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

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.

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.

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.

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.

#MeToo and Google Inquiries Into Sexual Violence: A Hashtag Campaign Can Sustain Information Seeking

The #MeToo Movement has brought new attention to sexual harassment and assault. While the movement originates with activist Tarana Burke, actor Alyssa Milano used the phrase on Twitter in October 2017 in response to multiple sexual harassment allegations against Hollywood producer Harvey Weinstein. Within 24 hours, 53,000 people tweeted comments and/or shared personal experiences of sexual violence. The study objective was to measure how information seeking via Google searches for sexual harassment and assault changed following Milano's tweet and whether this change was sustained in spite of celebrity scandals. Weekly Google search inquiries in the United States were downloaded for the terms metoo, sexual assault, sexual harassment, sexual abuse, and rape for January 1, 2017 to July 15, 2018. Seven related news events about perpetrator accusations were considered. Results showed that searches for metoo increased dramatically after the Weinstein accusation and stayed high during subsequent accusations. A small decrease in searches followed, but the number remained very high relative to baseline (the period before the Weinstein accusation). Searches for sexual assault and sexual harassment increased substantially immediately following the Weinstein accusation, stayed high during subsequent accusations, and saw a decline after the accusation of Matt Lauer (talk show host; last event considered). We estimated a 40% to 70% reduction in searches 6 months after the Lauer accusation, though the increase in searches relative to baseline remained statistically significant. For sexual abuse and rape, the number of searches returned close to baseline by 6 months. It appears that the #MeToo movement sparked greater information seeking that was sustained beyond the associated events. Given its recent ubiquitous use in the media and public life, hashtag activism such as #MeToo can be used to draw further attention to the next steps in addressing sexual assault and harassment, moving public web inquiries from information seeking to action.

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.

Ductal Carcinoma in Situ in Young Women: Increasing Rates of Mastectomy and Variability in Endocrine Therapy Use

BACKGROUND

Young women with ductal carcinoma in situ (DCIS) represent a unique cohort given considerations for future risk reduction and treatment effects on fertility and quality of life. We evaluated national patterns of care in the treatment of young women and the impact of those treatments on overall survival (OS).

METHODS

Women younger than 50 years of age diagnosed with pure DCIS from 2004 to 2016 in the National Cancer Database (NCDB) were identified. Clinical, demographic, and choice of local therapy are summarized and trended over time. OS was analyzed using Cox proportional hazard models.

RESULTS

A total of 52,150 women were identified, and the most common surgical treatment was breast-conservation surgery (BCS; 59%). Bilateral mastectomy (BM) increased in frequency from 2004 to 2016 (11-27%; p < 0.001). In women < 40 years of age, BM (39%) surpassed BCS (35%) in 2010 with a continued upward trend. On multivariable analysis, no OS benefit of BM (hazard ratio [HR] 0.99, p = 0.90) or unilateral mastectomy (UM; HR 0.98, p = 0.80) was observed when compared with BCS + radiation therapy (RT). Inferior OS was seen with BCS, Black race, estrogen receptor (ER)-negative, and tumor ≥ 2.5 cm (p ≤ 0.006). In ER+ patients, there was a significant difference in endocrine therapy (ET) use between BM (11%), UM (33%), and BCS (28%) compared with BCS + RT (64%, p < 0.001).

CONCLUSION

The use of BM for DCIS is increasing in younger patients and now exceeds breast-conservation approaches in women < 40 years of age with no evidence of improved OS. Among ER+ patients, the rates of ET are lower in the BM, UM, and BCS-alone groups compared with BCS + RT.

"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.

Genetic testing and surgical treatment after breast cancer diagnosis: Results from a national online cohort

BACKGROUND

Genetic testing for hereditary breast cancer has implications for breast cancer decision-making. We examined genetic testing rates, factors associated with testing, and the relationship between genetic testing and contralateral prophylactic mastectomy (CPM).

METHODS

Patients with breast cancer (2000-2015) from The Health of Women Study were identified and categorized as low, moderate, or high-likelihood of the genetic mutation using a previously published scale based on period-relevant national guidelines incorporating age and family history. Genetic testing and CPM rates were compared using univariate and multivariate logistic regression.

RESULTS

Among 4170 patients (median age 56-years), 38% were categorized as high-likelihood of having a genetic mutation. Among high-likelihood women, 67% underwent genetic testing, the odds of which were increased among women of higher-education and White-race (p < .001). Among 2028 patients reporting surgical treatment, 385 (19%) chose CPM. CPM rate was highest among mutation-positive women (41%), but 26% of women with negative tests still underwent CPM. Independent of test result, genetic testing increased the odds of CPM on multivariate analysis (adjusted-OR: 1.69; 95% CI: 1.29-2.22).

