Potential application of conversational agents in HIV testing uptake among high-risk populations.

Human Immunodeficiency Virus (HIV) continues to be a significant public health problem, with ~1.2 million Americans living with HIV and ~14% unaware of their infection. The Centers for Disease Control and Prevention recommends that patients 13 to 64 years of age get screened for HIV at least once, and those with higher risk profiles screen at least annually. Unfortunately, screening rates are below recommendations for high-risk populations, leading to problems of delayed diagnosis. Novel technologies have been applied in HIV research to increase prevention, testing and treatment. Conversational agents, with potential for integrating artificial intelligence and natural language processing, may offer an opportunity to improve outreach to these high-risk populations. The feasibility, accessibility and acceptance of using conversational agents for HIV testing outreach is important to evaluate, especially amidst a global coronavirus disease 2019 pandemic when clinical services have been drastically affected. This viewpoint explores the application of a conversational agent in increasing HIV testing among high-risk populations.

Role of Peer Coaches in Digital Interventions for MOUD Initiation and Maintenance.

Millions of Americans suffer from opioid use disorder (OUD) in the United States, resulting in thousands of deaths. The ongoing opioid crisis necessitates novel approaches to reduce the morbidity and mortality associated with misusing opioids. Studies using peer support models show success in engaging persons living with OUD in initiating treatment and decreasing relapse. Although most studies have focused on patients in clinical settings, community studies integrating peer community leaders also show promise. This viewpoint paper explores the use of peer coaches in online interventions in the community setting.

A Qualitative Exploration of the Potential Role of Using Online Social Media Support Communities to Increase Initiation of Medications for Opioid Use Disorder (MOUD).

Objectives: This study sought to explore the potential role of peer-led online communities to increase use of medications for opioid use disorder. Methods: From January through March 2020, participants with opioid use disorder and their family members/friends were recruited from paid Facebook ads; public health key stakeholders were recruited from referrals from the study team and opioid experts. Thirty participants from California were interviewed; 23 persons reporting opioid misuse, 3 family members/friends of persons misusing opioids, and 4 public health key stakeholders. We conducted semi-structured interviews asking about preferences, barriers and facilitators of treatment options for opioid use disorder, and perspectives around the use of digital/online communities. The categories of participants interviewed were each asked slightly different questions depending upon their role. Results: Results suggest that participants who misuse opioids (1) may prefer to engage in online communities rather than in-person meetings to discuss their opioid use, (2) generally prefer to receive opioid-related information from other patients with opioid use disorder and/or those in recovery rather than from health providers or other individuals, and (3) thought that an online community could be beneficial for helping address their opioid use. Conclusion: Results suggest an openness and interest in a peer-led online community to discuss opioid use and treatment among people who misuse opioids.

The Role of Misinformation and Stigma in Opioid Use Disorder Treatment Uptake.

Background: Deaths due to opioid overdose continue to rise in the United States. Despite availability of effective treatment for opioid use disorder, uptake is low among those who misuse opioids. Methods: This paper explores the role of misconception, stigma, and misinformation in influencing decisions to initiate medications for opioid use disorder among patients and providers. Conclusion: Misinformation about opioids has been prevalent among future healthcare providers and first responders as well as pharmaceutical companies, which may have implications for treatment. Among individuals with opioid use disorder, treatment uptake and adherence have been negatively affected by misconceptions about treatment efficacy and side effects, as well as stigma. We discuss the role of social media, education, and the community, in mitigating misinformation and addressing misconceptions about opioids and treatment options.

An online advertising intervention to increase adherence to stay-at-home-orders during the COVID-19 pandemic: An efficacy trial monitoring individual-level mobility data.

The COVID-19 pandemic has led public health departments to issue several orders and recommendations to reduce COVID-19-related morbidity and mortality. However, for various reasons, including lack of ability to sufficiently monitor and influence behavior change, adherence to these health orders and recommendations has been suboptimal. Starting April 29, 2020, during the initial stay-at-home orders issued by various state governors, we conducted an intervention that sent online website and mobile application advertisements to people's mobile phones to encourage them to adhere to stay-at-home orders. Adherence to stay-at-home orders was monitored using individual-level cell phone mobility data, from April 29, 2020 through May 10, 2020. Mobile devices across 5 regions in the United States were randomly-assigned to either receive advertisements from our research team advising them to stay at home to stay safe (intervention group) or standard advertisements from other advertisers (control group). Compared to control group devices that received only standard corporate advertisements (i.e., did not receive public health advertisements to stay at home), the (intervention group) devices that received public health advertisements to stay at home demonstrated objectively-measured increased adherence to stay at home (i.e., smaller radius of gyration, average travel distance, and larger stay-at-home ratios). Results suggest that 1) it is feasible to use mobility data to assess efficacy of an online advertising intervention, and 2) online advertisements are a potentially effective method for increasing adherence to government/public health stay-at-home orders.

