1
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Liu J, Niederdeppe J, Tong C, Margolin D, Chunara R, Smith T, King AJ. Associations between news coverage, social media discussions, and search trends about celebrity deaths, screening, and other colorectal cancer-related events. Prev Med 2024; 185:108022. [PMID: 38823651 PMCID: PMC11269033 DOI: 10.1016/j.ypmed.2024.108022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/03/2024]
Abstract
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.
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Affiliation(s)
- Jiawei Liu
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY, United States of America.
| | - Jeff Niederdeppe
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY, United States of America; Department of Communication, Cornell University, Ithaca, NY, United States of America
| | - Chau Tong
- Missouri School of Journalism, University of Missouri, Columbia, MO, United States of America; MU Institute for Data Science and Informatics, University of Missouri, Columbia, MO, United States of America
| | - Drew Margolin
- Department of Communication, Cornell University, Ithaca, NY, United States of America
| | - Rumi Chunara
- Department of Biostatistics, New York University, New York City, NY, United States of America; Department of Computer Science & Engineering, New York University, New York City, NY, United States of America
| | - Tanner Smith
- Department of Communication, University of Missouri, Columbia, MO, United States of America
| | - Andy J King
- Cancer Control & Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, United States of America; Department of Communication, University of Utah, Salt Lake City, UT, United States of America
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2
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Bachl M, Link E, Mangold F, Stier S. Search Engine Use for Health-Related Purposes: Behavioral Data on Online Health Information-Seeking in Germany. HEALTH COMMUNICATION 2024; 39:1651-1664. [PMID: 38326714 DOI: 10.1080/10410236.2024.2309810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Internet searches for health-related purposes are common, with search engines like Google being the most popular starting point. However, results on the popularity of health information-seeking behaviors are based on self-report data, often criticized for suffering from incomplete recall, overreporting, and low reliability. Therefore, the current study builds on user-centric tracking of Internet use to reveal how individuals actually behave online. We conducted a secondary analysis of passively recorded Internet use logs to examine the prevalence of health-related search engine use, the types of health information searched for, and the sources visited after the searches. The analysis revealed two key findings. 1) We largely support earlier survey-based findings on the prevalence of online health information seeking with search engines and the relatively minor differences in information-seeking behaviors between socio-demographic groups. 2) We provide a more granular picture of the process of HISB using search engines by identifying different selection patterns depending on the scope of the searches.
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Affiliation(s)
- Marko Bachl
- Institute for Media and Communication Studies, Department of Political and Social Sciences, Freie Universität Berlin
| | - Elena Link
- Department of Communication, Johannes Gutenberg University Mainz
| | - Frank Mangold
- Department Computational Social Science, GESIS - Leibniz Institute for the Social Sciences
| | - Sebastian Stier
- Department Computational Social Science, GESIS - Leibniz Institute for the Social Sciences
- School of Social Sciences, University of Mannheim
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3
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Wecker H, Maier D, Ziehfreund S, Fox FAU, Erhard I, Vehreschild JJ, Zink A. Cancer incidence and digital information seeking in Germany: a retrospective observational study. Sci Rep 2024; 14:10184. [PMID: 38702333 PMCID: PMC11068859 DOI: 10.1038/s41598-024-60267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024] Open
Abstract
Awareness is vital for cancer prevention. US studies show a strong link between web searches and cancer incidence. In Europe, the relationship remains unclear. This study characterizes regional and temporal relationships between cancer incidence and web searches and investigates the content of searches related to breast, cervical, colorectal, lung, prostate, and testicular cancer, brain tumors, and melanoma in Germany (July 2018-December 2019). Aggregate data from Google Ads Keyword Planner and national cancer registry data were analyzed. Spearman's correlation coefficient (rS) examined associations between cancer incidence and web search, repeated measures correlation (rrm) assessed time trends and searches were qualitatively categorized. The frequency of malignancy-related web searches correlated with cancer incidence (rS = 0.88, P = 0.007), e.g., breast cancer had more queries than the lower-incidence cervical cancer. Seasonally, incidence and searches followed similar patterns, peaking in spring and fall, except for melanoma. Correlations between entity incidence and searches (0.037 ≤ rrm ≤ 0.208) varied regionally. Keywords mainly focused on diagnosis, symptoms, and general information, with variations between entities. In Germany, web searches correlated with regional and seasonal incidence, revealing differences between North/East and South/West. These insights may help improve prevention strategies by identifying regional needs and assessing impact of awareness campaigns.
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Affiliation(s)
- Hannah Wecker
- Department of Dermatology and Allergy, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Daniel Maier
- Medical Department 2 (Hematology/Oncology and Infectious Diseases), Center for Internal Medicine, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefanie Ziehfreund
- Department of Dermatology and Allergy, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Fabienne A U Fox
- Medical Department 2 (Hematology/Oncology and Infectious Diseases), Center for Internal Medicine, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Ian Erhard
- Medical Department 2 (Hematology/Oncology and Infectious Diseases), Center for Internal Medicine, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jörg Janne Vehreschild
- Medical Department 2 (Hematology/Oncology and Infectious Diseases), Center for Internal Medicine, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- Department I for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
- Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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Javadi V, Kamfar S, Zeinali V, Rahmani K, Moghaddamemami FH. Online information-seeking behavior of Iranian web users on Google about Henoch-Schönlein purpura (HSP): an infodemiology study. BMC Health Serv Res 2023; 23:1389. [PMID: 38082454 PMCID: PMC10714479 DOI: 10.1186/s12913-023-10357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUNDS Previous studies have indicated that users' health information-seeking behavior can serve as a reflection of current health issues within a community. This study aimed to investigate the online information-seeking behavior of Iranian web users on Google about Henoch-Schönlein purpura (HSP). METHODS Google Trends (GTr) was utilized to collect big data from the internet searches conducted by Iranian web users. A focus group discussion was employed to identify users' selected keywords when searching for HSP. Additionally, keywords related to the disease's symptoms were selected based on recent clinical studies. All keywords were queried in GTr from January 1, 2012 to October 30, 2022. The outputs were saved in an Excel format and analyzed using SPSS. RESULTS The highest and lowest search rates of HSP were recorded in winter and summer, respectively. There was a significant positive correlation between HSP search rates and the terms "joint pain" (P = 0.007), "vomiting" (P = 0.032), "hands and feet swelling" (P = 0.041) and "seizure" (P < 0.001). CONCLUSION The findings were in accordance with clinical facts about HSP, such as its seasonal pattern and accompanying symptoms. It appears that the information-seeking behavior of Iranian users regarding HSP can provide valuable insights into the outbreak of this disease in Iran.