CONCLUSIONS

Genetic testing rates were higher among women at high-likelihood of mutation carriage, but one-third of these women were not tested. Racial disparities persisted, highlighting the need to improve testing in non-White populations. CPM rates were associated with mutation-carriage and genetic testing, but many women chose CPM despite negative testing, suggesting that well-educated women consider factors other than cancer mortality in selecting CPM.

Feel Worried, Overloaded, or Fatalistic? The Determinants of Cancer Uncertainty Management Preferences

Uncertainty in the context of cancer involves a complex and conflicting decision-making process. Individual preferences of seeking or avoiding information in the decisions of maintaining, reducing, or increasing uncertainty often depend on key cancer-related beliefs. The present study investigates whether cancer worry (CW), information overload (CIO), or fatalism (CF) can predict four constructs of uncertainty management preferences - avoid to maintain hope, avoid insufficient information, seek to increase uncertainty, and seek to reduce uncertainty. A hybrid model with structural and measurement components was specified and tested. The model analysis shows that cancer-related beliefs influenced individuals' needs and preferences for uncertainty management through seeking or avoiding information. CW was positively related to all but avoiding insufficient information. CIO was positively associated with all four preferences. CF was only associated with avoiding to maintain uncertainty. Theoretical and practical implications were discussed.

Effects of a sister's death in childbirth on reproductive behaviors: Difference-in-difference analyses using sisterhood mortality data from Indonesia

RATIONALE

Risk of maternal mortality increases rapidly during the intrapartum period making skilled care at delivery an effective intervention to reduce the risk of maternal death. Demand generation for skilled care typically focuses on institutional channels; however, much less attention has been paid to whether what women may learn through their social networks can potentially influence their choice of delivery care.

OBJECTIVE

The objective of this study was to analyze whether a sister's death in childbirth has the potential to improve delivery care choices for women who experience this event.

METHODS

This study uses retrospective reports of sister deaths - either in childbirth or from some other cause - reported in the sisterhood moratlity module from five waves of the Indonesia Demographic and Health Surveys (IDHS) spanning 1989 to 2012. A cross-sectional, difference-in-difference strategy compares delivery care behavior of women before and after losing a sister in childbirth to women before and after losing a sister of reproductive age from some other cause in an intent-to-treat framework.

RESULTS

Women are less likely to give birth at home after losing a sister in childbirth relative to women who lose a sister from some other cause. Losing a sister in childbirth may trigger behaviors that help usher women of lower socioeconomic status into formal delivery care.

CONCLUSION

This study extends the literature on health behavior change through social networks to improve delivery care. Public health campaigns should consider social networks when designing messages around maternal mortality in order to help women at risk of maternal mortality make decisions that reduce their risk of and ultimately avoid maternal death.

World Pneumonia Day 2011-2016: Twitter contents and retweets

BACKGROUND

Twitter is used for World Pneumonia Day (WPD; November 12) communication. We evaluate if themes of #pneumonia tweets were associated with retweet frequency.

METHODS

A total of 28 181 original #pneumonia tweets were retrieved (21 November 2016), from which six subcorpora, 1 mo before and 1 mo after WPD 2011-2016, were extracted (n=6721). Underlying topics were identified via latent Dirichlet allocation and were manually coded into themes. The association of themes with retweet count was assessed via multivariable hurdle regression.

RESULTS

Compared with personal experience tweets, tweets that both raised awareness and promoted intervention were 2.62 times as likely to be retweeted (adjusted odds ratio [aOR] 2.62 [95% 1.79 to 3.85]) and if retweeted had 37% more retweets (adjusted prevalence ratio [aPR] 1.37 [95% CI 1.06 to 1.78]). Tweets that raised concerns about vaccine price were twice as likely to be retweeted (aOR 2.29 [95% CI 1.36 to 3.84]) and if retweeted, had double the retweet count (aPR 2.05 [95% CI 1.27 to 3.29]) of tweets sharing personal experience.

CONCLUSIONS

The #pneumonia tweets that both raised awareness and promoted interventions and those discussing vaccine price were more likely to engage users than tweets about personal experience. These results help health professionals craft WPD messages that will engage the audience.

