Public Health and Online Misinformation: Challenges and Recommendations

Using Search Engine Data to Explore Interest in PrEP and HIV Testing in the United States

We used Google search data from January 1, 2014 to January 1, 2019 to explore public awareness of pre-exposure prophylaxis (PrEP) and HIV testing in the United States. Using two search strings, one for PrEP and one for HIV testing, we compared search volume to state HIV prevalence and new HIV diagnoses. We also used Google News to identify news events related to short-term spikes in search volume. Controlling for poverty, education, and internet access, a one-unit increase in a state's HIV prevalence rate was associated with a 3% increase in PrEP search volume (aPR = 1.03 [1.034, 1.037], P < 0.0001) and HIV testing search volume (aPR = 1.03 [1.030, 1.032], P < 0.0001). Short-term search volume spikes also coincided with celebrity news and pharmaceutical company advertising. We demonstrate that search engine data can be a powerful tool for understanding HIV knowledge-seeking and can provide key insight to the events that drive public interest about HIV online.

The Communication Infrastructure as a Social Determinant of Health: Implications for Health Policymaking and Practice

Policy Points Persistent communication inequalities limit racial/ethnic minority access to life-saving health information and make them more vulnerable to the effects of misinformation.  Establishing data collection systems that detect and track acute gaps in the supply and/or access of racial/ethnic minority groups to credible health information is long overdue. Public investments and support for minority-serving media and community outlets are needed to close persistent gaps in access to credible health information.

Online mis/disinformation and vaccine hesitancy in the era of COVID-19: Why we need an eHealth literacy revolution

The quality of online health information is cause for concern in general, and the spread of mis/disinformation on the benefits and risks of vaccines has certainly been fueling vaccine hesitancy. In the wake of the COVID-19 pandemic, we have entered an era of unprecedented “infodemic.” There has never been a more urgent time to address the long-standing question of how to overcome the deleterious influence of exposure to online mis/disinformation on vaccine uptake. eHealth literacy, a skill set including media literacy, is key to navigating the web in search for health information and processing the one encountered through social media. Studies assessing the impact of increasing eHealth literacy on behavioral attitudes and health outcomes in the general population are relatively scarce to date. Yet for many reasons, leveraging eHealth literacy skills, and more specifically, media literacy, could be of great value to help mitigate the detrimental effects of erroneous information on vaccination decision-making. In this paper, we make the case that eHealth and media literacies should be viewed as fundamental skills that have the potential to empower citizens to better recognize online mis/disinformation and make informed decisions about vaccination as any other health matters.

The bright and dark sides of social media usage during the COVID-19 pandemic: Survey evidence from Japan

The spread of misinformation on the internet regarding the COVID-19 pandemic, such as unproven or fake cures, has been a serious concern. However, the extent to which social media usage affects individuals' health behavior, particularly when reliable information is scarce, is not well understood. This study evaluates the impact of social media usage on individuals' responses to the COVID-19 pandemic, such as demand for necessities and social distancing. We conduct an original online survey of 1804 Japanese respondents in March 2020. Japan is suitable because it confirmed COVID-19 cases earlier than most other countries. Scientific evidence about the coronavirus and protective measures was scarce in the initial pandemic phase, despite the spread of unconfirmed rumors. Our analysis focuses on the usage of Twitter, Facebook, and Instagram. We use the entropy balancing method to control for heterogeneity in observed characteristics between social media users and non-users. The results show that while users are more likely to maintain social distancing practices, they are also more likely to take measures whose reliability is not scientifically confirmed, such as eating fermented soybeans. Although previous studies emphasize the negative effects of social media, our results suggest that it has both bright and dark sides.

Determinants of the Perceived Credibility of Rebuttals Concerning Health Misinformation

Users provide and share information with a broad audience on different forms of social media; however, information accuracy is questionable. Currently, the health information field is severely affected by misinformation. Thus, addressing health misinformation is integral for enhancing public health. This research can help relevant practitioners (i.e., government officials, medical and health service personnel, and educators) find the most effective correctional interventions for governing health misinformation. We constructed a theoretical model for credibility-oriented determinants refuting misinformation based on the elaboration likelihood model. We aggregated 415 pieces of valid data through a questionnaire survey. A partial least squares structural equation model evaluated this research model. The results indicated that both perceived information quality and perceived source credibility can enhance perceived information credibility. Under some circumstances, the influence of information quality on information credibility may be more important than that of the information source. However, the cognitive conflict and knowledge self-confidence of information receivers weaken the influence of information quality on information credibility. In contrast, cognitive conflict can strengthen the influence of source credibility on information credibility. Further, perceived information quality can be affected by information usefulness, understandability, and relevance, while perceived source reliability can be affected by source expertise and authority.

