Introducing the Power In Nepali Girls (PING) empowerment scale.

The multi-dimensional concept of empowerment is context specific, uniquely defined in various cultures, and challenging to measure. The aim of this study was to develop a scale for measuring empowerment among adolescent girls in Nepal. Twenty-nine items related to empowerment were drawn from formative, participatory research conducted in southern Nepal to comprise a draft empowerment scale. A case/control survey among 300 adolescent Nepali girls was then conducted to refine the scale. Factor analysis determined the most parsimonious scale and identified the underlying structure of items, resulting in the The Power In Nepali Girls (PING), a two-factor, 16-item empowerment scale. Factor 1 items address decision-making power and treatment in family and society. Factor 2 items address knowledge, education, and skills development. We used the 16-item scale to assess the impact of a social and financial skills program on empowerment among adolescent girls residing in southern Nepal. The PING scale is a culturally- and population-specific measure that can be used to quantify the impact of empowerment programs in Nepal among adolescent girls. The methods used also serve as a template for future work aiming to design context-specific measures of empowerment using community-engaged approaches.

Discussions and Misinformation About Electronic Nicotine Delivery Systems and COVID-19: Qualitative Analysis of Twitter Content.

BACKGROUND: Misinformation and conspiracy theories related to COVID-19 and electronic nicotine delivery systems (ENDS) are increasing. Some of this may stem from early reports suggesting a lower risk of severe COVID-19 in nicotine users. Additionally, a common conspiracy is that the e-cigarette or vaping product use-associated lung injury (EVALI) outbreak of 2019 was actually an early presentation of COVID-19. This may have important public health ramifications for both COVID-19 control and ENDS use. OBJECTIVE: Twitter is an ideal tool for analyzing real-time public discussions related to both ENDS and COVID-19. This study seeks to collect and classify Twitter messages ("tweets") related to ENDS and COVID-19 to inform public health messaging. METHODS: Approximately 2.1 million tweets matching ENDS-related keywords were collected from March 1, 2020, through June 30, 2020, and were then filtered for COVID-19-related keywords, resulting in 67,321 original tweets. A 5% (n=3366) subsample was obtained for human coding using a systematically developed codebook. Tweets were coded for relevance to the topic and four overarching categories. RESULTS: A total of 1930 (57.3%) tweets were coded as relevant to the research topic. Half (n=1008, 52.2%) of these discussed a perceived association between ENDS use and COVID-19 susceptibility or severity, with 42.4% (n=818) suggesting that ENDS use is associated with worse COVID-19 symptoms. One-quarter (n=479, 24.8%) of tweets discussed the perceived similarity/dissimilarity of COVID-19 and EVALI, and 13.8% (n=266) discussed ENDS use behavior. Misinformation and conspiracy theories were present throughout all coding categories. CONCLUSIONS: Discussions about ENDS use and COVID-19 on Twitter frequently highlight concerns about the susceptibility and severity of COVID-19 for ENDS users; however, many contain misinformation and conspiracy theories. Public health messaging should capitalize on these concerns and amplify accurate Twitter messaging.

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.

Acceptability and Efficacy of the SMARxT Media Literacy Education Program to Counter Pharmaceutical Marketing Influences among Medical Trainees.