Celebrity Influence Affecting Public Interest in Plastic Surgery Procedures: Google Trends Analysis

BACKGROUND

Medical decisions made by celebrities have a profound influence on medical decisions made by the general population. Google Trends (GT) is a free, online resource with virtually no barriers to use that allows for tracking of global search volumes as a proxy for determining public interest. In this study, we utilize GT to characterize the significant and measurable effects that the May 2013 announcement of Angelina Jolie's BRCA-influenced prophylactic mastectomy, May 2015 announcement of Kylie Jenner's lip augmentation, April 2017 announcement of Caitlyn Jenner's gender affirming surgery and February 2014 media attention given to Kim Kardashian's rumored buttock augmentation had on corresponding surgical procedure volumes.

METHODS

GT databases of search volumes were collected for terms related to prophylactic mastectomy, lip augmentation, gender affirming surgery and buttock augmentation categories from January 2004 to March 2019 using the "related queries" feature. Mean search volumes prior to respective announcements were compared to that of the period starting 6 months after. Additionally, the percent change from the month preceding respective celebrity announcements was compared to the month of the announcement for each search term.

RESULTS

For mastectomy, all terms demonstrated peak interest during May 2013. Following Jolie's announcement, interest in "mastectomy" rose 1328%, "prophylactic mastectomy" rose 324%, "BRCA1" rose 316%, "BRCA2" rose 138% and "BRCA gene" rose 354%. Long-term interest was higher after May 2013 than beforehand for all terms except "prophylactic mastectomy" (each, p < 0.001). Following Kylie Jenner's announcement, interest in "lip augmentation" rose 43%, "lip enhancement" rose 37%, "lip fillers" rose 3233%, "lip implants" rose 8% and "lip injections" rose 13%. Long-term interest was higher after May 2015 than beforehand for all terms except "lip augmentation" and "lip enhancement" (each, p < 0.001). Following Caitlyn Jenner's announcement, "gender affirming surgery" rose 119%, "gender reassignment" rose 186%, "gender reassignment surgery" rose 203% and "transgender surgery" rose 35%. Long-term interest was higher after April 2017 than beforehand for all terms except "sex change" (each, p < 0.001). Following Kardashian's rumored injections, interest in "butt enhancement" rose 34% and "butt implants" rose 100%. Long-term interest was higher after February 2014 than beforehand for all terms (each, p < 0.001).

CONCLUSIONS

GT data trends correlate with shifts in real-world healthcare utilization and healthcare-related public interest caused by high-profile public events, making it a useful tool for real-time prediction of trends in public health in response to a variety of observable influences.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The FDA authorization of direct-to-consumer genetic testing for three BRCA1/2 pathogenic variants: a twitter analysis of the public's response

Objectives

In March 2018, the Food and Drug Administration (FDA) announced its authorization of a direct-to-consumer (DTC) genetic test for three pathogenic BRCA1/2 variants. We sought to determine to whether social media discussion increased following the authorization, who was driving social media conversations, and what topics were discussed.

Methods

Using Crimson Hexagon, we described tweets before, during, and after the FDA announcement authorizing 23andMe to return BRCA1/2 results (3/4/18–3/10/18). We conducted qualitative coding of a subset of 605 tweets to better understand Twitter communication.

Results

We identified 11 055 twitter posts across the week of FDA’s announcement. Twitter discourse about 23andMe and the FDA authorization peaked the day following the FDA’s press release. Most tweets (48.6%) were informational and 26.3% were either expressing opinions (about 23andMe and/or FDA authorization, 14.9%) or testimonials (personal experiences with genetic testing, 11.4%). The types of tweets varied over the week-long period (P <  .001).

Discussion

Twitter discussion about the FDA’s authorization of DTC for three pathogenic BRCA1/2 variants increased immediately following the announcement. As more genetic technologies are brought to the DTC market, social media sites, like Twitter, will play a role in disseminating this information, providing a platform for information exchange, consumer testimonials, opinion pieces, and research.

Genetic Testing and Results in a Population-Based Cohort of Breast Cancer Patients and Ovarian Cancer Patients

PURPOSE

Genetic testing for cancer risk has expanded rapidly. We examined clinical genetic testing and results among population-based patients with breast and ovarian cancer.

METHODS

The study included all women 20 years of age or older diagnosed with breast or ovarian cancer in California and Georgia between 2013 and 2014 and reported to the SEER registries covering the entire state populations. SEER data were linked to results from four laboratories that performed nearly all germline cancer genetic testing. Testing use and results were analyzed at the gene level.

