Public figure announcements about cancer and opportunities for cancer communication: a review and research agenda

Associations between news coverage, social media discussions, and search trends about celebrity deaths, screening, and other colorectal cancer-related events

OBJECTIVE

Colorectal cancer (CRC) is the third leading cause of cancer death among both men and women in the United States. CRC-related events may increase media coverage and public attention, boosting awareness and prevention. This study examined associations between several types of CRC events (including unplanned celebrity cancer deaths and planned events like national CRC awareness months, celebrity screening behavior, and screening guideline changes) and news coverage, Twitter discussions, and Google search trends about CRC and CRC screening.

METHODS

We analyzed data from U.S. national news media outlets, posts scraped from Twitter, and Google Trends on CRC and CRC screening during a three-year period from 2020 to 2022. We used burst detection methods to identify temporal spikes in the volume of news, tweets, and search after each CRC-related event.

RESULTS

There is a high level of heterogeneity in the impact of celebrity CRC events. Celebrity CRC deaths were more likely to precede spikes in news and tweets about CRC overall than CRC screening. Celebrity screening preceded spikes in news and tweets about screening but not searches. Awareness months and screening guideline changes did precede spikes in news, tweets, and searches about screening, but these spikes were inconsistent, not simultaneous, and not as large as those events concerning most prominent public figures.

CONCLUSIONS

CRC events provide opportunities to increase attention to CRC. Media and public health professionals should actively intervene during CRC events to increase emphasis on CRC screening and evidence-based recommendations.

An Exploratory Content Analysis of the Use of Health Communication Strategies and Presence of Objectification in Fitness Influencer Social Media Posts

Health and fitness content intended to inspire people to live healthy lives (e.g. "fitspiration") has been linked to negative body image among girls and young women. Fitness influencers purport wanting to motivate healthy behaviors. This study seeks to examine the presence of strategies known to positively influence health behaviors (e.g. attitudes, self-efficacy) as well as of content known to have a negative influence (e.g. objectification) among fitness influencers. We conducted a content analysis (N = 441) of a random sample of one year of posts from four Instagram fitness influencers popular with girls and young women in the United States. The main analysis consisted of codes related to objectification, health promotion strategies, health-related content, and social engagement (i.e., likes). We found that fitness influencers included content that conveyed constructs previously found to positively influence health behaviors (e.g., attitudes and self-efficacy), but objectification was frequently present, in more than half of the posts. Additionally, we found that the presence of objectification in posts was negatively associated with likes, a form of social endorsement. We suggest health communicators aim to work in tandem with fitness influencers to include content that may motivate positive health behaviors and improve media literacy and that influencers aim to reduce the amount of objectifying content included in their posts. Our findings shed light on content being conveyed and possible insights into the negative effects associated with viewing such content.

The Impact of Celebrity and Influencer Illness Disclosures

When celebrities, political figures, influencers, or anyone with a large following publicly disclose an illness or die, the news becomes a de facto public health campaign. Until health communicators began studying such disclosures and the effects of the following waves of media coverage, however, it was not known to what extent these events impacted the public. A growing body of research has empirically documented these events and examined the factors that predict which types of audiences are most affected and why. Beyond motivating research opportunities, celebrity and influencer health disclosures or deaths can impact calls to hotlines, views on health-related websites, discussions of related topics on social media, behavioral changes relevant to the disclosure, increased news coverage of celebrity health research, integration of celebrity health narratives into strategic health campaigns, and even policy changes. We provide an overview of research conducted in this area and detail examples of the impact that celebrity health disclosures and studies about those disclosures have had on public discourse and public health.

Exposure to Pro and Anti-Cannabis Social Media Messages and Teens' and College Students' Intentions to Use Cannabis

Content analyses have documented that posts about cannabis are increasingly common on social media. The relationship between the cannabis-related content to which teens and college students are exposed on social media and how such content may be associated with intentions to use and use of cannabis is less known, however. We conducted an online survey with teens (N = 350) who lived in Washington state using online survey panel participants in June 2018 and with college students (N = 966) in a Washington state-wide university system in February and March 2019. Participants in both samples reported seeing both pro-cannabis and anti-cannabis messages on social media platforms. Exposure to pro-cannabis messages on social media was associated with an increased intention to use cannabis. Exposure to anti-cannabis messages on social media was indirectly associated with decreased intentions to use cannabis through negative outcome beliefs of cannabis use and, among college students, through perceived norms. Among college students specifically, exposure to pro-cannabis messages on social media was also associated with more frequent cannabis use. Health communicators could focus anti-cannabis messaging on negative outcome beliefs among teens and college students as well as norms among college students to potentially influence constructs associated with intentions and use.

'Are you vaccinated? Yeah, I'm immunized': a risk orders theory analysis of celebrity COVID-19 misinformation

BACKGROUND

On 11 March 2020, COVID-19 was declared a global health pandemic by the World Health Organization (WHO). Vaccinating populations is paramount in changing the course of a pandemic. The rapid spread of (mis) and disinformation online from celebrities, politicians, and media influencers creates a corrosion of trust in public health interventions.

METHODS

Given the importance of the spread of information during a public health crisis, the current study uses risk orders theory with a constructivist grounded theory approach to analyze an episode of a popular podcast available on YouTube, titled, 'Aaron Rodgers Tells Pat McAfee His Side of Vaccine Situation.'

RESULTS

Findings illuminated three themes concerning COVID-19 medical interventions from celebrity discourse: (1) misinterpreting medical terminology; (2) conflating bodily autonomy and altruism; and (3) political ideology as an impetus for misinformation.

CONCLUSIONS

The discussion offers implications for healthcare practitioners in debunking mis- and disinformation. Foremost, lack of transparency concerning autonomy, liberty, freedom, and choice from public health experts who design messages during a public health crisis creates a space for non-medical influencers to promote pseudoscience, misinformation, and disinformation. This leads to public distrust of medical experts and confuses the public's understanding of best practices based upon standard of medical evidence and care.

Racial Differences in Response to Chadwick Boseman's Colorectal Cancer Death: Media Use as a Coping Tool for Parasocial Grief

The August 2020 death of Black actor Chadwick Boseman, at age 43 from colon cancer was a notable public event. Given Boseman's popularity, particularly amongst Black audiences, and racial disparities in colorectal cancer rates, public responses to this news provided a window into potential racial differences in expressing and responding to parasocial grief, that is, grief at the loss of a public figure. Additionally, given how the movies he starred in were easily viewable by audiences stuck at home during the COVID-19 pandemic and given his popularity on digital spaces like Black Twitter, this case offers insights into how media use can help people cope with parasocial grief. We conducted a mixed-methods survey study of audience responses Boseman's death. Quantitative results reveal that Black audiences had different rates of social sharing and movie viewing than non-Black audiences, with additional insights emerging from a thematic analysis of the open-ended data.

