"Let's get back to normal": emotions mediate the effects of persuasive messages on willingness to vaccinate for COVID-19.

Objective: We examined the effectiveness of three different messages for persuading individuals to get vaccinated against COVID-19, and the role that emotions play in persuasion. Methods: Four hundred-thirty-six participants reported their concern about the COVID-19 pandemic and confidence/hesitancy toward vaccines. Participants were randomly assigned to one of three text conditions: (1) self-interest: a persuasive message that focused on how much of a "serious threat COVID-19 is to you," and to get vaccinated to "protect yourself"; (2) self-interest + altruistic: a persuasive message that focused on the "threat to you and your community" and to get vaccinated to "protect you and your loved ones"; (3) self-interest + altruistic + normal: a persuasive message that included (2) but added "This is the only way we can get back to a normal life."; and, (4) a baseline control: no text. After reading, participants reported their emotions toward COVID-19 vaccines and their willingness to get vaccinated. Results: Individuals in the self-interest + altruistic + normal condition were more willing to get vaccinated compared to the control condition and self-interest + altruistic condition. However, there were no differences in willingness between the self-interest + altruistic + normal condition and the self-interest condition. Moreover, emotions mediated relations between vaccine confidence/hesitancy and willingness. Conclusion: A message that focuses on "getting back to normal" can achieve important public health action by increasing vaccine uptake to protect the population. Future work is needed across multiple countries and contexts (i.e., non-pandemic) to assess message effectiveness.

Characterizing participants who respond to text, email, phone calls, or postcards in a SARS-CoV-2 prevalence study.

INTRODUCTION: Multiple modalities and frequencies of contact are needed to maximize recruitment in many public health surveys. The purpose of this analysis is to characterize respondents to a statewide SARS-CoV-2 testing study whose participation followed either postcard, phone outreach or electronic means of invitation. In addition, we examine how participant characteristics differ based upon the number of contacts needed to elicit participation. METHODS: This is a cross-sectional analysis of survey data collected from participants who were randomly selected to represent Indiana residents and were invited to be tested for Covid-19 in April 2020. Participants received invitations via postcard, text/emails, and/or robocalls/texts based upon available contact information. The modality, and frequency of contacts, that prompted participation was determined by when the notification was sent and when the participant responded and subsequently registered to participate in the study. Chi square analyses were used to determine differences between groups and significant findings were analyzed using multinomial logistic regression. RESULTS: Respondents included 3,658 individuals and were stratified by postcards (7.9%), text/emails (26.5%), and robocalls/text (65.7%) with 19.7% registering after 1 contact, 47.9% after 2 contacts, and 32.4% after 3 contacts encouraging participation. Females made up 54.6% of the sample and responded at a higher rate for postcards (8.2% vs. 7.5%) and text/emails (28.1 vs. 24.6%) as compared to males (χ2 = 7.43, p = 0.025). Compared to males, females responded at a higher percentage after 1 contact (21.4 vs. 17.9%, χ2 = 7.6, p = 0.023). Those over 60 years responded most often after 2 contacts (χ2 = 27.5, p < 0.001) when compared to others at younger age groups. In regression analysis, participant sex (p = 0.036) age (p = 0.005), educational attainment (p = < 0.0001), and being motivated by "free testing" (p = 0.036) were correlated with participation in the prevalence study. DISCUSSION: Researchers should be aware that the modality of contact as well as the number of prompts used could influence differential participation in public health studies. Our findings can inform researchers developing studies that rely on selective participation by study subjects. We explore how to increase participation within targeted demographic groups using specific modalities and examining frequency of contact.

Association Between Billing Patient Portal Messages as e-Visits and Patient Messaging Volume.

This study evaluates the adoption of clinician billing for patient portal messages as e-visits, prompted by significant increases in patient messaging after the onset of the COVID-19 pandemic.

Tailored Mobile Messaging Intervention for Waterpipe Tobacco Cessation in Young Adults: A Randomized Trial.