RESULTS

There were 77,085 patients with breast cancer and 6,001 with ovarian cancer. Nearly one quarter of those with breast cancer (24.1%) and one third of those with ovarian cancer (30.9%) had genetic test results. Among patients with ovarian cancer, testing was lower in blacks (21.6%; 95% CI, 18.1% to 25.4%; v whites, 33.8%; 95% CI, 32.3% to 35.3%) and uninsured patients (20.8%; 95% CI, 15.5% to 26.9%; v insured patients, 35.3%; 95% CI, 33.8% to 36.9%). Prevalent pathogenic variants in patients with breast cancer were BRCA1 (3.2%), BRCA2 (3.1%), CHEK 2 (1.6%), PALB2 (1.0%), ATM (0.7%), and NBN (0.4%); in patients with ovarian cancer, prevalent pathogenic variants were BRCA1 (8.7%), BRCA2 (5.8%), CHEK2 (1.4%), BRIP1 (0.9%), MSH2 (0.8%), and ATM (0.6%). Racial/ethnic differences in pathogenic variants included BRCA1 (ovarian cancer: whites, 7.2%; 95% CI, 5.9% to 8.8%; v Hispanics, 16.1%; 95% CI, 11.8% to 21.2%) and CHEK2 (breast cancer: whites, 2.3%; 95% CI, 1.8% to 2.8%; v blacks, 0.1%; 95% CI, 0% to 0.8%). When tested for all genes that current guidelines designate as associated with their cancer type, 7.8% of patients with breast cancer and 14.5% of patients with ovarian cancer had pathogenic variants.

CONCLUSION

Clinically-tested patients with breast and ovarian cancer in two large, diverse states had 8% to 15% prevalence of actionable pathogenic variants. Substantial testing gaps and disparities among patients with ovarian cancer are targets for improvement.

Retweeting Risk Communication: The Role of Threat and Efficacy

Social media platforms like Twitter and Facebook provide risk communicators with the opportunity to quickly reach their constituents at the time of an emerging infectious disease. On these platforms, messages gain exposure through message passing (called "sharing" on Facebook and "retweeting" on Twitter). This raises the question of how to optimize risk messages for diffusion across networks and, as a result, increase message exposure. In this study we add to this growing body of research by identifying message-level strategies to increase message passing during high-ambiguity events. In addition, we draw on the extended parallel process model to examine how threat and efficacy information influence the passing of Zika risk messages. In August 2016, we collected 1,409 Twitter messages about Zika sent by U.S. public health agencies' accounts. Using content analysis methods, we identified intrinsic message features and then analyzed the influence of those features, the account sending the message, the network surrounding the account, and the saliency of Zika as a topic, using negative binomial regression. The results suggest that severity and efficacy information increase how frequently messages get passed on to others. Drawing on the results of this study, previous research on message passing, and diffusion theories, we identify a framework for risk communication on social media. This framework includes four key variables that influence message passing and identifies a core set of message strategies, including message timing, to increase exposure to risk messages on social media during high-ambiguity events.

Concordance with BRCA1/2 testing guidelines among women in The Health of Women (HOW) Study®

PURPOSE

To evaluate factors associated with compliance to the National Comprehensive Cancer Network (NCCN) guidelines for BRCA1/2 testing and identify groups who are at risk of under- and over-use of BRCA1/2 testing.

METHODS

Data included 20,758 women from Dr. Susan Love Research Foundation's The Health of Women (HOW) Study^®. Multinomial logistic regression was used to examine the association of socioeconomic and demographic characteristics with whether the woman was over-, under-, or appropriately tested for BRCA1/2 mutations, per 2015 NCCN guidelines.

RESULTS

3894 women (18.8%) reported BRCA1/2 testing. 5628 (27.1%) women who met NCCN criteria for testing were not tested. Among women with a history of breast cancer, those without health insurance were more likely to be under-tested (OR 2.04, 95% CI 1.15-3.60) than those with managed care insurance, and higher education was associated with a lower likelihood of under-testing (Graduate/professional degree OR 0.71, 95% CI 0.55-0.91).

CONCLUSION

Almost 30% of women were under-tested, indicating that many high-risk women who may benefit from genetic testing are currently being missed. Without appropriate testing, providers are unable to tailor screening recommendations to those carrying mutations who are at highest risk. Patient and healthcare provider education and outreach targeted to low-income and under-served populations may assist in reducing under-testing.

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.

