Public Health Implications of Image-Based Social Media: A Systematic Review of Instagram, Pinterest, Tumblr, and Flickr.

INTRODUCTION: Image-based social media Instagram, Pinterest, Tumblr, and Flickr have become sources of health-related information and tools for health communication. No known systematic review exists that summarizes the existing research and its health implications. METHODS: We searched EBSCOhost Academic Search Complete, PubMed, and Web of Science in January 2016, April 2017, and November 2017, with the following keywords: Pinterest, Instagram, Tumblr, or Flickr. Only public health-related, peer-reviewed research articles were included (excluding surveys of self-reported social media use). RESULTS: Sixty-six research articles were included. All 12 experimental studies used Instagram. Of the 54 observational studies, 38 studied Instagram; 12, Pinterest; 7, Tumblr; and 6, Flickr; some studies investigated more than 1 platform. More than half of the included articles were related to mental health and substance abuse (n = 39, 59%). Other topics included chronic diseases, infectious diseases, surgery, injury prevention, pharmacovigilance, sexual and reproductive health, and adolescent psychology with functional magnetic resonance imaging. DISCUSSION: Public health-oriented research on Instagram, Pinterest, Tumblr, and Flickr is increasing. Most observational studies investigated questions ranging from public perception of diseases or interventions (vaccination) and undesirable media exposure ("echo chamber," distorted body image, underage substance use, and pro-suicide messages) to information dissemination and online engagement (likes and comments). A few studies attempted to use image-based social media as intervention tools, but the results were mainly exploratory. CONCLUSION: More research is needed to study how social media users discuss health through sharing images online, and how public health professionals can communicate effectively using image-sharing social media.

Adopting YouTube to Promote Health: Analysis of State Health Departments.

INTRODUCTION: We describe videos posted to the YouTube video-sharing Web site by US state health departments (SHDs) and associated institutional factors. METHODS: YouTube channels from SHDs were identified, their data retrieved, and their videos saved to a playlist on January 10, 2016. Ten randomly sampled videos from each channel were manually coded for topics. The 2012 Association of State and Territorial Health Officials profile survey was used to obtain information on staff, expenditure, and top 5 priorities for each SHD. Descriptive statistics and univariable regression were conducted. RESULTS: Forty-three SHDs had YouTube channels. Together, all SHDs posted 3957 videos, accumulated 12,151,720 views, and gained 6302 subscribers. In total, 415 videos were manually coded. Information about the agency (17.6%), communicable diseases (12.5%), and mother/infant health (8.9%) comprised the largest share of topics. No statistically significant association was observed between the log-transformed number of videos posted on an SHD's YouTube channel and any of the explanatory variables of SHD staffing and expenditure in 2011. The number of full-time employees (r = 0.34, p = 0.03), number of epidemiologists and biostatisticians (r = 0.41, p = 0.01), and 2011 total year expenditure (r = 0.38, p = 0.02) were positively correlated with the log-transformed number of views per YouTube video posted by SHDs. No meaningful patterns of statistical association were observed between the percentage of expenditure on a specific program area and the topics of videos. CONCLUSION: Most SHDs are using YouTube, which provides a unique opportunity for SHDs to disseminate health messages.

Sentiment, Contents, and Retweets: A Study of Two Vaccine-Related Twitter Datasets.

INTRODUCTION: Social media platforms are important channels through which health education about the utility and safety of vaccination is conducted. OBJECTIVE: To investigate if tweets with different sentiments toward vaccination and different contents attract different levels of Twitter users' engagement (retweets). METHODS: A stratified random sample (N = 1425) of 142,891 #vaccine tweets (February 4, 2010, to November 10, 2016) was manually coded. All 201 tweets with 100 or more retweets from 194,259 #vaccineswork tweets (January 1, 2014, to April 30, 2015) were manually coded. Regression models were applied to identify factors associated with retweet frequency. RESULTS: Among #vaccine tweets, provaccine tweets (adjusted prevalence ratio = 1.5836, 95% confidence interval = 1.2130-2.0713, p < 0.001) and antivaccine tweets (adjusted prevalence ratio = 4.1280, 95% confidence interval = 3.1183-5.4901, p < 0.001) had more retweets than neutral tweets. No significant differences occurred in retweet frequency for content categories among antivaccine tweets. Among 411 links in provaccine tweets, Twitter (53; 12.9%), content curator Trap.it (14; 3.4%), and the Centers for Disease Control and Prevention (8; 1.9%) ranked as the top 3 domains. Among 325 links in antivaccine tweets, social media links were common: Twitter (44; 14.9%), YouTube (25; 8.4%), and Facebook (10; 3.4%). Among highly retweeted #vaccineswork tweets, the most common theme was childhood vaccinations (40%; 81/201); 21% mentioned global vaccination improvement/efforts (42/201); 29% mentioned vaccines can prevent outbreaks and deaths (58/201). CONCLUSION: Engaging social media key opinion leaders to facilitate health education about vaccination in their tweets may allow reaching a wider audience online.

