Cancer and COVID-19 Vaccines on Twitter:The Voice and Vaccine Attitude of Cancer Community.

We investigate social media discourses on the relationship between cancer and COVID-19 vaccines focusing on the key textual topics, themes reflecting the voice of cancer community, authors who contribute to the discourse, and valence toward vaccines. We analyzed 6,427 tweets about cancer and COVID-19 vaccines, posted from when vaccines were approved in the U.S. (December 2020) to the February 2022. We mixed quantitative text mining, manual coding and statistical analysis, and inductive qualitative thematic analysis. Nearly 16% of the tweets posted by a cancer community member mentioned about refusal or delay of their vaccination at the state/local level during the initial rollout despite the CDC's recommendation to prioritize adults with high-risk medical conditions. Most tweets posted by cancer patients (pro = 82.4% vs. anti = 5.1%) and caregivers (pro = 89.2% vs. anti = 4.2%) showed positive valence toward vaccines and advocated for vaccine uptake increase among cancer patients and the general population. Vaccine hesitancy, self-reported adverse events, and COVID-19 disruption of cancer treatment also appeared as key themes. The cancer community called for actions to improve vaccination procedures to become safe and accessible especially for elderly cancer patients, develop COVID-19 vaccines suitable for varying type, stage, and treatment of cancer, and advance cancer vaccines. Future research should continue surveilling conversations around continuous impacts of COVID-19 interference with the cancer control continuum, beyond vaccination, focusing on the voice and concern of cancer community.

Heated debates on regulations of heated tobacco products in South Korea: the news valence, source and framing of relative risk/benefit.

BACKGROUND: We analyse news representations of the regulation of heated tobacco products (HTPs) in South Korea, the country where HTP use is among the highest in the world despite conflicts between the government and the HTP manufacturers. METHODS: We analysed a total of 571 print and TV news covering HTP regulations, published between 2017 and 2018, the time period when HTPs were introduced to the country and various regulations of HTPs were proposed and implemented. We assessed the prevalence and associations among specific types of HTP regulations that were discussed, valence towards regulation, sources, framing of the relative health risks/benefits of HTPs compared with conventional cigarettes. RESULTS: Taxation (55.2%) and warning labels (25.7%) were two regulation topics covered the most. Almost equal proportions of pro-regulation (2.5%) and anti-regulation valence (2.2%) were found in taxation-related news, while pro-regulation valence appeared more frequently for other restrictions, including warning labels (pro=9.5% vs anti=1.4%), marketing restrictions (pro=6.9% vs anti=0%) and integration of HTPs into smoke-free policies for cigarettes (pro=8.7% vs anti=0%). The government (59%), followed by the tobacco industry (39.4%), was the source cited most often across news stories while the presence of tobacco control advocates was low (4.9%). As for framing, there was no significant difference in the prevalence of stories mentioning reduced harm (31.7%) and equal or more harm (33.6%) of HTPs compared with cigarettes. CONCLUSIONS: We provide implications for governments and tobacco control advocates on building consensus for applying cigarette equivalent taxes and pictorial warning labels to HTPs.

Social Media Discussions on the FDA's Modified Risk Tobacco Product Authorization of IQOS.

Background: The U.S. Food and Drug Administration (FDA) authorized the marketing of the IQOS tobacco heating system as a modified risk tobacco product (MRTP) in July 2020, permitting its 'reduced exposure' marketing. This decision is accompanied by much controversy among the global health community. We provide a preliminary analysis of Twitter conversations regarding the MRTP authorization of IQOS by identifying the authors, valence towards the policy decision, source of cited link, and focused topic. Methods: We analyzed 548 tweets mentioning MRTP posted between July 2016 (when PMI submitted the proposal) and October 2020. Results: We found a higher proportion of pro-MRTP valence (25.4%) than anti-MRTP (16.2%). Nearly half of the tweets (47.2%) expressing personal opinions presented pro-MRTP valence (vs. anti-MRTP = 23.9%). The FDA website was more frequently cited in pro-MRTP tweets (30.8% vs. anti = 4.8%), while tobacco control advocates' websites were cited only in anti-MRTP tweets (77.4% vs. pro = 0). Pro-MRTP valence appeared more frequently in tweets mentioning health (53.1% vs. anti =38.5%) and cessation (100% vs. anti = 0). Nearly 42% of tweets showed a bot score greater than .43, indicating a possibility of automation. Conclusion: Continuous efforts are needed to surveil the industry's attempts to create a climate of false consensus and circulate misinformation regarding MRTP on social media, as well as to assist non-scientific audiences' understanding of MRTP.