The Causal Relationship Between Portal Usage and Self-Efficacious Health Information-Seeking Behaviors: Secondary Analysis of the Health Information National Trends Survey Data

Background

Patient portals have drawn much attention, as they are considered an important tool for health providers in facilitating patient engagement. However, little is known about whether the intensive use of patient portals contributes to improved management of patients’ health in terms of their confidence in acquiring health information and exercising self-care. There is a lack of randomized trials with these outcomes measured both pre- and postadoption of patient portals.

Objective

The aim of this study was to examine the causal relationship between the usage of patient portals and patients’ self-efficacy toward obtaining health information and performing self-care.

Methods

This study was a secondary data analysis that used data from a US national survey, the National Cancer Institute’s Health Information National Trends Survey 5 Cycle 1. Patient portal usage frequency was used to define the treatment. Survey items measuring self-efficacy on a Likert-type scale were selected as the main outcomes, including patients’ confidence in obtaining health information and performing self-care. To establish causality using survey data, we adopted the instrumental variables method. To determine the direction of the causal relationship in the presence of high-dimensional confounders, we further proposed a novel testing framework that employs conditional independence tests in a directed acyclic graph. The average causal effect was measured using the two-stage least squares regression method.

Results

We showed that frequently using patient portals improves patients’ confidence in obtaining health information. The estimand of the weighted average causal effect was 0.14 (95% CI 0.06-0.23; P<.001). This means that when increasing the portal usage intensity, for instance, from 1-2 times to 3-5 times per year, the expected average increase in confidence level measured on a Likert-type scale would be 0.14. However, we could not conclusively determine the causal effect between patient portal usage and patients’ confidence in exercising self-care.

Conclusions

The results support the use of patient portals and encourage better support and education to patients. The proposed statistical method can be used to exploit the potential of national survey data for causal inference studies.

A scientometric overview of CORD-19

As the COVID-19 pandemic unfolds, researchers from all disciplines are coming together and contributing their expertise. CORD-19, a dataset of COVID-19 and coronavirus publications, has been made available alongside calls to help mine the information it contains and to create tools to search it more effectively. We analyse the delineation of the publications included in CORD-19 from a scientometric perspective. Based on a comparison to the Web of Science database, we find that CORD-19 provides an almost complete coverage of research on COVID-19 and coronaviruses. CORD-19 contains not only research that deals directly with COVID-19 and coronaviruses, but also research on viruses in general. Publications from CORD-19 focus mostly on a few well-defined research areas, in particular: coronaviruses (primarily SARS-CoV, MERS-CoV and SARS-CoV-2); public health and viral epidemics; molecular biology of viruses; influenza and other families of viruses; immunology and antivirals; clinical medicine. CORD-19 publications that appeared in 2020, especially editorials and letters, are disproportionately popular on social media. While we fully endorse the CORD-19 initiative, it is important to be aware that CORD-19 extends beyond research on COVID-19 and coronaviruses.

Utilization of Self-Diagnosis Health Chatbots in Real-World Settings: Case Study

Background

Artificial intelligence (AI)-driven chatbots are increasingly being used in health care, but most chatbots are designed for a specific population and evaluated in controlled settings. There is little research documenting how health consumers (eg, patients and caregivers) use chatbots for self-diagnosis purposes in real-world scenarios.

Objective

The aim of this research was to understand how health chatbots are used in a real-world context, what issues and barriers exist in their usage, and how the user experience of this novel technology can be improved.

Methods

We employed a data-driven approach to analyze the system log of a widely deployed self-diagnosis chatbot in China. Our data set consisted of 47,684 consultation sessions initiated by 16,519 users over 6 months. The log data included a variety of information, including users’ nonidentifiable demographic information, consultation details, diagnostic reports, and user feedback. We conducted both statistical analysis and content analysis on this heterogeneous data set.

