Correlates of intention to screen for cervical cancer among adult women in Kyotera District, Central Uganda: a community based cross-sectional study.

INTRODUCTION: Cervical cancer continues to pose a major public health challenge in low-income countries. Cervical cancer screening programs enable early detection and effectively reduce the incidence of cervical cancer as well as late-stage diagnosis and mortality. However, screening uptake remains suboptimal in Uganda. This study assessed correlates of intention to screen for cervical cancer among women in the Kyotera district of Central Uganda. METHODS: We analyzed cross-sectional data collected to determine the effectiveness of community audio towers (CATs) as a modality of health communication to support cervical cancer prevention. Women (n = 430) aged 21-60 years without a prior history of cervical cancer screening were surveyed about demographics, sources of health information and cervical cancer screening intentions in 2020. We used generalized linear modelling with modified Poisson regression and backwards variable elimination to identify adjusted prevalence ratios and 95% confidence intervals (CI) to determine factors associated with intention to screen for cervical cancer. RESULTS: Half (50.2%) of the participants had intentions to screen for cervical cancer within twelve months and 26.5% had moderate knowledge about cervical cancer. Nearly half (46.0%) considered themselves at risk of cervical cancer. Compared to residents who primarily received their health information from social media and radio, participants who received health information primarily from CATs (aPR:0.64, 95% CI:0.52-0.80, p < 0.001) and TV (aPR:0.52, 95% CI:0.34-0.82, p = 0.005) had a lower prevalence of intention to screen for cervical cancer. The prevalence of intentions to screen for cervical cancer in twelve months was higher among those resided in town councils (aPR:1.44, 95% CI:1.12-1.86, p = 0.004) compared to rural areas, and higher among those who considered themselves to be at risk of cervical cancer (aPR:1.74, 95% CI:1.28-2.36, p < 0.001) compared to those who did not. CONCLUSIONS: We found suboptimal prevalence of intentions to screen for cervical cancer among women in central Uganda. Additional research and implementation projects are needed to increase cervical cancer screening. Targeting risk perceptions and behavioral approaches to increase intentions could be effective in future intervention work. Based on urban-rural differences, additional work is needed to support equitable sharing of information to support cancer prevention messaging; CATs and TV may best help reach those with lower intentions to screen based on our research.

Understanding the associations between information sources, sociodemographics, and views on public health measures: evidence from the COVID-19 pandemic in Austria.

BACKGROUND: Throughout the COVID-19 pandemic, it was a key priority for governments globally to ensure agreement with, and subsequently adherence to, imposed public health measures, specifically non-pharmaceutical interventions (NPIs). Prior research in this regard highlighted the role of COVID-19 information sources as well as sociodemographic and other personal characteristics, however, there is only limited evidence including both. To bridge this gap, this study investigated the associations of COVID-19 information sources such as social media and participant characteristics with agreement with and adherence to NPIs during the first lockdown in Austria. METHODS: An online survey was conducted in May 2020 among adult Austrian residents asking about their experiences during the first lockdown. Collected data included sociodemographic characteristics, main COVID-19-related information sources, agreement with/adherence to three NPIs (no physical contact to family members not living in the same household, leisurely walks restricted to members of the same household, mandatory face masks) and information about perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS), anxiety/depression levels using the Hospital Anxiety and Depression Scale (HADS), whether participants felt well advised by the government, and whether participants perceived the pandemic to threaten their income. Ordered and multinomial logistic regression models were employed to achieve the research aims. RESULTS: The cross-sectional sample consisted of 559 Austrian residents. Using social media as main COVID-19 information source was consistently associated with lower agreement with NPIs. A positive association with agreement with measures was found for higher educational backgrounds and higher anxiety levels. By contrast, higher levels of depression, not feeling well advised by the government, and perceiving the pandemic as an economic threat were negatively associated with agreement with measures. Moreover, the use of social media as main COVID-19 information source and not feeling well advised by the government were associated with lower adherence to NPIs. By contrast, higher levels of education were associated with higher adherence. CONCLUSIONS: This comprehensive analysis emphasizes the associations of COVID-19 information sources as well as sociodemographic and other participant characteristics with agreement with and adherence to NPIs, bearing important implications for future public health crisis communication strategies.

Social media heterogeneity and preventive behaviours during the COVID-19 outbreak: a survey on online shopping.