Background: Evidence-based prescribing (EBP) results in decreased morbidity and reduces medical costs. However, pharmaceutical marketing influences medication requests and prescribing habits, which can detract from EBP. Media literacy, which teaches critical thinking, is a promising approach for buffering marketing influences and encouraging EBP. The authors developed the "SMARxT" media literacy education program around marketing influences on EBP decision-making. The program consisted of six videos and knowledge assessments that were delivered as an online educational intervention through the Qualtrics platform. Methods: In 2017, we assessed program feasibility, acceptability, and efficacy of enhancing knowledge among resident physicians at the University of Pittsburgh. Resident physicians (n=73) responded to pre-test items assessing prior knowledge, viewed six SMARxT videos, and responded to post-test items. A 6-month follow-up test was completed to quantitatively assess sustained changes in knowledge and to qualitatively assess summative feedback about the program (n=54). Test scores were assessed from pre- to post-test and from pre-test to follow-up using paired-sample t-tests. Qualitative results were synthesized through content analysis. Results: Proportion of correct knowledge responses increased from pre-test to immediate post-test (31% to 64%, P<0.001) at baseline. Correct responses also increased from pre-test to 6-month follow-up (31% to 43%, P<0.001). Feasibility was demonstrated by 95% of enrolled participants completing all baseline procedures and 70% completing 6-month follow-up. Quantitative measures of acceptability yielded positive scores and qualitative responses indicated participants' increased confidence in understanding and countering marketing influences due to the intervention. However, participants stated they would prefer shorter videos, feedback about test scores, and additional resources to reinforce learning objectives. Conclusion: The SMARxT media literacy program was efficacious and acceptable to resident physicians. Participant suggestions could be incorporated into a subsequent version of SMARxT and inform similar clinical education programs. Future research should assess program impact on real-world prescribing practices.

#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.

Temporal Associations Between Social Media Use and Depression.

INTRODUCTION: Previous studies have demonstrated cross-sectional associations between social media use and depression, but their temporal and directional associations have not been reported. METHODS: In 2018, participants aged 18-30 years were recruited in proportion to U.S. Census characteristics, including age, sex, race, education, household income, and geographic region. Participants self-reported social media use on the basis of a list of the top 10 social media networks, which represent >95% of social media use. Depression was assessed using the 9-Item Patient Health Questionnaire. A total of 9 relevant sociodemographic covariates were assessed. All measures were assessed at both baseline and 6-month follow-up. RESULTS: Among 990 participants who were not depressed at baseline, 95 (9.6%) developed depression by follow-up. In multivariable analyses conducted in 2020 that controlled for all covariates and included survey weights, there was a significant linear association (p<0.001) between baseline social media use and the development of depression for each level of social media use. Compared with those in the lowest quartile, participants in the highest quartile of baseline social media use had significantly increased odds of developing depression (AOR=2.77, 95% CI=1.38, 5.56). However, there was no association between the presence of baseline depression and increasing social media use at follow-up (OR=1.04, 95% CI=0.78, 1.38). Results were robust to all sensitivity analyses. CONCLUSIONS: In a national sample of young adults, baseline social media use was independently associated with the development of depression by follow-up, but baseline depression was not associated with an increase in social media use at follow-up. This pattern suggests temporal associations between social media use and depression, an important criterion for causality.

Association Between LGB Sexual Orientation and Depression Mediated by Negative Social Media Experiences: National Survey Study of US Young Adults.

BACKGROUND: Lesbian, gay, and bisexual (LGB) persons are disproportionately affected by depression and have high social media use rates. Negative social media experiences may modify depressive symptoms among LGB persons. We sought to assess the potential influence of negative social media experiences on the association between LGB orientation and depression. OBJECTIVE: The aim of this study was to assess the potential influence of negative social media experiences on the association between LGB orientation and depression. METHODS: We performed a web-based survey of a national sample of US young adults aged 18-30 years. We assessed the respondents' LGB orientation, negative social media experiences, and depression using the 9-item Patient Health Questionnaire. We used generalized structural equation modeling to assess both the direct and indirect effects (via negative social media experiences) of LGB orientation on depression while controlling for relevant demographic and personal characteristics. RESULTS: We found a conditional indirect effect (ab path) of LGB orientation on depressive symptoms via negative social media experience (a: observed coefficient 0.229; P<.001; bias-corrected bootstrapped 95% CI 0.162-0.319, and b: observed coefficient 2.158; P<.001; bias-corrected bootstrapped 95% CI 1.840-2.494). The results show that among LGB respondents, for those who reported negative social media experiences in the past year, a 1 unit increase in these experiences was associated with a 0.494 unit increase in depressive symptomatology. CONCLUSIONS: Our results suggest that higher rates of depression among LGB young adults are partially explained by negative social media experiences; these results could help inform future patient/provider conversations about mental health risk and protective factors related to social media use. Reducing these experiences and increasing positive social media experiences among LGB persons may mitigate depressive symptomatology in this population.