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Grants
- 18441 Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- 18441 Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- 18441 Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- 18441 Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- 18441 Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Pediatric Pathology Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Affiliation(s)
- Vadood Javadi
- Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sharareh Kamfar
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahide Zeinali
- Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Khosro Rahmani
- Department of pediatric rheumatology, Shahid Beheshti University of Medical Sciences, Mofid children's Hospital, Tehran, Iran
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Kamiński M, Czarny J, Skrzypczak P, Sienicki K, Roszak M. The Characteristics, Uses, and Biases of Studies Related to Malignancies Using Google Trends: Systematic Review. J Med Internet Res 2023; 25:e47582. [PMID: 37540544 PMCID: PMC10439473 DOI: 10.2196/47582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The internet is a primary source of health information for patients, supplementing physician care. Google Trends (GT), a popular tool, allows the exploration of public interest in health-related phenomena. Despite the growing volume of GT studies, none have focused explicitly on oncology, creating a need for a systematic review to bridge this gap. OBJECTIVE We aimed to systematically characterize studies related to oncology using GT to describe its utilities and biases. METHODS We included all studies that used GT to analyze Google searches related to malignancies. We excluded studies written in languages other than English. The search was performed using the PubMed engine on August 1, 2022. We used the following search input: "Google trends" AND ("oncology" OR "cancer" or "malignancy" OR "tumor" OR "lymphoma" OR "multiple myeloma" OR "leukemia"). We analyzed sources of bias that included using search terms instead of topics, lack of confrontation of GT statistics with real-world data, and absence of sensitivity analysis. We performed descriptive statistics. RESULTS A total of 85 articles were included. The first study using GT for oncology research was published in 2013, and since then, the number of publications has increased annually. The studies were categorized as follows: 22% (19/85) were related to prophylaxis, 20% (17/85) pertained to awareness events, 11% (9/85) were celebrity-related, 13% (11/85) were related to COVID-19, and 47% (40/85) fell into other categories. The most frequently analyzed cancers were breast (n=28), prostate (n=26), lung (n=18), and colorectal cancers (n=18). We discovered that of the 85 studies, 17 (20%) acknowledged using GT topics instead of search terms, 79 (93%) disclosed all search input details necessary for replicating their results, and 34 (40%) compared GT statistics with real-world data. The most prevalent methods for analyzing the GT data were correlation analysis (55/85, 65%) and peak analysis (43/85, 51%). The authors of only 11% (9/85) of the studies performed a sensitivity analysis. CONCLUSIONS The number of studies related to oncology using GT data has increased annually. The studies included in this systematic review demonstrate a variety of concerning topics, search strategies, and statistical methodologies. The most frequently analyzed cancers were breast, prostate, lung, colorectal, skin, and cervical cancers, potentially reflecting their prevalence in the population or public interest. Although most researchers provided reproducible search inputs, only one-fifth used GT topics instead of search terms, and many studies lacked a sensitivity analysis. Scientists using GT for medical research should ensure the quality of studies by providing a transparent search strategy to reproduce results, preferring to use topics over search terms, and performing robust statistical calculations coupled with sensitivity analysis.
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Affiliation(s)
- Mikołaj Kamiński
- Department of Rheumatology, District Hospital in Kościan, Kościan, Poland
- Department of the Treatment of Obesity, Metabolic Disorders, and of Clinical Dietetics, Poznań University of Medical Sciences, Poznań, Poland
| | - Jakub Czarny
- Faculty of Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Piotr Skrzypczak
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Krzysztof Sienicki
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznań, Poland
| | - Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznań, Poland
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6
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Lee EWJ, Bekalu MA, McCloud RF, Viswanath K. Toward an Extended Infodemiology Framework: Leveraging Social Media Data and Web Search Queries as Digital Pulse on Cancer Communication. HEALTH COMMUNICATION 2023; 38:335-348. [PMID: 34266333 DOI: 10.1080/10410236.2021.1951957] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study aims to extend the infodemiology framework by postulating that effective use of digital data sources for cancer communication should consider four components: (a) content: key topics that people are concerned with, (b) congruence: how interest in cancer topics differ between public posts (i.e., tweets) and private web searches, (c) context: the influence of the information environment, and (d) information conduits. We compared tweets (n = 36, 968) and Google web searches on breast, lung, and prostate cancer between the National Cancer Prevention Month and a non-cancer awareness month in 2018. There are three key findings. First, reliance on public tweets alone may result in lost opportunities to identify potential cancer misinformation detected from private web searches. Second, lung cancer tweets were most sensitive to external information environment - tweets became substantially pessimistic after the end of cancer awareness month. Finally, the cancer communication landscape was largely democratized, with no prominent conduits dominating conversations on Twitter.
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Affiliation(s)
- Edmund W J Lee
- Wee Kim Wee School of Communication and Information, Nanyang Technological University
| | - Mesfin A Bekalu
- Center for Community-Based Research, Dana-Farber Cancer Institute
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health
| | - Rachel F McCloud
- Center for Community-Based Research, Dana-Farber Cancer Institute
| | - K Viswanath
- Center for Community-Based Research, Dana-Farber Cancer Institute
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health
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7
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Tas F, Erturk K. Online public interest in smoking and lung cancer: A comparative study in Google Trends. J Cancer Res Ther 2023; 19:S614-S617. [PMID: 38384027 DOI: 10.4103/jcrt.jcrt_276_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/15/2022] [Indexed: 02/23/2024]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death globally. There is a causal relationship between smoking and lung cancer; nearly 90% of cases are caused by cigarette smoking. AIM To investigate the public interest in the relationship between lung cancer and tobacco smoking through an analysis of searches in Google Trends over the past 16 years. MATERIAL AND METHODS We conducted a systematic search through Google Trends using the search terms "lung cancer" and "smoking" to identify the numbers of lung cancer and tobacco smoking searches in populations from Turkey, the United States, and the whole world between January 1, 2004 and December 31, 2019. RESULTS Online searches that reflect public awareness are nearly identical for both lung cancer and smoking; however, there is an inverse correlation between population interest and incidences of lung cancer and smoking. Furthermore, the numbers of searches on lung cancer and smoking decrease gradually in Turkey, in the world, and in the United States over the years, displaying a slight seasonal pattern. CONCLUSION Informative and educational campaigns covering the whole year are required to raise awareness of the relationship between lung cancer and smoking and keep people argus-eyed.