BACKGROUND: Residents' adoption of preventive behaviours proved beneficial in preventing the large-scale transmission of the virus during the early stages of the COVID-19 outbreak. It is critical to investigate how social media triggers residents' preventive behaviour decisions during the COVID-19 outbreak. METHODS: This paper selected online shopping as a specific preventive behaviour for empirical investigation. An online cross-sectional survey was conducted through the Sojump website from 1 to 15 March 2020, and a total of 1,289 valid questionnaires were collected from China. This paper uses multiple regression analysis to investigate the heterogeneous impacts of different information sources on residents' online shopping willingness and online shopping behaviour and the heterogeneous impacts of different information content in social media on the transformation of residents' online shopping willingness and online shopping behaviour. RESULTS: The findings indicate that both official-media and self-media positively promote residents' online shopping willingness and behaviour, with official-media having a stronger promotional effect than self-media. Furthermore, official-media and self-media can collaboratively promote residents' online shopping willingness and online shopping behaviour. The ease-of-use and usefulness of information significantly promoted the transformation of residents' online shopping willingness. CONCLUSIONS: This study analyses the heterogeneous impacts of social media on residents' preventive behaviours from the perspectives of information source differentiation and information content differentiation, which enriches related studies and provides feasible paths for promoting residents' preventive behaviours.

Trust in information sources during the COVID-19 pandemic and its association with vaccine trust among a sample of Hispanic adults.

BACKGROUND: Public response to the COVID-19 pandemic has underscored the importance of trust, particularly among minority populations. Several factors might affect vaccine safety trust, including source trustworthiness. Using data from the Puerto Rico Community Engagement Alliance, we assessed the association between trust in information sources and the COVID-19 vaccine in a sample of Hispanic adults. METHODS: A cross-sectional survey-based study was conducted from November 2021 to March 2022. Participants were telephone-interviewed to assess sociodemographic, clinical, and COVID-19-related variables. Vaccine trust was assessed by how confident respondents were regarding COVID-19 vaccine safety. Trust in COVID-19 information sources was assessed by asking respondents how much they trusted selected sources of information to provide accurate information about COVID-19, including the US and Puerto Rico governments, Centers for Disease Control and Prevention (CDC), health care professionals, and traditional media (television/radio/newspaper/internet). Logistic regression models estimated the odds ratio (OR, 95% CI) of COVID-19 vaccine trust based on trust in information sources. RESULTS: A total of 200 adults aged ≥21 years completed the telephone interview. While most of the study sample (97.5%) had been inoculated with at least one dose of the COVID-19 vaccine, 86% trusted in the COVID-19 vaccine's safety. After adjusting for age and sex, participants who attested greater trust in their healthcare professionals (OR=1.99, 95% CI=0.71, 5.62), the US government (OR=2.44, 95% CI=0.69, 8.68), and the CDC (OR=8.18, 95% CI=2.97, 22.57) reported increased vaccine trust as compared to those not having great confidence in these entities. CONCLUSION: These findings support that trust in information provided by the CDC is positively associated with COVID-19 vaccine trust. Acknowledging predictors of trust regarding COVID-19 vaccination could help address factors that affect vaccine confidence. In turn, it strengthens COVID-19 prevention efforts, benefiting common welfare, reducing health disparities, and aiding underserved populations.

Sources of information on surgical options for patients undergoing antireflux surgery: a single-center questionnaire-based survey.

BACKGROUND: To explore the sources of information on antireflux surgery for patients undergoing this surgery in China. METHODS: Patients who underwent antireflux surgery in the Gastroesophageal Reflux Center of the Zhejiang Provincial People's Hospital from January 2016 to June 2021 were selected as survey subjects, and a questionnaire survey was conducted by telephone. RESULTS: A total of 358 questionnaires were distributed, and 320 valid questionnaires were recovered, yielding a 89.4% completion rate. Among patients' sources of information about antireflux surgery, the media was the primary source (33.8%) followed by recommendations from relatives or friends (27.8%), referrals from physicians (23.4%) and other sources (15.0%). Patients of different ages and educational levels have different sources for obtaining information about the procedure. Most of the information on surgery for patients aged 20 to 49 years was derived from recommendations from friends or relatives, whereas most of the information on surgery for patients aged 50 to 80 years was obtained from the media. Most of the information on surgery for patients with a primary school education or less was derived from physicians' recommendations, whereas most of the information for patients with a junior secondary school education or higher was obtained from the media. The recommendation of patients for surgery varied among the different departments (X2 = 36.011, p < 0.001), and a two-to-two comparison found that the recommended rates for cardiology and gastroenterology differed from the rates of other groups (p < 0.001, Table 2). CONCLUSIONS: The results of this investigation show that a large number of patients who underwent antireflux surgery learned about the operation through the media and recommendations from relatives or friends rather than physicians at the hospital. Notably, physicians specializing in GERD need to increase their knowledge of the disease and surgical treatment options to provide correct medical information to patients and to conduct media campaigns.