COVID-19 risk perception and hoax beliefs in the US immediately before and after the announcement of President Trump's diagnosis

A notable challenge of the SARS-CoV-2 pandemic has been public scepticism over the severity of the disease, or even its existence. Such scepticism is politically skewed in the USA, with conservatives more likely to downplay or deny the risks of the virus. However, the hospitalization of President Trump with COVID-19 in October 2020 served as a high-profile exemplar of the reality and risks of the virus, and as such may have influenced opinions, particularly for US conservatives. We investigate whether President Trump testing positive was associated with changes in public attitudes towards the virus. In two studies, we surveyed independent representative US samples before and after the announcement of Trump's illness. In Study 1, measuring risk perceptions of the virus, we find that participants surveyed before and after the announcement did not differ in their risk perception regardless of political orientation. In Study 2, measuring belief that the virus is a hoax, we find that among those on the far right of the political spectrum, hoax belief was lower for those surveyed after the announcement, suggesting that Trump's hospitalization may have affected the beliefs of those most receptive to the President's earlier suggestions that the virus might be a hoax.

News Coverage of Colorectal Cancer on Google News: Descriptive Study

Background

Colorectal cancer (CRC) is one of the leading causes of cancer death in the United States. The incidence and prevalence of CRC have historically increased with age. Although rates of CRC in the United States have been decreasing over the past decades among those aged ≥65 years, there has been an uptick among those in younger age brackets. Google News is one of the biggest traffic drivers to top news sites. It aggregates and shares news highlights from multiple sources worldwide and organizes them by content type. Despite the widespread use of Google News, research is lacking on the type of CRC content represented in this news source. 

Objective

The purpose of this study was to analyze content related to CRC screening and prevention in Google News articles published during National Colorectal Cancer Awareness Month (March 2022).

Methods

Data collection for this cross-sectional study was conducted in March 2022—National Colorectal Cancer Awareness Month. Using the term colorectal cancer, 100 English-language Google News articles were extracted and coded for content. A combined approach—deductive and inductive coding—was utilized. Descriptive analyses were conducted, and frequency distributions were reported. Univariable analyses were performed to assess differences between articles that mentioned CRC screening and those that did not via chi-square tests.

Results

Of the 100 articles reviewed, nearly half (n=49, 49%) were created by health news organizations, and another 27% (n=27) were created by television news services. The predominant themes in the content included age at the onset of disease (n=59, 59%), mortality related to CRC (n=57, 57%), and the severity of disease (n=50, 50%). Only 18% (n=18) of articles discussed CRC disparities, 23% (n=23) mentioned that there are hereditary forms of the disease, 36% (n=36) spoke of colonoscopy to screen for the disease, and 37% (n=37) mentioned how the disease is treated. Although most articles mentioned CRC screening (n=61, 61%), it was striking that sex was only mentioned in 34% (21/61) of these articles, colonoscopy was mentioned in 46% (28/61), and diet was mentioned in 30% (18/61).

Conclusions

Heightening the public’s awareness of this disease is important, but it is critical that messages related to how preventable this cancer is, who is the most likely to develop CRC, and what can be done to detect it in the early stages when the disease is the most curable be the critical elements of dialogue, particularly during National Colorectal Cancer Awareness Month. There is a need to disseminate information about early-onset CRC and the importance of screening, especially among populations with low rates of uptake. Web-based news is potentially an underutilized communication mechanism for promoting CRC screenings as secondary prevention measures for high-risk groups.

A Mixed Methods Inquiry into the Role of Tom Hanks' COVID-19 Social Media Disclosure in Shaping Willingness to Engage in Prevention Behaviors

Given the vast amounts of COVID-19-related messages flooding mediated and interpersonal communication channels during the global pandemic, celebrity COVID-19 disclosures offer rare opportunities to cut through message fatigue and apathy and garner the attention of wide swaths of the public. We conducted a convergent mixed method analysis of audience responses to actor Tom Hanks' March 11, 2020 disclosure of his COVID-19 diagnosis via social media. We collected our data within 24 hours of his announcement, allowing us to quickly capture emotional and cognitive responses to the announcement and to assess both demographic and psychosocial differences in types of people who heard the news in this time frame and those who had not. In our study, 587 participants had heard the news of Hanks' disclosure while 95 had not. Participants who had heard responded to an open-ended prompt asking if the disclosure affected them at all. Those who had not heard were funneled into a field intervention to test how random assignment to seeing Hanks' disclosure post or not would affect audiences' COVID-19-related emotions, cognitions, and willingness to enact prevention behaviors. The results of this mixed methods study revealed differences in responses to Hanks' disclosure based on health information source trust and involvement with Hanks as well as effects of the intervention on efficacy for dealing with COVID-19. We discuss implications for health communication theory and crafting messages that can effectively build off the attentional inertia generated by celebrity illness disclosures to encourage prevention efforts.

Examining the Effects of Celebrity (Vs. Noncelebrity) Narratives on Opioid Addiction Prevention: Identification, Transportation, and the Moderating Role of Personal Relevance

Celebrity disclosures and narratives are popular strategies in health promotion. However, less is known about their joint effects and the mechanisms through which they function. A 2 (narrative type: celebrity vs. layperson) x 2 (personal relevance: low vs. high) online experiment (N = 248) tested the impact of different narrative types in increasing awareness about prescription opioid abuse. Results indicated that a celebrity narrative is more persuasive than its layperson counterpart. Also, personal relevance toward opioid addiction moderated the influence of narrative type. Celebrity narratives evoked more positive attitudes toward opioid prevention and greater behavioral compliance intentions with the recommended action for low-relevance individuals. Transportation and identification mediated the effects of celebrity narratives on participants' issue attitudes and behavioral intentions, but only for low-relevance individuals. Practically, the data suggest that incorporating celebrities in health narratives about opioid addiction prevention facilitates behavioral compliance, especially for individuals to whom a pressing health issue like opioid misuse is currently of low relevance.

How Video Streamers' Mental Health Disclosures Affect Viewers' Risk Perceptions

Celebrities' self-disclosures about their mental health issues can enhance public awareness of mental illness such as depression. As online live streaming becomes a popular choice for media entertainment, microcelebrities such as video streamers may have similar influence over their audience. Using an online survey (N = 474), this study examined how exposure to streamers' depression disclosures affected the viewer's perceptions toward the streamers and depression. We also examined how parasocial relationships, parasocial interactions, and identification with streamers were associated with 1) the viewers' perceived authenticity and credibility toward the streamers, 2) as well as increases in the viewers' perceived prevalence, risk susceptibility, and risk severity about mental health. The study demonstrates a strong association between streamers' health disclosures and public awareness regarding depression. The study extends previous studies around celebrity influencers as a promising opportunity for reducing social stigma around mental health discussions. The study also advances our theoretical understanding of microcelebrities' social influence in a new media context.