Objectives. To test a tailored mobile health (i.e., mHealth) intervention for waterpipe tobacco cessation in young adults. Methods. From 2018 to 2020 at 2 US sites, we conducted a randomized trial with 349 waterpipe tobacco smokers aged 18 to 30 years randomized to control (no intervention), untailored, or tailored intervention arms. Intervention arms received a 6-week mHealth intervention conveying risks of waterpipe tobacco through text and images and strategies to enhance motivation and support quitting. The tailored intervention was personalized to baseline measures and intervention text message responses. Risk appraisals, motivation to quit, waterpipe smoking frequency, and cessation were assessed at 6 weeks, 3 months, and 6 months. Results. At 6 months, cessation was higher in the tailored (49%) than the control arm (29%; odds ratio = 2.4; 95% confidence interval = 1.3, 4.2) and smoking frequency was lower in the tailored (mean = 3.5 days) than the control arm (mean = 4.3 days; P = .006). At interim follow-ups, significant differences in other outcomes favored the tailored intervention. Conclusions. Tailored mobile messaging can help young adult waterpipe tobacco smokers quit. This scalable intervention is poised for population implementation.

Improving routine immunization data quality using daily short message system reporting platform: An experience from Nasarawa state, Nigeria.

Routine immunization (RI) delivery was declared a public health concern in Nigeria in 2017 because of persistently low immunization coverage rates reported in independent surveys. However, administrative coverage rates remain high, suggesting serious data quality issues. We posit that a shorter timespan between service provision and data reporting can improve the monitoring of RI data, and developed a short message system (SMS) text reporting strategy to generate daily RI data points from health facilities (HFs). The goal was to assess whether daily data collection produces complete, reliable and internally consistent data points. The SMS reporting platform was piloted between December 2017 and April 2018 in two Local Government Areas (LGAs, equivalent to districts) of Nasarawa state, Nigeria. The 145 healthcare workers from 55 HFs received one mobile phone and pre-configured SIM card, and were trained to send data through predefined codes. Healthcare workers compiled the data after each vaccination session and transmitted them via SMS. We analyzed completeness, number of weekly sessions, and supportive supervision conducted. During the pilot phase, we received data from 85% (n = 47) of the 55 HFs. We expected 66 fixed-post sessions and 30 outreach sessions per week, but received data for 33 fixed-post and 8 outreach weekly session on average. More HFs reported on Tuesdays compared to other days of the week. When assessing internal consistency, we observed that the reported number of children vaccinated was sometimes higher than the number of doses available from opening a given number of vaccine vials. When found, this discrepancy was noted for all antigens during fixed-post and outreach vaccination sessions. Despite these initial discrepancies, transmitting RI data sessions via texting is feasible and can provide real-time updates to the performance of the RI services at the HF level.

Mobile-Mediated Communication in Romantic Relationships: The Effects of Communication Indicators and Love Attitude on Relationship Quality.

Whether mobile phones benefit or sabotage close relationships has been a persistent subject of debate in media and communication studies. Because previous studies have demonstrated contrasting findings, further studies on this topic are required. Based on media richness theory and social penetration theory, this study investigated the direct and indirect associations between mobile communication and relationship quality (i.e., depth, support, and conflict) in romantic relationships. A survey of 1,000 university students in China revealed that relationship depth was positively predicted by mobile phone calls and negatively predicted by mobile short messages. Mobile WeChat had dialectical effects, as it reinforced relationship depth and support, but increased conflict. Regarding indirect effects, communication quality online positively mediated the effects of mobile phone calls on relationship quality and negatively mediated the effects of mobile short messages and Weibo on relationship quality. Moreover, passionate love attitudes (PLAs) and gender negatively moderated the effects of mobile phone calls on relationship depth, indicating that females and individuals who had stronger PLAs had lower relationship quality when they used mobile phone calls to interact with their romantic partners. The moderating effects of PLA were extended to the indirect relationship between phone calls and relationship quality through communication quality. Overall, this study developed a typology to examine mobile relational communication by integrating the quantity (i.e., mobile use frequencies) and quality of mobile communication, as well as personal attitudes in close relationships.

Local information sources received the most attention from Puerto Ricans during the aftermath of Hurricane Maria.