Patient education information material assessment criteria: A scoping review.

BACKGROUND: Patient education information material (PEIM) is an essential component of patient education programs in increasing patients' ability to cope with their diseases. Therefore, it is essential to consider the criteria that will be used to prepare and evaluate these resources. OBJECTIVE: This paper aims to identify these criteria and recognize the tools or methods used to evaluate them. METHODS: National and international databases and indexing banks, including PubMed, Scopus, Web of Science, ProQuest, the Cochrane Library, Magiran, SID and ISC, were searched for this review. Original or review articles, theses, short surveys, and conference papers published between January 1990 and June 2022 were included. RESULTS: Overall, 4688 documents were retrieved, of which 298 documents met the inclusion criteria. The criteria were grouped into 24 overarching criteria. The most frequently used criteria were readability, quality, suitability, comprehensibility and understandability. CONCLUSION: This review has provided empirical evidence to identify criteria, tools, techniques or methods for developing or evaluating a PEIM. The authors suggest that developing a comprehensive tool based on these findings is critical for evaluating the overall efficiency of PEIM using effective criteria.

Multi-information source Bayesian optimization of culture media for cellular agriculture.

Culture media used in industrial bioprocessing and the emerging field of cellular agriculture is difficult to optimize due to the lack of rigorous mathematical models of cell growth and culture conditions, as well as the complexity of the design space. Rapid growth assays are inaccurate yet convenient, while robust measures of cell number can be time-consuming to the point of limiting experimentation. In this study, we optimized a cell culture media with 14 components using a multi-information source Bayesian optimization algorithm that locates optimal media conditions based on an iterative refinement of an uncertainty-weighted desirability function. As a model system, we utilized murine C2C12 cells, using AlamarBlue, LIVE stain, and trypan blue exclusion cell counting assays to determine cell number. Using this experimental optimization algorithm, we were able to design media with 181% more cells than a common commercial variant with a similar economic cost, while doing so in 38% fewer experiments than an efficient design-of-experiments method. The optimal medium generalized well to long-term growth up to four passages of C2C12 cells, indicating the multi-information source assay improved measurement robustness relative to rapid growth assays alone.

Relationship between communicative and critical health literacy, health information sources, and participation in health checkups among middle-aged Japanese community residents.

We assessed the relationship between health literacy and participation in health checkups among middle-aged Japanese community residents. Additionally, we explored the health information sources related to participation in health checkups among those with low, medium, and high health literacy. This mail survey using a self-administered questionnaire was conducted in 2020 and included 33,902 community residents with National Health Insurance (NHI), aged 40-64 years from five cities in Osaka Prefecture, Japan. Of these, 12,446 (36.7%) agreed to participate in the survey. After exclusion of those with regular visits to medical institutions and those with missing data, the analysis included 3582 participants. Health literacy was measured by the Communicative and Critical Health Literacy (CCHL) scale, and participants were classified into three groups (low, medium, and high health literacy groups) by the tertiles of CCHL scale score. After adjusting for confounding factors, the multivariable-adjusted odds ratios for non-participation in health checkups were 1.20 (95% CI 1.01-1.43, p = 0.039) in the medium health literacy group and 1.47 (95% CI 1.20-1.80, p < 0.001) in the low health literacy group compared with the high health literacy group. Additionally, some health information sources were associated with participation in health checkups in the medium and high health literacy groups, whereas none of the health information sources were associated with participation in health checkups in the low health literacy group. We believe that it is important to develop materials and interventions aimed at low health literacy populations to promote participation in health checkups.

Information needs and sources of information among people with depression and anxiety: a scoping review.