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Affiliation(s)
- Faruk Tas
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Kayhan Erturk
- Department of Medical Oncology, Koc University, Istanbul, Turkey
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8
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Luna-Abanto J, Gamarra L, Armestar DD, Condori BH, Tisoc GBM, Trujillo GF, Apumayta E, Tairo-Cerrón T, Centurión-Rodríguez C, Ruiz LG, Espinoza-Figueroa J, Garcia KTM, Yovera JN, Trujillo MU, Sarria G. Impact of cancer awareness campaigns in Peru: a 5-year Google Trends analysis. Ecancermedicalscience 2022; 16:1477. [PMID: 36819814 PMCID: PMC9934880 DOI: 10.3332/ecancer.2022.1477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this research was to characterise the interest on the most frequent cancers in Peru through Google Trends, its geographic and temporal relationship with massive awareness campaigns. Methods A temporal trends analysis for the last 5 years was carried out, comparing the Relative Search Volume (RSV) with the dates of mass cancer awareness campaigns in Peru. Google Trends application was used to evaluate the interest in the topics: breast, prostate, cervical stomach and colorectal cancer between 1 January 2016 and 31 December 2020, expressed in RSV. The annual RSV for each neoplasm was compared, as well as its annual variation using the Kruskal-Wallis test. The correlation between the RSV and the estimated incidence for each province was measured using the Spearman test. Results The topics with the highest RSV were breast (median: 20, range: 6-100) and prostate cancer (median: 28, range: 9-48). The topic 'breast cancer' showed a cyclical punctual increase in October, its awareness month. Searches for cervical, stomach and colorectal cancer were smaller and did not show peaks of interest. It was observed that the RSV was variable when compared with previous years (p < 0.05 for all the evaluated topics). Geographically, different provincial configurations of interest were observed according to neoplasia. When correlating the RSV with the incidence by province, a non-significant positive correlation (p > 0.05) was found for breast, cervical and colorectal cancer. Conclusions This study suggests a positive temporal correlation between RSV and awareness cancer campaigns in Peru specially to breast cancer and, to a lesser extent, prostate cancer. Significant variations of interest were demonstrated for each neoplasm among the evaluated years. No significant correlation was found between the incidence rate and the average RSV among Peruvian provinces.
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Affiliation(s)
- Jorge Luna-Abanto
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 15000, Perú,Universidad Peruana Cayetano Heredia, Lima 15102, Perú,https://orcid.org/0000-0001-8795-6635
| | - Luis Gamarra
- Departamento de Radioterapia, Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 15000, Perú,https://orcid.org/0000-0001-5018-2904
| | | | | | - Grivette Betsy Mendoza Tisoc
- Servicio de Anatomía Patológica, Hospital Antonio Lorena, Cusco 08001, Perú,https://orcid.org/0000-0001-7807-1931
| | - Gustavo Flores Trujillo
- Universidad Privada Antenor Orrego, Trujillo 13008, Perú,https://orcid.org/0000-0002-7428-411X
| | - Elily Apumayta
- Universidad Peruana Cayetano Heredia, Lima 15102, Perú,https://orcid.org/0000-0002-1828-7009
| | - Tessy Tairo-Cerrón
- Departamento de Medicina Nuclear, Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 15000, Perú,https://orcid.org/0000-0002-4565-9875
| | - Cesar Centurión-Rodríguez
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 15000, Perú,https://orcid.org/0000-0001-9169-1895
| | - Luis García Ruiz
- Universidad Peruana Cayetano Heredia, Lima 15102, Perú,Departamento de Medicina Crítica, Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 15000, Perú,https://orcid.org/0000-0003-1832-7952
| | - Jossué Espinoza-Figueroa
- Departamento de Radiodiagnóstico, Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 15000, Perú,https://orcid.org/0000-0002-0761-3366
| | | | - Jorge Navarro Yovera
- Universidad de San Martín de Porres, Lima 15011, Perú,https://orcid.org/0000-0002-3124-1224
| | - Milward Ubillús Trujillo
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 15000, Perú,Universidad de Huánuco, Huánuco 10001, Perú,https://orcid.org/0000-0002-3684-9394
| | - Gustavo Sarria
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 15000, Perú,Universidad de Huánuco, Huánuco 10001, Perú,https://orcid.org/0000-0002-7459-7730
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9
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Niu Q, Liu J, Zhao Z, Onishi M, Kawaguchi A, Bandara A, Harada K, Aoyama T, Nagai-Tanima M. Explanation of hand, foot, and mouth disease cases in Japan using Google Trends before and during the COVID-19: infodemiology study. BMC Infect Dis 2022; 22:806. [PMID: 36309663 PMCID: PMC9617033 DOI: 10.1186/s12879-022-07790-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
Background Coronavirus Disease 2019 (COVID-19) pandemic affects common diseases, but its impact on hand, foot, and mouth disease (HFMD) is unclear. Google Trends data is beneficial for approximate real-time statistics and because of ease in access, is expected to be used for infection explanation from an information-seeking behavior perspective. We aimed to explain HFMD cases before and during COVID-19 using Google Trends. Methods HFMD cases were obtained from the National Institute of Infectious Diseases, and Google search data from 2009 to 2021 in Japan were downloaded from Google Trends. Pearson correlation coefficients were calculated between HFMD cases and the search topic “HFMD” from 2009 to 2021. Japanese tweets containing “HFMD” were retrieved to select search terms for further analysis. Search terms with counts larger than 1000 and belonging to ranges of infection sources, susceptible sites, susceptible populations, symptoms, treatment, preventive measures, and identified diseases were retained. Cross-correlation analyses were conducted to detect lag changes between HFMD cases and search terms before and during the COVID-19 pandemic. Multiple linear regressions with backward elimination processing were used to identify the most significant terms for HFMD explanation. Results HFMD cases and Google search volume peaked around July in most years, excluding 2020 and 2021. The search topic “HFMD” presented strong correlations with HFMD cases, except in 2020 when the COVID-19 outbreak occurred. In addition, the differences in lags for 73 (72.3%) search terms were negative, which might indicate increasing public awareness of HFMD infections during the COVID-19 pandemic. The results of multiple linear regression demonstrated that significant search terms contained the same meanings but expanded informative search content during the COVID-19 pandemic. Conclusions The significant terms for the explanation of HFMD cases before and during COVID-19 were different. Awareness of HFMD infections in Japan may have improved during the COVID-19 pandemic. Continuous monitoring is important to promote public health and prevent resurgence. The public interest reflected in information-seeking behavior can be helpful for public health surveillance. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07790-9.