Do state regulations on e-cigarettes have impacts on the e-cigarette prevalence?

BACKGROUND: We examine the association among five types of state regulations on electronic cigarettes (defining e-cigarettes, special tax, packaging, youth access and licensure) and initiation and current usage of e-cigarettes in 50 US states and the District of Columbia. METHODS: Data came from the 2017 Behavioral Risk Factor Surveillance System and the US e-cigarette regulations-50 state review by the Public Health Law Center. Logistic regressions were used to determine the odds of initiation and current use of e-cigarettes among individuals aged 18-24, 25-34 and the whole sample, adjusting for socio-demographic covariates. RESULTS: Despite the short history of state laws on e-cigarettes, each of the five state laws was associated with lower odds of initiation and use of e-cigarettes in the whole sample. In the 18-24 age group, only the licensure was associated with lower initiation. In the 25-34 age group, the licensure and taxation were related to lower initiation and current usage. There were significant differences of e-cigarette initiation and usage based on the number of state laws regulating e-cigarettes. CONCLUSIONS: Our analysis indicates the potential of states' policy efforts to regulate e-cigarettes comprehensively in leading significant changes to e-cigarette prevalence in their populations.

News Media Presentations of Heated Tobacco Products (HTPs): A Content Analysis of Newspaper and Television News Coverage in South Korea.

Our content analysis of newspaper and television news stories in South Korea examines the quantity and nature of news about novel heated tobacco products (HTPs), which heat instead of burn tobacco and that manufacturers claim are less harmful than cigarettes. The amount of news coverage peaked when the government introduced new regulations, suggesting that HTP news was driven largely by new policies. Indeed, HTPs were more likely to be presented as a policy rather than a health issue. When it comes to news sources, government agencies and HTP manufacturers were referenced most often in the news. As for benefits of HTPs, news stories focused on reduced harm, greater social acceptability, and convenience, while discussions of drawbacks included potentially being equally or more harmful than cigarettes, the possibility of extensive future regulations, and HTPs' unknown health effects. Findings suggested that certain journalistic practices, such as relying heavily on established routine sources, focusing on the stories that could attract large audiences, and representing the perspectives of the publishers and the primary audiences, might have affected the nature of HTP discourse.

The Effects of Self vs. Group Affirmation and Message Framing on College Students' Vape-Free Campus Policy Support.

A growing number of American colleges and universities have become vape-free campuses in response to the high e-cigarette use prevalence among young adults. However, little is known about communication or social-psychological factors associated with campus members' support for a tobacco policy prohibiting e-cigarette use on the campus (vape-free policy support). The present study explores the main and interaction effects of affirmation and message framing on the vape-free policy support among college students who vary in their vaping status. We conducted a computer-based experiment with a two (affirmation: self vs. group) by two (message framing: gain vs. loss) by two (vaping status: vapers vs. non-vapers) between-subjects design. Our analysis indicated that self-affirmation is associated with a higher level of vape-free policy support than group-affirmation. The main effects of message framing as well as two-way interactions between framing and affirmation were not statistically significant. A notable finding was the three-way interaction effect among affirmation, framing, and vaping status. For vapers, the level of policy support was the highest when they were self-affirmed and exposed to a gain-framed message. For non-vapers, the level of policy support was the highest when they were self-affirmed and exposed to a loss-framed message. Our findings suggest that colleges may use varied approaches in communicating a vape-free campus policy based on the target students' vaping status, and the group-pride or collective identity appeals may not be effective in promoting such policy.