BACKGROUND: Previous studies have identified substantial unmet information needs in people with depression and anxiety. Sufficient information about the disorder, treatment, available services, and strategies for self-management is essential as it may influence quality of care and patients' quality of life. This scoping review aimed to provide a broad overview of information needs of people with depression and anxiety as well as the sources that they use to seek this information. METHODS: We included all primary research published in English that investigated information needs or information sources in people with depression or anxiety, with no restrictions imposed on the study design, location, setting, or participant characteristics. Six electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, LISTA, Web of Science) and the grey literature (Google and Google Scholar) were searched for relevant studies published up to November 2021. Two reviewers independently screened articles and extracted data. Narrative synthesis was performed to identify key themes of information needs and information sources. Factors associated with information needs/sources such as demographic variables and symptom severity were also identified. RESULTS: Fifty-six studies (comprising 8320 participants) were included. Information needs were categorised into seven themes, including general facts, treatment, lived experience, healthcare services, coping, financial/legal, and other information. The most frequently reported needs in both people with depression and anxiety were general facts and treatment information. Subclinical samples who self-reported depressive/anxious symptoms appeared less interested in treatment information than patients with clinical diagnoses. Information sources were summarised into five categories: health professionals, written materials, media, interpersonal interactions, and organisational resources. Health professionals and media (including the internet) were the most frequently adopted and preferred sources. Although few studies have examined factors associated with information needs and information sources, there is preliminary evidence that symptom severity and disease subtypes are related to information needs/sources, whereas findings on demographic factors were mixed. CONCLUSIONS: Information needs appear to be high in people with depression and anxiety. Future research should examine differences between subgroups and associated factors such as the treatment course. Personalised information provision strategies are also needed to customise information according to individual needs and patient profiles. TRIAL REGISTRATION: The protocol of this scoping review was registered on Open Science Framework (OSF; link: https://doi.org/10.17605/OSF.IO/DF2M6 ).

Medical information seeking behavior of urban patients in Zhejiang Province, China: a cross-sectional study.

BACKGROUND: Health information seeking behavior (HISB) is a prevalent research topic. However, little is known about sociodemographic factors of HISB in China. This study aimed to examine the HISB of urban patients in China and identify predictors of source preference, online information seeking, and the timing of online seeking. METHODS: Based on the Health Information National Trends Survey (HINTS), this study conducted a cross-sectional survey of 1653 participants in different types of hospitals in 3 cities of different income levels within Zhejiang Province, China. Binary logistic regression analysis and multinomial logistic regression analysis were used to identify predictors of source preference, online medical information seeking, and the timing of online seeking for urban patients. RESULTS: The offline was the primary source of medical information for 58.61% of adult urban patients, while 78.19% had ever sought medical information online. 36.81% of online medical information seekers sought information before the medical visit, 8.65% sought information after the visit, and 54.54% sought information before and after the visit. China's urban patients with higher education levels, higher income levels, young, active in internet use, and living in high-income cities were more likely to be active online medical information seekers (using the internet as the primary source) and online medical information seekers (having ever sought medical information online). Except for gender and age, most sociodemographic characteristics were not significantly associated with the timing of online medical information seeking. CONCLUSIONS: Significant predictors of active online medical information seekers and online medical information seekers in China were almost the same. Regional economic development had a significant direct impact on medical information seekers. Most sociodemographic characteristics were not significantly associated with the timing of online medical information seeking. The findings of this study imply that China's health information technology industry has Chinese characteristics.

The Relationship Between Information Sources, Health Literacy, and COVID-19 Knowledge in the COVID-19 Infodemic: Cross-sectional Online Study in Japan.