Results

The chatbot users spanned all age groups, including middle-aged and older adults. Users consulted the chatbot on a wide range of medical conditions, including those that often entail considerable privacy and social stigma issues. Furthermore, we distilled 2 prominent issues in the use of the chatbot: (1) a considerable number of users dropped out in the middle of their consultation sessions, and (2) some users pretended to have health concerns and used the chatbot for nontherapeutic purposes. Finally, we identified a set of user concerns regarding the use of the chatbot, including insufficient actionable information and perceived inaccurate diagnostic suggestions.

Conclusions

Although health chatbots are considered to be convenient tools for enhancing patient-centered care, there are issues and barriers impeding the optimal use of this novel technology. Designers and developers should employ user-centered approaches to address the issues and user concerns to achieve the best uptake and utilization. We conclude the paper by discussing several design implications, including making the chatbots more informative, easy-to-use, and trustworthy, as well as improving the onboarding experience to enhance user engagement.

Healthcare professionals' acts of correcting health misinformation on social media

BACKGROUND

Health misinformation on social media is a public health concern, and healthcare professionals can help correct it. However, research on how they correct health misinformation on social media is rare.

OBJECTIVE

To develop a conceptual model that demonstrates how healthcare professionals correct health misinformation on social media.

METHODS

In-depth semi-structured interviews were conducted between January and March 2020 with 30 U.S. healthcare professionals (15 registered nurses and 15 medical doctors). Participants were recruited through purposive and snowball sampling and interviewed via mobile phone calls (using their mobile phone number) or apps (via Zoom or Skype). Interview data were analyzed using a grounded theory approach.

RESULTS

This study presents a two-phased conceptual model that shows healthcare professionals' acts of correcting health misinformation on social media (e.g., Twitter and Facebook). The first phase involves acts of authentication by which healthcare professionals verify health-related social media posts to be true or not. They undergo the process of internal acts of authentication (i.e., checking the author, checking for cues, checking the topic) and, if needed, external acts of authentication (i.e., examining the author and examining the content). When social media posts are deemed to contain health misinformation, they proceed to the second phase - acts of correction. In this phase, they undergo correction preparation (i.e., reflect, reveal, relate, and respect) and correction dissemination (i.e., private priming, public priming, public rebuttal, and private rebuttal).

CONCLUSIONS

The study proposed a conceptual model that shows how healthcare professionals correct health misinformation on social media. The findings can guide healthcare professionals when identifying and correcting health misinformation on and off social media, and can guide health authorities when developing campaigns against health misinformation.

The library's role in countering infodemics

Internet and communication technologies enable the creation of tremendous amounts of textual, graphic, and pictorial information. User-generated content published through personal web pages, blogs, and social media platforms has not only increased the amount of information available, but also expanded its reach. However, this ubiquity of information and empowerment of its creators leads to potentially controversial, futile, and inaccurate content circulating throughout the world. In the case of the COVID-19 pandemic, this can create false hope, fear, anxiety, harm, and confusion amongst information stakeholders. The World Health Organization recently applied the term "infodemic" to the COVID-19 pandemic. This commentary briefly discusses the current infodemic, its potential consequences, and the role of libraries-specifically health sciences, biomedical, and medical libraries-to help counter the COVID-19 infodemic. The discussion also has relevance for infodemics relating to other health and non-health affairs.

A Cross-National Survey of People Living with Hemophilia: Impact on Daily Living and Patient Education in Central Europe

BACKGROUND

Information about the impact of hemophilia on daily living and information preferences for patients and their caregivers in Central Europe has been limited.

METHODS

This cross-national survey was conducted between April 1 and October 15, 2020 and utilized a self-administered questionnaire to collect data (Typeform™) from people living with hemophilia in Bulgaria, Croatia, Czech Republic, Hungary, Slovakia and Slovenia. The questionnaire included 22 questions regarding difficulties in daily life and preferences for receiving hemophilia-related information. Respondents were stratified into two main groups, people with hemophilia (PwH) or their caregivers (CPwH). Results were analyzed using descriptive statistics.