Digital Public Health Surveillance Tools for Alcohol Use and HIV Risk Behaviors.

There is a need for real-time and predictive data on alcohol use both broadly and specific to HIV. However, substance use and HIV data often suffer from lag times in reporting as they are typically measured from surveys, clinical case visits and other methods requiring extensive time for collection and analysis. Social big data might help to address this problem and be used to provide near real-time assessments of people's alcohol use and/or alcohol. This manuscript describes three types of social data sources (i.e., social media data, internet search data, and wearable device data) that might be used in surveillance of alcohol and HIV, and then discusses the implications and potential of implementing them as additional tools for public health surveillance.

Mental Health-Related Behaviors and Discussions Among Young Adults: Analysis and Classification.

BACKGROUND: There have been recurring reports of web-based harassment and abuse among adolescents and young adults through anonymous social networks. OBJECTIVE: This study aimed to explore discussions on the popular anonymous social network Yik Yak related to social and mental health messaging behaviors among college students, including cyberbullying, to provide insights into mental health behaviors on college campuses. METHODS: From April 6, 2016, to May 7, 2016, we collected anonymous conversations posted on Yik Yak at 19 universities in 4 different states and performed statistical analyses and text classification experiments on a subset of these messages. RESULTS: We found that prosocial messages were 5.23 times more prevalent than bullying messages. The frequency of cyberbullying messages was positively associated with messages seeking emotional help. We found significant geographic variation in the frequency of messages offering supportive vs bullying messages. Across campuses, bullying and political discussions were positively associated. We also achieved a balanced accuracy of over 0.75 for most messaging behaviors and topics with a support vector machine classifier. CONCLUSIONS: Our results show that messages containing data about students' mental health-related attitudes and behaviors are prevalent on anonymous social networks, suggesting that these data can be mined for real-time analysis. This information can be used in education and health care services to better engage with students, provide insight into conversations that lead to cyberbullying, and reach out to students who need support.

The Relationship Between Social Media Use and Sleep Quality among Undergraduate Students.

Insufficient sleep is a growing health problem among University students, especially for freshmen during their first quarter/semester of college. Little research has studied how social media technologies impact sleep quality among college students. This study aims to determine the relationship between social media use and sleep quality among freshman undergraduates during their first quarter in college. Specifically, we explored whether variations in Twitter use across the time of day and day of the week would be associated with self-reported sleep quality. We conducted a study of Freshman Twitter-using students (N = 197) over their first quarter of college, between October to December of 2015. We collected students' tweets, labeled the content of the tweets according to different emotional states, and gave theme weekly surveys on sleep quality. Tweeting more frequently on weekday late nights was associated with lower sleep quality (ß = -0.937, SE = 0.352); tweeting more frequently on weekday evenings was associated with better quality sleep (ß = 0.189, SE = 0.097). Tweets during the weekday that were labeled related to the emotion of fear were associated with lower sleep quality (ß = -0.302, SE = 0.131). Results suggest that social media use is associated with sleep quality among students. Results provide can be used to inform future interventions to improve sleep quality among college students.

Ethical Issues in Using Social Media to Deliver an HIV Prevention Intervention: Results from the HOPE Peru Study.

Social media technologies have become increasingly useful tools for research-based interventions. However, participants and social media users have expressed ethical concerns with these studies, such as risks and benefits of participation, as well as privacy, confidentiality, and informed consent issues. This study was designed to follow up with and assess experiences and perceptions of ethics-related issues among a sample of 211 men who have sex with men who participated in the Harnessing Online Peer Education (HOPE) Peru study, a randomized controlled HIV prevention intervention conducted in Peru. We found that after adjusting for age, highest educational attainment, race, sexual orientation, and prior HIV research experience, participants in the intervention group were more likely than those in the control group to have safe sex (p = 0.0051) and get tested for HIV regularly (p = 0.0051). As a result of their participation, those in the intervention group benefited more positively than participants in the control group in improving HIV care (p = 0.0077) and learning where to receive sexual health services (p = 0.0021). Participants in the intervention group expressed higher levels of comfort than those in the control group in joining and seeing other people in the Facebook group (p = 0.039), seeing other people's posts (p = 0.038) and having other group members talk to them online (p = 0.040). We discuss the implications of these results as they relate to social media-based HIV research.

HIV/AIDS stigma among a sample of primarily African-American and Latino men who have sex with men social media users.