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10
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Kulkarni V, Okoye GA, Garza LA, Wongvibulsin S. Geospatial Heterogeneity of Hidradenitis Suppurativa Searches in the United States: Infodemiology Study of Google Search Data. JMIR DERMATOLOGY 2022; 5:e34594. [PMID: 37632873 PMCID: PMC10334890 DOI: 10.2196/34594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/23/2022] [Accepted: 05/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Ginette A Okoye
- Department of Dermatology, Howard University Hospital, Washington DC, DC, United States
| | - Luis A Garza
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shannon Wongvibulsin
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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11
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Using Google as a Source of Information About Breast Cancer. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03457-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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12
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Salbaş E, Ketenci S. Infodemiology of Bell's palsy: Tracing the seasonality of facial paralysis. J Back Musculoskelet Rehabil 2022; 35:615-623. [PMID: 34602459 DOI: 10.3233/bmr-210021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although there are a few studies on the seasonality of facial paralysis, no studies have utilized internet data for this purpose. The use of internet data to investigate diseases and user-contributed health-related content is increasingly prevalent, and has earned the name "infodemiology". OBJECTIVE This study aims to use Google Trends data to investigate whether there is a seasonal variation in facial paralysis. METHODS In this observational study, the search volume for the terms "facial paralysis" and "Bell's palsy" for a total of 19 countries was queried from Google Trends, selecting the time interval between January 2004 and October 2020. RESULTS In the Cosinor analysis of data from a total of 19 countries, from both northern and southern hemisphere, a statistically significant seasonality was found in the search volume of facial paralysis. It was observed that facial paralysis searches peaked in spring in the northern hemisphere and in winter in the southern hemisphere. CONCLUSION Internet search query data showed that facial paralysis has a seasonal variation, with peaks in spring for the northern hemisphere and winter for the southern hemisphere. Further studies are needed to understand the deviation between hemispheres and the cause of the peak in winter-spring season.
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Affiliation(s)
- Ender Salbaş
- Physical Medicine and Rehabilitation Department, Omer Halisdemir University Medical Faculty, Bor Physical Medicine and Rehabilitation Hospital, Nigde, Turkey
| | - Sertaç Ketenci
- Rheumatology Department, Manisa City Hospital, Manisa, Turkey
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13
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Okunoye B, Ning S, Jemielniak D. Searching for HIV and AIDS Health Information in South Africa, 2004-2019: Analysis of Google and Wikipedia Search Trends. JMIR Form Res 2022; 6:e29819. [PMID: 35275080 PMCID: PMC8956998 DOI: 10.2196/29819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/29/2021] [Accepted: 02/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background AIDS, caused by HIV, is a leading cause of mortality in Africa. HIV/AIDS is among the greatest public health challenges confronting health authorities, with South Africa having the greatest prevalence of the disease in the world. There is little research into how Africans meet their health information needs on HIV/AIDS online, and this research gap impacts programming and educational responses to the HIV/AIDS pandemic. Objective This paper reports on how, in general, interest in the search terms “HIV” and “AIDS” mirrors the increase in people living with HIV and the decline in AIDS cases in South Africa. Methods Data on search trends for HIV and AIDS for South Africa were found using the search terms “HIV” and “AIDS” (categories: health, web search) on Google Trends. This was compared with data on estimated adults and children living with HIV, and AIDS-related deaths in South Africa, from the Joint United Nations Programme on HIV/AIDS, and also with search interest in the topics “HIV” and “AIDS” on Wikipedia Afrikaans, the most developed local language Wikipedia service in South Africa. Nonparametric statistical tests were conducted to support the trends and associations identified in the data. Results Google Trends shows a statistically significant decline (P<.001) in search interest for AIDS relative to HIV in South Africa. This trend mirrors progress on the ground in South Africa and is significantly associated (P<.001) with a decline in AIDS-related deaths and people living longer with HIV. This trend was also replicated on Wikipedia Afrikaans, where there was a greater interest in HIV than AIDS. Conclusions This statistically significant (P<.001) association between interest in the search terms “HIV” and “AIDS” in South Africa (2004-2019) and the number of people living with HIV and AIDS in the country (2004-2019) might be an indicator that multilateral efforts at combating HIV/AIDS—particularly through awareness raising and behavioral interventions in South Africa—are bearing fruit, and this is not only evident on the ground, but is also reflected in the online information seeking on the HIV/AIDS pandemic. We acknowledge the limitation that in studying the association between Google search interests on HIV/AIDS and cases/deaths, causal relationships should not be drawn due to the limitations of the data.
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Affiliation(s)
- Babatunde Okunoye
- Berkman Klein Centre for Internet and Society, Harvard University, Cambridge, MA, United States.,Department of Journalism, Film and Television, University of Johannesburg, Johannesburg, South Africa
| | - Shaoyang Ning
- Department of Mathematics and Statistics, Williams College, Massachusetts, MA, United States
| | - Dariusz Jemielniak
- Management in Networked and Digital Societies Department, Kozminski University, Warsaw, Poland
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Khene ZE, Guérin S, Khene F, Pradère B, Roumiguié M, Mathieu R, Pignot G, Massard C, Neuzillet Y, Ploussard G, Bigot P, De la taille A, Rouprêt M, Bensalah K. Online Public Interest in Urological Cancers During the COVID-19 Pandemic: What Can “Dr. Google” Teach Us? EUR UROL SUPPL 2022; 37:73-79. [PMID: 35072118 PMCID: PMC8761543 DOI: 10.1016/j.euros.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 01/23/2023] Open
Abstract
Background Objective Design, setting, and participants Outcome measurements and statistical analysis Results and limitations Conclusions Patient summary
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15
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Cao M, Guan T, Han X, Shen B, Chao B, Liu Y. Impact of a health campaign on Chinese public awareness of stroke: evidence from internet search data. BMJ Open 2021; 11:e054463. [PMID: 34907069 PMCID: PMC8672014 DOI: 10.1136/bmjopen-2021-054463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Health campaigns have the potential to improve public awareness, but their impact can be difficult to assess. Internet search data provide information concerning online health information-seeking behaviour in the population and may serve as a proxy for public awareness to evaluate health campaigns. This study aimed to measure the impact of World Stroke Day (WSD) in China using Baidu search data. METHODS Daily search index values (SIV) for the term 'stroke' were collected from January 2011 to December 2019 using the Baidu Index platform. We examined the mean difference in SIV between the 4 weeks surrounding WSD (period of interest) and the rest of the year (control period) for each year by t-test analysis. The mean difference between the period of interest and the control period was also calculated. The joinpoint regression model was used to analyse the trends of internet search activity 30 days before and after WSD for each year (2011-2019). Finally, the top and rising queries related to stroke during the week of the campaign in 2020 were summarised. RESULTS A significant mean increase in SIV of 418.5 (95% CI: 298.8 to 538.2) for the period of interest surrounding WSD was observed, 36.2% greater than the SIV during the control period (2011-2019). Short-term joinpoint analysis showed a significant increase in SIV 3 days before WSD, a peak on WSD and a decrease to the precampaign level 3 days after WSD. The rising related queries suggested that the public had increasing concerns about stroke warning signs, stroke prevention and stroke recovery during the campaign. CONCLUSIONS The WSD campaign increased internet search activity. These research techniques can be applied to evaluation of other health campaigns. Advancing understanding of public demand will enable tailoring of the campaign and strengthen health management.
