TikTok: a far-reaching opportunity for health professionals to address weight loss.

OBJECTIVES: Recent behavioral research indicates that social media may be successfully integrated into weight loss interventions to mitigate the obesity epidemic that has been linked with type two diabetes, cardiovascular diseases, cancers, as well as poor psychological health. This study aimed to examine the content and characteristics of 100 most trending TikTok videos related to weight loss. STUDY DESIGN: This was a cross-sectional, descriptive study. METHODS: Videos were analyzed for source, predominant theme, and inclusion of specific content. Independent two-tailed t-tests assessed the effect of content on number of comments, likes, and forwards garnered by the videos. RESULTS: More than 90% of the videos were consumer generated, indicating a missed opportunity by health professionals to use social media to provide accurate information regarding weight loss. Less than one-fifth of the videos were informational but significantly influenced the number of comments (P < .001) and likes (P = .002). Videos mentioning benefits ((P < .001) and speed of weight loss (P = .003) significantly influenced the number of forwards, whereas those that mentioned recipes (P = .005) and how to lose weight (P = .003) significantly affected the number of comments. CONCLUSION: The results underscore the need for further research to elucidate the effectiveness of social media in impacting weight loss, as well as how they may supplement traditional health promotion and behavior interventions for weight loss.

Readability analysis of online health information on preexposure prophylaxis (PrEP).

OBJECTIVES: When considering PreExposure Prophylaxis (PrEP) as a HIV prevention method, many rely on information available online. Limited research has examined the quality, including readability, of PrEP information on the Internet. The current study evaluates the readability of PrEP information online employing six commonly used readability tests. STUDY DESIGN: This is a cross-sectional study. METHODS: Using the Google Chrome browser, a search for articles was conducted using two terms: "pre-exposure prophylaxis" and "Truvada." The URLs of the first 50 English language websites for each term were recorded to create the overall study sample of 100 unique websites. Using six established readability scales, we determined the readability scores for each examined website. Websites were stratified by .com, .org, and .gov URL extensions to compare readability metrics. RESULTS: Mean Flesch-Kincaid Grade Level (FKGL) was 9.5 (SD = 2.2), mean Gunning Fog Index (GFI) was 11.1 (SD = 2.7), mean Coleman-Liau Index (CLI) was 11.3 (SD = 2.0), while mean Simple Measure of Gobbledygook (SMOG) Grade Level was 12.1 (SD = 1.8). Using Flesch-Kincaid Reading Ease (FRE), one article was found easy to read, while 23 were found of average difficulty to read. Mean New Dale-Chall (NDS) score was 7.3 (SD = 1.3), or grade 9-10. Mean reading levels were significantly different among the commercial, organization, and government sites, however, no category was at the recommended sixth-grade level. CONCLUSIONS: PrEP information online surpasses the reading ability of most U.S. adults. Improving the readability of PrEP information online may help to increase uptake of PrEP among populations at risk for HIV.

Content of widely viewed YouTube videos about celiac disease.

OBJECTIVE: To describe the most widely viewed English language videos related to celiac disease on YouTube. STUDY DESIGN: This is a cross-sectional study. METHODS: Videos sorted by number of views yielded the 100 most widely viewed. Number of views, source (consumer, professional, or news agency), and inclusion of specific content were recorded. RESULTS: Collectively, the 100 videos were viewed nearly 7 million times. Between 2007 and 2010, 28% were uploaded, while more than 70% were uploaded after 2010. Professionals uploaded almost half (48%), consumers posted 32%, and news sources posted the remaining 20%. While gluten-containing foods/drinks were presented in 57% of the videos, these videos garnered almost 78% of cumulative views. Comparatively few videos provided substantive information related to age at diagnosis, who is at risk for the disease, hereditary nature, or that the disease can inhibit growth and development among children. Most videos (56%) did not cover how celiac disease is diagnosed, and only 14% mentioned family members of diagnosed individuals should be screened for the disease (garnering only 9% of cumulative views). CONCLUSION: Given the popularity and potential reach of YouTube, medical professionals have an opportunity to use this medium to reach a large audience in providing accurate and useful information to the public about celiac disease.

Sugar sweetened beverages on emerging outdoor advertising in New York City.