Associations between positive and negative social media experiences and sleep disturbance among young adults.

OBJECTIVES: We sought to examine the association of positive and negative experiences using social media (SM) and sleep disturbance in a national survey of U.S. young adults. METHODS: Experiences using SM were assessed with 2 items asking participants about the percentage of time using SM that involved a negative/positive experience that they were personally involved in. Sleep disturbance was assessed using the validated PROMIS 4-item short form. Ordinal logistic regression was used to examine associations between positive and negative SM experiences and high sleep disturbance, while controlling for relevant covariates. RESULTS: Although reporting high levels of negative experiences was significantly associated with greater odds of high sleep disturbance (AOR = 1.49, 95%CI = 1.18-1.89), reporting high levels of positive experiences was not associated with sleep disturbance. CONCLUSIONS: These findings suggest that more robust examinations of negative SM experiences-especially as they relate to sleep disturbance-may be warranted.

Integrating Social Dynamics Into Modeling Cigarette and E-Cigarette Use.

Background. The use of electronic cigarettes (e-cigarette) offers potential to facilitate cigarette smoking cessation, yet potentially increases risk of cigarette smoking initiation. This relationship has been primarily modeled in mathematical ways that often do not represent real-world complexities, which could inform decisions regarding local prevention programs or policies. Aims. To develop a model of cigarette and e-cigarette use that combines current research on tobacco use and incorporates real-world geographic and demographic data. Method. We used a platform for developing agent-based models with demographic information representative of the population in Pennsylvania. We developed three models of cigarette and e-cigarette use. The primary outcome for each was the total number of users for cigarette, e-cigarette, and total nicotine. The first model applied current cigarette and e-cigarette data, the second tested the effect of implementing a program of e-cigarette education and policies, and the third considered a social contagion factor, where local schools functioned as a transmission vector. Results. The baseline and social contagion models found an overall decline in cigarette use but an increase in e-cigarette and total nicotine use. The education/policies model had declines in all categories. Sensitivity analysis suggested the importance of nuanced e-cigarette/cigarette interactions when modeling tobacco use. Discussion. Public health campaigns that focus on reducing youth e-cigarette usage can have a large effect. Social contagion should be strongly considered when studying e-cigarette spread. Conclusion. Targeted public health campaigns focused on reducing school prevalence of e-cigarette use may be particularly valuable.

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.

Emotional support from social media and face-to-face relationships: Associations with depression risk among young adults.

BACKGROUND: Emotional support is highly protective against poor mental health. Though several measures of emotional support exist, none specifically addresses social media (SM) as a source of emotional support. Therefore, the objectives of this study were to determine if SM-based emotional support is an extension of or distinct construct from face-to-face (FTF) emotional support and to assess the independent associations between each domain of emotional support and depression risk among U.S. young adults. METHODS: In March 2018, we surveyed 2408 18-30 year olds. We assessed perceived FTF emotional support with the brief PROMIS emotional support scale and perceived SM-based emotional support using a new four-item measure. Depression risk was assessed using the PHQ-9. We performed factor analysis (FA) to determine the underlying factor structure of all items and to develop composite scales. Multivariable logistic regression was used to examine the independent association between each resulting emotional support scale and depression risk. RESULTS: FA revealed two distinct constructs. FTF emotional support was associated with 43% lower odds of depression per 1-unit increase on the 5-point scale (AOR = 0.57, 95% CI = 0.52-0.63). However, SM-based emotional support was significantly associated with 20% greater odds of depression per 1-unit increase on the 5-point scale (AOR = 1.20, 95% CI = 1.09-1.32). LIMITATIONS: This study utilized a cross-sectional design and self-report data. CONCLUSIONS: While FTF emotional support was associated with slightly lower odds of depression, SM-based emotional support was associated with slightly greater odds of depression. It may be valuable for clinicians treating individuals with depression to ask about sources of emotional support.