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Affiliation(s)
- Man Cao
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tianjia Guan
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xueyan Han
- Department of Medical Statistics, Peking University First Hospital, Beijing, China
| | - Bingjie Shen
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Baohua Chao
- National Health Commission of the People's Republic of China, Beijing, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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16
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Cohen SA, Ebrahimian S, Cohen LE, Tijerina JD. Online public interest in common malignancies and cancer screening during the COVID-19 pandemic in the United States. J Clin Transl Res 2021; 7:723-732. [PMID: 34901518 PMCID: PMC8654364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIM The COVID-19 pandemic was declared a national emergency in the United States in March 2020. The Centers for Medicare and Medicaid Services subsequently released recommendations that health-care facilities temporarily delay elective surgeries and non-essential medical procedures. Disruptions to medical care significantly impacted cancer patients, with cancer screenings halted and nonurgent cancer surgeries postponed as health-care facilities shifted resources toward the COVID-19 pandemic. Although it has been reported that cancer screening rates decreased dramatically in the United States in 2020, it is unclear whether this trend was driven by factors related to public interest in cancer and/or cancer screening as opposed to other factors such as clinical backlogs, pandemic-related policies, and/or resource limitations. The purpose of this study was to use the Google Trends tool to evaluate public interest in six common malignancies and four common cancer screening methods during the COVID-19 pandemic. METHODS We used the Google Trends tool to quantify public interest in six different malignancies (Breast Cancer, Colon Cancer, Lung Cancer, Prostate Cancer, Thyroid Cancer, and Cervical Cancer) and four cancer screening methods (Pap Smear, Lung Cancer Screening, Mammogram, and Colonoscopy) in the United States during the COVID-19 pandemic. Welch's t-tests were used to compare monthly search volumes during the COVID-19 pandemic (2020) to the 4 years before the pandemic (2016 - 2019) for all ten search terms included in our study. We used Benjamini-Hochberg to adjust raw p values to account for multiple statistical comparisons. The level of statistical significance was defined by choosing a false discovery rate of 0.05. RESULTS Our results indicate significantly reduced interest in all malignancies studied at the beginning of the COVID-19 pandemic. Public interest in ['Breast Cancer'], ['Colon Cancer'], ['Lung Cancer'], ['Thyroid Cancer'], and ['Cervical Cancer'] significantly decreased in the months of March, April, May, and June 2020 when compared with public interest in 2016-2019. Public interest in cancer screening methods such as ['Pap Smear'], ['Lung Cancer Screening'], ['Mammogram'], and ['Colonoscopy'] significantly deceased in the months of April and May compared to 2016 - 2019 values. However, decreased public interest in cancer screening methods was temporary, with Google search volumes returning to pre-pandemic levels in June 2020 - December 2020. CONCLUSION There was significantly reduced public interest in both common malignancies and cancer screening methods at the beginning of the COVID-19 pandemic in the United States. However, after an initial decline, public interest as indicated by Google search volumes quickly returned to pre-pandemic levels in the second half of the calendar year 2020. In addition, trends in public interest in cancer screening as indicated by Google search volumes aligned with cancer screening uptake rates in the United States during the study period. This finding suggests that Google Trends may serve as an effective tool in gauging the public's interest in cancer and/or cancer screenings in the United States, which makes it a valuable resource that can be used to inform decisions aimed at improving cancer screening rates in the future. RELEVANCE FOR PATIENTS The Google Trends tool can be used to measure public interest in various malignancies and their associated screening methods. Google Trends data may be used to inform measures aimed at improving cancer screening uptake.
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Affiliation(s)
- Samuel A. Cohen
- 1Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, United States of America,Corresponding author: Samuel A. Cohen Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, United States of America. Tel: 847-648-3323 E-mail:
| | - Shayan Ebrahimian
- 2UCLA David Geffen School of Medicine, 10833 Le Conte Avenue, Los Angeles, CA, 90095, United States of America
| | - Landon E. Cohen
- 3Keck School of Medicine of USC, 1975 Zonal Avenue, Los Angeles, CA, 90089, United States of America
| | - Jonathan D. Tijerina
- 4Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL 33136, United States of America
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Vasconcellos-Silva PR, Araújo-Jorge TCD. [Collective interest cycles and trends in Google searches related to institutional campaigns on prostate cancer: promoting health or illness?]. CIENCIA & SAUDE COLETIVA 2021; 26:3517-3525. [PMID: 34468647 DOI: 10.1590/1413-81232021269.2.26282019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/28/2019] [Indexed: 11/22/2022] Open
Abstract
Google algorithms record trends in interest on topics relevant to public health. WEB searches were analyzed (2014-2019) to identify patterns linked to prostate cancer. Relative Search Volumes (RSV) were analyzed by Google Trends on "prostate cancer" (PC), "prostate examination" (PE) and "PSA"; 260-week time series; Brazil region; Health category; Trend lines (degree 2 polynomials) to identify patterns; Averages compared by ANOVA; Sudden increase in November searches; Searches on PC greatly surpass PE and PSA; Stable annual PC averages; Discreet reduction in PE; Marked increase in PSA. In campaign months: Discreet increase in PC; stability in PE; Marked increase in PSA. "Blue November" campaigns encourage early identification of prostate cancer, although interest is seen to be focused on the disease per se with a lack of interest in diagnosis throughout the year. Differences in relation to "Pink October" are discussed - tenuous relation to educational level on prevention habits and the influence of celebrities. The conclusion drawn is that RSV analysis might be useful in tracking trends in prostate cancer screening to provide input for campaign developers.