In September 2017, Hurricane Maria made landfall across the Caribbean region as a category 4 storm. In the aftermath, many residents of Puerto Rico were without power or clean running water for nearly a year. Using both English and Spanish tweets from September 16 to October 15 2017, we investigate discussion of Maria both on and off the island, constructing a proxy for the temporal network of communication between victims of the hurricane and others. We use information theoretic tools to compare the lexical divergence of different subgroups within the network. Lastly, we quantify temporal changes in user prominence throughout the event. We find at the global level that Spanish tweets more often contained messages of hope and a focus on those helping. At the local level, we find that information propagating among Puerto Ricans most often originated from sources local to the island, such as journalists and politicians. Critically, content from these accounts overshadows content from celebrities, global news networks, and the like for the large majority of the time period studied. Our findings reveal insight into ways social media campaigns could be deployed to disseminate relief information during similar events in the future.

SMS messaging to improve retention and viral suppression in prevention of mother-to-child HIV transmission (PMTCT) programs in Kenya: A 3-arm randomized clinical trial.

BACKGROUND: Pregnant and postpartum women living with HIV (WLWH) need support for HIV and maternal child health (MCH) care, which could be provided using short message service (SMS). METHODS AND FINDINGS: We compared 2-way (interactive) and 1-way SMS messaging to no SMS in a 3-arm randomized trial in 6 MCH clinics in Kenya. Messages were developed using the Health Belief Model and Social Cognitive Theory; HIV messages were integrated into an existing MCH SMS platform. Intervention participants received visit reminders and prespecified weekly SMS on antiretroviral therapy (ART) adherence and MCH, tailored to their characteristics and timing. Two-way participants could message nurses as needed. Clinic attendance, viral load (VL), and infant HIV results were abstracted from program records. Primary outcomes were viral nonsuppression (VL ≥1,000 c/ml), on-time clinic attendance, loss to follow-up from clinical care, and infant HIV-free survival. Among 824 pregnant women randomized between November 2015 and May 2017, median age was 27 years, gestational age was 24.3 weeks, and time since initiation of ART was 1.0 year. During follow-up to 2 years postpartum, 9.8% of 3,150 VL assessments and 19.6% of women were ever nonsuppressed, with no significant difference in 1-way versus control (11.2% versus 9.6%, adjusted risk ratio (aRR) 1.02 [95% confidence interval (CI) 0.67 to 1.54], p = 0.94) or 2-way versus control (8.5% versus 9.6%, aRR 0.80 [95% CI 0.52 to 1.23], p = 0.31). Median ART adherence and incident ART resistance did not significantly differ by arm. Overall, 88.9% (95% CI 76.5 to 95.7) of visits were on time, with no significant differences between arms (88.2% in control versus 88.6% in 1-way and 88.8% in 2-way). Incidence of infant HIV or death was 3.01/100 person-years (py), with no significant difference between arms; risk of infant HIV infection was 0.94%. Time to postpartum contraception was significantly shorter in the 2-way arm than control. Study limitations include limited ability to detect improvement due to high viral suppression and visit attendance and imperfect synchronization of SMS reminders to clinic visits. CONCLUSIONS: Integrated HIV/MCH messaging did not improve HIV outcomes but was associated with improved initiation of postpartum contraception. In programs where most women are virally suppressed, targeted SMS informed by VL data may improve effectiveness. Rigorous evaluation remains important to optimize mobile health (mHealth) interventions. TRIAL REGISTRATION: ClinicalTrials.gov number NCT02400671.

WhatsApp-propriate? A retrospective content analysis of WhatsApp use and potential breaches in confidentiality among a team of doctors at a district hospital, South Africa.