College Women's Responses to a Celebrity Health Disclosure

Celebrities can have a powerful influence on people's health-related attitudes and behaviors, often by publicly disclosing their own personal health decisions. In May 2013, Angelina Jolie, an internationally recognized actress, director, and author, wrote an op-ed for the New York Times disclosing her decision to undergo a prophylactic double mastectomy to reduce her risk of breast cancer after learning that she carried the BRCA1 gene mutation. This cross-sectional study examined whether exposure to Angelina Jolie and her mastectomy disclosure and parasocial involvement (PSI) with Angelina Jolie were related to female college students' perceived risk of breast cancer and breast cancer screening intentions. Participants were 198 female undergraduate college students. Data were collected anonymously via an online questionnaire and analyzed using bivariate correlations and hierarchical linear regression analyses. Neither exposure to Angelina and her disclosure nor PSI with Angelina Jolie was related to participants' attitudes or behaviors related to breast cancer. However, having a family history of cancer was associated with more exposure to Angelina Jolie and her disclosure. Findings suggest that exposure to and PSI with a celebrity who has disclosed a health-related message may not be sufficient to motivate young women to change their health-related attitudes and behaviors. Future studies should explore how celebrities disclosing different types of health issues might influence the attitudes and behaviors of young women.

Trends in Use of Risk-Reducing Mastectomy in a Context of Celebrity Decisions and Media Coverage: An Observational Study in the United States and Australia

OBJECTIVE

To examine trends in risk-reducing mastectomy (RRM) and immediate breast reconstruction in New York State and New South Wales, especially before and after Angelina Jolie's announcement of her surgery in 2013.

DATA SOURCE

Hospital discharge data, 2004-2014.

STUDY DESIGN

Trends in procedures were assessed using Poisson regression and the Cochrane-Armitage test.

DATA EXTRACTION METHODS

Extracted using procedure codes.

PRINCIPAL FINDINGS

There was an increase in RRM procedures after May 2013 in both regions, with a peak during late 2013-early 2014. The average bimonthly RRM procedures were significantly higher after Jolie's announcement than before.

CONCLUSIONS

In both countries, we found a substantial increase of RRM after Jolie's announcement, highlighting the impact of celebrity health care coverage on preventive surgical choice and the need for decision aids to assist patients.

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.

Italian Wikipedia and epilepsy: An infodemiological study of online information-seeking behavior

Wikipedia is the most commonly accessed source of health information by both healthcare professionals and the lay public worldwide. We aimed to evaluate information-seeking behavior of Internet users searching the Italian Wikipedia for articles related to epilepsy and its treatment. Using Pageviews Analysis, we assessed the total and mean monthly views of articles from the Italian Wikipedia devoted to epilepsy, epileptic syndromes, seizure type, and antiepileptic drugs (AEDs) from January 1, 2015 to October 31, 2017. We compared the views of the article on epilepsy with those of articles focusing on Alzheimer's disease, migraine, multiple sclerosis, syncope, and stroke and adjusted all results for crude disease prevalence. With the only exception of the article on multiple sclerosis, the adjusted views for the Italian Wikipedia article on epilepsy were higher than those for the other neurological disorders. The most viewed articles on seizure type were devoted to tonic-clonic seizure, typical absence seizure, tonic convulsive seizures, and clonic convulsive seizures. The most frequently accessed articles on epilepsy syndromes were about temporal lobe epilepsy and Lennox-Gastaut syndrome. The most frequently viewed articles on AEDs were devoted to valproic acid, carbamazepine, and levetiracetam. Wikipedia searches seem to mirror patients' fears and worries about epilepsy more than its actual epidemiology. The ultimate reasons for searching online remain unknown. Epileptologists and epilepsy scientific societies should make greater efforts to work jointly with Wikipedia to convey more accurate and up-to-date information about epilepsy.

Evaluation of the "Angelina Jolie Effect" on Screening Mammography Utilization in an Academic Center

PURPOSE

The aim of this study was to understand the impact on screening mammography at our institution, comparing weekly utilization in the 2 years before and the 2 years after Ms Angelina Jolie disclosed in the New York Times on May 13, 2013, that she had had a prophylactic double mastectomy.

METHODS

All 48,110 consecutive screening mammograms conducted at our institution between May 16, 2011, and May 16, 2015, were selected from our electronic medical record system. We used interrupted time series statistical models and graphical methods on utilization data to understand utilization changes before and after Ms Jolie's news.

RESULTS

The graphed trend of weekly screening mammogram utilization failed to show changes around the time of interest. Analytical models and statistical tests also failed to show a step change increase or acceleration of utilization around May 2013. However, graphical and time series analyses showed a flattening of utilization in the middle of 2014.

CONCLUSIONS

In our well-powered analysis in a large regional breast imaging center, we found no support for the hypothesis that this celebrity news drove increased screening.

