Effects of brief exposure to misinformation about e-cigarette harms on Twitter on knowledge and perceptions of e-cigarettes.

Background: This study examined whether exposure to misinformation found on Twitter about e-cigarette harms leads to inaccurate knowledge and misperceptions of harms of e-cigarette use among cigarette smokers. Methods: We conducted an online randomized controlled experiment in November 2019 among an online sample of 2400 adult US and UK cigarette smokers who did not currently use e-cigarettes. Participants viewed four tweets in one of four conditions: 1) e-cigarettes are as or more harmful than smoking, 2) e-cigarettes are completely harmless, 3) e-cigarette harms are uncertain and 4) control (physical activity). Outcomes were knowledge about e-cigarettes and harm perceptions of e-cigarette use for five diseases. We conducted multiple logistic and linear regressions to analyze the effect of experimental conditions on outcomes, controlling for baseline knowledge and perceived harms. Findings: Participants in the 'as or more harmful' condition (vs. control group) had higher odds of accurate knowledge about e-cigarettes containing toxic chemicals (p < 0.001), not containing only water vapor (p < 0.001) and containing formaldehyde (p < 0.001). However, these participants had lower odds of accurate knowledge that e-cigarettes did not contain tar (p < 0.001) and contained fewer toxins than cigarettes (p < 0.001). Exposure to 'as or more harmful' tweets also increased harm perceptions for five diseases (all p < 0.001), with the greatest effect observed for lung cancer (ß = 0.313, p < 0.001). This effect was greater among UK participants for all diseases. Interpretation: Brief exposure to misinformation on Twitter reduced accurate knowledge of the presence of tar and the level of toxins compared with smoking and increased harm perceptions of e-cigarette use.

Impact of public health team engagement in alcohol licensing on health and crime outcomes in England and Scotland: A comparative timeseries study between 2012 and 2019.

Background: Public health teams (PHTs) in England and Scotland engage to varying degrees in local alcohol licensing systems to try to reduce alcohol-related harms. No previous quantitative evidence is available on the effectiveness of this engagement. We aimed to quantify the effects of PHT engagement in alcohol licensing on selected health and crime outcomes. Methods: 39 PHTs in England (n = 27) and Scotland (n = 12) were recruited (of 40 contacted) for diversity in licensing engagement level and region, with higher activity areas matched to lower activity areas. Each PHT's engagement in licensing for each 6 month period from April 2012 to March 2019 was quantified using a new measure (PHIAL) developed using structured interviews, documentary analyses, and expert consultation. Outcomes examined were ambulance callouts, alcohol-related hospital admissions, alcohol-related and alcohol-specific mortality and violent, sexual and public order offences. Timeseries were analysed using multivariable negative binomial mixed-effects models. Correlations were assessed between each outcome and 18-month average PHIAL score (primary metric), cumulative PHIAL scores and change in PHIAL scores. Additionally, 6-month lagged correlations were also assessed. Findings: There was no clear evidence of any associations between the primary exposure metric and the public health or crime outcomes examined, nor between cumulative PHIAL scores or change in PHIAL score and any outcomes. There were no significant associations in England or Scotland when analysed separately or between outcomes and lagged exposure metrics. Interpretation: There is no clear evidence that allocating PHT resources to engaging in alcohol licensing is associated with downstream reductions in alcohol-related health harms or crimes, in the short term or over a seven year follow-up period. Such engagement likely has benefits in shaping the licensing system to take account of health issues longer term, but as current systems cannot reduce alcohol availability or contain online sales, their potential benefits are somewhat constrained. Funding: The ExILEnS project is funded by the NIHR Public Health Research Programme (project number 15/129/11). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Smokers' Likelihood to Engage With Information and Misinformation on Twitter About the Relative Harms of e-Cigarette Use: Results From a Randomized Controlled Trial.

