Conflict of interest and funding in health communication on social media: a systematic review.

OBJECTIVES: To synthesise the available evidence on the reporting of conflicts of interest (COI) by individuals posting health messages on social media, and on the reporting of funding sources of studies cited in health messages on social media. DATA SOURCES: MEDLINE (OVID) (2005-March 2022), Embase (2005-March 2022) and Google Scholar (2005-August 2022), supplemented with a review of reference lists and forward citation tracking. DESIGN: Reviewers selected eligible studies and abstracted data in duplicate and independently. We appraised the quality of the included studies using the Mixed Methods Appraisal Tool. We summarised the results in both narrative and tabular formats. We followed the PRISMA 2020 checklist for reporting our study. RESULTS: Of a total of 16 645 retrieved citations, we included 17 eligible studies. The frequency of reporting of conflicts of interest varied between 0% and 60%, but it was mostly low. In addition, a significant proportion, ranging between 15% and 80%, of healthcare professionals using social media have financial relationships with industry. However, three studies assessed the proportion of conflicts of interest of physicians identified through Open Payment Database but not reported by the authors. It was found that 98.7-100% of these relationships with industry are not reported when communicating health-related information. Also, two studies showed that there is evidence of a potential association between COI and the content of posting. No data was found on the reporting of funding sources of studies cited in health messages on social media. CONCLUSIONS: While a significant proportion of healthcare professionals using social media have financial relationships with industry, lack of reporting on COI and undisclosed COI are common. We did not find studies on the reporting of funding sources of studies cited in health messages on social media. TRIAL REGISTRATION: dx.doi.org/10.17504/protocols.io.5jyl8jj4rg2w/v1.

The association of waterpipe tobacco smoking with later initiation of cigarette smoking: a systematic review and meta-analysis exploring the gateway theory.

INTRODUCTION: There is a concern that waterpipe tobacco smoking (WTS) can lead to the later initiation of cigarette smoking, a concept referred to as the 'gateway theory'. The objective of the study was to systematically review the literature for the association of WTS with later initiation of cigarette smoking. METHODS: We searched Medline, Embase and ISI Web of Science in April 2018 without using any language or date restrictions. We selected eligible studies, abstracted data and assessed the risk of bias using a duplicate and independent approach. We meta-analysed the ORs across eligible studies using the inverse variance method and the random-effects model. We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation methodology. RESULTS: We included eight papers reporting on six eligible prospective cohort studies with a total of 21 224 participants, belonging to the adolescent and young adult age categories. The pooled adjusted OR for the association between ever waterpipe user (compared with never waterpipe user) at baseline, with 'cigarette smoking initiation' (ever cigarette use) was 2.54 (95% CI 1.60 to 4.02) at 6 months to 3 years follow-up (moderate certainty evidence). The pooled adjusted OR for the association between ever waterpipe user (compared with never waterpipe user) at baseline, with 'current cigarette smoking' (past 30-day cigarette use) was 2.04 (95% CI 1.32 to 3.15) at 1-2 years follow-up (moderate certainty evidence). The pooled adjusted OR for the association between past 30-day waterpipe user (compared with never waterpipe user) at baseline, with current cigarette smoking (past 30-day cigarette use) 2.46 (95% CI 1.73 to 3.49) at 6 months to 1 year follow-up (high certainty evidence). CONCLUSION: Our findings indicate that WTS is associated with more than doubling of the odds of later initiation of cigarette smoking, supporting the gateway theory. Strengthening WTS policies is a priority and further research is needed on the development and evaluation of appropriate clinical and public health interventions.

Knowledge, Attitudes and Practices Regarding Breast Cancer amongst Lebanese Females in Beirut

Objectives: Regular screening for breast cancer is associated with better survival, but compliance with guidelines depends on good knowledge and attitudes. This study aimed to assess the level of breast cancer knowledge, attitudes and screening practices in Lebanese females, and identify their socio-demographic determinants as well as barriers to mammography use. Methods: This cross-sectional study was conducted with 371 Lebanese females residing in Beirut aged 18-65 with no history of breast cancer. The questionnaire applied was adapted from Stager and Champion. The overall knowledge score was determined with sections on general knowledge, curability, symptoms, and screening; the overall attitude score concerned attitudes towards breast cancer, screening, and barriers; and the overall practices score was for breast self examination (BSE), clinical breast examination (CBE) and mammography. Bivariate and multivariate analyses of socioeconomic determinants were performed for each score. Results: The mean knowledge score was 55.5±17.1% and that for attitudes was 71.9±8.3%. For self-examination, mammography and clinical examination practices, individual means were 45.7±42.3%, 77.9±36.5% and 29.1±45.5%, respectively. Knowledge, attitudes and practices correlated positively with each other (p<0.0001). The highest average was the knowledge of symptoms (72.8±24.7%), and the lowest that of curability (49.6±25.7%). Most frequent barriers to mammography were fear of learning bad news, pain, costs, and staff unpleasantness. Higher education was associated with better knowledge (p=0.002) and smoking with lower levels (p=0.003). Older age (p=0.002), higher education (p=0.02), and taking exercise (p=0.02) were associated with better attitudes. Higher education (p=0.02) and having children (p=0.003) were associated with better practices. Conclusion: More emphasis should be placed on educating females on the curability of breast cancer and specific targeting of the barriers identified.