Twitter and Non-Elites: Interpreting Power Dynamics in the Life Story of the (#)BRCA Twitter Stream

In May 2013 and March 2015, actress Angelina Jolie wrote in the New York Times about her choice to undergo preventive surgery. In her two op-eds, she explained that - as a carrier of the BRCA1 gene mutation - preventive surgery was the best way to lower her heightened risk of developing breast and ovarian cancer. By applying a digital methods approach to BRCA-related tweets from 2013 and 2015, before, during, and after the exposure of Jolie's story, this study maps and interprets Twitter discursive dynamics at two time points of the BRCA Twitter stream. Findings show an evolution in curation and framing dynamics occurring between 2013 and 2015, with individual patient advocates replacing advocacy organizations as top curators of BRCA content and coming to prominence as providers of specialist illness narratives. These results suggest that between 2013 and 2015, Twitter went from functioning primarily as an organization-centered news reporting mechanism, to working as a crowdsourced specialist awareness system. This article advances a twofold contribution. First, it points at Twitter's fluid functionality for an issue public and suggests that by looking at the life story-rather than at a single time point-of an issue-based Twitter stream, we can track the evolution of power roles underlying discursive practices and better interpret the emergence of non-elite actors in the public arena. Second, the study provides evidence of the rise of activist cultures that rely on fluid, non-elite, collective, and individual social media engagement.

Gaps in Incorporating Germline Genetic Testing Into Treatment Decision-Making for Early-Stage Breast Cancer

Purpose Genetic testing for breast cancer risk is evolving rapidly, with growing use of multiple-gene panels that can yield uncertain results. However, little is known about the context of such testing or its impact on treatment. Methods A population-based sample of patients with breast cancer diagnosed in 2014 to 2015 and identified by two SEER registries (Georgia and Los Angeles) were surveyed about genetic testing experiences (N = 3,672; response rate, 68%). Responses were merged with SEER data. A patient subgroup at higher pretest risk of pathogenic mutation carriage was defined according to genetic testing guidelines. Patients' attending surgeons were surveyed about genetic testing and results management. We examined patterns and correlates of genetic counseling and testing and the impact of results on bilateral mastectomy (BLM) use. Results Six hundred sixty-six patients reported genetic testing. Although two thirds of patients were tested before surgical treatment, patients without private insurance more often experienced delays. Approximately half of patients (57% at higher pretest risk, 42% at average risk) discussed results with a genetic counselor. Patients with pathogenic mutations in BRCA1/2 or another gene had the highest rates of BLM (higher risk, 80%; average risk, 85%); however, BLM was also common among patients with genetic variants of uncertain significance (VUS; higher risk, 43%; average risk, 51%). Surgeons' confidence in discussing testing increased with volume of patients with breast cancer, but many surgeons (higher volume, 24%; lower volume, 50%) managed patients with BRCA1/2 VUS the same as patients with BRCA1/2 pathogenic mutations. Conclusion Many patients with breast cancer are tested without ever seeing a genetic counselor. Half of average-risk patients with VUS undergo BLM, suggesting a limited understanding of results that some surgeons share. These findings emphasize the need to address challenges in personalized communication about genetic testing.

Familial breast cancer: Genetic counseling over time, including patients´ expectations and initiators considering the Angelina Jolie effect

Purpose

The German Consortium for hereditary breast/ovarian cancer (GC-HBOC) aims for nationwide access to professional, individualized yet structured care for families at high risk. The identification of such families remains key for optimal care. Our study evaluates counselees’ characteristics, referral practices, expectations and motivations in respect to their first genetic consultation. The impact of the Angelina Jolie Effect (AJE) was prospectively assessed.

Methods

All counselees could participate through a questionnaire. Groups were built in respect to neoadjuvant chemotherapy (FT) and before/after AJE.

Results

The 917 (88.5%) counselees (FT: 8.2%) were on average female (97.3%), with a mean age of 44.6, had children (71.9%), higher education (88%), personal (46.4%) or at least one first-degree relative (74.6%) with BC/OC or known BRCA1/2 mutation (11.8%), were in a relationship (76.1%), and living in a village (40.7%). The AJE is associated with significantly fewer cancelations (p = 0.005), more attendance among men (4.2% vs. 0.8%, p = 0.002), and people with familial BRCA1/2 (14.8% vs. 7.5%, p = 0.003). The majority seek information regarding their cancer risk (83%) or relatives’ risk (74.8%), HBOC (69.1%), and surveillance programs for themselves (66.6%) or relatives (60.6%).