BACKGROUND: Information and misinformation on the internet about e-cigarette harms may increase smokers' misperceptions of e-cigarettes. There is limited research on smokers' engagement with information and misinformation about e-cigarettes on social media. OBJECTIVE: This study assessed smokers' likelihood to engage with-defined as replying, retweeting, liking, and sharing-tweets that contain information and misinformation and uncertainty about the harms of e-cigarettes. METHODS: We conducted a web-based randomized controlled trial among 2400 UK and US adult smokers who did not vape in the past 30 days. Participants were randomly assigned to view four tweets in one of four conditions: (1) e-cigarettes are as harmful or more harmful than smoking, (2) e-cigarettes are completely harmless, (3) uncertainty about e-cigarette harms, or (4) control (physical activity). The outcome measure was participants' likelihood of engaging with tweets, which comprised the sum of whether they would reply, retweet, like, and share each tweet. We fitted Poisson regression models to predict the likelihood of engagement with tweets among 974 Twitter users and 1287 non-Twitter social media users, adjusting for covariates and stratified by UK and US participants. RESULTS: Among Twitter users, participants were more likely to engage with tweets in condition 1 (e-cigarettes are as harmful or more harmful than smoking) than in condition 2 (e-cigarettes are completely harmless). Among other social media users, participants were more likely to likely to engage with tweets in condition 1 than in conditions 2 and 3 (e-cigarettes are completely harmless and uncertainty about e-cigarette harms). CONCLUSIONS: Tweets stating information and misinformation that e-cigarettes were as harmful or more harmful than smoking regular cigarettes may receive higher engagement than tweets indicating e-cigarettes were completely harmless. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN) 16082420; https://doi.org/10.1186/ISRCTN16082420.

Effects of brief exposure to misinformation about e-cigarette harms on twitter: a randomised controlled experiment.

OBJECTIVES: To assess the effect of exposure to misinformation about e-cigarette harms found on Twitter on adult current smokers' intention to quit smoking cigarettes, intention to purchase e-cigarettes and perceived relative harm of e-cigarettes compared with regular cigarettes. SETTING: An online randomised controlled experiment conducted in November 2019 among USA and UK current smokers. PARTICIPANTS: 2400 adult current smokers aged ≥18 years who were not current e-cigarette users recruited from an online panel. Participants' were randomised in a 1:1:1:1 ratio using a least-fill randomiser function. INTERVENTIONS: Viewing 4 tweets in random order within one of four conditions: (1) e-cigarettes are just as or more harmful than smoking, (2) e-cigarettes are completely harmless, (3) e-cigarette harms are uncertain, and (4) a control condition of tweets about physical activity. PRIMARY OUTCOMES MEASURES: Self-reported post-test intention to quit smoking cigarettes, intention to purchase e-cigarettes, and perceived relative harm of e-cigarettes compared with smoking. RESULTS: Among US and UK participants, after controlling for baseline measures of the outcome, exposure to tweets that e-cigarettes are as or more harmful than smoking versus control was associated with lower post-test intention to purchase e-cigarettes (ß=-0.339, 95% CI -0.487 to -0.191, p<0.001) and increased post-test perceived relative harm of e-cigarettes (ß=0.341, 95% CI 0.273 to 0.410, p<0.001). Among US smokers, exposure to tweets that e-cigarettes are completely harmless was associated with higher post-test intention to purchase e-cigarettes (ß=0.229, 95% CI 0.002 to 0.456, p=0.048) and lower post-test perceived relative harm of e-cigarettes (ß=-0.154, 95% CI -0.258 to -0.050, p=0.004). CONCLUSIONS: US and UK adult current smokers may be deterred from considering using e-cigarettes after brief exposure to tweets that e-cigarettes were just as or more harmful than smoking. Conversely, US adult current smokers may be encouraged to use e-cigarettes after exposure to tweets that e-cigarettes are completely harmless. These findings suggest that misinformation about e-cigarette harms may influence some adult smokers' decisions to consider using e-cigarettes. TRIAL REGISTRATION NUMBER: ISRCTN16082420.