OBJECTIVES: As a replacement for traditional phone booths, LinkNYC kiosks provide the ability to make free calls, connect to WiFi, and to charge electronic devices. These structures, which are supported by advertising revenue, are found in growing numbers on the streets of New York City (NYC). The purpose of this study was to determine the prevalence of sugar-sweetened beverage advertisements on LinkNYC kiosks. STUDY DESIGN: Cross-sectional, observational. METHODS: A total of 100 kiosks from a sample of 507 kiosks were randomly selected and observed in Manhattan, NYC. RESULTS: A total of 2025 advertisements, including duplicates, were observed that included 347 (17.1%) viewed at 64 kiosks for non-alcoholic beverages. Over half (n = 206, 59.4%) featured beverages with added sugar. For the 206 beverages with sugar, the mean kilocalories and grams of sugar per serving were 149.90 (SD = 64.95, range = 90-300) and 35.04 (SD = 19.54, range = 17-81), respectively. Differences in the frequency of these 206 advertisements were examined by the median annual income quartile of the census tract where the kiosk was located, and no significant differences were observed, χ2 (3, N = 206) = 3.09, P = 0.38. CONCLUSIONS: As the NYC Department of Health and Mental Hygiene invests in efforts to reduce consumption of sugar-sweetened beverages, promoting these very products through new media controlled by the City does not seem well aligned with the goal of improving dietary intake of citizens.

YouTube as a source of information on skin bleaching: a content analysis.

BACKGROUND: Skin bleaching is a common, yet potentially harmful body modification practice. AIM: To describe the characteristics of the most widely viewed YouTube™ videos related to skin bleaching. METHODS: The search term 'skin bleaching' was used to identify the 100 most popular English-language YouTube videos relating to the topic. Both descriptive and specific information were noted. RESULTS: Among the 100 manually coded skin-bleaching YouTube videos in English, there were 21 consumer-created videos, 45 internet-based news videos, 30 television news videos and 4 professional videos. Excluding the 4 professional videos, we limited our content categorization and regression analysis to 96 videos. Approximately 93% (89/96) of the most widely viewed videos mentioned changing how you look and 74% (71/96) focused on bleaching the whole body. Of the 96 videos, 63 (66%) of videos showed/mentioned a transformation. Only about 14% (13/96) mentioned that skin bleaching is unsafe. The likelihood of a video selling a skin bleaching product was 17 times higher in internet videos compared with consumer videos (OR = 17.00, 95% CI 4.58-63.09, P < 0.001). Consumer-generated videos were about seven times more likely to mention making bleaching products at home compared with internet-based news videos (OR = 6.86, 95% CI 1.77-26.59, P < 0.01). CONCLUSIONS: The most viewed YouTube video on skin bleaching was uploaded by an internet source. Videos made by television sources mentioned more information about skin bleaching being unsafe, while consumer-generated videos focused more on making skin-bleaching products at home.

Readability of online material related to skin cancer.

OBJECTIVES: The key to reducing mortality from skin cancer depends on early detection and treatment, which, in many cases, means a patient should be informed and possess the self-efficacy necessary to seek expert opinion. The purpose of this study was to determine the readability of skin cancer materials on the Internet using the commonly used readability tests. STUDY DESIGN: This is a cross-sectional study. METHODS: A search was conducted using the key words 'skin cancer.' The first 15 pages of websites that contained English language articles on skin cancer comprised the sample for this study. All English language articles appearing on these websites were analyzed using the Readable.io service to automate popular readability scores. For each article, it was determined if it was generated from a .org, .com, .gov, .net, .edu or other source. Five readability tests were conducted on the materials to determine the ease with which one can read each article. RESULTS: Of the 102 websites sampled, none received an acceptable score on all five assessments. In fact, more than 90% of the websites sampled received an unacceptable score on any one of the five assessments, and more than 78% of the websites sampled received an unacceptable level on all five assessments. All five readability assessments demonstrated statistically significant results; each P-value obtained from the t-tests was substantially below 0.01 and, hence, below the α = 0.05 threshold. These results indicate that it is unlikely that skin cancer websites are being written at the recommended level. Of the websites sampled, roughly 42% were .com, and slightly more than 36% were .org. Statistical evidence indicated that neither .com nor .org websites are likely to be written at the acceptable level. CONCLUSIONS: Both for-profit and non-profit agencies which aim to provide health information to consumers should be mindful of the readability levels of the materials they disperse.

TMJ online: Investigating temporomandibular disorders as "TMJ" on YouTube.