Conclusion

Enhanced media awareness of genetic cancer motivates patients, including other patient groups. A higher number of participants, including more men, are attending GC due to the AJE. In terms of the rising complexity of genetic testing, the analysis of patients’ expectations and initiators for GC suggests that there is an urgent need to develop to participate motivation analysis. The factors revealed as impediments to accessing GC-HBOC guide recommendations to optimize access to genetic counseling. Medical educational programs for primary gynecologists and families at risk might be options to reach more participants.

Tracking the dissemination of a culturally targeted brochure to promote awareness of hereditary breast and ovarian cancer among Black women

OBJECTIVE

Black women have a higher rate of BRCA1 and BRCA2 (BRCA) mutations, compared with other populations, that increases their risk for hereditary breast and ovarian cancer (HBOC). However, Black women are less likely to know about HBOC and genetic testing. Based on a request from a community advisory panel of breast cancer survivors, community leaders and healthcare providers in the Black community, our team developed a culturally targeted educational brochure to promote awareness of HBOC among Black women.

METHODS

To reach the target population we utilized a passive dissemination strategy. Using Diffusion of Innovations (DOI) as a framework, we traced dissemination of the brochure over a five year period using self-addressed postcards contained inside the brochure that included several open-ended questions about the utility of the brochure, and a field for written comments. Closed-ended responses were analyzed using descriptive statistics and thematic analysis was conducted on the open-ended responses.

RESULTS

DOI captured the proliferation of the brochure among Black women across the US.

PRACTICE IMPLICATIONS

The use of passive dissemination strategies among pre-existing social networks proved to be a useful and sustainable method for increasing knowledge of HBOC among Black women.

The effect of a celebrity health disclosure on demand for health care: trends in BRCA testing and subsequent health services use

In May 2013, an internationally renowned celebrity-Angelina Jolie-disclosed her receipt of BRCA1/BRCA2 (BRCA) testing and subsequent double mastectomy in a highly publicized editorial. Publicity surrounding celebrity health services use increases awareness of important health issues and demand for health services. We aimed to describe BRCA testing trends before and after Jolie's disclosure, breast cancer-related services use following testing, and test reimbursement trends. MarketScan Commercial Claims data were used to compare trends in BRCA testing before and after Jolie's health disclosure using an interrupted time series model among women aged 18-64. We used modified Poisson regression to estimate risks for health services use (surgical consult, mastectomy, mammography, magnetic resonance imaging, genetic counseling) following BRCA testing. BRCA testing rates increased from 12.5 to 19.0 tests/100,000 women between January 2013 and October 2014. Immediately following Jolie's disclosure, testing increased by approximately 37% (p < 0.001). Although BRCA testing increased, use of post-testing follow-up services declined after Jolie's disclosure. Mean insurance reimbursement and patient out-of-pocket spending on the test decreased by 3 and 36%, respectively. While genetic testing uptake increased following Jolie's disclosure, subsequent health services use associated with BRCA mutations declined, suggesting that celebrity disclosures may be associated with potential genetic testing overuse.

Public health awareness of autoimmune diseases after the death of a celebrity

Autoimmune disorders impose a high burden, in terms of morbidity and mortality worldwide. Vasculitis is an autoimmune disorder that causes inflammation and destruction of blood vessels. Harold Allen Ramis, a famous American actor, director, writer, and comedian, died on the February 24, 2014, of complications of an autoimmune inflammatory vasculitis. To investigate the relation between interests and awareness of an autoimmune disease after a relevant event such as the death of a celebrity, we systematically mined Google Trends, Wikitrends, Google News, YouTube, and Twitter, in any language, from their inception until October 31, 2016. Twenty-eight thousand eight hundred fifty-two tweets; 4,133,615 accesses to Wikipedia; 6780 news; and 11,400 YouTube videos were retrieved, processed, and analyzed. The Harold Ramis death of vasculitis resulted into an increase in vasculitis-related Google searches, Wikipedia page accesses, and tweet production, documenting a peak in February 2014. No trend could be detected concerning uploading YouTube videos. The usage of Big Data is promising in the fields of immunology and rheumatology. Clinical practitioners should be aware of this emerging phenomenon.