Cancer/health communication and breast/cervical cancer screening among Asian Americans and five Asian ethnic groups.

Objectives: This paper is an examination of cancer/health communication factors (i.e. cancer/health information seeking, patient-provider communication (PPC), cancer screening information from providers) and screening for breast and cervical cancer among Asian Americans and five Asian ethnic groups (Chinese, Filipinos, Japanese, Koreans, Vietnamese) in comparison to Whites. Additionally, the relationship between cancer/health communication disparity and cancer screening gaps between Asian Americans and Whites was investigated. Design: Data comes from a nationally representative sample of 2011-2014 Health Information National Trends Surveys (HINTS). Results: Asian Americans and most Asian ethnic-groups reported significantly lower rates of cancer/health information seeking and lower evaluations for PPC as compared to Whites, though differences within Asian ethnic groups were observed (Koreans' greater cancer/health information seeking, Japanese' higher PPC evaluation). When the cancer/health communication factors were controlled, Asian Americans' odds of cancer screening were increased. Especially, Asian Americans' odds of adhering to the breast cancer screening guideline became nearly 1.4 times greater than Whites. Conclusion: This research demonstrates that health organizations, providers, and Asian American patients' collaborative efforts to increase the access to quality cancer information, to make culturally competent but straightforward screening recommendations, and to practice effective communication in medical encounters will contribute to diminishing cancer disparities among Asian Americans.

Tobacco Risk Information and Comparative Risk Assessment of E-Cigarettes Vs. Cigarettes: Application of the Reinforcing Spirals Model.

We examine how individuals seek information about e-cigarette risk and selectively expose themselves to media sources that may provide information consistent with their existing beliefs and behaviors related to e-cigarettes in application of the Reinforcing Spirals Model (Slater, 2007). Additionally, the associations among e-cigarette risk information-seeking, tobacco risk information exposure via media, and comparative risk assessment of e-cigarettes versus conventional cigarettes were identified. The results were compared among current users, former users, and those who had never used e-cigarettes ("never users"). A nationally representative data from the 2017 Health Information National Trends Surveys - FDA was employed. Our analyses suggest the presence of comparative risk perception among current users as assessing the health harm and addiction risk of e-cigarettes significantly lower than cigarettes. Current users did not avoid information about the health effects of e-cigarettes; they were more likely to look for such information than former and never users. Current users' e-cigarette risk information-seeking was negatively associated with the difference between perceived addiction risk of e-cigarettes and that of cigarettes. Current users' tobacco risk information exposure via social media was related with a lower level of the perceived risk of e-cigarettes, while such exposure via news media was related with a higher level of perceived risk of e-cigarettes. Our findings suggest the need for regulating and counteracting the prevalent e-cigarette information that discounts the relative risks of e-cigarettes as well as the potential of news media as influential sources helping current users scrutinize the risks.

Determinants of Cancer Screening Disparities Among Asian Americans: A Systematic Review of Public Health Surveys.

We conducted a systematic analysis of 24 peer-reviewed literary works that examined Asian Americans' breast, cervical, and colon cancer screening, focusing on empirical findings from large-scale public health surveys (i.e., NHIS, CHIS, HINTS, BRFSS). We provide an overview of relevant research in terms of study characteristics, samples, predictor/covariate of cancer screenings, and key findings. Our analysis indicates that Asian Americans' cancer screening rates are lower than for non-Hispanic Whites for all cancer types in four large-scale public health surveys throughout 17 study years. Acculturation and healthcare access were two significant factors in explaining Asian Americans' cancer screening rates. Cancer fatalism and family cancer history emerged as potential factors that may account for more variances. However, the screening disparities between Asian Americans and whites persist even after adjusting all covariates, including SES, acculturation, healthcare access, health status, and health perception/literacy. More individual and cultural factors should be identified to address these disparities.

Framing Service, Benefit, and Credibility Through Images and Texts: A Content Analysis of Online Promotional Messages of Korean Medical Tourism Industry.