BACKGROUND: The COVID-19 pandemic has caused not only a disease epidemic but also an infodemic. Due to the increased use of the internet and social media, along with the development of communication technology, information has spread faster and farther during the COVID-19 infodemic. Moreover, the increased choice of information sources has made it more difficult to make sound decisions regarding information. Although social media is the most common source of misinformation, other forms of media can also spread misinformation. However, the media sources used by people with high health literacy and COVID-19 knowledge to obtain information are unclear. Furthermore, the association between the use of multiple information sources and health literacy or COVID-19 knowledge is ill-defined. OBJECTIVE: This study aims to examine the following 3 aspects regarding the COVID-19 infodemic: (1) the relationship between health literacy, COVID-19 knowledge, and the number of information sources used; (2) the impact of media use on health literacy; and (3) the impact of media use on COVID-19 knowledge. METHODS: An online cross-sectional study was conducted in November 2021. Participants were 477 individuals aged 20-69 years. After obtaining consent to participate in the study, participants were asked about sociodemographic indicators, sources of health-related information, health literacy, and COVID-19 knowledge. Sources of health-related information were categorized into 4 types: mass media, digital media, social media, and face-to-face communication. The Spearman rank correlation test was conducted to determine the relationship between health literacy, the number of correct answers to COVID-19 knowledge, and the number of information sources used. Multiple regression analysis was conducted with health literacy and the number of correct answers as dependent variables, the 4 media types as independent variables, and age and sex as adjustment variables. RESULTS: Mass media was the most frequently used source of information, followed by digital media, face-to-face communication, and social media. Social media use was significantly higher among individuals aged 20-29 years than among other age groups. Significant positive correlations were found between health literacy, the number of positive responses to COVID-19 knowledge, and the number of information sources used. Multiple linear regression analysis showed that health literacy is associated with access to information from digital media and face-to-face communication. Additionally, COVID-19 knowledge was associated with access to information from mass media, digital media, and face-to-face communication. CONCLUSIONS: Health literacy and COVID-19 knowledge could be improved using diverse information sources, especially by providing opportunities to use digital media and face-to-face communication. Furthermore, it may be important to improve health literacy and provide accurate knowledge about COVID-19 to young adults.

Environmental information disclosure and public choice decisions for urban river restoration: A comparative study between Brussels (Belgium) and Guangzhou (China).

Worldwide environmental information disclosure (EID) has been widely promoted as a policy approach to establish transparent governments, enhance public environmental awareness, and foster participatory environmental governance. While information disclosure and transparency are inherently incentivised within democratic regimes, how and through what pathways an increased flow of environmental information in the absence of democracy could lead to favourable public support for environmental/ecological projects remain under-investigated. Particularly, there exists very limited literature which compares how EID is associated with public environmental choices between different sociopolitical contexts. Taking Brussels (Belgium) and Guangzhou (China) as a comparative case, this study examines the association between citizens' perceived trustworthiness of various environmental information sources and their choice decisions regarding urban river restoration initiatives in contrasting socialpolitical contexts. Latent class modelling of two paralleled discrete choice experiments unveils a consistent classification of three distinctive groups for each city and also the combined sample, including Enthusiastic Supporters (Class 1, who are cost-insensitive and supportive of all proposed changes), Pragmatic Supporters (Class 2, who are cost-sensitive, prefer some changes they favour), and Non-Supporters (Class 3, who are unwilling to support the proposed initiatives). Incorporating respondents' trustworthiness in information sources as covariates in class membership likelihood function, respondents' membership is found to be associated solely with the most trusted information source, i.e., social contacts in Guangzhou, third parties in Brussels, and social contacts for the whole sample. Holding trust toward the most-trusted information source can increase the probability of being a member of Class 1, otherwise, more likely being a member of Class 3. Taken together with the insignificance of the variable denoting a respondent's city in explaining class membership, this study reveals that the variations in the EID levels (matured vs. emerging) and sociopolitical contexts (democratic vs. non-democratic) cannot significantly shape citizens' environmental decisions. Instead, it is respondents' perceived trustworthiness of information outlets that plays a positive role in their supportive decisions. These analytical results offer new insights about the role of EID in environmental governance and call for instilling institutional trust in China and relational trust in Belgium for facilitating effective communication and pro-environmental behaviours across the whole community.

Logical Entropy of Information Sources.

In this paper, we present the concept of the logical entropy of order m, logical mutual information, and the logical entropy for information sources. We found upper and lower bounds for the logical entropy of a random variable by using convex functions. We show that the logical entropy of the joint distributions X1 and X2 is always less than the sum of the logical entropy of the variables X1 and X2. We define the logical Shannon entropy and logical metric permutation entropy to an information system and examine the properties of this kind of entropy. Finally, we examine the amount of the logical metric entropy and permutation logical entropy for maps.

The relationship between social media use, anxiety and burden caused by coronavirus (COVID-19) in Spain.