RESULTS

Of the 364 respondents, 232 were PwH (63.7%) and 132 were CPwH (36.3%). In total, 70.3% of hemophilia patients/caregivers responded that they are kept sufficiently informed about life with hemophilia, with 68.0%, 59.1% and 56.3% of respondents obtaining information from their physicians, patient associations and via digital media (internet and social media), respectively. However, 97.8% of respondents expressed an interest in additional information, particularly new hemophilia treatment options (62.1%), which in contrast to other topics was indicated most frequently by both patients and caregivers in all six countries. Most frequent difficulties in everyday life with hemophilia were identified as mobility problems (41.8%), unexpected bleeding (38.5%), pain (35.4%), and uncertainty with what they can or cannot do (25.0%). During the 2020 COVID-19 pandemic, 52.5% of respondents reported that they did not experience any major change in daily living with hemophilia.

CONCLUSION

Based on our Central European survey, hemophilia mostly affects peoples' lives by causing mobility difficulties, unexpected bleeding, pain and uncertainty in daily activities. Although the majority of respondents reported being educated about hemophilia, most PwH and CPwH respondents sought additional information, highlighting the need for continuous personalized patient education to cope with present challenges.

Royal society of Canada COVID-19 report: Enhancing COVID-19 vaccine acceptance in Canada

COVID-19 vaccine acceptance exists on a continuum from a minority who strongly oppose vaccination, to the “moveable middle” heterogeneous group with varying uncertainty levels about acceptance or hesitancy, to the majority who state willingness to be vaccinated. Intention for vaccine acceptance varies over time. COVID-19 vaccination decisions are influenced by many factors including knowledge, attitudes, and beliefs; social networks; communication environment; COVID-19 community rate; cultural and religious influences; ease of access; and the organization of health and community services and policies.

Reflecting vaccine acceptance complexity, the Royal Society of Canada Working Group on COVID-19 Vaccine Acceptance developed a framework with four major factor domains that influence vaccine acceptance (people, communities, health care workers; immunization knowledge; health care and public health systems including federal/provincial/territorial/indigenous factors)—each influencing the others and all influenced by education, infection control, extent of collaborations, and communications about COVID-19 immunization. The Working Group then developed 37 interrelated recommendations to support COVID vaccine acceptance nested under four categories of responsibility: 1. People and Communities, 2. Health Care Workers, 3. Health Care System and Local Public Health Units, and 4. Federal/Provincial/Territorial/Indigenous. To optimize outcomes, all must be engaged to ensure co-development and broad ownership.

Pandemics and infodemics: Research on the effects of misinformation on memory

On social media and in everyday life, people are often exposed to misinformation. Decades of research have shown that exposure to misinformation can have significant impacts on people's thoughts, actions, and memories. During global pandemics like COVID-19, people are likely exposed to heightened quantities of misinformation as they search for and are exposed to copious amounts of information about the disease and its effects. This media environment, with an abundance of both accurate and inaccurate information, is often called an "infodemic." In the current essay, we discuss the consequences of exposure to misinformation during this infodemic, particularly in the domain of memory. We review existing research demonstrating how inaccurate, postevent information impacts a person's memory for a previously witnessed event. We discuss various factors that strengthen the impact of misinformation, including repetition and whether the misinformation is consistent with people's pre-existing attitudes or beliefs. We conclude by describing how social media companies and individual users can help prevent the spread of misinformation and the ways in which cognitive science research can inform these approaches.

COVID-19 research in Wikipedia

Wikipedia is one of the main sources of free knowledge on the Web. During the first few months of the pandemic, over 5,200 new Wikipedia pages on COVID-19 were created, accumulating over 400 million page views by mid-June 2020. 1 At the same time, an unprecedented amount of scientific articles on COVID-19 and the ongoing pandemic have been published online. Wikipedia’s content is based on reliable sources, such as scientific literature. Given its public function, it is crucial for Wikipedia to rely on representative and reliable scientific results, especially in a time of crisis. We assess the coverage of COVID-19-related research in Wikipedia via citations to a corpus of over 160,000 articles. We find that Wikipedia editors are integrating new research at a fast pace, and have cited close to 2% of the COVID-19 literature under consideration. While doing so, they are able to provide a representative coverage of COVID-19-related research. We show that all the main topics discussed in this literature are proportionally represented from Wikipedia, after accounting for article-level effects. We further use regression analyses to model citations from Wikipedia and show that Wikipedia editors on average rely on literature that is highly cited, widely shared on social media, and peer-reviewed.