This study examines how the Korean medical tourism industry frames its service, benefit, and credibility issues through texts and images of online brochures. The results of content analysis suggest that the Korean medical tourism industry attempts to frame their medical/health services as "excellence in surgeries and cancer care" and "advanced health technology and facilities." However, the use of cost-saving appeals was limited, which can be seen as a strategy to avoid consumers' association of lower cost with lower quality services, and to stress safety and credibility.

Framing risks and benefits of medical tourism: a content analysis of medical tourism coverage in Korean American community newspapers.

This study examines Korean American community newspapers' representation of risks and benefits involved with medical tourism offered in Korea. Using framing theory, this research attempts to explain Korean Americans' highly positive perceptions and high willingness to use health and medical services in Korea through medical tourism rather than using such services in the United States. The result of content analyses indicated that Korean American community newspapers are rarely engaged in risk communication and lack sufficient information about potential risks of medical tourism while emphasizing diverse benefits. Korean ethnic media, as the primary source of health communication for Korean Americans, should provide more reliable health and medical information for the population's appropriate health management.

Cancer Information Seeking Behaviors of Korean American Women: A Mixed-Methods Study Using Surveys and Focus Group Interviews.

Despite the high risk of cancer to the population, Korean Americans are known to have lower knowledge about cancer related information and a lower level of adherence to cancer prevention guidelines. This indicates the necessity of cancer interventions targeting the Korean American population. To reach this population effectively, it is imperative to understand Korean Americans' cancer information seeking behaviors. This study (a) identified cancer information sources that are trusted and used by Korean American women and (b) examined how general media exposure and trust in cancer information sources are related to the use of these sources. It also (c) explored perceived usefulness and limitations of cancer information sources. A mixed methods study using seven focus group interviews with 34 Korean American women and surveys with 152 Korean American women was conducted in the Washington, DC, metropolitan area from 2011 to 2012. The results indicate that Korean American women viewed health care professionals as the most trusted cancer information source but used the Internet and Korean ethnic media more often for cancer information seeking because of language, cultural, and economic barriers. Korean American women were most likely to obtain cancer information from media they used frequently for general purposes. Correlations between usage frequency and trust in doctor/health providers and the Internet as cancer information sources were negligible. When seeking cancer information, important factors for Korean American women were accessibility, affordability, and language proficiency, cultural sensitivity, meeting immediate needs, understandability, convenience, and reliability of cancer information sources. Findings from this study support developing interventions using Korean language media, including print, television and the Internet for health promotion and cancer prevention targeting Korean American women.

Korean American women's perceptions about physical examinations and cancer screening services offered in Korea: the influences of medical tourism on Korean Americans.

Cancer is the leading cause of death for Korean-Americans (KAs), while cancer screening rates among KAs have been consistently low. Seven semi-structured focus group interviews with 34 KA women aged 40 or older in the Washington, DC metropolitan area were conducted to explore the perceptions of KA women about seeking physical examinations and cancer screening services in Korea. Data were analyzed using a framework approach. Informants positively perceived the use of health screening services in Korea in comparison to seeking such services in the US. Decision-making factors included cost benefits, high quality services, and more convenient screening procedures in Korea. These benefits outweighed the risks of delaying health care and travelling a vast distance with incurring additional travel costs. Motivations to seek these services in Korea included opportunities to visit their homeland and to enjoy comfortable communication with their native language. The increase of available information about Korean medical services due to the industry's aggressive marketing/PR was identified as a facilitator. Most informants did not recognize possible negative health outcomes of obtaining services in Korea such as inappropriate follow up care if having abnormal findings. Educational programs are needed to educate KAs about the benefits and risks of getting the services in Korea and proper follow up care in the US. Health care providers need to know the different cancer risks and screening needs for this population.

Anti-intellectualism amid the COVID-19 pandemic: The discursive elements and sources of anti-Fauci tweets.

