable normative beliefs are associated with initiation of HTS in a cohort of never-users, increased knowledge about toxins is not associated with lower initiation. It may be particularly valuable for educational interventions to attempt to alter positive attitudes and normative beliefs related to HTS.

The LWDS-10J: reliability and validity of the Lebanon Waterpipe Dependence Scale among university students in Jordan.

INTRODUCTION: While the Lebanon Waterpipe Dependence Scale (LWDS-11) has shown promise in assessing dependence on waterpipe tobacco smoking (WTS) in Lebanon among adult users, it would be valuable to identify WTS addiction earlier and to explore reliability and validity of these items in other populations. METHODS: In 2010-2012, we conducted a multiyear survey of 5,853 students from 4 Jordanian universities. We measured WTS, sociodemographic data, and the LWDS-11 items. We conducted exploratory factor analysis with half of the sample and confirmed the resulting model using confirmatory factor analysis with the other half. We examined construct validity with regression models assessing associations between the modified scale and 5 constructs conceptually expected to be associated with dependence. RESULTS: WTS rates were 35% in the past 30 days and 56% ever. Principal-components analysis of LWDS items in the first half of the sample yielded 10 items representing 3 factors labeled physical dependence, relaxation/pleasure, and social aspects. Cronbach's α was .77 for the total scale and was .75, .70, and .67 for each individual subscale. Confirmatory factor analysis in a structural equation modeling framework confirmed good fit (root mean squared error of approximation = 0.068, and comparative fit index = 0.937). Dependence according to the resulting scale (LWDS-10J) was strongly associated with each of the 5 expected constructs, whether the dependent variable was treated as categorical or continuous. CONCLUSIONS: The LWDS-11 items exhibited a different factor structure in our sample. However, the modified scale (LWDS-10J) showed promising reliability and construct validity in this population.

Associations between race, ethnicity, religion, and waterpipe tobacco smoking.

We surveyed a random sample of 852 students at a large university in 2010-2011 to clarify associations between waterpipe tobacco smoking (WTS), ethnicity, and religion. Current (past 30 day) WTS was reported by 116 (14%) students, and 331 (39%) reported ever WTS. Middle Eastern ethnicity was associated with current WTS (odds ratio [OR] = 2.37; 95% confidence interval [CI] = 1.06, 5.34) and ever WTS (OR = 2.59; 95% CI = 1.22, 5.47). South Asian ethnicity was associated with lower odds for ever WTS (OR = 0.42; 95% CI = 0.21, 0.86), but there was no significant association between South Asian ethnicity and current WTS. Being an atheist and having lower religiosity were associated with both WTS outcomes.

Waterpipe smoking among U.S. university students.

INTRODUCTION: While cigarette use is declining, smoking tobacco with a waterpipe is an emerging trend. We aimed to determine the prevalence of waterpipe use in a large diverse sample of U.S. university students and to assess the association of waterpipe use with individual and institution-related characteristics. METHODS: We assessed students from 152 U.S. universities participating in the National College Health Assessment during 2008-2009. We used multivariable regression models to determine independent associations between individual and institutional characteristics and waterpipe tobacco use in the past 30 days and ever. RESULTS: Of 105,012 respondents included in the analysis, most were female (65.7%), White (71.2%), and attending public (59.7%) nonreligious (83.1%) institutions. Mean age was 22.1 years. A total of 32,013 (30.5%) reported ever using a waterpipe to smoke tobacco. Rates for current tobacco use were 8.4% for waterpipes, 16.8% for cigarettes, 7.4% for cigars (including cigarillos), and 3.5% for smokeless tobacco. Of current waterpipe users, 51.4% were not current cigarette smokers. Although current waterpipe use was reported across all individual and institutional characteristics, fully adjusted multivariable models showed that it was most strongly associated with younger age, male gender, White race, fraternity/sorority membership, and nonreligious institutions in large cities in the western United States. CONCLUSIONS: After cigarettes, waterpipe use was the most common form of tobacco use among university students. Because waterpipe use affects groups with a wide variety of individual and institutional characteristics, it should be included with other forms of tobacco in efforts related to tobacco surveillance and intervention.

A comparison of cigarette- and hookah-related videos on YouTube.

OBJECTIVE: YouTube is now the second most visited site on the internet. The authors aimed to compare characteristics of and messages conveyed by cigarette- and hookah-related videos on YouTube. METHODS: Systematic search procedures yielded 66 cigarette-related and 61 hookah-related videos. After three trained qualitative researchers used an iterative approach to develop and refine definitions for the coding of variables, two of them independently coded each video for content including positive and negative associations with smoking and major content type. RESULTS: Median view counts were 606,884 for cigarettes-related videos and 102,307 for hookah-related videos (p<0.001). However, the number of comments per 1000 views was significantly lower for cigarette-related videos than for hookah-related videos (1.6 vs 2.5, p=0.003). There was no significant difference in the number of 'like' designations per 100 reactions (91 vs 87, p=0.39). Cigarette-related videos were less likely than hookah-related videos to portray tobacco use in a positive light (24% vs 92%, p<0.001). In addition, cigarette-related videos were more likely to be of high production quality (42% vs 5%, p<0.001), to mention short-term consequences (50% vs 18%, p<0.001) and long-term consequences (44% vs 2%, p<0.001) of tobacco use, to contain explicit antismoking messages (39% vs 0%, p<0.001) and to provide specific information on how to quit tobacco use (21% vs 0%, p<0.001). CONCLUSIONS: Although internet user-generated videos related to cigarette smoking often acknowledge harmful consequences and provide explicit antismoking messages, hookah-related videos do not. It may be valuable for public health programmes to correct common misconceptions regarding hookah use.