Hepatitis C virus media coverage favorably impacts on antibody testing in the non-interferon era

BACKGROUND

In the non-interferon era, many patients still remain untested for hepatitis C virus (HCV) infection. Our aim was to determine if media coverage, number and type of news, can influence the rate of HCV testing.

METHODS

For each calendar year we searched from national, regional and local newspapers for articles published related to HCV between 2001 and 2013 (interferon era) and 2014-2018 (non-interferon era) and the HCV tests performed. Demographics, provider data and test result were collected from patients tested.

RESULTS

During the studied period, 21 913 press articles were found, and we identified a total of 293 226 HCV tests. A total of 9778 HCV tests from 5237 patients tested positive (1.88%). An inverse correlation was found between media coverage and the number of HCV tests during the interferon era (r2 = -0.558, P = 0.024), where news concerning epidemiology and burden of the disease were more frequent. By contrast, in the non-interferon era a strong correlation was observed (r2 = 0.900, P = 0.019), where news related to treatment prevailed.

CONCLUSION

Our results show that media coverage on HCV fluctuate so the type of news. It remains to be prospectively evaluated if well designed publicity campaigns about the benefits of HCV screening and treatment influences on HCV testing.

Cancer Fatalism and Cancer Information Seeking Among Black Women: Examining the Impact of Aretha Franklin's Death on Cancer Communication Outcomes

Information seeking is often heightened following news coverage of cancer announcements from prominent celebrities or public figures. While scholars have sought to explicate the mechanisms influencing cancer information seeking following celebrity health announcements, the focus has primarily been on cognitive and emotional factors. Other influences such as sociocultural constructs have largely been ignored in this domain. Additionally, few studies have examined the health communication behaviors of minority individuals. The purpose of this study was to examine Black women's information seeking behaviors as a response to the death of the singer Aretha Franklin from pancreatic cancer and the role of fatalistic beliefs about cancer in the information seeking process. Using a survey conducted a few weeks after Franklin's death (N = 164), we found moderate amounts of pancreatic cancer information seeking, with almost 30% of women looking for information. Younger Black women were much more likely to search for information after Franklin's death than older women. Moreover, while we found fatalistic beliefs to be associated with pancreatic cancer information seeking, the findings were driven by younger women. In particular, younger women were more likely to seek pancreatic cancer information regardless of their beliefs about cancer. This study advances the understanding of cancer information seeking among Black women. Implications for cancer communication with Black women are discussed.

Internet Interest in Colon Cancer Following the Death of Chadwick Boseman: Infoveillance Study

Background

Compared with White Americans, Black Americans have higher colon cancer mortality rates but lower up-to-date screening rates. Chadwick Boseman was a prominent Black American actor who died of colon cancer on August 28, 2020. As announcements of celebrity diagnoses often result in increased awareness, Boseman’s death may have resulted in greater interest in colon cancer on the internet, particularly among Black Americans.

Objective

This study aims to quantify the impact of Chadwick Boseman’s death on web-based search interest in colon cancer and determine whether there was an increase in interest in regions of the United States with a greater proportion of Black Americans.

Methods

We conducted an infoveillance study using Google Trends (GT) and Wikipedia pageview analysis. Using an autoregressive integrated moving average algorithm, we forecasted the weekly relative search volume (RSV) for GT search topics and terms related to colon cancer that would have been expected had his death not occurred and compared it with observed RSV data. This analysis was also conducted for the number of page views on the Wikipedia page for colorectal cancer. We then delineated GT RSV data for the term colon cancer for states and metropolitan areas in the United States and determined how the RSV values for these regions correlated with the percentage of Black Americans in that region. Differences in these correlations before and after Boseman’s death were compared to determine whether there was a shift in the racial demographics of the individuals conducting the searches.

Results

The observed RSVs for the topics colorectal cancer and colon cancer screening increased by 598% and 707%, respectively, and were on average 121% (95% CI 72%-193%) and 256% (95% CI 35%-814%) greater than expected during the first 3 months following Boseman’s death. Daily Wikipedia page view volume during the 2 months following Boseman’s death was on average 1979% (95% CI 1375%-2894%) greater than expected, and it was estimated that this represented 547,354 (95% CI 497,708-585,167) excess Wikipedia page views. Before Boseman’s death, there were negative correlations between the percentage of Black Americans living in a state or metropolitan area and the RSV for colon cancer in that area (r=−0.18 and r=−0.05, respectively). However, in the 2 weeks following his death, there were positive correlations between the RSV for colon cancer and the percentage of Black Americans per state and per metropolitan area (r=0.73 and r=0.33, respectively). These changes persisted for 4 months and were all statistically significant (P<.001).

Conclusions

There was a significant increase in web-based activity related to colon cancer following Chadwick Boseman’s death, particularly in areas with a higher proportion of Black Americans. This reflects a heightened public awareness that can be leveraged to further educate the public.

The "celebrity canary in the coal mine for the coronavirus": An examination of a theoretical model of celebrity illness disclosure effects

RATIONALE

On March 11, 2020, actor Tom Hanks announced via social media that he had been diagnosed with COVID-19. Previous research has found celebrity illness disclosures to influence behavior, but during the uncertainty of a pandemic, the effects of such a disclosure were unclear.

OBJECTIVE

To test the proposed Celebrity Illness Disclosure Effects (CIDE) model, demonstrating how an illness disclosure, communicated through mediated and interpersonal channels, may shape willingness to engage in prevention behaviors.

METHODS

We conducted an online survey (N = 587) 24 hours after Hanks' COVID-19 disclosure.

RESULTS

Findings revealed that celebrity-related perception variables predicted illness-related cognitions and emotions\, which were associated with willingness to enact prevention behaviors. Greater willingness to seek information, stronger perceptions of COVID as a threat, and stronger perceptions of efficacy for dealing with COVID after learning of Hanks' diagnosis predicted stronger willingness to enact prevention behaviors. However, anxiety about COVID predicted lower willingness to enact prevention behaviors.

CONCLUSIONS

The CIDE model can serve as a guide for future research in this area. The results can help scholars who aim to better understand the phenomena around celebrities and health communication as well as policymakers who hope to ride the wave of star power to improved public health outcomes.