Anti-intellectualism (resentment, hostility, and mistrust of experts) has become a growing concern during the pandemic. Using topic modeling and supervised machine learning, this study examines the elements and sources of anti-Fauci tweets as a case of anti-intellectual discourse on social media. Based on the theoretical framework of science-related populism, we identified three anti-intellectual discursive elements in anti-Fauci tweets: people-scientist antagonism, delegitimizing the motivation of scientists, and delegitimizing the knowledge of scientists. Delegitimizing the motivation of scientists appeared the most in anti-Fauci tweets. Politicians, conservative news media, and non-institutional actors (e.g. individuals and grassroots advocacy organizations) co-constructed the production and circulation of anti-intellectual discourses on Twitter. Anti-intellectual discourses resurged even under Twitter's content moderation mechanism. We discuss theoretical and practical implications for building public trust in scientists, effective science communication, and content moderation policies on social media.

Examining the health information-seeking behaviors of Korean Americans.

Many Korean Americans suffer from high levels of cancer incidence and have low cancer screening rates. A significant number of Korean Americans lack adequate information about cancer screening tests. However, little is known about their health behaviors. This article examines exposure to mass media and health information-seeking behaviors for Korean Americans, and their associations with demographic characteristics influencing variations in exposure to the different health information and trust in health information sources. The authors gathered data for this study using a cross-sectional, community-based survey conducted in the Washington, DC, metropolitan area during 2006 and 2007. It was administered to 254 Korean Americans who were 40 years of age or older. This study is part of the first health-related program of research to study exposure to mass media, health and cancer information sources, and seeking preferences and experiences of Korean Americans. Results indicated that Korean ethnic media sources and Internet are important sources used regularly. Age, years of education completed, and English proficiency levels for Korean Americans significantly predicted the likelihood of their Internet use. Low-income Korean Americans with less education were more likely to seek health information in Korean ethnic magazines and newspapers, whereas Korean Americans with higher education and English proficiency were more likely to seek information online. The most trusted source of health information among respondents was from a doctor or other health care professional. Future research should be conducted to determine whether physicians are actually used as a primary source for health information.

COVID-19 Racial Discrimination and Depressive Symptoms among Asians Americans: Does Communication about the Incident Matter?

Since the outbreak of COVID-19, Asians in the US have experienced a spike of racism. The goal of this paper is to examine the association between racial discrimination amid COVID-19 pandemic and depressive symptoms among Asian subgroups and to test whether communications about the incident with various sources moderate this relationship. Data come from an online survey conducted among 245 Asian Americans. Multiple linear regression analyses were conducted. COVID-19 racial discrimination was positively associated with depressive symptoms, and this association did not vary between Chinese Americans and other Asian subgroups. Communications with a spouse/partner buffered the mental burden of racial discrimination. Those who shared their experience in online ethnic communities displayed stronger depressive symptoms than who did not. These results suggest the potential benefit of communication with a spouse/partner in mitigating the mental burden of discrimination and call for more online mental health support for Asians.

Adverse Mentions, Negative Sentiment, and Emotions in COVID-19 Vaccine Tweets and Their Association with Vaccination Uptake: Global Comparison of 192 Countries.

Background: Many countries show low COVID-19 vaccination rates despite high levels of readiness and delivery of vaccines. The public's misperceptions, hesitancy, and negative emotions toward vaccines are psychological factors discouraging vaccination. At the individual level, studies have revealed negative perceptual/behavioral outcomes of COVID-19 information exposure via social media where misinformation and vaccine fear flood. Objective: This study extends research context to the global level and investigates social media discourse on the COVID-19 vaccine and its association with vaccination rates of 192 countries in the world. Methods: COVID-19 vaccine tweets were compared by country in terms of (1) the number per million Twitter users, (2) mentions of adverse events-death, side-effects, blood clots, (3) negative sentiment (vs. positive), and (4) fear, sadness, or anger emotions (vs. joy). Artificial intelligence (AI) was adopted to classify sentiment and emotions. Such tweets and covariates (COVID-19 morbidity and mortality rates, GDP, population size and density, literacy rate, democracy index, institutional quality, human development index) were tested as predictors of vaccination rates in countries. Results: Over 21.3 million COVID-19 vaccine tweets posted between November 2020 and August 2021 worldwide were included in our analysis. The global average of COVID-19 vaccine tweets mentioning adverse events was 2% for 'death', 1.15% for 'side-effects', and 0.80% for 'blood clots'. Negative sentiment appeared 1.90 times more frequently than positive sentiment. Fear, anger, or sadness appeared 0.70 times less frequently than joy. The mention of 'side-effects' and fear/sadness/anger emotions appeared as significant predictors of vaccination rates, along with the human development index. Conclusions: Our findings indicate that global efforts to combat misinformation, address negative emotions, and promote positive languages surrounding COVID-19 vaccination on social media may help increase global vaccination uptakes.