"I Don't Feel Like the Odd One": Utilizing Content Analysis to Compare the Effects of Social Media Use on Well-Being Among Sexual Minority and Nonminority US Young Adults.

PURPOSE: Although there is evidence of associations between social media (SM) use and mental well-being among the general population, these associations among lesbian, gay, and bisexual (LGB) persons are poorly understood. This study compared the influence of SM experiences on mental well-being between LGB and non-LGB persons. DESIGN AND SETTING: Online cross-sectional survey. PARTICIPANTS: National sample of 2408 US adults aged 18 to 30 years. METHOD: We asked participants to provide examples of when SM affected their well-being separately in good and bad ways. We coded, summed, and used rate ratios (RRs) to compare responses of LGB and non-LGB individuals. Thematically similar codes were described and grouped into categories. RESULTS: Most responses described positive SM effects. However, of 6 codes that were significantly more frequent among LGB respondents, only social capital (RR = 1.58, 95% confidence interval [CI], 1.17-2.12) described a positive effect. Five codes described negative effects of SM for LGB users: negative emotional contagion (RR = 1.28, 95% CI, 1.04-1.58), comparison with others (RR = 1.28, 95% CI, 1.01-1.62), real-life repercussions (RR = 1.86, 95% CI, 1.18-2.94), envy (RR = 2.49, 95% CI, 1.48-4.19), and need for profile management (RR = 2.32, 95% CI, 1.07-5.03). CONCLUSION: These findings suggest that, for LGB persons, gaining social capital from SM is valuable for establishing and maintaining connections. Increased negative SM experiences may pose a risk for the mental well-being of LGB individuals.

I wake up and hit the JUUL: Analyzing Twitter for JUUL nicotine effects and dependence.

BACKGROUND: JUUL-a novel electronic nicotine delivery system (ENDS)-comprises most of the ENDS market share. Additionally, JUUL has a high nicotine content and utilizes a patented nicotine salt formulation aimed to speed absorption. Many JUUL users are not aware of the nicotine content and therefore may not be expecting acute nicotine effects or potential for dependence. This study sought to analyze Twitter messages ("tweets") regarding nicotine, symptoms of dependence, and withdrawal related to JUUL use. METHODS: Data were collected from Twitter's Filtered Streams interface 4/11-6/16/2018 by retrieving tweets matching the terms "juul," "juuls," and "juuling" that also used words consistent with nicotine effects, symptoms of dependence, and withdrawal. A random 5% subsample (n = 1986) was coded by 2 independent coders. Cohen's κ for inter-rater reliability ranged 0.62-1.00 for all coded variables. Tweets were assessed using a qualitative content analysis approach. RESULTS: A total of 335 tweets mentioned dependence-related themes, including use upon waking and compulsion to use. A total of 189 tweets mentioned themes related to nicotine, with almost 15% of these tweets describing physical effects. Additionally, 42 tweets mentioned themes related to quitting JUUL and/or withdrawal from JUUL. DISCUSSION: This qualitative analysis suggests that users of JUUL are experiencing symptoms of nicotine exposure and dependence. Considering the high nicotine content of JUUL and the rising popularity among young people, more research around initiation of and dependence on JUUL, as well as the impact of recent FDA policy changes, should be conducted.

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.

Positive and Negative Experiences on Social Media and Perceived Social Isolation.