"Twitter is Really Therapeutic at Times": Examination of Black Men's Twitter Conversations Following Hip-Hop Artist Kid Cudi's Depression Disclosure

Mental illness affects a considerable number of African Americans, and Black men bare a heavy burden. Over the past few years, more and more Black male celebrities have publicly discussed their struggles with mental illness, aiming to raise awareness, educate the public, and reduce stigma around mental health in the Black community. In this exploratory study, I investigated Twitter conversations following hip-hop artist Scott "Kid Cudi" Mescudi's October 2016 depression disclosure. Following the disclosure, the hashtag #YouGoodMan was created to engage Black men on Twitter in conversations about mental health. I used thematic analysis to analyze a sample of 1,482 tweets from the hashtag. Three distinct themes emerged from this study, with implications for mental health communication. The three themes are (a) advocating for mental health disclosure, (b) providing online and offline support, and (c) acknowledging the role and impact of culture and society. The findings are discussed relevant to social representations theory, celebrity influence, and health campaigns.

A Systematic Literature Review of Cancer Communication with Indigenous Populations in Canada and the United States

Cancer is one of the leading causes of death among Indigenous populations. Communication campaigns are an important component of cancer prevention and treatment. However, communication about cancer with Indigenous populations has yet to be fully explored and understood. In this systematic literature review, we examine peer-reviewed research to gain insight into the factors that contribute to effective communication about cancer with Indigenous populations. The review yielded a total of 7313 potential articles and a total of 25 of these manuscripts met the inclusion criteria. Results indicate five primary factors that may increase the effectiveness of communication about cancer with Indigenous populations. Factors include the need to (1) respect traditional knowledge, (2) use appropriate language, (3) involve community members in the communication process, (4) include people from different generations in message design, and (5) engender trust in health communicators. Results also provide insight into communication methods that contribute to effective cancer communication. We identify gaps in the literature and provide recommendations for future cancer communication strategies and research with Indigenous populations.

Sharing on Social Network Sites following Carrie Fisher's Death: Responses to Her Mental Health Advocacy

Grounded in work on health narratives of public figures, an online survey (N = 305) explored amplification of Carrie Fisher's mental health advocacy following her death through sharing about mental health on SNSs. Parasocial relationship (PSR) to Fisher and grief in response to her death both predicted greater sharing about mental health on social network sites, but parasocial grief fully mediated the influence of PSR on social sharing. Prosocial motivations (pleasure, pressure) moderated the relationship between parasocial grief and social sharing. In a separate analysis, parasocial grief predicted greater exposure to both media about mental health and media that mourned/celebrated Fisher. Mental health-related media exposure mediated the influence of parasocial grief on social sharing, but this mediation occurred only among people who were not aware of Fisher's mental health advocacy prior to her death.

The Power of Celebrity Health Events: Meta-analysis of the Relationship between Audience Involvement and Behavioral Intentions

Audience involvement processes - such as parasocial interaction and identification - may impact an individual's response to celebrity health events, yet to date, no synthesis of the literature exists. The present meta-analysis examined audience involvement processes and their influence on health behavior intentions in the context of celebrity health events. Fourteen studies (N = 5,718) met criteria and were analyzed using meta-analytic procedures. The weighted mean effect of the association between audience involvement and behavioral intentions was r = 0.20 (95% CI, 0.08-0.31, p <.001), indicating a statistically significant small-to-medium-sized positive association. Moderator analyses revealed that celebrity disclosures and events had greater effects than depictions of a media persona with a health condition; greater effects were also found for health behaviors not requiring a medical procedure. Our findings suggest that those who most feel a sense of attachment or affinity for a celebrity or media personae may be the ones who are most likely to modify their behavioral intentions in the wake of a celebrity health event. Results highlight the need for health practitioners to recognize the role of audience involvement in celebrity health events and to better assess how to harness these opportunities to promote healthy behaviors.

Cancer Control Continuum in Korean American Community Newspapers: What Is the Association with Source Nationality-US vs. Korea?

Prior research suggests that cancer information obtained from Korean American community media, which are the primary health information sources among the population, does not connect to Korean Americans' increased cancer knowledge or cancer protective/detective behavior. We aim to identify the reason by analyzing cancer type, cancer control continuum, and cancer topic presented in Korean American community newspapers. The nationality of news source, US and Korea, and its association with the cancer coverage were examined. We found that among articles that cited any source, nearly one third used a source from Korea. The source nationality was associated with cancer coverage. In particular, cancer risk factors and screening were more likely to be discussed when a US source was cited as compared to when no source was cited. Korean sources were never or rarely observed in articles focusing on a few cancer sites (e.g., breast and prostate, which Korean Americans have higher risks compared to native Koreans), cancer preventive behaviors (diet, physical activity, no smoking), and specific cancer detection methods (mammogram, pap-smear). We suggest Korean American media to reflect the cancer priority and information needs among Korean Americans, which are varied from native Koreans, and to acknowledge the differences in cancer prevention and detection guidelines between the U.S. and Korean healthcare system. Also, the U.S. government should disseminate cancer screening and prevention guidelines, customized to racial/ethnic groups' cancer prevalence and communication preference.

Communicating Environmental Health Risks with Indigenous Populations: A Systematic Literature Review of Current Research and Recommendations for Future Studies

Indigenous populations are recognized as a group who are potentially vulnerable to environmental health hazards due to their intimate relationship with and reliance on local environments for aspects of culture, health, and well-being. In many circumstances barriers to effective communication and health risk management are linked to cultural, economic, and geographic factors. A systematic literature review was conducted to consolidate peer-reviewed research on the communication of environmental health risks with Indigenous populations. The comprehensive literature review procedures included searching databases and key journals that represented various fields in communication, environmental health, and Indigenous studies. The review yielded a total of 4,469 potential articles and a total of 13 of these manuscripts met the inclusion criteria. The 13 articles were analyzed to identify lessons learned for effective risk communication. Factors that influence successful risk communication strategies with Indigenous populations on this topic include: (1) developing messages that are congruent with the populations' cultural beliefs and understanding of the environment; (2) including Indigenous populations in message design and delivery; (3) using credible and trustworthy spokespeople in message delivery; (4) identifying and utilizing effective communication materials and channels; and (5) ensuring that messages are understandable to the target audience. Gaps in the literature include the lack of longitudinal studies that empirically measure changes in perception, awareness and behavior, as well as a general lack of theory-based research. Results from this review provide directions for future work to help guide the development of more effective health risk communication research and strategies with Indigenous populations.

Preventive Care: How Mammography Utilization Changes as Women Age

OBJECTIVE

To evaluate the impact of comorbid conditions and age on mammography use.

METHODS

We used data from the 2011 to 2015 Medical Expenditure Panel Survey, which contained records for 40,752 women over the age of 40. Use was defined as a mammogram within the previous 1 or 2 years, analyzed separately. A logit model was employed to evaluate associations between use and comorbidities and age. Statistical significance was defined by a P < .05 by two-sided test.