BACKGROUND: There has been a steady increase in the use of electronic media and instant messaging among healthcare professionals, where it has been almost universally adopted in the workplace. The use of WhatsApp and its perceived benefits in healthcare have been extensively studied; however, there are concerns regarding the potential for ethical breaches in confidentiality through shared electronic patient information. OBJECTIVES: To identify the usage characteristics and incidence of shared patient information with WhatsApp use in a team of medical doctors in an unobserved and unregulated setting. METHODS: We conducted a retrospective cross-sectional content analysis of WhatsApp messages (n=3 340) among a team of 20 doctors in a South African district hospital over 6 months. All messages found within this time period were allocated unique identifiers. The text and image messages were thematically grouped into four categories, i.e. clinical care, resource allocation, social and administrative. Messages that contained patient-identifying information were included in the analysis. RESULTS: Of a total of 3 340 messages sent, 220 (6.6%) contained patient-identifying information. Of these, 109 (3.3%) contained non-anonymised patient information, while in 111 (3.3%) messages, the information was anonymised. The likelihood of sharing patient identifiers was proportionally much higher in shared images (odds ratio (OR) 5.1; 95% confidence interval (CI) 3.2 - 8.2; p<0.0001) compared with text messages, and in messages that related to clinical care (OR 9.3; 95% CI 2.2 - 38.8; p=0.0023) compared with those sent for resource allocation, and social or administrative purposes. CONCLUSIONS: Non-anonymised patient identifiers were found in 3.3% of messages, constituting the potential for breaching patient confidentiality. While WhatsApp groups have significant utility in co-ordinating aspects of clinical care, resource allocation, as well as social and administrative functions, the safe use of WhatsApp should be promoted to ensure that patient confidentiality is maintained.

Mobile phone use intention while driving among public service vehicle drivers: Magnitude and its social and cognitive determinants.

Despite its risks for accident and illegality, little is known about the magnitude and associated social and cognitive factors that motivate drivers to use mobile phone while driving. The present study, guided by theory of planned behavior, aimed at describing the magnitude of mobile use while driving and examining the role of attitudes, subjective norms, perceived behavioral control, and risk perceptions in predicting drivers' intentions to use mobile phone while driving. A total of 155 public service vehicle drivers, who were selected from Debre Markos Town and its vehicle terminal took part in the study. To select study participants, systematic random sampling technique was employed. The instrument used to collect data was self-report questionnaire. The results indicated that more than two-third (69%) of the participants used their mobile phone while driving over the past week. Hierarchical regression analysis displayed that perceived behavioral control, risk perception, and attitude were found to be the most significant social and cognitive predictors of public service vehicle drivers' intention to use mobile phone while driving, but not age and subjective norm variables. So as to reduce drivers' intention to use mobile phone while driving, intervention strategies should focus on enhancing their confidence to avoid this behavior; alerting drivers to the traffic control regulation and the dangers of using mobile phones while driving.

Factors Associated With Opting Out of Automated Text and Telephone Messages Among Adult Members of an Integrated Health Care System.

Importance: Health care systems deliver automated text or telephone messages to remind patients of appointments and to provide health information. Patients who receive multiple messages may demonstrate message fatigue by opting out of future messages. Objective: To assess whether the volume of automated text or interactive voice response (IVR) telephone messages is associated with the likelihood of patients requesting to opt out of future messages. Design, Setting, and Participants: This retrospective cohort study was conducted at Kaiser Permanente Colorado (KPCO), an integrated health care system. All adult members who received 1 or more automated text or IVR message between October 1, 2018, and September 30, 2019, were included. Exposures: Receipt of automated text or IVR messages. Main Outcomes and Measures: Message volume and opt-out rates obtained from messaging systems over 1 year. Results: Of the 428 242 adults included in this study, 59.7% were women, and 66.5% were White; the mean (SD) age was 52.3 (17.7) years. During the study period, 84.1% received 1 or more text messages (median, 4 messages; interquartile range, 2-8 messages) and 67.8% received 1 or more IVR messages (median, 3 messages; interquartile range, 1-6 messages). A total of 8929 individuals (2.5%) opted out of text messages, and 4392 (1.5%) opted out of IVR messages. In multivariable analyses, individuals who received 10 to 19.9 or 20 or more text messages per year had higher opt-out rates for text messages compared with those who received fewer than 2 messages per year (adjusted odds ratio [aOR]: 10-19.9 vs <2 messages, 1.27 [95% CI, 1.17-1.38]; ≥20 vs <2 messages, 3.58 [95% CI, 3.28-3.91]), whereas opt-out rates increased progressively in association with IVR message volume, with the highest rates among individuals who received 10.0 to 19.9 messages (aOR, 11.11; 95% CI, 9.43-13.08) or 20.0 messages or more (aOR, 49.84; 95% CI, 42.33-58.70). Individuals opting out of text messages were more likely to opt out of IVR messages (aOR, 4.07; 95% CI, 3.65-4.55), and those opting out of IVR messages were more likely to opt out of text messages (aOR, 5.92; 95% CI, 5.29-6.61). Conclusions and Relevance: In this cohort study among adult members of an integrated health care system, requests to discontinue messages were associated with greater message volume. These findings suggest that, to preserve the benefits of automated outreach, health care systems should use these messages judiciously to reduce message fatigue.