PURPOSE: To examine the association between positive and negative experiences on social media (SM) and perceived social isolation (PSI). DESIGN: Cross-sectional survey. SETTING: One large mid-Atlantic University. PARTICIPANTS: A total of 1178 students aged 18 to 30 were recruited in August 2016. MEASURES: Participants completed an online survey assessing SM use and PSI. We assessed positive and negative experiences on SM by directly asking participants to estimate what percentage of their SM experiences involved positive and negative experiences, respectively. Social isolation was measured using the established Patient-Reported Outcomes Measures Information System scale. ANALYSIS: We used multivariable logistic regression to assess associations between both positive and negative experiences on SM and PSI. Primary models controlled for sex, age, race/ethnicity, educational status, relationship status, and living situation. RESULTS: Participants had an average age of 20.9 (standard deviation = 2.9) and were 62% female. Just over one-quarter (28%) were nonwhite. After controlling for all sociodemographic covariates, each 10% increase in positive experiences was not significantly associated with social isolation (adjusted odds ratio [AOR] = 0.97; 95% confidence interval [CI]: 0.93-1.005). However, each 10% increase in negative experiences was associated with a 13% increase in odds of PSI (AOR = 1.13; 95% CI: 1.05-1.21). CONCLUSION: Having positive experiences on SM is not associated with lower social isolation, whereas having negative experiences on SM is associated with higher social isolation. These findings are consistent with the concept of negativity bias, which suggests that humans tend to give greater weight to negative entities compared with positive ones.

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.

JUUL: Spreading Online and Offline.

PURPOSE: The increasing popularity of the JUUL electronic nicotine delivery system among youth poses several potential public health concerns. Social media can be used to better understand the spread of information related to JUUL. This study examined whether adolescents (age < 18) are following JUUL's official Twitter account and subsequently sharing (retweeting) JUUL's posts to their followers. We also assessed various patterns in which adolescents share information on JUUL with each other. METHODS: We collected 3,239 tweets from JUUL's official Twitter account (@JUULVapor) for one full year from February 2017 to January 2018. These tweets were shared by Twitter users to their followers 1,124times by 721 unique users. Users were determined to be either adolescent (age <18) or adult (≥18) based on a systematic procedure involving double coding. We used social network analysis to explore the relationships between users retweeting JUUL. RESULTS: One-quarter (25%) of users were determined to be adolescents. Social network analysis revealed a maximum path length of 4 and a positive assortativity (r = .29). There were 25 (9%) instances of an adolescent retweeting content from another adolescent, 35 (12%) of an adolescent retweeting from an adult, and 30 (11%) of an adult retweeting from an adolescent. CONCLUSIONS: JUUL's official Twitter account is being followed-and its messages are being shared-by adolescents. Rigorous policies and prevention programs are needed to curb adolescent exposure to JUUL content and discussions online.

Passive and Active Social Media Use and Depressive Symptoms Among United States Adults.

Social media allows users to explore self-identity and express emotions or thoughts. Research looking into the association between social media use (SMU) and mental health outcomes, such as anxiety or depressive symptoms, have produced mixed findings. These contradictions may best be addressed by examining different patterns of SMU as they relate to depressive symptomatology. We sought to assess the independent associations between active versus passive SMU and depressive symptoms. For this, we conducted an online survey of adults 18-49 of age. Depressive symptoms were measured using the Patient-Reported Outcomes Measurement Information System brief depression scale. We measured active and passive SMU with previously developed items. Factor analysis was used to explore the underlying factor structure. Then, we used ordered logistic regression to assess associations between both passive and active SMU and depressive symptoms while controlling for sociodemographic covariates. Complete data were received from 702 participants. Active and passive SMU items loaded on separate factors. In multivariable analyses that controlled for all covariates, each one-point increase in passive SMU was associated with a 33 percent increase in depressive symptoms (adjusted odds ratio [AOR] = 1.33, 95 percent confidence interval [CI] = 1.17-1.51). However, in the same multivariable model, each one-point increase in active SMU was associated with a 15 percent decrease in depressive symptoms (AOR = 0.85, 95 percent CI = 0.75-0.96). To inform interventions, future research should determine directionality of these associations and investigate related factors.