RESULTS

Of the 36,575 women in our study sample, 45.9%, 43.6%, 3.9%, and 5.7% reported a history of hypertension (HTN), hyperlipidemia (HLD), prior heart attack (MI), and prior stroke, respectively. Among women without a comorbid condition, there was 47.3% annual mammography use. HTN and HLD were associated with increased use (2.5 and 6.8 percentage points [pp], P< .01). In comparison, prior MI was associated with decreased annual use (-8.2 pp, P < .01). Prior stroke was not significantly associated with annual mammography (-1.5 pp, P = .42). Results were similar for biennial use. The age trend in use showed that the age with maximum screening use was approximately 60 years.

DISCUSSION

Mammography use was higher in patients with HTN and HLD and lower in patients with prior MI and stroke, which may reflect differences in comorbidity-related general health care use. Use increased until it peaked around age 60. An understanding of how mammography use naturally evolves as people age may help better target specific populations and improve overall use of preventive care.

Celebrity Cancer on Twitter: Mapping a Novel Opportunity for Cancer Prevention

Social media platforms have the potential to facilitate the dissemination of cancer prevention and control messages following celebrity cancer diagnoses. However, cancer communicators have yet to systematically leverage these naturally occurring interventions on social media as these events are difficult to identify as they are unfolding and little research has analyzed their effect on social media conversations. In this study, we add to the research by analyzing how a celebrity cancer announcement influenced Twitter conversations in terms of the volume of social media messages and the type of content. Over a 9-day period, during which actor Ben Stiller announced that he had been treated for prostate cancer, we collected 1.2 million Twitter messages about cancer. We conducted automated content analyses to identify how often common cancer sites (prostate, breast, colon, or lung) were discussed. Then, we used manual content analysis on a sample of messages to identify cancer continuum content (awareness, prevention, early detection, diagnosis, treatment, survivorship, and end of life). Chi-square analyses were implemented to evaluate changes in cancer site and cancer continuum content before and after the announcement. We found that messages related to prostate cancer increased significantly more than expected for 2 days following Stiller’s announcement. However, the number of cancer messages that described other cancer locations either did not increase or did not increase by the same magnitude. In terms of message content, results showed larger than expected increases in diagnosis messages. These results suggest opportunities to shape social media conversations following celebrity cancer announcements and increase prevention and early detection messages.

An Experimental Test of the Roles of Audience Involvement and Message Frame in Shaping Public Reactions to Celebrity Illness Disclosures

Much research has investigated what happens when celebrities disclose an illness (via media) to the public. While audience involvement (i.e., identification and parasocial relationships) is often the proposed mechanism linking illness disclosures with audience behavior change, survey designs have prevented researchers from understanding if audience involvement prior to the illness disclosure actually predicts post-disclosure emotions, cognitions, and behaviors. Rooted in previous work on audience involvement as well as the Extended Parallel Process Model, the present study uses a national online experiment (N = 1,068) to test how pre-disclosure audience involvement may initiate post-disclosure effects for the message context of skin cancer. The data demonstrate that pre-disclosure audience involvement as well as the celebrity's framing of the disclosure can shape emotional responses (i.e., fear and hope), and that cognitive perceptions of the illness itself also influence behavioral intentions.

The Effect of Media Coverage of Celebrities with Panic Disorder on the Health Behaviors of the Public

Although having a mental illness has become common, many people tend to hide their illness and avoid seeking treatment. One of the reasons for not seeking treatment is the stigma of mental illness. Celebrity confessions about their experiences of mental illness can reduce such stigma, because the public obtains more knowledge about the illness and becomes more familiar with it. However, little research has been conducted on the influence of a celebrity's confession about mental illness on the public's health behaviors related to the illness. The present study examined the effects of the media coverage of celebrities with panic disorder on information-seeking, providing information about the illness, and the number of people who visited a psychiatrist in South Korea. For this, we collected all the news articles on celebrities' confessions regarding their panic disorder, search frequency of panic disorder, the number of questions on a Questions & Answers (Q&A) Website, a number of blog posts about panic disorder, and the number of people that visited a psychiatrist for panic disorder between 2010 and 2015. We found that there were positive correlations between the media's coverage of celebrities with panic disorder with other variables. In addition, the search frequency and the number of questions on the Q&A Website were also positively associated with the number of people who visited a psychiatrist. Regression analysis showed that the search frequency was the most significant predictor of the increase in the number of people who visited a psychiatrist for panic disorder.

Influence of political and medical leaders on parental perception of vaccination: a cross-sectional survey in Australia

OBJECTIVES

The aim of this survey was to investigate parental vaccination attitudes and responses to vaccine-related media messages from political and medical leaders.

DESIGN

This was a cross-sectional study using a semiquantitative questionnaire. Data were analysed using descriptive statistics, X² tests and logistic regression.

SETTING

Data were collected from a web-based questionnaire distributed in Australia by a market research company in May of 2017.

PARTICIPANTS

411 participants with at least one child under 5 were included in this study. The sample was designed to be representative of Australia in terms of gender and state of residence.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measures were parental attitudes towards childhood immunisation before and after viewing vaccine-related messages from political and medical leaders, including Donald Trump (USA), Pauline Hanson (Australia) and Michael Gannon (Australia). Parents were classified as having 'susceptible' (not fixed) or 'fixed' (positive or negative) views towards vaccination based on a series of questions.

RESULTS

Parents with fixed vaccination views constituted 23.8% (n=98) of the total sample; 21.7% (n=89) were pro-vaccination and 2.2% (n=9) were anti-vaccination. The remaining 76.2% of participants were classified as having susceptible views towards vaccination. Susceptible parents were more likely to report a change in their willingness to vaccinate after watching vaccine-related messages compared with fixed-view parents, regardless of whether the messaging was positive or negative (Trump OR 2.54, 95% CI (1.29 to 5.00); Hanson OR 2.64, 95% CI (1.26 to 5.52); Gannon OR 2.64, 95% CI (1.26 to 5.52)). Susceptible parents were more likely than fixed-view parents to report increased vaccine hesitancy after viewing negative vaccine messages (Trump OR 2.14, 95% CI (1.11 to 4.14), Hanson OR 2.34, 95% CI (1.21 to 4.50)).

CONCLUSIONS

The findings suggest that most parents including the vaccinating majorty are susceptible to vaccine messaging from political and medical leaders. Categorising parents as 'fixed-view' or 'susceptible' can be a useful strategy for designing and implementing future vaccine promotion interventions.