Have E-cigarette Risk Perception and Cessation Intent of Young Adult Users Changed During the Pandemic?

Objectives: Emerging evidence indicates that young adults who use e-cigarettes can withhold greater exposure to COVID-19 risk. We examine how young e-cigarette users perceive COVID-19 related threat of e-cigarette use and benefit of cessation as compared to traditional ones, applying the health belief model. We investigate changes of such perceptions during the pandemic and their associations with past attempt and future intent to quit e-cigarette use. Methods: We collected responses from US young adults (aged 18-25) who have used e-cigarettes in the past month by conducting 2 waves of online surveys in 2020 (wave 1, N=165) and 2021 (wave 2, N=347). Results: Young e-cigarette users in wave 2 reported greater estimates of COVID-19 and traditional threat as well as COVID-19 and traditional benefit of quitting than wave 1. However, we also found significant increases of e-cig dependence, perceived barriers of quitting, and the percentage of young e-cigarette users (33%) who had never attempted to quit in the past month. Importantly, a COVID-19 benefit of cessation and efficacy of quitting were significantly associated with cessation intent. Conclusions: Ongoing efforts are required to track post-pandemic e-cigarette risk perceptions and behaviors, as well as to identify strategies to mitigate increased dependence and usage of e-cigarettes.

Data Veracity of Patients and Health Consumers Reported Adverse Drug Reactions on Twitter: Key Linguistic Features, Twitter Variables, and Association Rules.

As Twitter emerged as an important data source for pharmacovigilance, heterogeneous data veracity becomes a major concern for extracted adverse drug reactions (ADRs). Our objective is to categorize different levels of data veracity and explore linguistic features of tweets and Twitter variables as they may be used for automatic screening high-veracity tweets that contain ADR-related information. We annotated a published Twitter corpus with linguistic features from existing studies and clinical experts. Multinomial logistic regression models found that first-person pronouns, expressing negative sentiment, ADR and drug name being in the same sentence were significantly associated with higher levels of data veracity (p<0.05), using medical terminology and fewer indications were associated with good data veracity (p<0.05), less drug numbers were marginally associated with good data veracity (p=0.053). These findings suggest opportunities for developing machine learning models for automatic screening of ADR-related tweets using key linguistic features, Twitter variables, and association rules.

Cancer information seeking and awareness of cancer information sources among Korean Americans.

Many Korean Americans (KAs) suffer high cancer incidence levels and have low cancer screening rates. A significant number of KAs lack adequate information about cancer screening tests. However, little is known about the health information seeking behaviors of KAs. This study examines the types of cancer information searched for, the cancer information seeking experiences, and the awareness of major cancer information sources, such as the National Cancer Institutes (NCI) and the NCI's Cancer Information Service, among KAs. It also examines associations with demographic characteristics and media use influencing variations in the awareness of cancer information sources. Data for this study were gathered with a cross-sectional, community-based survey (254 KAs). The survey results indicated that KA's involvement in cancer information seeking is relatively low, and they have somewhat negative experiences in seeking cancer information. In addition, their awareness of cancer information sources was limited. Despite of the heavy use of Korean ethnic media, it did not connect to cancer information source awareness. Rather, use of US mainstream media was significantly related with awareness. Campaigns using the Korean language through partnerships with Korean ethnic media to inform KAs about credible sources of health information appear to be warranted by our findings.