A systems map of the determinants of child health inequalities in England at the local level.

Children and young people in the UK have worse health outcomes than in many similar western countries and child health inequalities are persistent and increasing. Systems thinking has emerged as a promising approach to addressing complex public health issues. We report on a systems approach to mapping the determinants of child health inequalities at the local level in England for young people aged 0-25, and describe the resulting map. Qualitative group concept mapping workshops were held in two contrasting English local authorities with a range of stakeholders: professionals (N = 35); children and young people (N = 33) and carers (N = 5). Initial area maps were developed, and augmented using data from qualitative interviews with professionals (N = 16). The resulting local maps were reviewed and validated by expert stakeholders in each area (N = 9; N = 35). Commonalities between two area-specific system maps (and removal of locality-specific factors) were used to develop a map that could be applied in any English local area. Two rounds of online survey (N = 21; N = 8) experts in public health, local governance and systems science refined the final system map displaying the determinants of child health inequalities. The process created a map of over 150 factors influencing inequalities in health outcomes for children aged 0-25 years at the local area level. The system map has six domains; physical environment, governance, economic, social, service, and personal. To our knowledge this is the first study taking a systems approach to addressing inequalities across all aspects of child health. The study shows how group concept mapping can support systems thinking at the local level. The resulting system map illustrates the complexity of factors influencing child health inequalities, and it may be a useful tool in demonstrating to stakeholders the importance of policies that tackle the systemic drivers of child health inequalities beyond those traditionally associated with public health.

Sleep quality and falls in older people living in self- and assisted-care villages.

BACKGROUND: Older people often experience unusual sleeping patterns and a poor quality of night-time sleep. Insufficient sleep has potential effects on cognition and physical functioning and therefore may increase the incidence of falls in older people. OBJECTIVES: To determine the extent to which a range of physiological, psychological and health-related factors predict night-time sleep quality of older people living in self-care and assisted-care, and whether poor sleep quality is a risk factor for falls. METHODS: 572 people, 81 men and 491 women (mean age 79.7 years, SD 6.4), recruited from self-care retirement villages and assisted-care hostels participated in the cross-sectional study with a subgroup of 169 followed up for falls for 1 year. The main outcome measures were sleep quality and prospective falls. RESULTS: Approximately half of the sample rated their sleep quality as poor or fair. Many measures of health, medication use and mood were significantly associated with ratings of poor night-time sleep quality. Multiple regression analyses revealed poor circulation, use of psychotropic and diuretic medications, negative affect, pain, not having a friend in the village, lower fitness levels and daytime napping were significant and independent predictors of night-time sleep quality in both residential care groups. Napping daily was reported by 28% of the self-care group and 37% of the assisted-care group. Residents across both care levels who napped >30 min during the day, or reported <6 h sleep at night, were three times more likely to suffer multiple falls in the follow-up year when adjusting for health, medication and activity measures. CONCLUSIONS: Sleep disturbances were common and associated with a variety of psychological, physiological, health and lifestyle factors. Long daytime naps and short night-time sleep periods were associated with an increased risk of falls.

Are specialist breast nurses available to Australian women with breast cancer?

Despite evidence of benefit, little is know about Australian women's access to and perceptions of specialist breast nurse (SBN) care. The aims of this study were to: explore access to SBNs by Australian women with breast cancer; identify factors associated with receiving systematic SBN care (at least 3 SBN contacts including preoperatively and postoperatively and at follow-up); and explore the impact of systematic SBN care on women's perceptions of treatment and support. A population-based sample of 544 women with early breast cancer was randomly selected through state and territory cancer registries. Participants completed a structured telephone interview. Over half (52%) of the women had no SBN contact and only 11% received systematic SBN care. Factors associated with systematic SBN care were being treated in a public hospital and receiving systemic adjuvant therapy. Women who received systematic SBN care were more likely to report receiving enough support for themselves and their families, and enough information about where to get more support or counseling and the costs of treatment. In conclusion, systematic SBN contact was uncommon in this population-based sample but positively influenced women's perceptions of care, particularly in relation to the provision of support.