Media coverage of celebrity suicide caused by depression and increase in the number of people who seek depression treatment

We examined how media coverage of a celebrity who died by suicide due to depression was associated with the change in the number of people who visited a psychiatrist for depression. For this, of all news articles published in South Korea between 2010 and 2017, we identified all cases in which a celebrity died by suicide due to depression. Further, from the Korean health big data system, we collected monthly data on the number of people who visited a psychiatrist for depression. Regression analyses showed that, when there was media coverage of celebrity suicide due to depression in a particular month, more people visited a psychiatrist for depression-not in the same month but in the following month. We also found that, when there was media coverage of celebrity suicide due to depression, more news articles provided information about depression treatment or prevention. But, the increase in the number of such news articles did not play mediating roles between the media coverage of celebrity suicide, of which depression was known to be the main cause, and the increase in the number of visits to a psychiatrist.

Mental Health-Related Outcomes of Robin Williams' Death: The Role of Parasocial Relations and Media Exposure in Stigma, Help-Seeking, and Outreach

This study explores responses to the death of actor/comedian Robin Williams, focusing on the role of celebrity attachment and exposure to media coverage following his suicide. A total of 350 respondents recruited on Mechanical Turk completed an online survey. Participants who had a stronger parasocial relationship with Williams reported lower social distance from people with depression, greater willingness to seek treatment for depression, and more frequent outreach to other people with depression or suicidal thoughts following his death. Exposure to media coverage of suicide/depression - both informational and stigmatizing - was associated with more frequent outreach to others, but only informational coverage was related to greater willingness to seek treatment. Stigmatizing media exposure was related to greater depression stereotypes. Seeing more media stories celebrating Williams' life and career was associated with reduced depression stigma but also with less willingness to seek treatment for depression and less outreach to others. Implications of the findings for media and mental health are discussed.

Evolution of accesses to information on breast cancer and screening on the Brazilian National Cancer Institute website: an exploratory study

Delays in diagnosis due to low Breast Cancer awareness are widespread in Brazil maybe owing to ineffective strategies to raise attention on early diagnosis. As a proxy of collective interest in BC screanning (BCS) we studied the monthly accesses to BC and BCS webpages in INCA's website along 48 months. A log analyzer built a time serie (2006-2009) of BC and BCS monthly means, which oscilations were studied by analysis of variance (ANOVA). We found significant increasing accesses to BC and transient "attention peaks". Enlargement in BC/BCS differences along all period were caused by increasing accesses to BC and decreasing/minor/stable oscillations to SBC pages. These results are consistent with previous reports on increasing interest to BC contrasting with indifference on BCS. In the context of an exploratory study, we discussed some aspects: weakness of a "prevention culture"; lack of confidence in health system and screening programs; "celebrity effect" in the context of media framing; collective perception of risks heightened by perception of social vulnerability. Findings suggest that culture-tailored communication strategies would be necessary to inform Brazilian people about BCS. Future research is needed to study social perceptions and constructions on BC topics.

Young Black Men's Information Seeking following Celebrity Depression Disclosure: Implications for Mental Health Communication

Celebrity health disclosures motivate people to seek information about various health topics. However, limited systematic evaluations exist on effects of celebrity disclosures of mental illness, despite observations that this is a growing phenomenon and have important implications for public health education. Further, research has rarely examined the impact of such disclosures on minority populations. This study sought to understand factors associated with young Black men's information seeking following exposure to a depression disclosure by Scott Mescudi. Mescudi is a well-known Black male hip-hop artist who shared his depression diagnosis and subsequent treatment plans with his fans in October 2016. For this study, I surveyed 182 Black males aged 18-34, 1 month after the disclosure. Fifty percent sought general information about depression, and 16% sought information to ascertain whether they themselves were at risk for depression. Feeling emotional distress following the disclosure and having current depression symptoms were significantly associated with information seeking behaviors. Identification was indirectly related to information seeking through emotional distress. Thus, emotional distress appears to play an important role in information seeking behaviors following celebrity health disclosures. The findings suggest celebrity health disclosures are associated with proactive health behaviors among this sample. Implications of the results for theorization of celebrity health effects and research on mental health communication with young Black men are discussed.

A Cross-Sectional Review of Cervical Cancer Messages on Twitter During Cervical Cancer Awareness Month

OBJECTIVES

The objectives of this study were to quantify personal stories about cervical cancer and to determine the proportion and sentiment (positive vs negative) of messages ("tweets") that discussed cervical cancer prevention strategies on Twitter.

METHODS

This study was a cross-sectional Twitter review of English-language top tweets about cervical cancer during the Cervical Cancer Awareness month, January 2016. Theme categories were identified, and tweets were independently coded by 2 reviewers; discrepancies in coding were resolved by a third reviewer. Descriptive statistical analyses were performed.

RESULTS

During January 2016, approximately 348 top tweets about cervical cancer were identified. Professional health organizations produced 20.7% of tweets, and individuals identifying themselves as health-care professionals contributed an additional 4%. In addition to the tweet, 45.1% attached a photo or video; 54.6% included links to a larger article. Only 11.2% of tweets included personal stories from cervical cancer patients. Among the top tweets, 70.3% were focused on prevention through screening and/or HPV vaccination, with 97.4% recommending such practices. A substantial proportion of the Twitter traffic (24.7%) referenced the #SmearForSmear campaign by the patient-advocate organization Jo's Cervical Cancer Trust, based in the United Kingdom.

CONCLUSIONS

Analysis of top tweets during the cervical cancer awareness month showed that, although personal stories about cervical cancer were rare, cervical cancer prevention was a popular topic during the cervical cancer awareness month. This was largely driven by a picture-based twitter campaign from a single advocacy organization.

Can a selfie promote public engagement with skin cancer?

Social media may provide new opportunities to promote skin cancer prevention, but research to understand this potential is needed. In April of 2015, Kentucky native Tawny Willoughby (TW) shared a graphic skin cancer selfie on Facebook that subsequently went viral. We examined the volume of comments and shares of her original Facebook post; news volume of skin cancer from Google News; and search volume for skin cancer Google queries. We compared these latter metrics after TWs announcement against expected volumes based on forecasts of historical trends. TWs skin cancer story was picked up by the media on May 11, 2015 after the social media post had been shared approximately 50,000 times. All search queries for skin cancer increased 162% (95% CI 102 to 320) and 155% (95% CI 107 to 353) on May 13th and 14th, when news about TW's skin cancer selfie was at its peak, and remained higher through May 17th. Google searches about skin cancer prevention and tanning were also significantly higher than expected volumes. In practical terms, searches reached near-record levels - i.e., May 13th, 14th and 15th were respectively the 6th, 8th, and 40th most searched days for skin cancer since January 1, 2004 when Google began tracking searches. We conclude that an ordinary person's social media post caught the public's imagination and led to significant increases in public engagement with skin cancer prevention. Digital surveillance methods can rapidly detect these events in near real time, allowing public health practitioners to engage and potentially elevate positive effects.