Mothers intention and preference to use mobile phone text message reminders for child vaccination in Northwest Ethiopia.

OBJECTIVES: With the unprecedented penetration of mobile devices in the developing world, mHealth applications are being leveraged for different health domains. Among the different factors that affect the use of mHealth interventions is the intention and preference of end-users to use the system. This study aimed to assess mother's intention and preference to use text message reminders for vaccination in Ethiopia. METHODS: A cross-sectional study was conducted among 460 mothers selected through a systematic random sampling technique. Initially, descriptive statistics were computed. Binary logistic regression analysis was also used to assess factors associated with the outcome variable. RESULTS: In this study, of the 456 mothers included for analysis, 360 (78.9%) of mothers have intention to use text message reminders for vaccination. Of these, 270 (75%) wanted to receive the reminders a day before the vaccination due date. Mothers aged 35 years or more (AOR=0.35; 95% CI: 0.15 to 0.83), secondary education and above (AOR=4.43; 95% CI: 2.05 to 9.58), duration of mobile phone use (AOR=3.63; 95% CI: 1.66 to 7.94), perceived usefulness (AOR=6.37; 95% CI: 3.13 to 12.98) and perceived ease of use (AOR=3.85; 95% CI: 2.06 to 7.18) were predictors of intention to use text messages for vaccination. CONCLUSION: In conclusion, majority of mothers have the intention to use text message reminders for child vaccination. Mother's age, education, duration of mobile phone use, perceived usefulness and perceived ease of use were associated with intention of mothers to use text messages for vaccination. Considering these predictors and user's preferences before developing and testing text message reminder systems is recommended.

Sexual health interventions delivered to participants by mobile technology: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: The use of mobile technologies to prevent STIs is recognised as a promising approach worldwide; however, evidence has been inconclusive, and the field has developed rapidly. With about 1 million new STIs a day globally, up-to-date evidence is urgently needed. OBJECTIVE: To assess the effectiveness of mobile health interventions delivered to participants for preventing STIs and promoting preventive behaviour. METHODS: We searched seven databases and reference lists of 49 related reviews (January 1990-February 2020) and contacted experts in the field. We included randomised controlled trials of mobile interventions delivered to adolescents and adults to prevent sexual transmission of STIs. We conducted meta-analyses and assessed risk of bias and certainty of evidence following Cochrane guidance. RESULTS: After double screening 6683 records, we included 22 trials into the systematic review and 20 into meta-analyses; 18 trials used text messages, 3 used smartphone applications and 1 used Facebook messages as delivery modes. The certainty of evidence regarding intervention effects on STI/HIV occurrence and adverse events was low or very low. There was moderate certainty of evidence that in the short/medium-term text messaging interventions had little or no effect on condom use (standardised mean differences (SMD) 0.02, 95% CI -0.09 to 0.14, nine trials), but increased STI/HIV testing (OR 1.83, 95% CI 1.41 to 2.36, seven trials), although not if the standard-of-care control already contained an active text messaging component (OR 1.00, 95% CI 0.68 to 1.47, two trials). Smartphone application messages also increased STI/HIV testing (risk ratio 1.40, 95% CI 1.22 to 1.60, subgroup analysis, two trials). The effects on other outcomes or of social media or blended interventions is uncertain due to low or very low certainty evidence. CONCLUSIONS: Text messaging interventions probably increase STI/HIV testing but not condom use in the short/medium term. Ongoing trials will report the effects on biological and other outcomes.

Examining the Correlation Between Depression and Social Behavior on Smartphones Through Usage Metadata: Empirical Study.