The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial.

OBJECTIVES: To determine whether a 12-month program of group exercise can improve physical functioning and reduce the rate of falling in frail older people. DESIGN: Cluster randomized, controlled trial of 12 months duration. SETTING: Retirement villages in Sydney and Wollongong, Australia. PARTICIPANTS: Five hundred fifty-one people aged 62 to 95 (mean+/-standard deviation=79.5+/-6.4) who were living in self- and intermediate-care retirement villages. MEASUREMENTS: Accidental falls, choice stepping reaction time, 6-minute walk distance postural sway, leaning balance, simple reaction time, and lower-limb muscle strength. RESULTS: Two hundred eighty subjects were randomized to the weight-bearing group exercise (GE) intervention that was designed to improve the ability of subjects to undertake activities for daily living. Subjects randomized to the control arm (n=271) attended flexibility and relaxation (FR) classes (n=90) or did not participate in a group activity (n=181). In spite of the reduced precision of cluster randomization, there were few differences in the baseline characteristics of the GE and combined control (CC) subjects, although the mean age of the GE group was higher than that of the CC group, and there were fewer men in the GE group. The mean number of classes attended was 39.4+/-28.7 for the GE subjects and 31.5+/-25.2 for the FR subjects. After adjusting for age and sex, there were 22% fewer falls during the trial in the GE group than in the CC group (incident rate ratio=0.78, 95% confidence interval (CI)=0.62-0.99), and 31% fewer falls in the 173 subjects who had fallen in the past year (incident rate ratio=0.69, 95% CI=0.48-0.99). At 6-month retest, the GE group performed significantly better than the CC group in tests of choice stepping reaction time, 6-minute walking distance, and simple reaction time requiring a hand press. The groups did not differ at retest in tests of strength, sway, or leaning balance. CONCLUSION: These findings show that group exercise can prevent falls and maintain physical functioning in frail older people.

Is breast cancer care in accord with clinical practice guidelines: a consumer audit.

OBJECTIVES: To assess whether information, support and other psychosocial care for women with early breast cancer in Australia is in accord with published Australian clinical practice guidelines. DESIGN: An interview survey of a population-based sample of women with early breast cancer. SETTING: The whole of Australia. PARTICIPANTS: Women diagnosed with early breast cancer 6-12 months before the survey were identified through the population-based cancer registries. An initial sample of 1184 women was drawn from the cancer registries; the doctors of 104 women did not agree to any participation and a further 212 women were excluded as ineligible. A randomly selected sample of 832 of the 868 women who were eligible to participate were invited to participate in the study and 544 (76%) of the 716 who could be contacted completed a full interview. MAIN OUTCOME MEASURES: A telephone interview covering 12 aspects of care recommended in the published guidelines. RESULTS: Most women received care in accord with the following recommendations: diagnosis given by a senior doctor (95%), face to face (86%) and in an open manner (90%). Fewer women received recommended care in relation to: involvement in decision making (73%), information about clinical trials (13%); receiving breast reconstruction following mastectomy (8%), evidence-based consumer guides (62%) and adequate support for families (65%). CONCLUSIONS: The extent to which the provision of information, support and psychosocial care is in accord with recommendations can be audited effectively by a survey of women who have received treatment. Some 80% or more of women received care in accord with half of the 12 target guidelines; however, further programmes are required to improve access to information and participation in clinical trials and to better understand participation in decision making.

The use and acceptability of a one-on-one peer support program for Australian women with early breast cancer.