We Need the Lens of Equity in COVID-19 Communication

The ongoing COVID-19 pandemic has brought forward the centrality of public communication as a force for information, and in highlighting the differential impact on diverse segments of the society. Information and communication technologies-led developments including social media have previously been discussed as instruments of democratization of knowledge. However, the evidence so far shows that the promise remains unfulfilled as upper socioeconomic groups acquire information at a faster rate than others. The communication inequalities have only reinforced the existing societal fault lines of race, class and place. As the first pandemic of the social media age, COVID-19 has also given rise to an "infodemic", providing fertile ground for the spread of information, misinformation and disinformation. With limited gatekeeping, an immense amount of unprocessed scientific information is being put forward to publics not trained in science. In this commentary, we offer some propositions on how disinformation on COVID-19 has become mainstreamed through social media's spiral of amplification and what role public communication has in an emergency from a lens of equity. We raise the question of whether the tremendous flow of scientific information during the COVID-19 pandemic has a differential impact on different socioeconomic groups. We propose that more systematic research is urgently needed to understand how mis/disinformation originate, spread and what their consequences are. In our view, research in health communication inequalities is foundational to mitigating the current off-line and online ravages of the pandemic.

Pandemics and infodemics: Research on the effects of misinformation on memory

On social media and in everyday life, people are often exposed to misinformation. Decades of research have shown that exposure to misinformation can have significant impacts on people's thoughts, actions, and memories. During global pandemics like COVID-19, people are likely exposed to heightened quantities of misinformation as they search for and are exposed to copious amounts of information about the disease and its effects. This media environment, with an abundance of both accurate and inaccurate information, is often called an "infodemic." In the current essay, we discuss the consequences of exposure to misinformation during this infodemic, particularly in the domain of memory. We review existing research demonstrating how inaccurate, postevent information impacts a person's memory for a previously witnessed event. We discuss various factors that strengthen the impact of misinformation, including repetition and whether the misinformation is consistent with people's pre-existing attitudes or beliefs. We conclude by describing how social media companies and individual users can help prevent the spread of misinformation and the ways in which cognitive science research can inform these approaches.

Social connections with COVID-19-affected areas increase compliance with mobility restrictions

We study the role of social connections in compliance of U.S. households with mobility restrictions imposed in response to the coronavirus disease 2019 (COVID-19) pandemic, using aggregated and anonymized Facebook data on social connections and mobile phone data for measuring social distancing at the county level. Relative to the average restriction efficacy, a county with one-SD more social connections with China and Italy-the first countries with major COVID-19 outbreaks-has a nearly 50% higher compliance with mobility restrictions. By contrast, social connections of counties with less-educated populations, a higher Trump vote share, and a higher fraction of climate change deniers show decreased compliance with mobility restrictions. Our analysis suggests that social connections are conduits of information about the pandemic and an economically important factor affecting compliance with, and impact of, mobility restrictions.

Reimagining Public Health in the Aftermath of a Pandemic

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for society, affecting those already subject to unacceptable health inequalities and resulting in vast economic impacts. The pandemic reminds everyone of the value and necessity of public health.In the context of an era that will be shaped by COVID-19, we outline the coming series of challenges and transitions in public health and the needed actions over the next 5 years to reinvent our public health systems. Multiple limitations in current US and global public health systems have been uncovered by the pandemic, including insufficient preparedness and surveillance capabilities complicated by long-standing and worsening health inequalities and the rapid spread of misinformation that needs to be countered. We foresee 3 phases for public health over the next 5 years: (1) reactive crisis management, (2) efforts to maintain initial gains, and (3) efforts to sustain and enhance progress.A reinvented public health system will depend highly on leadership and political will, rethinking how we categorize and address population-level risk, employing 21st-century data sciences, and applying new communication skills.

Intersection of the Web-Based Vaping Narrative With COVID-19: Topic Modeling Study

BACKGROUND

The COVID-19 outbreak was designated a global pandemic on March 11, 2020. The relationship between vaping and contracting COVID-19 is unclear, and information on the internet is conflicting. There is some scientific evidence that vaping cannabidiol (CBD), an active ingredient in cannabis that is obtained from the hemp plant, or other substances is associated with more severe manifestations of COVID-19. However, there is also inaccurate information that vaping can aid COVID-19 treatment, as well as expert opinion that CBD, possibly administered through vaping, can mitigate COVID-19 symptoms. Thus, it is necessary to study the spread of inaccurate information to better understand how to promote scientific knowledge and curb inaccurate information, which is critical to the health of vapers. Inaccurate information about vaping and COVID-19 may affect COVID-19 treatment outcomes.