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18
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Xu R, Brown P, Baxter N, Sawka AM. Online Public Interest in Cancer During the COVID-19 Pandemic. JCO Clin Cancer Inform 2021; 5:695-700. [PMID: 34138637 DOI: 10.1200/cci.21.00036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Health care priorities of individuals may change during a pandemic, which may, in turn, affect health services utilization. We examined Canadians' online relative search interest in five common solid tumors (breast, colon, lung, prostate, and thyroid) during the COVID-19 pandemic to that observed in the same months in the prior 5 years. METHODS We conducted a cross-sectional retrospective study using Google Trends aggregate anonymous online search data from Canada. We compared the respective relative search volumes for breast, colon, lung, prostate, and thyroid cancers for the months March-November 2020 with the mean for the same months in 2015-2019. Welch's two-sample t tests were performed and the raw P values were then adjusted using Benjamini-Hochberg procedure to correct for multiple comparisons. The level of statistical significance was defined by choosing false discovery rate at .05 for the primary analysis. RESULTS We observed temporary statistically significant reductions in Canadians' relative search volumes for various cancers, largely early in the pandemic, in the spring of 2020. Specifically, significant reductions (after adjustment for multiple comparisons) were observed for breast cancer in April, May, and October 2020; colon cancer in March and April of 2020; lung cancer in April and September 2020; and prostate cancer in April and May 2020. Thyroid cancer relative search volumes were not significantly different from those observed prior to the pandemic. CONCLUSION Although Canadians' online interest in various cancers temporarily waned early in the COVID-19 pandemic, recent relative search volumes for various cancers are largely not significantly different from prior to the pandemic.
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Affiliation(s)
- Ruoyong Xu
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - Patrick Brown
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - Nancy Baxter
- LiKa Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anna M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
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Naik H, Johnson MDD, Johnson MR. Internet Interest in Colon Cancer Following the Death of Chadwick Boseman: Infoveillance Study. J Med Internet Res 2021; 23:e27052. [PMID: 34128824 PMCID: PMC8277405 DOI: 10.2196/27052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 12/26/2022] Open
Abstract
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.
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Affiliation(s)
- Hiten Naik
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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20
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The pink elephant in the room: Declining public interest in breast cancer and the impact of marketing efforts. J Cancer Policy 2021; 28:100287. [DOI: 10.1016/j.jcpo.2021.100287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/26/2021] [Accepted: 05/07/2021] [Indexed: 11/19/2022]
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21
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Erectile dysfunction and prostate diseases are the predominant Google search terms amongst men's health topics. Int J Impot Res 2021; 34:552-557. [PMID: 34017114 DOI: 10.1038/s41443-021-00448-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/26/2021] [Accepted: 05/06/2021] [Indexed: 12/09/2022]
Abstract
Patients are becoming increasingly active consumers of health information on the internet with urologic concerns being no exception. Our objective was to explore online search trends for topics related to men's health and identify information-seeking patterns related to news and media coverage of these topics. We used Google Trends ( http://google.com/trends ) to explore search trends for various search terms related to men's health in the United States over a 5-year period. Search queries provided graphs depicting search volume as a function of time, geographical data, and related topics and queries. Isolated spikes in search volume were further explored to identify a related event. Erectile dysfunction was the most-searched topic over the last 5 years in the United States. Prostate cancer and benign prostatic hyperplasia were the second and third most-searched topics, respectively. Other popular topics involved symptoms or pathologies of the testicles and penis. Most topics had relatively stable search volumes, with the exceptions of premature ejaculation and Peyronie's disease. Several observed spikes in search volume were attributable to singular events, mostly in the form of online article publications or social media posts. We believe it may be helpful for providers to stay informed of cultural events relating to medical conditions to anticipate patient concerns.
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Yao J, Tan CS, Lim N, Tan J, Chen C, Müller-Riemenschneider F. Number of daily measurements needed to estimate habitual step count levels using wrist-worn trackers and smartphones in 212,048 adults. Sci Rep 2021; 11:9633. [PMID: 33953288 PMCID: PMC8100112 DOI: 10.1038/s41598-021-89141-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/16/2021] [Indexed: 11/22/2022] Open
Abstract
Daily step count is a readily accessible physical activity measure inversely related to many important health outcomes. However, its day-to-day variability is not clear, especially when measured by recent mobile devices. This study investigates number of measurement days required to reliably estimate the weekly and monthly levels of daily step count in adults using wrist-worn fitness trackers and smartphones. Data were from a 5-month physical activity program in Singapore. The 5-month period was divided into 22 weekly and 5 monthly time windows. For each time window, we leveraged data sampling procedures and estimated the minimum number of measurement days needed to achieve reliable mean daily step count with intraclass correlation coefficients (ICC) above 80%. The ICCs were derived using linear mixed effect models. We examined both simple random and random consecutive measurement days and conducted subgroup analysis by participant characteristics and tracking devices. Analysis of weekly and monthly step count included 212,048 and 112,865 adults, respectively. Fewer simple random measurement days are needed than random consecutive days for weekly time windows (mean 2.5, SD 0.5 vs mean 2.7, SD 0.5; p-value = 0.025). Similarly, monthly time windows require fewer measurements of simple random days than random consecutive days (mean 3.4, SD 0.5 vs mean 4.4, SD 0.5; p-value = 0.025). Younger participants and those tracking steps via smartphones consistently required more days. Being obese was associated with more measurement days for weekly time windows. In sum, to obtain reliable daily step count level, we recommend at least 3 measurement days for weekly and 5 days for monthly time window in adults. Fewer days could be considered for adults age 60+ years, while more days are required when tracking daily step via smartphones.
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Affiliation(s)
- Jiali Yao
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building (Block MD1), 12 Science Drive 2, #09-01v, Singapore, 117549, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building (Block MD1), 12 Science Drive 2, #09-01v, Singapore, 117549, Singapore
| | - Nicole Lim
- Policy, Research and Surveillance Division, Health Promotion Board, Singapore, Singapore
| | - Jeremy Tan
- Policy, Research and Surveillance Division, Health Promotion Board, Singapore, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building (Block MD1), 12 Science Drive 2, #09-01v, Singapore, 117549, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building (Block MD1), 12 Science Drive 2, #09-01v, Singapore, 117549, Singapore.
- Berlin Institute of Health, Charite University Medical Centre, Berlin, Germany.
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Yang J, Zhang Y, Xiao Y, Shen S, Su M, Bai Y, Zhou J, Gong P. Using Internet Search Queries to Assess Public Awareness of the Healthy Cities Approach: A Case Study in Shenzhen, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084264. [PMID: 33920543 PMCID: PMC8072553 DOI: 10.3390/ijerph18084264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022]
Abstract
Cities around the globe are embracing the Healthy Cities approach to address urban health challenges. Public awareness is vital for successfully deploying this approach but is rarely assessed. In this study, we used internet search queries to evaluate the public awareness of the Healthy Cities approach applied in Shenzhen, China. The overall situation at the city level and the intercity variations were both analyzed. Additionally, we explored the factors that might affect the internet search queries of the Healthy Cities approach. Our results showed that the public awareness of the approach in Shenzhen was low. There was a high intercity heterogeneity in terms of interest in the various components of the Healthy Cities approach. However, we did not find a significant effect of the selected demographic, environmental, and health factors on the search queries. Based on our findings, we recommend that the city raise public awareness of healthy cities and take actions tailored to health concerns in different city zones. Our study showed that internet search queries can be a valuable data source for assessing the public awareness of the Healthy Cities approach.