As the understanding of temporomandibular disorders' (TMDs) aetiologies and treatments develops from non-evidence-based to evidence-based approaches, the availability of sound information will likewise grow and need to be disseminated. The purpose of this study is to describe the content most commonly viewed in YouTube videos related to TMDs or "TMJ" and see whether videos from different sources have different content. Video information was gathered by searching YouTube for the term "TMJ," and data were recorded related to descriptive information as well as content. Statistical analyses included Kruskal-Wallis H Test, Spearman's Rho and univariate logistic regression. The sources of upload were Consumer (n = 62), Professional (n = 29) and News (n = 9). There were almost no statistically significant differences in content distribution among video sources. Videos garnered a total of 4 749 360 views, with an overall median of 7014.5 views. About two-thirds of the videos (68/100) explained what "TMJ" is, with a surprising third of Professional videos (9/29) not covering the subject. Roughly half of the videos mentioned at least one reason "TMJ" occurs (55/100), and seven in ten mentioned some kind of treatment (70/100). Video names mentioned a cure or treatment in 64 cases, while the other 36 referred to TMJ anatomy or "TMJ" aetiology. Future research should focus on ways to popularise professional videos with reliable information for those who are searching on YouTube for advice related to "TMJ."

An exploratory assessment of weight loss videos on YouTube™.

OBJECTIVE: To describe the variation in contents between different video sources on YouTube ™ regarding weight loss. STUDY DESIGN: The 100 most widely viewed weight loss videos on YouTube™ were selected for manual coding. METHODS: Videos were manually coded based on sources and contents, we also identify themes for each of the videos. Univariate logistic regression was used to assess difference in contents between videos from different sources. RESULTS: After excluding two videos, a sample of 98 videos remained. Among them, there were 74 consumer-generated videos, 12 news videos, and 12 from commercial television and companies. Collectively, the 98 videos were viewed more than 365 million times. The odds of mentioning ongoing lifestyle that includes long-term changes in daily eating was 90% less in commercial and company videos compared to consumer videos (odds ratio [OR] = 0.10, 95% confidence interval [CI] 0.01-0.85, P = 0.03). The odds of showing a female talking in the video about weight loss was 81% less in news videos compared to consumer videos (OR = 0.19, 95% CI 0.05-0.68, P = 0.01). In addition, commercial and company videos were found to be 18 times as likely to carry a theme on workout as consumer videos (OR = 18.13, 95% CI 3.60-91.22, P < 0.01). CONCLUSION: Public health professionals need to be more creative to make their videos popular if they want to reach a wide audience.

What do popular YouTubeTM videos say about vaccines?

BACKGROUND: The unregulated social network YouTube TM has become an increasingly popular source of information on health topics such as vaccine safety. With a reach of over one billion users per month, the potential for misinformation is significant. METHODS: Using the keywords 'vaccine safety' and 'vaccines and children', 87 of the most widely viewed YouTubeTM videos were identified and analyzed for content, author status and view count. RESULTS: The range of view counts was 25 532 to 6 229 835, with a median of 62 075 views per video. Most videos (n = 74, 85.1%) were devoted exclusively to the topic of vaccination. The three most common sources of these YouTubeTM videos were consumers (27.6%), TV-based or Internet-based news (26.4%) and individual health professionals (25.3%). Top topics covered were autism causality (47.1% of videos), undisclosed or poorly understood risks (42.5%), adverse reactions (40.2%) and thimerosol or mercury in vaccines (36.8%). The majority of videos (65.5%) discouraged the use of vaccines. CONCLUSION: Health professionals should be aware of the widely disseminated vaccination information available on the Internet and should appreciate its possible effect on the public.

An analysis of sodium, total fat and saturated fat contents of packaged food products advertised in Bronx-based supermarket circulars.

Americans' consumption of sodium, fat, and saturated fat exceed federally recommended limits for these nutrients and has been identified as a preventable leading cause of hypertension and cardiovascular disease. More than 40% of the Bronx population comprises African-Americans, who have increased risk and earlier onset of hypertension and are also genetically predisposed to salt-sensitive hypertension. This study analyzed nutrition information for packaged foods advertised in Bronx-based supermarket circulars. Federally recommended limits for sodium, saturated fat and total fat contents were used to identify foods that were high in these nutrients. The proportion of these products with respect to the total number of packaged foods was calculated. More than a third (35%) and almost a quarter (24%) of the 898 advertised packaged foods were high in saturated fat and sodium respectively. Such foods predominantly included processed meat and fish products, fast foods, meals, entrees and side dishes. Dairy and egg products were the greatest contributors of high saturated fat. Pork and beef products, fast foods, meals, entrees and side dishes had the highest median values for sodium, total fat and saturated fat content. The high proportion of packaged foods that are high in sodium and/or saturated fat promoted through supermarket circulars highlights the need for nutrition education among consumers as well as collaborative public health measures by the food industry, community and government agencies to reduce the amounts of sodium and saturated fat in these products and limit the promotion of foods that are high in these nutrients.