Jon-Patrick Allem

Seasonality in seeking mental health information on Google.

BACKGROUND Population mental health surveillance is an important challenge limited by resource constraints, long time lags in data collection, and stigma. One promising approach to bridge similar gaps elsewhere has been the use of passively generated digital data. PURPOSE This article assesses the viability of aggregate Internet search queries for real-time monitoring of several mental health problems, specifically in regard to seasonal patterns of seeking out mental health information. METHODS All Google mental health queries were monitored in the U.S. and Australia from 2006 to 2010. Additionally, queries were subdivided among those including the terms ADHD (attention deficit-hyperactivity disorder); anxiety; bipolar; depression; anorexia or bulimia (eating disorders); OCD (obsessive-compulsive disorder); schizophrenia; and suicide. A wavelet phase analysis was used to isolate seasonal components in the trends, and based on this model, the mean search volume in winter was compared with that in summer, as performed in 2012. RESULTS All mental health queries followed seasonal patterns with winter peaks and summer troughs amounting to a 14% (95% CI=11%, 16%) difference in volume for the U.S. and 11% (95% CI=7%, 15%) for Australia. These patterns also were evident for all specific subcategories of illness or problem. For instance, seasonal differences ranged from 7% (95% CI=5%, 10%) for anxiety (followed by OCD, bipolar, depression, suicide, ADHD, schizophrenia) to 37% (95% CI=31%, 44%) for eating disorder queries in the U.S. Several nonclinical motivators for query seasonality (such as media trends or academic interest) were explored and rejected. CONCLUSIONS Information seeking on Google across all major mental illnesses and/or problems followed seasonal patterns similar to those found for seasonal affective disorder. These are the first data published on patterns of seasonality in information seeking encompassing all the major mental illnesses, notable also because they likely would have gone undetected using traditional surveillance.

A Novel Evaluation of World No Tobacco Day in Latin America

Background World No Tobacco Day (WNTD), commemorated annually on May 31, aims to inform the public about tobacco harms. Because tobacco control surveillance is usually annualized, the effectiveness of WNTD remains unexplored into its 25th year. Objective To explore the potential of digital surveillance (infoveillance) to evaluate the impacts of WNTD on population awareness of and interest in cessation. Methods Health-related news stories and Internet search queries were aggregated to form a continuous and real-time data stream. We monitored daily news coverage of and Internet search queries for cessation in seven Latin American nations from 2006 to 2011. Results Cessation news coverage peaked around WNTD, typically increasing 71% (95% confidence interval [CI] 61–81), ranging from 61% in Mexico to 83% in Venezuela. Queries indicative of cessation interest peaked on WNTD, increasing 40% (95% CI 32–48), ranging from 24% in Colombia to 84% in Venezuela. A doubling in cessation news coverage was associated with approximately a 50% increase in cessation queries. To gain a practical perspective, we compared WNTD-related activity with New Year’s Day and several cigarette excise tax increases in Mexico. Cessation queries around WNTD were typically greater than New Year’s Day and approximated a 2.8% (95% CI –0.8 to 6.3) increase in cigarette excise taxes. Conclusions This novel evaluation suggests WNTD had a significant impact on popular awareness (media trends) and individual interest (query trends) in smoking cessation. Because WNTD is constantly evolving, our work is also a model for real-time surveillance and potential improvement in WNTD and similar initiatives.

Pokémon GO—A New Distraction for Drivers and Pedestrians

Pokemon GO, an augmented reality game, has swept the nation. As players move, their avatar moves within the game, and players are then rewarded for collecting Pokemon placed in real-world locations. By rewarding movement, the game incentivizes physical activity. However, if players use their cars to search for Pokemon they negate any health benefit and incur serious risk. Motor vehicle crashes are the leading cause of death among 16- to 24-year-olds, whom the game targets. Moreover, according to the American Automobile Association, 59% of all crashes among young drivers involve distractions within 6 seconds of the accident. We report on an assessment of drivers and pedestrians distracted by Pokemon GO and crashes potentially caused by Pokemon GO by mining social and news media reports. Language: en

Population Health Concerns During the United States' Great Recession

BACKGROUND Associations between economic conditions and health are usually derived from cost-intensive surveys that are intermittently collected with nonspecific measures (i.e., self-rated health). PURPOSE This study identified how precise health concerns changed during the U.S. Great Recession analyzing Google search queries to identify the concern by the query content and their prevalence by the query volume. METHODS Excess health concerns were estimated during the Great Recession (December 2008 through 2011) by comparing the cumulative difference between observed and expected (based on linear projections from pre-existing trends) query volume for hundreds of individual terms. As performed in 2013, the 100 queries with the greatest excess were ranked and then clustered into themes based on query content. RESULTS The specific queries with the greatest relative excess were stomach ulcer symptoms and headache symptoms, respectively, 228% (95% CI=35, 363) and 193% (95% CI=60, 275) greater than expected. Queries typically involved symptomology (i.e., gas symptoms) and diagnostics (i.e., heart monitor) naturally coalescing into themes. Among top themes, headache queries were 41% (95% CI=3, 148); hernia 37% (95% CI=16, 142); chest pain 35% (95% CI=6, 313); and arrhythmia 32% (95% CI=3, 149) greater than expected. Pain was common with back, gastric, joint, and tooth foci, with the latter 19% (95% CI=4, 46) higher. Among just the top 100, there were roughly 205 million excess health concern queries during the Great Recession. CONCLUSIONS Google queries indicate that the Great Recession coincided with substantial increases in health concerns, hinting at how population health specifically changed during that time.