OBJECTIVE

Using structural topic modeling, we aimed to map temporal trends in the web-based vaping narrative (a large data set comprising web-based vaping chatter from several sources) to indicate how the narrative changed from before to during the COVID-19 pandemic.

METHODS

We obtained data using a textual query that scanned a data pool of approximately 200,000 different domains (4,027,172 documents and 361,100,284 words) such as public internet forums, blogs, and social media, from August 1, 2019, to April 21, 2020. We then used structural topic modeling to understand changes in word prevalence and semantic structures within topics around vaping before and after December 31, 2019, when COVID-19 was reported to the World Health Organization.

RESULTS

Broadly, the web-based vaping narrative can be organized into the following groups or archetypes: harms from vaping; Vaping Regulation; Vaping as Harm Reduction or Treatment; and Vaping Lifestyle. Three archetypes were observed prior to the emergence of COVID-19; however, four archetypes were identified post-COVID-19 (Vaping as Harm Reduction or Treatment was the additional archetype). A topic related to CBD product preference emerged after COVID-19 was first reported, which may be related to the use of CBD by vapers as a COVID-19 treatment.

CONCLUSIONS

Our main finding is the emergence of a vape-administered CBD treatment narrative around COVID-19 when comparing the web-based vaping narratives before and during the COVID-19 pandemic. These results are key to understanding how vapers respond to inaccurate information about COVID-19, optimizing treatment of vapers who contract COVID-19, and possibly minimizing instances of inaccurate information. The findings have implications for the management of COVID-19 among vapers and the monitoring of web-based content pertinent to tobacco to develop targeted interventions to manage COVID-19 among vapers.

Combatting Against Covid-19 & Misinformation: A Systematic Review

Accompanied by false information, mass media content is hindering efforts to cope with the current outbreak. Although the World Health Organization and other concerned bodies are notified regarding misinformation, myths and rumors are highly prevalent. This paper aims to highlight the misinformation and its potential impacts during the Covid-19 by using the Systematic Review Approach. The researcher randomly selected n = 35 research articles published from 2015 to 2020, witnessing the misinformation as a major concern during previous endemics and the current Covid-19 pandemic. Myths and rumors through traditional and new media platforms cause Xenophobia, LGBT Rights violations, and psychological disorders among the masses. Despite the efforts made by the World Health Organization, much more is required to nullify the impacts of misinformation and Covid-19. Therefore, the researcher recommended improved global healthcare policies and strategies to counteract against misinformation to mitigate the impacts of Covid-19.

How the Health Rumor Misleads People's Perception in a Public Health Emergency: Lessons from a Purchase Craze during the COVID-19 Outbreak in China

Health rumors often mislead people and cause adverse health behaviors. Especially during a public health emergency, health rumors may result in severe consequences for people's health and risk governance. Insight into how these rumors form and harm people's health behavior is critical for assisting people in establishing scientific health cognition and to enhance public health emergency responses. Using the case study with interview data of a salient purchase craze led by a health rumor during the COVID-19 outbreak in China, this article aimed to illustrate the process of how a piece of information becomes a health rumor. Furthermore, we identify factors that cause people to believe rumors and conduct behavior that leads to a purchase craze. Results show that a public misunderstanding of the unique psychology of uncertainty, cultural and social cognition, and conformity behavior jointly informs people's beliefs in rumors and further causes purchase craze behavior. We developed a simplified model to demonstrate how an ordinary news report can lead to a rumor. Based on this model, some implications of effective health communication are suggested for managing rumors.

Bots as Active News Promoters: A Digital Analysis of COVID-19 Tweets

In this study, we examined the activities of automated social media accounts or bots that tweet or retweet referencing #COVID-19 and #COVID19. From a total sample of over 50 million tweets, we used a mixed method to extract more than 185,000 messages posted by 127 bots. Our findings show that the majority of these bots tweet, retweet and mention mainstream media outlets, promote health protection and telemedicine, and disseminate breaking news on the number of casualties and deaths caused by COVID-19. We argue that some of these bots are motivated by financial incentives, while other bots actively support the survivalist movement by emphasizing the need to prepare for the pandemic and learn survival skills. We only found a few bots that showed some suspicious activity probably due to the fact that our dataset was limited to two hashtags often used by official health bodies and academic communities.