Big Data Sensors of Organic Advocacy: The Case of Leonardo DiCaprio and Climate Change

The strategies that experts have used to share information about social causes have historically been top-down, meaning the most influential messages are believed to come from planned events and campaigns. However, more people are independently engaging with social causes today than ever before, in part because online platforms allow them to instantaneously seek, create, and share information. In some cases this “organic advocacy” may rival or even eclipse top-down strategies. Big data analytics make it possible to rapidly detect public engagement with social causes by analyzing the same platforms from which organic advocacy spreads. To demonstrate this claim we evaluated how Leonardo DiCaprio’s 2016 Oscar acceptance speech citing climate change motivated global English language news (Bloomberg Terminal news archives), social media (Twitter postings) and information seeking (Google searches) about climate change. Despite an insignificant increase in traditional news coverage (54%; 95%CI: -144 to 247), tweets including the terms “climate change” or “global warming” reached record highs, increasing 636% (95%CI: 573–699) with more than 250,000 tweets the day DiCaprio spoke. In practical terms the “DiCaprio effect” surpassed the daily average effect of the 2015 Conference of the Parties (COP) and the Earth Day effect by a factor of 3.2 and 5.3, respectively. At the same time, Google searches for “climate change” or “global warming” increased 261% (95%CI, 186–335) and 210% (95%CI 149–272) the day DiCaprio spoke and remained higher for 4 more days, representing 104,190 and 216,490 searches. This increase was 3.8 and 4.3 times larger than the increases observed during COP’s daily average or on Earth Day. Searches were closely linked to content from Dicaprio’s speech (e.g., “hottest year”), as unmentioned content did not have search increases (e.g., “electric car”). Because these data are freely available in real time our analytical strategy provides substantial lead time for experts to detect and participate in organic advocacy while an issue is salient. Our study demonstrates new opportunities to detect and aid agents of change and advances our understanding of communication in the 21st century media landscape.

Media Exposure and Genetic Literacy Skills to Evaluate Angelina Jolie's Decision for Prophylactic Mastectomy

PURPOSE

To examine public preparedness to evaluate and respond to Angelina Jolie's well-publicized decision to have a prophylactic mastectomy.

METHODS

A consumer panel (n = 1,008) completed an online survey in November 2013, reporting exposure to Jolie's story, confidence applying genomic knowledge to evaluate her decision, and ability to interpret provided genetic risk information (genetic literacy skills). Linear and logistic regressions tested mediating/moderating models of these factors in association with opinions regarding mastectomies.

RESULTS

Confidence with genomics was associated with increased genetic literacy skills and increased media exposure, with a significant interaction between the two. Confidence was also associated with favoring mastectomies for women with BRCA mutations, mediating the relationship with media exposure. Respondents were more likely to form opinions about mastectomies if they had high genetic literacy skills.

CONCLUSION

These findings suggest that having higher genetic literacy skills may increase the public's ability to form opinions about clinical applications of genomic discovery. However, repeated media exposure to high-profile stories may artificially inflate confidence among those with low genetic literacy.

Leveraging Big Data to Improve Health Awareness Campaigns: A Novel Evaluation of the Great American Smokeout

Background

Awareness campaigns are ubiquitous, but little is known about their potential effectiveness because traditional evaluations are often unfeasible. For 40 years, the “Great American Smokeout” (GASO) has encouraged media coverage and popular engagement with smoking cessation on the third Thursday of November as the nation’s longest running awareness campaign.

Objective

We proposed a novel evaluation framework for assessing awareness campaigns using the GASO as a case study by observing cessation-related news reports and Twitter postings, and cessation-related help seeking via Google, Wikipedia, and government-sponsored quitlines.

Methods

Time trends (2009-2014) were analyzed using a quasi-experimental design to isolate spikes during the GASO by comparing observed outcomes on the GASO day with the simulated counterfactual had the GASO not occurred.

Results

Cessation-related news typically increased by 61% (95% CI 35-87) and tweets by 13% (95% CI −21 to 48) during the GASO compared with what was expected had the GASO not occurred. Cessation-related Google searches increased by 25% (95% CI 10-40), Wikipedia page visits by 22% (95% CI −26 to 67), and quitline calls by 42% (95% CI 19-64). Cessation-related news media positively coincided with cessation tweets, Internet searches, and Wikipedia visits; for example, a 50% increase in news for any year predicted a 28% (95% CI −2 to 59) increase in tweets for the same year. Increases on the day of the GASO rivaled about two-thirds of a typical New Year’s Day—the day that is assumed to see the greatest increases in cessation-related activity. In practical terms, there were about 61,000 more instances of help seeking on Google, Wikipedia, or quitlines on GASO each year than would normally be expected.

Conclusions

These findings provide actionable intelligence to improve the GASO and model how to rapidly, cost-effectively, and efficiently evaluate hundreds of awareness campaigns, nearly all for the first time.

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.