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Affiliation(s)
- Jun Yang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing 100084, China; (Y.Z.); (Y.X.); (Y.B.); (P.G.)
- Tsinghua Urban Institute, Beijing 100084, China
- Correspondence: ; Tel.: +86-10-62787211
| | - Yutong Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing 100084, China; (Y.Z.); (Y.X.); (Y.B.); (P.G.)
| | - Yixiong Xiao
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing 100084, China; (Y.Z.); (Y.X.); (Y.B.); (P.G.)
- Tsinghua Urban Institute, Beijing 100084, China
| | - Shaoqing Shen
- Shenzhen Research Center of Digital City Engineering, Shenzhen Municipal Bureau of Planning and Natural Resource Management, Shenzhen 518034, China;
| | - Mo Su
- School of Resource and Environment Science, Wuhan University, Wuhan 430079, China;
| | - Yuqi Bai
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing 100084, China; (Y.Z.); (Y.X.); (Y.B.); (P.G.)
- Tsinghua Urban Institute, Beijing 100084, China
| | - Jingbo Zhou
- Business Intelligence Lab, Baidu Research, Baidu Inc., Beijing 100193, China;
| | - Peng Gong
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing 100084, China; (Y.Z.); (Y.X.); (Y.B.); (P.G.)
- Tsinghua Urban Institute, Beijing 100084, China
- Department of Earth Sciences, the University of Hong Kong, Hong Kong
- Department of Geography, the University of Hong Kong, Hong Kong
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Decreased public pursuit of cancer-related information during the COVID-19 pandemic in the United States. Cancer Causes Control 2021; 32:577-585. [PMID: 33683506 PMCID: PMC7938033 DOI: 10.1007/s10552-021-01409-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/25/2021] [Indexed: 12/15/2022]
Abstract
Background In response to the prioritization of healthcare resources towards the COVID-19 pandemic, routine cancer screening and diagnostic have been disrupted, potentially explaining the apparent COVID-era decline in cancer cases and mortality. In this study, we identified temporal trends in public interest in cancer-related health information using the nowcasting tool Google Trends. Methods We used Google Trends to query search terms related to cancer types for short-term (September 2019–September 2020) and long-term (September 2016–September 2020) trends in the US. We compared average relative search volumes (RSV) for specified time ranges to detect recent and seasonal variation. Results General search interest declined for all cancer types beginning in March 2020, with changes in search interest for “Breast cancer,” “Colorectal cancer,” and “Melanoma” of − 30.6%, − 28.2%, and − 26.7%, respectively, and compared with the mean RSV of the two previous months. In the same time range, search interest for “Telemedicine” has increased by + 907.1% and has reached a 4-year peak with a sustained increased level of search interest. Absolute cancer mortality has declined and is presently at a 4-year low; however, search interest in cancer has been recuperating since July 2020. Conclusion We observed a marked decline in searches for cancer-related health information that mirrors the reduction in new cancer diagnoses and cancer mortality during the COVID-19 pandemic. Health professions need to be prepared for the coming demand for cancer-related healthcare, foreshadowed by recovering interest in cancer-related information on Google Trends. Supplementary Information The online version contains supplementary material available at 10.1007/s10552-021-01409-1.
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Meira TM, Prestes J, Gasparello GG, Antelo OM, Pithon MM, Tanaka OM. The effects of images posted to social media by orthodontists on public perception of professional credibility and willingness to become a client. Prog Orthod 2021; 22:7. [PMID: 33682012 PMCID: PMC7937582 DOI: 10.1186/s40510-021-00353-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/22/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Many patients choose health professionals using the Internet, whether through websites or social media. In orthodontics, an orthodontist's relationship with active and potential patients can be affected by social media interactions, both as a marketing tool and as a tool for providing educational information. The purpose of the present study was to analyze the public perception of professional credibility and willingness to become a client, based on images posted by orthodontists on Instagram. METHOD This was a cross-sectional study performed using a digital self-administered questionnaire based on images from public Instagram profiles of orthodontists found using certain hashtags. The themes of the posts were analyzed through a qualitative analysis, and the results were expressed as categories. After analyzing 2445 images, 12 thematic categories emerged. A total of 446 individuals (225 laypeople, 66 dental students, and 155 dentists) evaluated the images in regard to the perception of professional credibility and willingness to become a client. One-way ANOVA and chi-square tests were applied, considering a 5% significance level. RESULTS It was found that more than 95% of the participants used social media, primarily Instagram, WhatsApp, and Facebook, and the social network most used to research health services was Instagram. Statistically significant differences were found in the mean value of perceived professional credibility between the groups (p < 0.05) for the following categories: "dental traction," "mini-implant mechanics," "before and after treatment," "aesthetic brackets," "metallic brackets," and "clear aligners." The categories "being a teacher" and "before and after treatment" had a higher impact on the participants' perception of credibility and willingness to become a client, unlike the "social relationship" and "family relationship" categories. CONCLUSIONS Some of the themes found in the orthodontists' social media posts were found to influence the perceptions around professional credibility and willingness to become a client, although there were differences among the participants in the present study.
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Affiliation(s)
- Thiago Martins Meira
- School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
- Bahia State University (UNEB), Guanambi, Brazil
| | - Jeany Prestes
- School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | - Oscar Mario Antelo
- Department of Orthodontics, Universidad Católica Boliviana San Pablo, Santa Cruz de La Sierra, Bolivia
| | - Matheus Melo Pithon
- Department of Orthodontics, Southwest Bahia State University (UESB), Jequié, Brazil
| | - Orlando Motohiro Tanaka
- School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.
- Graduate Dentistry Program in Orthodontics, PUCPR, R. Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil.