"I Think It's Been Met With a Shrug:" Oncologists' Views Toward and Experiences With Right-to-Try

BACKGROUND

The federal Right-to-Try (RTT) Act created an alternate regulatory pathway for preapproval access to investigational drugs. A few studies have examined the experiences of physicians with the Food and Drug Administration's Expanded Access Programs, but to our knowledge, no study has yet to examine their attitudes and experiences toward RTT.

METHODS

This study explored the views of 21 oncologists at a major cancer center with 3 main sites across the United States using semi-structured interviews and qualitative analysis. Participants were selected to have experience with Expanded Access Programs.

RESULTS

Most oncologists had limited familiarity with RTT, and several reported confusion about the legislation, including whether patients have a right to investigational drugs and an obligation for companies to provide them. Although oncologists were interested in decreased regulatory burdens, 3 areas of concern were articulated: lack of safety and oversight, unclear structure and no provision for data collection, and potential heightening of patient expectations. Only 4 oncologists had experience discussing RTT, and none formally attempted to obtain the drug through this mechanism. Participants questioned the practicality of RTT legislation and suggested alternative ways to improve access.

CONCLUSIONS

The study provides foundational empirical data underlying challenging ambiguities by experienced oncologists familiar with off-trial use of investigational therapeutics and reaffirms the role of physicians and regulatory bodies in mitigating the risks of investigational drugs. Our findings highlight the need for medical centers to inform oncologists about RTT and other preapproval pathways so that they are able to address questions from patients interested in nontrial investigational drugs.

Feeling angry: the effects of vaccine misinformation and refutational messages on negative emotions and vaccination attitude

Vaccine misinformation circulated on social media has negatively impacted people's vaccine beliefs and behaviors. Communication strategies to address misinformation including fact-checking and warning labels have shown conflicting effects. This study examined how short-term exposure to vaccine misinformation impacted vaccination attitude through both cognitive and affective routes and tested whether and how two-sided refutational messages could negate the misinformation's impact. We conducted an online experiment involving a convenient sample of 609 U.S. adult participants with five message conditions: two misinformation messages (one using the conspiracy frame and one using the uncertainty frame), two corresponding two-sided refutational messages, and a control group. Results showed that both conspiracy and uncertainty framed misinformation messages decreased pro-vaccination attitude in comparison to the control. The two refutational messages increased pro-vaccination attitude in comparison to the corresponding misinformation messages. These effects were further mediated by the emotion of anger. Parental status and conspiracy beliefs did not moderate effects of the messages on vaccination attitude. Our findings indicate two-sided refutational messages can be a promising strategy to combat vaccine misinformation.

Internet Public Opinion Evolution in the COVID-19 Event and Coping Strategies

Objectives:

In this study, we carried out a text analysis on the information disseminated and discussed among netizens on the Baidu Post Bar (the world’s largest Chinese forum) during the coronavirus disease 2019 (COVID-19) epidemic, to create a policy basis for health administrative departments.

Methods:

We used Python tools to search for the relevant data on the Baidu Post Bar. Next, a text analysis was performed on the posts’ contents using a combination of latent Dirichlet allocation (LDA), sentiment analysis, and correlation analysis.

Results:

According to the LDA analysis, the public was highly interested in topics such as COVID-19 prevention, infection symptoms, infection and coping measures, sources of transmission and treatments, community management, and work resumption. The majority of the public had negative emotional values, yet a portion of the public held positive emotional values. We also performed a correlation analysis of the influencing factors was established.

Conclusions:

Netizens’ degree of concern shown in their posts was greatly associated with the spread of COVID-19. With the rise, diffusion, outbreak, and mitigation of COVID-19 in China, netizens have successively created a large number of posts, and the topics of discussion varied over time. Therefore, the media and the government have the responsibility to distribute positive information, to correctly guide the public’s emotions to bring some sort of reassurance to the public.