A population-based survey of Australian women diagnosed with early breast cancer examined the uptake and acceptability of a peer support program, the Breast Cancer Support Service (BCSS). We examined the characteristics and perceptions of women who did and did not use the BCSS. More than one-third (36%) had used the BCSS, most of whom first heard of it from hospital staff (36%) or clinicians (16%). Women perceived meeting someone else with similar experiences (53%) as the most beneficial aspect of the program and 89% said they would definitely recommend it to others. The findings suggest that uptake is related to provision of information about the BCSS. Peer support programs appear to be acceptable to both women who do and do not use the BCSS. To ensure that women can choose whether to participate in peer support programs requires strategies that encourage health professionals to provide comprehensive supportive care information.

Assessing the support needs of women with early breast cancer in Australia.

The purpose of the current study was to access the degree to which the support needs of women with a newly diagnosed, early invasive, primary breast cancer and their families are being met. A random sample of 544 women diagnosed with early breast cancer was recruited to participate in a telephone survey via state and territory cancer registries. Sixteen percent of women reported not receiving enough support during their diagnosis and treatment, and only 65% of these women reported that their families received enough support. The primary sources of support for women and their families were medical practitioners (eg, surgeons, oncologists, and general practitioner) with very few women or family members utilizing mental health professionals. Given the importance of adequate support when being diagnosed and treated for breast cancer, urgent attention needs to be paid to training medical professionals in providing appropriate support and referrals for their patients.

Defining social support in context: a necessary step in improving research, intervention, and practice.

A substantial body of work on the concept of social support has resulted in many definitions, but none have been accepted as definitive. The lack of consensus about the definition of social support has resulted in a lack of consistency and comparability among studies. More important, the validity of any study attempting to measure or influence social support is undermined by the use of generic definitions, which lack contextual sensitivity. In this article concept analysis is used to evaluate definitions of social support to ascertain their utility for research. The authors argue that a contextualized approach to the definition of social support is necessary to improve clarity in research, and results in interventions or practices that are useful. They also assert that the development of a contextualized definition of social support requires qualitative methods to explore the meaning of social support with groups of people for whom intervention research is ultimately intended.

Risk of falling: predictors based on reduced strength in persons previously affected by polio.

OBJECTIVES: To examine the contributions of sensorimotor factors to postural control and falling in people with prior polio and to determine whether these contributions differ from those found in normal populations. DESIGN: Survey and case-control study. SETTING: A falls and balance laboratory in Australia. PARTICIPANTS: Forty persons with prior polio (age range, 28-71 y) and 38 age- and sex-matched control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Lower-limb muscle strength, sway, vision, lower-limb sensation, reaction time, foot-tapping speed, and falls. RESULTS: Compared with the control subjects, the prior polio subjects performed similarly in sensory tests but worse in tests that involved a motor component. Within the prior polio group, lower-limb strength was strongly associated with postural sway on a compliant surface and explained more of the variance in sway than in control subjects. Prior polio subjects who fell multiple times had reduced lower-limb strength, slower reaction time, lower foot-tapping speed, and increased sway compared with those who fell less often. However, the rate of decline in lower-limb strength within the prior polio group did not exceed normal, age-related changes. CONCLUSIONS: This investigation of prior polio subjects provides an appropriate model for studying muscle weakness as a falls risk factor. Weakness was directly associated with falls, and had an indirect effect mediated through increased sway.

Assessing the practical and psychosocial needs of rural women with early breast cancer in Australia.

The purpose of the current study was to assess the practical and psychosocial needs of rural women with early breast cancer in Australia and recommend strategies to ensure equity in availability and access to cancer treatment for all women. A random sample of 204 rural women diagnosed with early breast cancer was recruited to participate in a telephone survey via state and territory cancer registries. Although the majority of women were satisfied with their provision of information overall, less than a third of participants were provided with specific information on assistance for rural women. Findings also revealed that only 47% of the women who had to travel for treatment received financial assistance, and 13% of these women had difficulty organizing or claiming financial assistance. Furthermore, only 10% of women found social workers to be a source of support.