The outbreak of COVID-19 and national restrictions to slow down its spread have significantly changed people's everyday lives. Many people engage in intensive social media use (SMU) to stay up-to-date about the pandemic. The present study investigated the extent of SMU as source of COVID-19 information, and its relationship with anxiety and the experienced burden caused by the pandemic in Spain. Of the 221 participants, 52.5% reported to frequently use SM as information source. The use of other information sources such as print and online newspaper reports, television reports, and official governmental online sites was not associated with anxiety and burden caused by the current COVID-19 situation. However, SMU was significantly positively linked to both variables. Moreover, anxiety significantly mediated the relationship between SMU and the experienced burden. The findings show the potential negative effect of SMU on individual emotional state and behavior during the pandemic. They emphasize the significance of an accurate and conscious use of SM specifically during extraordinary circumstances such as the COVID-19 outbreak.

Childhood immunisation timeliness and vaccine confidence by health information source, maternal, socioeconomic, and geographic characteristics in Albania.

BACKGROUND: Albania is facing decreasing childhood immunisation coverage and delay in timeliness of vaccination despite a growing economy and universal health insurance. Our aim is to estimate childhood immunisation timeliness and vaccine confidence associated with health information source, maternal, socioeconomic, and geographic characteristics in Albania. METHODS: We used the 2017-2018 Albania Demographic and Health Survey to analyse childhood immunisation timeliness and vaccine confidence among 2113 and 1795 mothers of under-5-year-old children respectively using simple and multivariable logistic regression. RESULTS: Among mothers of under-5-year-old children in Albania, 78.1% [95% CI: 74.3, 81.5] never postponed or rejected childhood vaccines. Immunisation delay was reported by 21.3% [18.0, 25.1] of mothers, but a majority (67.0%) were caused by the infant's sickness at the time of vaccination, while a minority (6.1%) due to mothers' concerns about vaccine safety and side effects. Vaccine confidence was high among the mothers at 92.9% [91.0, 94.4] with similar geographical patterns to immunisation timeliness. Among 1.3% of mothers who ever refused vaccination of their children, the main concerns were about vaccine safety (47.8%) and side effects (23.1%). With respect to childhood immunisation timeliness, after controlling for other background characteristics, mothers whose main health information source was the Internet/social media had 34% (adjusted odds-ratio AOR = 0.66 [0.47, 0.94], p = 0.020) lower odds in comparison to other sources, working mothers had 35% (AOR = 0.65 [0.47, 0.91], p = 0.013) lower odds in comparison to non-working mothers, mothers with no education had 86% (AOR = 0.14 [0.03, 0.67], p = 0.014) lower odds compared to those who completed higher education, and mothers living in AL02-Qender and AL03-Jug regions had 62% (AOR = 0.38 [0.23, 0.63], p < 0.0001) and 64% (AOR = 0.36 [0.24, 0.53], p < 0.0001) lower odds respectively in comparison to those residing in AL01-Veri region (p < 0.0001).   With respect to vaccine confidence, mothers whose main health information source was the Internet/social media had 56% (AOR = 0.44 [0.27, 0.73], p = 0.002) lower odds in comparison to other sources, single mothers had 92% (AOR = 0.08 [0.01, 0.65], p = 0.019) lower odds compared to those married/living with a partner, mothers of specific ethnicites (like Roma) had 61% (AOR = 0.39 [0.15, 0.97], p = 0.042) lower odds in comparison to mothers of Albanian ethnicity, and mothers living in AL03-Jug region had 67% (AOR = 0.33 [0.19, 0.59], p ≤ 0.0001) lower odds compared to mothers residing in AL01-Veri region. CONCLUSIONS: Reinforcement of scientific evidence-based online communication about childhood immunisation in combination with tracking and analysis of vaccine hesitancy sentiment and anti-vaccination movements on the Internet/social media would be beneficial in improving immunisation timeliness and vaccine confidence in Albania. Since parents tend to search online for information that would confirm their original beliefs, traditional ways of promoting vaccination by healthcare professionals who enjoy confidence as trusted sources of health information should be sustained and strengthened to target the inequities in childhood immunisation timelines and vaccine confidence in Albania.

Determinants of gluten-free diet adoption among individuals without celiac disease or non-celiac gluten sensitivity.