Declining awareness of HPV and HPV vaccine within the general US population

Programs aimed at boosting human papillomavirus (HPV)-related awareness are considered one of the most effective strategies for increasing vaccination uptake and eliminating HPV-associated cancers. Several US states have made strong commitments to this effort through legislation and dedicated funds. However, it is not known if these efforts have resulted in population-level increments in HPV awareness overtime. Using the Health Information National Trends Survey data, we examined the awareness of HPV and HPV vaccine in the US, between 2008 and 2018. Prevalence estimates and confidence intervals were calculated for HPV and HPV vaccine awareness. Further, we assessed awareness after stratifying by key sociodemographic characteristics. Overall, the awareness of HPV and HPV vaccine declined over time. The lowest awareness was among racial minorities, rural residents, male respondents, those aged 65 years and older, as well as those with the lowest educational and socioeconomic standing. Between 2013 and 2018, the awareness of HPV and HPV vaccine declined by almost 10% among males, those with a high school level of education or lower, and those who earned less than USD 35,000 per annum. In 2018, the awareness of HPV and HPV vaccine was highest among non-Hispanic whites (65.8% and 66.5%) and female adults (70.5% and 71.4%); however, these figures represented declines of about 5% from rates observed in 2008. Amidst a background of sub-optimal HPV vaccination uptake and a growing incidence of HPV-associated cancers in the US, HPV-related awareness within the general US population has declined over time. This calls for stricter enforcement of legislation aimed at boosting HPV awareness, as well as frequent evaluation of government-funded HPV awareness programs.

Misinformation about spinal manipulation and boosting immunity: an analysis of Twitter activity during the COVID-19 crisis

Background

Social media has become an increasingly important tool in monitoring the onset and spread of infectious diseases globally as well monitoring the spread of information about those diseases. This includes the spread of misinformation, which has been documented within the context of the emerging COVID-19 crisis. Understanding the creation, spread and uptake of social media misinformation is of critical importance to public safety. In this descriptive study, we detail Twitter activity regarding spinal manipulative therapy (SMT) and claims it increases, or “boosts”, immunity. Spinal manipulation is a common intervention used by many health professions, most commonly by chiropractors. There is no clinical evidence that SMT improves human immunity.

Methods

Social media searching software (Talkwalker Quick Search) was used to describe Twitter activity regarding SMT and improving or boosting immunity. Searches were performed for the 3 months and 12 months before March 31, 2020 using terms related to 1) SMT, 2) the professions that most often provide SMT and 3) immunity. From these searches, we determined the magnitude and time course of Twitter activity then coded this activity into content that promoted or refuted a SMT/immunity link. Content themes, high-influence users and user demographics were then stratified as either promoting or refuting this linkage.

Results

Twitter misinformation regarding a SMT/immunity link increased dramatically during the onset of the COVID crisis. Activity levels (number of tweets) and engagement scores (likes + retweets) were roughly equal between content promoting or refuting a SMT/immunity link, however, the potential reach (audience) of tweets refuting a SMT/immunity link was 3 times higher than those promoting a link. Users with the greatest influence on Twitter, as either promoters or refuters, were individuals, not institutions or organizations. The majority of tweets promoting a SMT/immunity link were generated in the USA while the majority of refuting tweets originated from Canada.

Conclusion

Twitter activity about SMT and immunity increased during the COVID-19 crisis. Results from this work have the potential to help policy makers and others understand the impact of SMT misinformation and devise strategies to mitigate its impact.

Misinformation, manipulation, and abuse on social media in the era of COVID-19

The COVID-19 pandemic represented an unprecedented setting for the spread of online misinformation, manipulation, and abuse, with the potential to cause dramatic real-world consequences. The aim of this special issue was to collect contributions investigating issues such as the emergence of infodemics, misinformation, conspiracy theories, automation, and online harassment on the onset of the coronavirus outbreak. Articles in this collection adopt a diverse range of methods and techniques, and focus on the study of the narratives that fueled conspiracy theories, on the diffusion patterns of COVID-19 misinformation, on the global news sentiment, on hate speech and social bot interference, and on multimodal Chinese propaganda. The diversity of the methodological and scientific approaches undertaken in the aforementioned articles demonstrates the interdisciplinarity of these issues. In turn, these crucial endeavors might anticipate a growing trend of studies where diverse theories, models, and techniques will be combined to tackle the different aspects of online misinformation, manipulation, and abuse.