Public Perceptions of Celebrity Cancer Deaths: How Identification and Emotions Shape Cancer Stigma and Behavioral Intentions

Celebrity cancer deaths can focus public attention on the disease like few events can. However, not all celebrities or their families are open about the exact cause of death. Anecdotal reports suggest that some do not reveal the exact cause of death due to fears of stigma associated with the specific type of cancer. However, empirical evidence regarding whether or how the cause of death actually impacts public perceptions and behaviors is lacking. A three (cause of death: nonspecified cancer, liver cancer, or lung cancer) by two (celebrity obituary: David Bowie or Alan Rickman) fully factorial between-subjects online experiment (N = 390) tested a proposed model of effects on identification, discrete emotional reactions, stigma-related perceptions, and behavioral intentions. Results suggest that specific causes of death do not have a direct impact on stigma but they can alter identification and emotional reactions, such as compassion and anxiety, which subsequently shape stigma-related perceptions and behavioral intentions.

Colorectal cancer, screening and primary care: A mini literature review

Colorectal cancer (CRC) is a common health problem, representing the third most commonly diagnosed cancer worldwide and causing a significant burden in terms of morbidity and mortality, with annual deaths estimated at 700000. The western way of life, that is being rapidly adopted in many regions of the world, is a well discussed risk factor for CRC and could be targeted in terms of primary prevention. Furthermore, the relatively slow development of this cancer permits drastic reduction of incidence and mortality through secondary prevention. These facts underlie primary care physicians (PCPs) being assigned a key role in health strategies that enhance prevention and prompt diagnosis. Herein, we review the main topics of CRC in the current literature, in order to better understand its pathogenesis, risk and protective factors, as well as screening techniques. Furthermore, we discuss preventive and screening policies to combat CRC and the crucial role served by PCPs in their successful implementation. Relevant articles were identified through electronic searches of MEDLINE and through manual searches of reference lists.

Perceived Efficacy and Intentions Regarding Seeking Mental Healthcare: Impact of Deepika Padukone, A Bollywood Celebrity's Public Announcement of Struggle with Depression

The current research examines the impact of Deepika Padukone's (one of the most popular Bollywood celebrities) public announcement of struggle with depression on people's perceived efficacy and intentions to seek help for mental healthcare. A survey conducted with 206 participants from India, the country with the highest depression rates in the world, revealed that parasocial interaction with the celebrity mediated the effect of exposure on intentions and efficacy perceptions regarding seeking mental healthcare. Our study expands the research on celebrity influence on health conditions in an international realm and in a mental health context. The findings have immense practical implications and may raise awareness about mental health in India given the popularity and reach of Bollywood among audiences in India and beyond, the level of stigmatization attached to mental health issues in India, and the lack of available resources for care. Theoretically, the study explores processes and effects of involvement with a celebrity and discusses potential implications for the behaviors related to health.

Identification and Emotions Experienced after a Celebrity Cancer Death Shape Information Sharing and Prosocial Behavior

Based on the previous work investigating public reactions to celebrity cancer deaths as well as on the appraisal theory of emotions, an online survey (N = 641) was conducted after the cancer death of popular sportscaster Stuart Scott. The aim was to better understand how the public shared news and reactions with others and if this social sharing impacted prosocial cancer-related behaviors (e.g., donating, volunteering, talking to others about cancer research). Two hierarchical logistic regression models were run. In the first, identification with Scott and emotional reactions to hearing about his death were significant predictors of sharing, even after controlling for demographics. In the second, feeling hopeful and having shared information with others predicted prosocial cancer-related behaviors. These results suggest promising strategies for designing more effective cancer awareness messages and fundraising campaigns after celebrity cancer announcements.

Using Google Trends Data to Study Public Interest in Breast Cancer Screening in Brazil: Why Not a Pink February?

Background

One of the major challenges of the Brazilian Ministry of Health is to foster interest in breast cancer screening (BCS), especially among women at high risk. Strategies have been developed to promote the early identification of breast cancer mainly by Pink October campaigns. The massive number of queries conducted through Google creates traffic data that can be analyzed to show unrevealed interest cycles and their seasonalities.

Objectives

Using Google Trends, we studied cycles of public interest in queries toward mammography and breast cancer along the last 5 years. We hypothesize that these data may be correlated with collective interest cycles leveraged by national BCS campaigns such as Pink October.

Methods

Google Trends was employed to normalize traffic data on a scale from 0 (<1% of the peak volume) to 100 (peak of traffic) presented as weekly relative search volume (RSV) concerning mammography and breast cancer as search terms. A time series covered the last 261 weeks (November 2011 to October 2016), and RSV of both terms were compared with their respective annual means. Polynomial trendlines (second order) were employed to estimate overall trends.

Results

We found an upward trend for both terms over the 5 years, with almost parallel trendlines. Remarkable peaks were found along Pink October months— mammography and breast cancer searches were leveraged up reaching, respectively, 119.1% (2016) and 196.8% (2015) above annual means. Short downward RSVs along December-January months were also noteworthy along all the studied period. These trends traced an N-shaped pattern with higher peaks in Pink October months and sharp falls along subsequent December and January.

Conclusions

Considering these findings, it would be reasonable to bring Pink October to the beginning of each year, thereby extending the beneficial effect of the campaigns. It would be more appropriate to start screening campaigns at the beginning of the year, when new resolutions are taken and new projects are added to everyday routines. Our work raises attention to the study of traffic data to encourage health campaign analysts to undertake better analysis based on marketing practices.

Young Adults' Information Seeking Following Celebrity Suicide: Considering Involvement With the Celebrity and Emotional Distress in Health Communication Strategies

Young adults (N = 357) were surveyed following the suicide of celebrity Robin Williams to better understand how involvement with the actor and emotional responses to his death influenced searches for information concerning depression, suicide, and mental health. Emotional distress following the actor's death mediated the relationship between involvement and certain types of information searches. Most respondents sought information about the celebrity's career, suicide, and depression using portable devices such as smartphones and laptop computers to access news websites for information. Those respondents who sought information about the suicide reported changes in their thoughts about suicide, most often dealing with the difficulty in spotting warning signs and the idea that "it can happen to anyone." Findings suggest placement of health messages within existing material about celebrity announcements on online websites and social media to drive more traffic toward general informational outlets. Messages that acknowledge emotional distress might be best placed within content specific to the celebrity's tragedy, rather than specific to the celebrity's career or performances.