OBJECTIVES: Gluten-free (GF) foods are typically less nutritious and more expensive than their gluten-containing variants, yet people without a diagnosed gluten sensitivity continue to adopt this diet. There is a lack of research about what factors drive people without Celiac disease or non-Celiac gluten sensitivity to follow the GF diet. METHODS: A nationally representative sample of 2982 US residents without a diagnosed gluten sensitivity were surveyed about their attitudes, perceptions, and experiences with the GF diet. Logistic regression was used to compare respondents who were currently avoiding or had avoided gluten previously (GF consumer) to respondents who had never tried a GF diet (non-GF consumer). RESULTS: Over one-fifth of respondents were GF consumers. Beliefs that a gluten-reduced diet is healthier (OR 1.69; 95% CI [1.30,2.18]), that GF products are more nutritious (OR 1.46, 95% CI [1.11,1.90), and that a GF diet can help clear acne (OR 1.46; 95% CI [1.13,1.88]) were all positively associated with trying a GF diet. Personal research was the most influential source of information associated with trying a GF diet (OR 2.92; 95% CI [1.91,4.52]). This was followed by "healthcare center or health professional" (OR 2.57; 95% CI [1.71,3.90]. Respondents who were never encouraged to try the GF diet were less likely to try the diet (OR 0.33, 95% CI [0.23,0.46]). CONCLUSIONS: Positive, but scientifically unsubstantiated, beliefs about the benefits of the GF diet were strongly associated with trying a GF diet, and the source of recommendation to try a GF diet was important.

Reliability of Commercial Voice Assistants' Responses to Health-Related Questions in Noncommunicable Disease Management: Factorial Experiment Assessing Response Rate and Source of Information.

BACKGROUND: Noncommunicable diseases (NCDs) constitute a burden on public health. These are best controlled through self-management practices, such as self-information. Fostering patients' access to health-related information through efficient and accessible channels, such as commercial voice assistants (VAs), may support the patients' ability to make health-related decisions and manage their chronic conditions. OBJECTIVE: This study aims to evaluate the reliability of the most common VAs (ie, Amazon Alexa, Apple Siri, and Google Assistant) in responding to questions about management of the main NCD. METHODS: We generated health-related questions based on frequently asked questions from health organization, government, medical nonprofit, and other recognized health-related websites about conditions associated with Alzheimer's disease (AD), lung cancer (LCA), chronic obstructive pulmonary disease, diabetes mellitus (DM), cardiovascular disease, chronic kidney disease (CKD), and cerebrovascular accident (CVA). We then validated them with practicing medical specialists, selecting the 10 most frequent ones. Given the low average frequency of the AD-related questions, we excluded such questions. This resulted in a pool of 60 questions. We submitted the selected questions to VAs in a 3×3×6 fractional factorial design experiment with 3 developers (ie, Amazon, Apple, and Google), 3 modalities (ie, voice only, voice and display, display only), and 6 diseases. We assessed the rate of error-free voice responses and classified the web sources based on previous research (ie, expert, commercial, crowdsourced, or not stated). RESULTS: Google showed the highest total response rate, followed by Amazon and Apple. Moreover, although Amazon and Apple showed a comparable response rate in both voice-and-display and voice-only modalities, Google showed a slightly higher response rate in voice only. The same pattern was observed for the rate of expert sources. When considering the response and expert source rate across diseases, we observed that although Google remained comparable, with a slight advantage for LCA and CKD, both Amazon and Apple showed the highest response rate for LCA. However, both Google and Apple showed most often expert sources for CVA, while Amazon did so for DM. CONCLUSIONS: Google showed the highest response rate and the highest rate of expert sources, leading to the conclusion that Google Assistant would be the most reliable tool in responding to questions about NCD management. However, the rate of expert sources differed across diseases. We urge health organizations to collaborate with Google, Amazon, and Apple to allow their VAs to consistently provide reliable answers to health-related questions on NCD management across the different diseases.

Signal Fluctuations and the Information Transmission Rates in Binary Communication Channels.

In the nervous system, information is conveyed by sequence of action potentials, called spikes-trains. As MacKay and McCulloch suggested, spike-trains can be represented as bits sequences coming from Information Sources (IS). Previously, we studied relations between spikes' Information Transmission Rates (ITR) and their correlations, and frequencies. Now, I concentrate on the problem of how spikes fluctuations affect ITR. The IS are typically modeled as stationary stochastic processes, which I consider here as two-state Markov processes. As a spike-trains' fluctuation measure, I assume the standard deviation σ, which measures the average fluctuation of spikes around the average spike frequency. I found that the character of ITR and signal fluctuations relation strongly depends on the parameter s being a sum of transitions probabilities from a no spike state to spike state. The estimate of the Information Transmission Rate was found by expressions depending on the values of signal fluctuations and parameter s. It turned out that for smaller s<1, the quotient ITRσ has a maximum and can tend to zero depending on transition probabilities, while for 1

[The relationship between information sources, media, and "anxiety about the effects of radiation on future generations" in Hamadori and Fukushima Prefecture's evacuation areas after the nuclear accident].