Campaigns and counter campaigns: reactions on Twitter to e-cigarette education

Background Social media present opportunities for public health departments to galvanise interest in health issues. A challenge is creating content that will resonate with target audiences, and determining reactions to educational material. Twitter can be used as a real-time surveillance system to capture individuals’ immediate reactions to education campaigns and such information could lead to better campaigns in the future. A case study testing Twitters potential presented itself when the California Department of Public Health launched its ‘Still Blowing Smoke’ media campaign about the potential harmful effects of e-cigarettes. Pro-e-cigarette advocacy groups, in response, launched a counter campaign titled ‘Not Blowing Smoke’. This study tracked the popularity of the two campaigns on Twitter, analysed the content of the messages and determined who was involved in these discussions. Methods The study period was from 22 March 2015 to 27 June 2015. A stratified sampling procedure supplied 2192 tweets for analysis. Content analysis identified pro, anti and neutral e-cigarette tweets, and five additional themes: Marketing Elements, Money, Regulation/propaganda, Health, and Other. Metadata were analysed to obtain additional information about Twitter accounts. Results ‘Not Blowing Smoke’ was referenced more frequently than ‘Still Blowing Smoke’ on Twitter. Messages commonly objected to government regulation of e-cigarettes, refuted claims that e-cigarette manufactures were aligned with big tobacco, and touted the health benefits of e-cigarette use. E-cigarette companies and vape shops used campaign slogans to communicate with customers on Twitter. Conclusions Findings showed the time dynamics of Twitter and the possibility for real-time monitoring of education campaigns.

Diffusion of Messages from an Electronic Cigarette Brand to Potential Users through Twitter

Objective This study explores the presence and actions of an electronic cigarette (e-cigarette) brand, Blu, on Twitter to observe how marketing messages are sent and diffused through the retweet (i.e., message forwarding) functionality. Retweet networks enable messages to reach additional Twitter users beyond the sender’s local network. We follow messages from their origin through multiple retweets to identify which messages have more reach, and the different users who are exposed. Methods We collected three months of publicly available data from Twitter. A combination of techniques in social network analysis and content analysis were applied to determine the various networks of users who are exposed to e-cigarette messages and how the retweet network can affect which messages spread. Results The Blu retweet network expanded during the study period. Analysis of user profiles combined with network cluster analysis showed that messages of certain topics were only circulated within a community of e-cigarette supporters, while other topics spread further, reaching more general Twitter users who may not support or use e-cigarettes. Conclusions Retweet networks can serve as proxy filters for marketing messages, as Twitter users decide which messages they will continue to diffuse among their followers. As certain e-cigarette messages extend beyond their point of origin, the audience being exposed expands beyond the e-cigarette community. Potential implications for health education campaigns include utilizing Twitter and targeting important gatekeepers or hubs that would maximize message diffusion.

Tobacco Attitudes and Behaviors of Vape Shop Retailers in Los Angeles.

OBJECTIVES The growing popularity of e-cigarettes has been accompanied by the proliferation of vape shops in the US. Vape shops are devoted to the sale and use of e-cigarettes, allowing customers to sample flavors and learn about different hardware from retailers. Research on vape shop retailers is lagging behind their popularity. This study documented the attitudes and behaviors regarding e-cigarettes and other tobacco products of retailers located in Los Angeles. METHODS Surveys were conducted among retailers at 78 vape shops in 2014. RESULTS The majority of retailers (76%) believed e-cigarettes are safer than combustible cigarettes, with about one-fourth believing e-cigarettes are completely safe. Retailers believed e-cigarettes are, on average, safer than products (eg, nicotine patch, gum, and inhaler) that have been approved for cessation by the FDA. About 14% of retailers reported dual use of cigarettes and e-cigarettes in the past month. CONCLUSION This is the first study to investigate tobacco-related behaviors and attitudes of vape shop retailers located in Los Angeles. Educating vape shop retailers on the benefits and harms of e-cigarettes is important, especially if retailers are to be informed about a product that is only now being considered to receive regulation from the FDA.