Contents, Followers, and Retweets of the Centers for Disease Control and Prevention's Office of Advanced Molecular Detection (@CDC_AMD) Twitter Profile: Cross-Sectional Study.

BACKGROUND: The Office of Advanced Molecular Detection (OAMD), Centers for Disease Control and Prevention (CDC), manages a Twitter profile (@CDC_AMD). To our knowledge, no prior study has analyzed a CDC Twitter handle's entire contents and all followers. OBJECTIVE: This study aimed to describe the contents and followers of the Twitter profile @CDC_AMD and to assess if attaching photos or videos to tweets posted by @CDC_AMD would increase retweet frequency. METHODS: Data of @CDC_AMD were retrieved on November 21, 2016. All followers (N=809) were manually categorized. All tweets (N=768) were manually coded for contents and whether photos or videos were attached. Retweet count for each tweet was recorded. Negative binomial regression models were applied to both the original and the retweet corpora. RESULTS: Among the 809 followers, 26.0% (210/809) were individual health professionals, 11.6% (94/809) nongovernmental organizations, 3.3% (27/809) government agencies' accounts, 3.3% (27/809) accounts of media organizations and journalists, and 0.9% (7/809) academic journals, with 54.9% (444/809) categorized as miscellaneous. A total of 46.9% (360/768) of @CDC_AMD's tweets referred to the Office's website and their current research; 17.6% (135/768) referred to their scientists' publications. Moreover, 80% (69/86) of tweets retweeted by @CDC_AMD fell into the miscellaneous category. In addition, 43.4% (333/768) of the tweets contained photos or videos, whereas the remaining 56.6% (435/768) did not. Attaching photos or videos to original @CDC_AMD tweets increases the number of retweets by 37% (probability ratio=1.37, 95% CI 1.13-1.67, P=.002). Content topics did not explain or modify this association. CONCLUSIONS: This study confirms CDC health communicators' experience that original tweets created by @CDC_AMD Twitter profile sharing images or videos (or their links) received more retweets. The current policy of attaching images to tweets should be encouraged.

Fluoride-related YouTube videos: A cross-sectional study of video contents by upload sources.

Purpose: The aim of this study was to describe characteristics of the most widely viewed fluoride-related videos on the video sharing website, YouTube, and to compare the content of videos uploaded from different sources.Methods: Using a cross-sectional design, a total of 100 fluoride-related, English language videos were manually coded and statistically analyzed.Results: A majority of videos were consumer-generated. Videos that were consumer-generated had the most views of any source (9,737,845 views; 69.32%). Compared to consumer-generated videos, videos uploaded by a professional source were 15.52 times as likely to mention fluoridated toothpaste (Odds ratio, OR=15.52, 95% CI, 1.92, 125.35), 5.04 times as likely to mention the need for training of health personnel (OR=5.04, 95% CI, 1.15, 22.02), 9.69 times as likely to mention the benefits of fluoride on teeth (OR=9.69; 95% CI, 2.01, 46.81), 3.52 times as likely to mention that too much fluoride is negative (OR=3.52, 95% CI, 1.06, 11.73), and 3.44 times as likely to mention the dangers of fluoride use in children 1-5 years old (OR=3.44, 95% CI, 1.05, 11.23).Conclusion: Widely-viewed fluoride-related information on YouTube has an anti-fluoride sentiment, focusing more on the danger of fluoride rather than its benefits.

Eastern Equine Encephalitis and YouTube videos: A content analysis.