The recent increase in social media use allows these technologies to rapidly reach communities with higher HIV prevalence, such as African-American and Latino men who have sex with men (MSM). However, no studies have looked at HIV/AIDS stigma among social media users from African-American and Latino MSM communities, or the association between stigma and social media use among these groups. This study sought to assess the level of HIV/AIDS stigma among a sample of social media-using African-American and Latino MSM from Los Angeles. A total of 112 (primarily African-American and Latino, n = 98, 88%) MSM Facebook users completed a survey on demographics, online social network use, and HIV/AIDS stigma. A composite stigma score was created by taking the cumulative score from a 15-item stigma questionnaire. Cumulative logistic models were used to assess the association between HIV/AIDS stigma and online social network use. In general, participants reported a low level of HIV/AIDS stigma (mean = 22.2/75, SD = 5.74). HIV/AIDS stigma composite score was significantly associated with increased time spent on online social networks each day (Adjusted odds ratios (AOR): 1.07, 95% CI: 1.00, 1.15). Among this diverse sample of MSM online social network users, findings suggest that HIV/AIDS stigma is associated with usage of social media. We discuss the implications of this work for future HIV prevention.

Potential Effects of Digital Inequality on Treatment Seeking for Opioid Use Disorder.

Despite the availability of effective treatment, medications for opioid use disorder are underutilized due to a variety of practical, political, and psychological reasons. Digital inequalities, such as limited access to technology, skills to leverage the technology for desirable outcomes, and social resources, may be contributing to negative health outcomes. In addition, broader health literacy plays an integral part in the capacity of individuals to appraise opioid medication-related online information. This paper explores the role of digital inequalities in the uptake of treatment for opioid use disorder. Given the shift toward telemedicine and online counseling for substance use treatment as a consequence of the COVID-19 pandemic, more research into the digital inequalities faced by those who misuse opioids may provide insight into ways of engaging and encouraging this population to utilize treatment.

Cryptocurrency as a new method for participant compensation in research.

Public health research relies heavily on participant involvement. Investigators have examined factors that affect participation and found that altruism enables engagement. At the same time, time commitment, family concerns, multiple follow-up visits, and potential adverse events are barriers to engagement. Thus, investigators may need to find new methods to attract and motivate participants to participate, including new compensation methods. As cryptocurrency is being increasingly used and accepted to pay and reimburse people for work activities, this currency should be similarly explored as an option for research participants to attempt to incentivize them to participate in studies and offer new possibilities for study reimbursement. This paper explores the potential use of cryptocurrency as a form of compensation in public health research studies and discusses the pros and cons of its use. Although few studies have used cryptocurrency to compensate participants, cryptocurrency may be used as a reward for various research tasks, including filling out surveys, participating in in-depth interviews or focus groups, and/or completing interventions. Using cryptocurrencies to compensate participants in health-related studies can provide benefits such as anonymity, security, and convenience. However, it also poses potential challenges, including volatility, legal and regulatory challenges, and the risk of hacking and fraud. Researchers must carefully weigh the benefits against the potential downsides before using them as a compensation method in health-related studies.

A HOPE Online Community Peer Support Intervention for Help Seeking: A Randomized Controlled Trial.

OBJECTIVE: A 6-week study was conducted to test the effectiveness of the Harnessing Online Peer Education (HOPE) intervention on anxiety, help seeking (requests for electronic resources [e-resources] on anxiety reduction), and online engagement. METHODS: Three hundred participants with moderate to severe anxiety (i.e., seven-item Generalized Anxiety Disorder scale [GAD-7] scores ≥10) were randomly assigned to social media (i.e., Facebook) groups with or without peer leaders. The study was conducted from April 5 to May 17, 2020. GAD-7 scores, e-resource requests, and online engagement were measured at baseline and at weeks 2, 4, and 6. RESULTS: GAD-7 scores improved in both intervention and control groups, with no difference between conditions. Participants in the intervention group were more likely than those in the control group to request e-resources (OR=10.27, 95% CI=4.52-23.35) and engage online (OR=2.84, 95% CI=1.70-4.76). CONCLUSIONS: The HOPE intervention effectively promoted mental health help-seeking behavior and online engagement.

Ethical Views on Sharing Digital Data for Public Health Surveillance: Analysis of Survey Data Among Patients.

Digital data, including social media, wearable device data, electronic health records, and internet search data, are increasingly being integrated into public health research and policy. Because of the current issues around public distrust of science and other ethical issues in public health research, it is essential that researchers conduct ongoing studies assessing people's perceptions around and willingness to share digital data. This study aims to examine participants' social media use and comfort sharing their data with health researchers. One hundred and sixty-one participants with medical conditions were recruited through social media paid advertisements and referral from a website, and invited to complete surveys on social media use and ethical perspectives on data sharing. Eligibility criteria were adults 18 years old or older, living in the US, self-reported having been diagnosed by a physician with a medical condition, belonging to at least one social media platform, using social media at least twice a week, and owning a smartphone. Study participants were mostly female, White, and with a mean age of 36.31 years. More than one third of participants reported being very comfortable sharing electronic health data and social media data for personalized healthcare and to help others. Findings suggest that participants are very uncomfortable sharing their location and text message data with researchers, with primary concerns centered around loss of privacy, disclosing private information, and that friends, family, and others may find out that they shared text messages with researchers. We discuss the implications of this research before and after the COVID-19 pandemic, along with its potential implications for future collection of digital data for public health.