Objectives　Nine years after the accident at the TEPCO Fukushima Daiichi Nuclear Power Plant in March 2011, anxiety about the effects of radiation on future generations persists. We considered the possibility that information from mass media sources and the Internet might influence this anxiety. Thus, this study examined the relationship between information sources and anxiety; based on the results, we consider the necessary measures to reduce this anxiety.Methods　We conducted a mail-based survey by distributing an anonymous self-administered questionnaire to 2,000 Fukushima Prefecture residents aged 20 to 79. We randomly selected 500 residents from Aizu, Nakadori, Hamadori, and the evacuation areas, and compared the data obtained from Hamadori and the evacuation areas. The objective variable was anxiety about the effects (of radiation) on future generations, while the explanatory variables were trusted sources and media the respondents used to get information on radiation. Other variables assessed included health status and knowledge of radiation. We conducted univariate analysis of combined data to assess the relationship between anxiety and the questionnaire items. This was followed by multiple regression analysis with anxiety as the objective variable and those showing significant differences in the univariate analysis as the explanatory ones. We then conducted multiple regression analysis, that included the interaction means between explanatory variables and evacuation areas.Results　Of the 500, 201 respondents were from Hamadori (40.2%) and 192 from the evacuation areas (38.4%). Multiple regression analysis revealed that anxiety was significantly lower among those who trusted government ministries and those who were healthy. Anxiety was also significantly lower among those who correctly answered the question on the genetic influence of radiation, while it was significantly higher among those who correctly answered the question on the dose-response model of radiation-induced cancer. In Hamadori, anxiety was significantly higher among those who watched private national television. In the evacuation areas, the result was the same as that of the combined data.Conclusion　Different information sources and media were significantly associated with anxiety about the effects of radiation on future generations. Therefore, media sensationalism should be reduced to prevent anxiety among citizens. Our findings highlight the importance of selecting information sources and media that disseminate accurate information, as well as the need to improve media literacy among citizens. Furthermore, a dose-response model of radiation-induced cancer must be communicated in a way that is not misleading. Receiving accurate information on the genetic effects of radiation can reduce anxiety among citizens.

Sources of Information and Beliefs About the Health Effects of Marijuana.

BACKGROUND: Marijuana is currently legal for recreational use in 10 states and Washington DC while a total of 34 states have implemented varying degrees of medical marijuana. The commercialization of marijuana has been accompanied by a proliferation of false claims regarding the therapeutic potential of marijuana, which are popularized by several different information sources. To date, no study has examined where US adults get their information regarding marijuana. OBJECTIVE: To determine the sources of information associated with believing unsupported claims about marijuana. DESIGN: Probability-based online survey PARTICIPANTS: 16,820 adults, with a response rate of about 55% (N = 9003) MAIN MEASURES: Most influential sources of information about marijuana and belief of statements consistent with misinformation, for example, smoking marijuana has preventative health benefits, secondhand marijuana smoke or use during pregnancy is completely or somewhat safe, and marijuana is not at all addictive. KEY RESULTS: There were 9003 respondents (response rate 55%). Forty-three percent believed unsupported claims about marijuana. The most influential sources of information were health professionals, traditional media, friends/relatives, and social media/internet. Individuals reporting social media or the Internet (1.46 CI [1.30, 1.64]), the marijuana industry (e.g., advertisements, dispensaries) (2.88 CI [2.15, 3.88]), and friends or relatives (1.41 CI[1.26, 1.58]) as the most influential source of information about marijuana were more likely to believe any statement consistent with misinformation about marijuana in comparison with those who reported other sources as most influential. CONCLUSIONS: Individuals reporting the most significant source of information regarding marijuana was from social media or the Internet, the marijuana industry, or friends or relatives were more likely to believe unsupported claims about marijuana. Public health campaigns to counter the misinformation about marijuana to the public are needed.