BACKGROUND: Eastern Equine Encephalitis virus (EEEV) infections among humans are rare, but can result in severe consequences. YouTube can serve as a platform for EEEV health education. This study aims to assess the characteristics of the top EEEV-related YouTube videos, and whether their informational contents vary by uploading source. METHODS: On August 15, 2016, we searched YouTube.com for the top 100 videos by number of views featuring "Eastern Equine Encephalitis". We manually coded and statistically analyzed the contents, source of uploads and meta-data of 100 most viewed EEEV-related YouTube videos. Univariate logistic regression was applied to identify if videos of different sources (consumer, professional, and news) differed in their contents. RESULTS: Excluding one video, 21 Consumer, 9 Professional, and 69 News videos were analyzed (N = 99). Compared with news-videos, consumer-videos are less likely to mention the geography of EEEV transmission (OR = 0.21, p < 0.01); professional-videos are more likely to mention other types of encephalitis (OR = 27.50, p < 0.01), and to mention horses only (OR = 8.5, p < 0.01). CONCLUSIONS: Professional videos provided the most comprehensive information. However, few videos from professionals made it to the top 100 list. The untapped potential of YouTube as a unique platform to disseminate EEEV information deserves the attention of public health professionals.

Zika Virus on YouTube: An Analysis of English-language Video Content by Source.

OBJECTIVES: The purpose of this study was to describe the source, length, number of views, and content of the most widely viewed Zika virus (ZIKV)-related YouTube videos. We hypothesized that ZIKV-related videos uploaded by different sources contained different content. METHODS: The 100 most viewed English ZIKV-related videos were manually coded and analyzed statistically. RESULTS: Among the 100 videos, there were 43 consumer-generated videos, 38 Internet-based news videos, 15 TV-based news videos, and 4 professional videos. Internet news sources captured over two-thirds of the total of 8 894 505 views. Compared with consumer-generated videos, Internet-based news videos were more likely to mention the impact of ZIKV on babies (odds ratio [OR], 6.25; 95% confidence interval [CI], 1.64 to 23.76), the number of cases in Latin America (OR, 5.63; 95% CI, 1.47 to 21.52); and ZIKV in Africa (OR, 2.56; 95% CI, 1.04 to 6.31). Compared with consumer-generated videos, TV-based news videos were more likely to express anxiety or fear of catching ZIKV (OR, 6.67; 95% CI, 1.36 to 32.70); to highlight fear of ZIKV among members of the public (OR, 7.45; 95% CI, 1.20 to 46.16); and to discuss avoiding pregnancy (OR, 3.88; 95% CI, 1.13 to 13.25). CONCLUSIONS: Public health agencies should establish a larger presence on YouTube to reach more people with evidence-based information about ZIKV.

Zika-Virus-Related Photo Sharing on Pinterest and Instagram.

OBJECTIVE: Pinterest (San Francisco, CA) and Instagram (Menlo Park, CA) are 2 popular photo-sharing social media platforms among young individuals. We assessed differences between Instagram and Pinterest in relaying photographic information regarding Zika virus. Specifically, we investigated whether the percentage of Zika-virus-related photos with Spanish or Portuguese texts embedded therein was higher for Instagram than for Pinterest and whether the contents of Zika-virus-related photos shared on Pinterest were different from those shared on Instagram. METHODS: We retrieved and manually coded 616 Pinterest (key words: "zika" AND "virus") and 616 Instagram (hashtag: #zikavirus) photos. RESULTS: Among the manually coded samples, 47% (290/616) of Pinterest photos and 23% (144/616) of Instagram photos were relevant to Zika virus. Words were embedded in 57% (164/290) of relevant Pinterest photos and all 144 relevant Instagram photos. Among the photos with embedded words, photos in Spanish or Portuguese were more prevalent on Instagram (77/144, 53%) than on Pinterest (14/164, 9%). There were more Zika-virus-related photos on Instagram than on Pinterest pertinent to Zika virus prevention (59/144, 41%, versus 41/290, 14%; P<0.0001), the effects of Zika virus on pregnancy (27/144, 19%, versus 32/290, 11%; P=0.04), and Zika-virus-associated deaths (4/144, 2%, versus 0/290, 0%; P=0.01). CONCLUSIONS: Pinterest and Instagram are similar platforms for Zika virus prevention communication. (Disaster Med Public Health Preparedness. 2017;11:656-659).