Informing or Exploiting? Public Reponses to Giuliana Rancic's Health Narrative

Popular entertainment journalist Giuliana Rancic has shared her struggles with pregnancy loss, infertility, and breast cancer in an array of public forums. In this study, we analyzed online comments responding to public discourses surrounding Rancic's revelations, including her miscarriage and fertility treatments, her breast cancer diagnosis, and her decision to undergo a double mastectomy. Our goal was to explore how the public framed Rancic's health challenges. Using a narrative lens, we argue that online comments reveal the tensions that celebrities like Rancic must manage as they contend with public scrutiny of their stories. Online commenters in this study framed Rancic's narrative as a privileged vantage point in which she exploited her health struggles for personal and financial gain. Our analysis of these comments also demonstrates how Rancic's narrative exists in concert with other discourses that challenge and disrupt her own account of events. The examination of these mediated discourses has implications for understanding the role of celebrity experiences in personal and public conversations about health.

Barriers to cancer screening among Orthodox Jewish women

The increased risk of genetic cancer mutations for Ashkenazi Jews is well known. However, little is known about the cancer-related health behaviors of a subset of Ashkenazi Jews, Orthodox Jews, who are a very religious and insular group. This study partnered with Rabbinical leadership and community members in an Orthodox Jewish community to investigate barriers to cancer screening in this community. Orthodox Jewish women were recruited to participate in focus groups designed to elicit their perspectives on barriers to cancer screening. A total of five focus groups were conducted, consisting of 3-5 members per group, stratified by age and family history of cancer. Focus groups were audio recorded and transcribed. Transcripts were coded using conventional content analysis. The resulting themes identified as barriers to cancer screening were: preservation of hidden miracles, fate, cost, competing priorities, lack of culturally relevant programming, lack of information, and fear. These results provide a unique perspective on barriers to cancer screening in a high risk but understudied population. Findings from this study may serve to inform culturally appropriate cancer education programs to overcome barriers to screening in this and other similar communities.

Celebrity Influence and Identification: A Test of the Angelina Effect

Angelina Jolie's announcement that she is a BRCA1 carrier and has had a prophylactic bilateral mastectomy was met with widespread support as well as speculation about its possible impact on the public. These speculations were the subject of a Time magazine cover story titled "The Angelina Effect" (Kluger et al., 2013 ). Although there is anecdotal evidence to support this hypothesized Angelina effect, empirical tests are lacking. To explore possible links between Angelina's announcement and public health, we surveyed 356 adults immediately after the announcement. Guided by a model of celebrity influence, the survey assessed participants' demographics and health history, identification and parasocial interaction with Jolie, and genetic testing intentions. Results supported the model's predictions and provided preliminary evidence of an Angelina effect.

Theorizing the Pathways From Seeking and Scanning to Mammography Screening

This study combines insights from existing theories in mass communication and health communication, and builds an integrated model accounting for the mechanisms by which an individual's acquisition of mammogram-related media information becomes associated with intentions to obtain a mammogram. Our model was largely supported by a survey with a nationally representative sample of American females between the ages of 40 and 70 years. As expected, seeking and scanning mammogram-related information from the media were both positively associated with reflective integration of media health information, which in turn was positively related to behavioral attitudes and perceived normative pressures. Attitudes and normative pressures were then positively linked to the intention to get a mammogram. Based on these findings, we offer some suggestions for future research in this area.

Celebrity Health Announcements and Online Health Information Seeking: An Analysis of Angelina Jolie's Preventative Health Decision

On May 14, 2013, Angelina Jolie disclosed she carries BRCA1, which means she has an 87% risk of developing breast cancer during her lifetime. Jolie decided to undergo a preventative bilateral mastectomy (PBM), reducing her risk to 5%. The purpose of this study was to analyze the type of information individuals are exposed to when using the Internet to search health information regarding Jolie's decision. Qualitative content analysis revealed four main themes--information about genetics, information about a PBM, information about health care, and information about Jolie's gender identity. Broadly, the identified websites mention Jolie's high risk for developing cancer due to the genetic mutation BRCA1, describe a PBM occasionally noting reasons why she had this surgery and providing alternatives to the surgery, discuss issues related to health care services, costs, and insurances about Jolie's health decision, and portray Jolie as a sexual icon, a partner to Brad Pitt, a mother of six children, and an inspirational humanitarian. The websites also depict Jolie's health decision in positive, negative, and/or both ways. Discussion centers on how this actress' health decision impacts the public.

Cancer information seeking in the digital age: effects of Angelina Jolie's prophylactic mastectomy announcement

OBJECTIVE

. This study used digital surveillance to examine the impact of Angelina Jolie's prophylactic mastectomy announcement on cancer information seeking.

METHODS

. We analyzed 4 categories of breast cancer-related Internet search queries from 2010 to 2013 in the United States.

RESULTS

. Compared with the preceding 6 weeks, general information queries were 112% (95% confidence interval [CI], 79-146) higher the day of the announcement and remained 35% (95% CI, 22-49) higher over the week after the editorial. Risk assessment queries were 165% (95% CI, 110-222) higher the day of the announcement and 52% (95% CI, 31-75) higher across the week. Genetics and treatment queries showed little volume before the announcement but increased 2154% (95% CI, 1550-7076) and 9900% (95% CI, 3196-1,064,000) the day of, respectively, and remained higher across the week (812% [95% CI, 402-3913] and 2625% [95% CI, 551-317,000]). All query categories returned to normal volumes by the beginning of the second week.

CONCLUSION

. Jolie's unique announcement spurred significant information seeking about breast cancer genetic testing and treatment procedures, although the surge in queries returned to preannouncement levels after 1 week. Future research should apply digital methods to advance our understanding of cancer information seeking in the digital age.

Celebrity disclosures and information seeking: the case of Angelina Jolie

Purpose

On May 14, 2013, actress Angelina Jolie disclosed that she had a BRCA1 mutation and underwent a prophylactic bilateral mastectomy. This study documents the impact of her disclosure on information-seeking behavior, specifically regarding online genetics and risk reduction resources available from the National Cancer Institute (NCI).

Methods

Using Adobe Analytics, daily page views for 11 resources were tracked from April 23, 2013 through June 25, 2013. Usage data were also obtained for four resources over a 2-year period (2012–2013). Source of referral by which viewers located a specific resource was also examined.

Results

There was a dramatic and immediate increase in traffic to NCI’s online resources. The Preventive Mastectomy fact sheet received 69,225 page views on May 14, representing a 795-fold increase compared with the previous Tuesday. A fivefold increase in page views was observed for the PDQ^®Genetics of Breast and Ovarian Cancer summary in the same timeframe. A substantial increase from 0% to 49% was seen in referrals from news outlets to four resources from May 7 to May 14.

Conclusion

Celebrity disclosures can dramatically influence online information-seeking behaviors. Efforts to capitalize on these disclosures to ensure easy access to accurate information are warranted.