Emerging adulthood themes, role transitions and substance use among Hispanics in Southern California

INTRODUCTION Hispanic emerging adults appear to be at especially high risk for substance use but little is known about their risk and protective factors. A crucial next step to reducing substance use among this priority population may involve understanding how transition-to-adulthood themes are associated with substance use. Intervention and prevention programs could also benefit from information about which if any specific transitions undergone in emerging adulthood are associated with substance use. METHODS Hispanic emerging adults (aged 18 to 24) completed surveys indicating their identification with transition-to-adulthood themes, role transitions in the past year, and use of alcohol and marijuana. Logistic regression models were used to examine the associations between transition-to-adulthood themes and past-month binge drinking and marijuana use, controlling for age and gender. Separate logistic regression models explored the association between each individual role transition and past-month binge drinking and marijuana use, controlling for age and gender and using a Bonferonni correction. RESULTS Among the participants (n=1,390), 41% were male, the average age was 21, 24% reported past-month marijuana use and 34% reported past-month binge drinking. Participants who felt emerging adulthood was a time of focusing on others were less likely to report marijuana use and binge drinking. Among the 24 transitions, five were significantly associated with past-month marijuana use and 10 were significantly associated with past-month binge drinking. CONCLUSION Findings suggest transition-to-adulthood themes as well as specific changes experienced by emerging adults are meaningful for Hispanics and should be explored in prevention and intervention programs in the future. Future research should determine what specific mechanisms are making these transitional processes risk factors for substance use.

Why do people use electronic nicotine delivery systems (electronic cigarettes)? A content analysis of Twitter, 2012-2015

The reasons for using electronic nicotine delivery systems (ENDS) are poorly understood and are primarily documented by expensive cross-sectional surveys that use preconceived close-ended response options rather than allowing respondents to use their own words. We passively identify the reasons for using ENDS longitudinally from a content analysis of public postings on Twitter. All English language public tweets including several ENDS terms (e.g., “e-cigarette” or “vape”) were captured from the Twitter data stream during 2012 and 2015. After excluding spam, advertisements, and retweets, posts indicating a rationale for vaping were retained. The specific reasons for vaping were then inferred based on a supervised content analysis using annotators from Amazon’s Mechanical Turk. During 2012 quitting combustibles was the most cited reason for using ENDS with 43% (95%CI 39–48) of all reason-related tweets cited quitting combustibles, e.g., “I couldn’t quit till I tried ecigs,” eclipsing the second most cited reason by more than double. Other frequently cited reasons in 2012 included ENDS’s social image (21%; 95%CI 18–25), use indoors (14%; 95%CI 11–17), flavors (14%; 95%CI 11–17), safety relative to combustibles (9%; 95%CI 7–11), cost (3%; 95%CI 2–5) and favorable odor (2%; 95%CI 1–3). By 2015 the reasons for using ENDS cited on Twitter had shifted. Both quitting combustibles and use indoors significantly declined in mentions to 29% (95%CI 24–33) and 12% (95%CI 9–16), respectively. At the same time, social image increased to 37% (95%CI 32–43) and lack of odor increased to 5% (95%CI 2–5), the former leading all cited reasons in 2015. Our data suggest the reasons people vape are shifting away from cessation and toward social image. The data also show how the ENDS market is responsive to a changing policy landscape. For instance, smoking indoors was less frequently cited in 2015 as indoor smoking restrictions became more common. Because the data and analytic approach are scalable, adoption of our strategies in the field can inform follow-up survey-based surveillance (so the right questions are asked), interventions, and policies for ENDS.

Vaping on Instagram: cloud chasing, hand checks and product placement.

Introduction This study documented images posted on Instagram of electronic cigarettes (e-cigarette) and vaping (activity associated with e-cigarette use). Although e-cigarettes have been studied on Twitter, few studies have focused on Instagram, despite having 500 million users. Instagrams emphasis on images warranted investigation of e-cigarettes, as past tobacco industry strategies demonstrated that images could be used to mislead in advertisements, or normalise tobacco-related behaviours. Findings should prove informative to tobacco control policies in the future. Methods 3 months of publicly available data were collected from Instagram, including images and associated metadata (n=2208). Themes of images were classified as (1) activity, for example, a person blowing vapour; (2) product, for example, a personal photo of an e-cigarette device; (3) advertisement; (4) text, for example, ‘meme’ or image containing mostly text and (5) other. User endorsement (likes) of each type of image was recorded. Caption text was analysed to explore different trends in vaping and e-cigarette-related text. Results Analyses found that advertisement-themed images were most common (29%), followed by product (28%), and activity (18%). Likes were more likely to accompany activity and product-themed images compared with advertisement or text-themed images (p<0.01). Vaping-related text greatly outnumbered e-cigarette-related text in the image captions. Conclusions Instagram affords its users the ability to post images of e-cigarette-related behaviours and gives advertisers the opportunity to display their product. Future research should incorporate novel data streams to improve public health surveillance, survey development and educational campaigns.