BACKGROUND: As smartphone has been widely used, understanding how depression correlates with social behavior on smartphones can be beneficial for early diagnosis of depression. An enormous amount of research relied on self-report questionnaires, which is not objective. Only recently the increased availability of rich data about human behavior in digital space has provided new perspectives for the investigation of individual differences. OBJECTIVE: The objective of this study was to explore depressed Chinese individuals' social behavior in digital space through metadata collected via smartphones. METHODS: A total of 120 participants were recruited to carry a smartphone with a metadata collection app (MobileSens). At the end of metadata collection, they were instructed to complete the Center for Epidemiological Studies-Depression Scale (CES-D). We then separated participants into nondepressed and depressed groups based on their scores on CES-D. From the metadata of smartphone usage, we extracted 44 features, including traditional social behaviors such as making calls and sending SMS text messages, and the usage of social apps (eg, WeChat and Sina Weibo, 2 popular social apps in China). The 2-way ANOVA (nondepressed vs depressed × male vs female) and multiple logistic regression analysis were conducted to investigate differences in social behaviors on smartphones among users. RESULTS: The results found depressed users received less calls from contacts (all day: F1,116=3.995, P=.048, η2=0.033; afternoon: F1,116=5.278, P=.02, η2=0.044), and used social apps more frequently (all day: F1,116=6.801, P=.01, η2=0.055; evening: F1,116=6.902, P=.01, η2=0.056) than nondepressed ones. In the depressed group, females used Weibo more frequently than males (all day: F1,116=11.744, P=.001, η2=0.092; morning: F1,116=9.105, P=.003, η2=0.073; afternoon: F1,116=14.224, P<.001, η2=0.109; evening: F1,116=9.052, P=.003, η2=0.072). Moreover, usage of social apps in the evening emerged as a predictor of depressive symptoms for all participants (odds ratio [OR] 1.007, 95% CI 1.001-1.013; P=.02) and male (OR 1.013, 95% CI 1.003-1.022; P=.01), and usage of Weibo in the morning emerged as a predictor for female (OR 1.183, 95% CI 1.015-1.378; P=.03). CONCLUSIONS: This paper finds that there exists a certain correlation between depression and social behavior on smartphones. The result may be useful to improve social interaction for depressed individuals in the daily lives and may be insightful for early diagnosis of depression.

Look Who's Talking: Mediums of Contact Among Mid-to Later-Life Siblings.

Adult siblings maintain contact and remain close to one another. The current study used participants recruited via Amazon Mechanical Turk (n = 491) to conduct regression analyses examining five methods of contact (in person, telephone, email, texting, and social media) predicting sibling closeness and conflict. Further, two- and three-way interactions assessed the role of sibling dyad composition (e.g., women with a sister and women with a brother). Results suggested that as contact in person, through social media, the telephone, or email increased, sibling closeness increased, while increased contact through email indicated less conflict. Assessing sibling dyad composition suggested as telephone contact increased, sibling closeness increased for all sibling dyads, especially for women with a sister compared to men with a brother. In-person and texting contacts were beneficial for women with a brother. Even in mid- to later-life, siblings connect through synchronous and asynchronous mediums, and this contact appears beneficial for sisters.

Prevalence of Vaping and Behavioral Associations of Vaping Among a Community of College Students in the United States.

We investigated the prevalence of vaping among college students in South-central Appalachia in the United States and explored factors which were associated with and could predict vaping among the college students. A sample of 498 enrolled students voluntarily completed a self-report REDCap health survey questionnaire in 2018. Outcome variable was use of electronic cigarettes categorized as yes/no. Independent variables included risky behaviors such as texting or emailing while driving, riding in a car with someone who had been drinking, history of protected and unprotected sexual intercourse, age at first intercourse, and type of contraceptive used. Covariates were age, gender, ethnicity/race and high school location. The first category was used as reference. Binary logistic regression was used to identify factors associated with and predicting vaping. Mean age of participants was 20.93(± 8.26), 62.9% were female, a majority (76.5%) were non-Hispanic White, and 43.2% reported vaping at some point in their lives. Initial univariate analysis showed gender (p < 0.0001), seat belt usage (p = 0.002), texting or emailing while driving (p = 0.002), riding in a car with someone who had been drinking (p = 0.001), history of sexual intercourse (p < 0.001), coitarche (p = 0.026), use of birth control pills and withdrawal method were associated with vaping. Adjusting for co-variates, gender (p < 0.002), county of high school (p < 0.009) and texting and e-mailing while driving (0.05), seat belt usage (0.04) remained significant. Vaping was highly prevalent (43.2%) among our participants. Gender, location of high school, texting/emailing while driving and seat belt usage are predictors of vaping among these students.