Geolocation, ethics, and HIV research.

The HIV epidemic continues to disproportionally affect marginalized populations. Digital tools, including global positioning system and ecologic momentary assessment, have been studied as methods for improving data collection and interventions among HIV-affected communities. Although people living with HIV and populations at high risk have found it acceptable to use digital technologies for HIV research, concerns over privacy and trust have also been expressed. This paper explores and describes the use of geolocation technology data (e.g., location-based social media) in HIV research as well as the ethical and implementation considerations that warrant examination prior to use. Transparent and clear language in consent forms might improve participant trust in the project and investigators' ability to keep participant data secure and private. With respect to institutional review boards, a committee member who is knowledgeable about digital technologies and consumer protections may offer guidance in assessing adequate protections in study protocols. As technology used in research continues to evolve, investigators and the research community must continue to examine the ethical challenges that emerge to address participant concerns.

Online misinformation and vaccine hesitancy.

Although rates of vaccination have increased worldwide, the rise in nonmedical exemptions for vaccination may have caused a resurgence of childhood vaccine-preventable diseases. Vaccine hesitancy plays an important role in the decreasing rates of vaccination and is considered by the World Health Organization as a top ten global threat to public health. Online vaccine misinformation is present in news outlets, websites, and social media, and its rapid and extensive dissemination is aided by artificial intelligence (AI). In combating online misinformation, public health experts, the medical community, and lay vaccination advocates can correct false statements using language that appeal to those who are undecided about vaccination. As the gatekeepers to online information, they can implement and enforce policy that limits or bans vaccine misinformation on their platforms. AI tools might also be used to address misinformation, but more research is needed before implementing this approach more broadly in health policy. This commentary examines the role that different online platforms appear to be playing in the spread of misinformation about vaccines. We also discuss the implications of online misinformation on attitudes about COVID-19 vaccine uptake and provide suggestions for ways to combat online misinformation.

Vaccine hesitancy, the rejection or delay to get vaccinated even if there is an effective vaccine available, may be instrumental in the resurgence of vaccine-preventable disease. Studies have shown that the rise in nonmedical exemptions for vaccination increases rates of childhood vaccine-preventable disease. One factor that influences vaccine hesitancy is online misinformation. False or misleading information online regarding vaccines can be found in independent news outlets, websites, and social media. The spread of vaccine misinformation is especially important during the COVID-19 pandemic as false information can decrease pro-vaccine opinions. The recent announcement of an effective COVID-19 vaccine became a hot topic online, with many adults hesitant to take the vaccine. Public health experts, medical professionals, and pro-vaccine individuals can help curb the spread of misinformation by correcting false statements online. Social media companies can also aid in stopping misinformation by implementing and enforcing policy that limits misinformation on their platforms.

Ethical Issues in Addressing Social Media Posts About Suicidal Intentions During an Online Study Among Youth: Case Study.

Due to the popularity of social media, researchers are increasingly conducting studies that monitor and analyze people's health-related social media conversations. Because social media users can post about any topic at any time, no known best ethical practices exist as to whether and how to monitor participants' posts for safety-related issues that might be unrelated to the study, such as expressions of suicidal intentions. This is a case study during a social media-based study on sleep and activity among freshman undergraduate students, where we by chance noticed that a student was using social media to express suicidal intentions. Although we connected the student to student psychological services in order to receive treatment, we encountered a number of barriers that initially prevented this from occurring, such as institutional review board and regulatory practices related to lack of experience with these newer types of studies. We discuss the implications of this experience for future research.

A longitudinal analysis of stress among incoming college freshmen.

OBJECTIVES: The objectives of this study were to: (1) examine changes in stress during first semester among freshmen undergraduates and (2) identify predictors of stress (coping strategies, emotional states, and quality of sleep). PARTICIPANTS: One hundred ninety-seven freshmen students were recruited for a 10-week study during first quarter (October-December, 2015). METHODS: Students completed weekly self-report surveys on stress, coping strategies, emotions, and quality of sleep. A generalized linear mixed model was used for analyses. RESULTS: Stress was elevated during examinations periods. Women reported a greater stress level than men. Increased stress level was significantly associated with lower sleep quality and greater negative emotions (fear, anger). Exercise was an effective stress coping strategy, while other coping methods (Internet usage, meditation, and self-isolation) were associated with higher stress. Social media usage did not influence stress level. CONCLUSIONS: Future stress management programs for freshmen need to consider gender differences and may focus on sleep, exercise, and decreased general Internet usage.