Sexting: What's Law Got to Do with It?

Sexting, the phenomenon commonly defined as the sending, receiving, and forwarding of nude, semi-nude, or sexually explicit images within digital forms of communication, is a practice that has received heightened public attention. While many scholars consider consensual sexting to be innocuous and a normative part of development, the potential for youth engagement to result in instances of cyberbullying, revenge porn, and child pornography has ignited public fear and anxiety, resulting in a messy patchwork of legal responses that often yield disproportionately punitive responses. Upon exploring the legal parameters surrounding youth sexting in Canada, this paper will argue that while the logic of the current legislation in protecting youth from harm is appropriate, its method of implementation is misguided. The legal reform advocated here calls upon child pornography and online harm laws only when the case involves an adult perpetrator, and suggests a more nuanced, graduated juvenile scheme when the behavior involves youth sexting participants.

Caregivers' Perceptions and Responses to a New Norm: The Missing Link in Addressing Adolescent Sexting Behaviors in the U.S.

Youth sharing of self- or peer-produced sexual content via electronic communications, dubbed by the media as "sexting" (i.e., sexting behaviors), has generated concern among a wide variety of adult stakeholders in the U.S. Experts recognize the need to integrate perspectives and knowledge about adolescents' sexting behaviors from individuals who interact with adolescents (e.g., their caregivers) to inform the development of prevention policy and practice. The present study fills this gap by interviewing 10 separate groups of caregivers in three different states, with the sole focus on adolescent sexting behaviors. Results indicated seven themes: (1) characteristics of adolescent sexting behaviors, (2) influences on sexting behaviors, (3) communication about sexting behaviors, (4) gender and sexting behaviors, (5) sociohistorical conditions and sexting behaviors, (6) consequences of sexting behaviors, and (7) ways to address sexting behaviors; multiple themes emerged within each of the seven parent codes. Findings inform the need to integrate adolescent sexting behaviors into comprehensive sexual education curricula and to develop educational content on adolescent sexting behaviors for adolescents and caregivers in online and printable handout formats. Clearly defining sexting and norms around sexting are of particular importance in such educational materials.

Asynchronous video messaging promotes family involvement and mitigates separation in neonatal care.

OBJECTIVE: To evaluate the parent and staff experience of a secure video messaging service as a component of neonatal care. DESIGN: Multicentre evaluation incorporating quantitative and qualitative items. SETTING: Level II and level III UK neonatal units. POPULATION: Families of neonatal inpatients and neonatal staff. INTERVENTION: Use of a secure, cloud-based asynchronous video messaging service to send short messages from neonatal staff to families. Evaluation undertaken July-November 2019. MAIN OUTCOME MEASURES: Parental experience, including anxiety, involvement in care, relationships between parents and staff, and breastmilk expression. RESULTS: In pre-implementation surveys (n=41), families reported high levels of stress and anxiety and were receptive to use of the service. In post-implementation surveys (n=42), 88% perceived a benefit of the service on their neonatal experience. Families rated a positive impact of the service on anxiety, sleep, family involvement and relationships with staff. Qualitative responses indicated enhanced emotional closeness, increased involvement in care and a positive effect on breastmilk expression. Seventy-seven post-implementation staff surveys were also collected. Staff rated the service as easy to use, with minimal impact on workload. Seventy-one percent (n=55) felt the service had a positive impact on relationships with families. Staff identified the need to manage parental expectations in relation to the number of videos that could be sent. CONCLUSIONS: Asynchronous video messaging improves parental experience, emotional closeness to their baby and builds supportive relationships between families and staff. Asynchronous video supports models of family integrated care and can mitigate family separation, which could be particularly relevant during the COVID-19 pandemic.