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Using Search Engine Data to Explore Interest in PrEP and HIV Testing in the United States. AIDS Behav 2021; 25:983-991. [PMID: 33033997 DOI: 10.1007/s10461-020-03057-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
We used Google search data from January 1, 2014 to January 1, 2019 to explore public awareness of pre-exposure prophylaxis (PrEP) and HIV testing in the United States. Using two search strings, one for PrEP and one for HIV testing, we compared search volume to state HIV prevalence and new HIV diagnoses. We also used Google News to identify news events related to short-term spikes in search volume. Controlling for poverty, education, and internet access, a one-unit increase in a state's HIV prevalence rate was associated with a 3% increase in PrEP search volume (aPR = 1.03 [1.034, 1.037], P < 0.0001) and HIV testing search volume (aPR = 1.03 [1.030, 1.032], P < 0.0001). Short-term search volume spikes also coincided with celebrity news and pharmaceutical company advertising. We demonstrate that search engine data can be a powerful tool for understanding HIV knowledge-seeking and can provide key insight to the events that drive public interest about HIV online.
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Zhang H, Wang Y, Zheng Q, Tang K, Fang R, Wang Y, Sun Q. Research Interest and Public Interest in Melanoma: A Bibliometric and Google Trends Analysis. Front Oncol 2021; 11:629687. [PMID: 33680968 PMCID: PMC7930473 DOI: 10.3389/fonc.2021.629687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/04/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Melanoma is a severe skin cancer that metastasizes quickly. Bibliometric analysis can quantify hotspots of research interest. Google Trends can provide information to address public concerns. METHODS The top 15 most frequently cited articles on melanoma each year from 2015 to 2019, according to annual citations, were retrieved from the Web of Science database. Original articles, reviews, and research letters were included in this research. For the Google Trends analysis, the topic "Melanoma" was selected as the keyword. Online search data from 2004 to 2019 were collected. Four countries (New Zealand, Australia, the United States and the United Kingdom) were selected for seasonal analysis. Annual trends in relative search volume and seasonal variation were analyzed, and the top related topics and rising related topics were also selected and analyzed. RESULTS The top 15 most frequently cited articles each year were all original articles that focused on immunotherapy (n=8), omics (n=5), and the microbiome (n=2). The average relative search volume remained relatively stable across the years. The seasonal variation analysis revealed that the peak appeared in summer, and the valley appeared in winter. The diseases associated with or manifestations of melanoma, treatment options, risk factors, diagnostic tools, and prognosis were the topics in which the public was most interested. Most of the topics revealed by bibliometric and Google Trends analyses were consistent, with the exception of issues related to the molecular biology of melanoma. CONCLUSION This study revealed the trends in research interest and public interest in melanoma, which may pave the way for further research.
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Vernon E, Gottesman Z, Warren R. The value of health awareness days, weeks and months: A systematic review. Soc Sci Med 2020; 268:113553. [PMID: 33280924 DOI: 10.1016/j.socscimed.2020.113553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/03/2020] [Accepted: 11/21/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this systematic review was to analyze the value of awareness days, weeks, and months as found in peer-reviewed research and highlight any related trends. METHODS A systematic review was conducted across four electronic databases for articles published between 1970 and July 2020. The researchers reviewed articles which included awareness days, weeks, or months in the title or abstract and extracted articles which used quantitative analysis to assess the impact of such campaigns. RESULTS The 73 included articles were separated into categories based on outcome measure(s) with 12 articles included in more than one category. Of the 31 articles which examined online activity outcomes, the vast majority reported the awareness day, week, or month in question positively correlated with increased activity. Of the 14 articles focused on knowledge outcomes, those which focused on specific day, week, or month sub-interventions with targeted populations had relatively greater success. The 29 studies that examined the impact of awareness days, weeks, and months on health outcomes reported mixed results. Another twelve studies provided treatment insights based on convenience sample research conducted during awareness days, weeks, and months. The majority of articles across all outcome categories did not examine costs. CONCLUSION Although online activity seemed to generally increase during the awareness days, weeks, and months studied, the relationship between this increase and improved health behaviors and outcomes remains unclear. In addition, there is a paucity of research pertaining to the cost and cost effectiveness of such campaigns. Future research in this area needs to focus more on health outcome impacts and include an examination of cost effectiveness when possible.
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Affiliation(s)
- Erin Vernon
- Department of Economics, Seattle University, 901 12th Avenue, Seattle, WA, 98122, USA.
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29
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Xu C, Cao Z, Yang H, Gao Y, Sun L, Hou Y, Cao X, Jia P, Wang Y. Leveraging Internet Search Data to Improve the Prediction and Prevention of Noncommunicable Diseases: Retrospective Observational Study. J Med Internet Res 2020; 22:e18998. [PMID: 33180022 PMCID: PMC7691086 DOI: 10.2196/18998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/10/2020] [Accepted: 10/26/2020] [Indexed: 01/19/2023] Open
Abstract
Background As human society enters an era of vast and easily accessible social media, a growing number of people are exploiting the internet to search and exchange medical information. Because internet search data could reflect population interest in particular health topics, they provide a new way of understanding health concerns regarding noncommunicable diseases (NCDs) and the role they play in their prevention. Objective We aimed to explore the association of internet search data for NCDs with published disease incidence and mortality rates in the United States and to grasp the health concerns toward NCDs. Methods We tracked NCDs by examining the correlations among the incidence rates, mortality rates, and internet searches in the United States from 2004 to 2017, and we established forecast models based on the relationship between the disease rates and internet searches. Results Incidence and mortality rates of 29 diseases in the United States were statistically significantly correlated with the relative search volumes (RSVs) of their search terms (P<.05). From the perspective of the goodness of fit of the multiple regression prediction models, the results were closest to 1 for diabetes mellitus, stroke, atrial fibrillation and flutter, Hodgkin lymphoma, and testicular cancer; the coefficients of determination of their linear regression models for predicting incidence were 80%, 88%, 96%, 80%, and 78%, respectively. Meanwhile, the coefficient of determination of their linear regression models for predicting mortality was 82%, 62%, 94%, 78%, and 62%, respectively. Conclusions An advanced understanding of search behaviors could augment traditional epidemiologic surveillance and could be used as a reference to aid in disease prediction and prevention.
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Affiliation(s)
- Chenjie Xu
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhi Cao
- School of Public Health, Tianjin Medical University, Tianjin, China.,Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongxi Yang
- School of Public Health, Tianjin Medical University, Tianjin, China.,School of Public Health, Yale University, New Haven, CT, United States
| | - Ying Gao
- Health Management Center, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Sun
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yabing Hou
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xinxi Cao
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Peng Jia
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China.,International Institute of Spatial Lifecourse Epidemiology, Hong Kong, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
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30
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Vuong J, Singh A, Falk RH, Merchant R, Dorbala S. Geographic variation in public interest about amyloidosis in the United States and English speaking countries. Amyloid 2020; 27:210-212. [PMID: 32053019 DOI: 10.1080/13506129.2020.1724941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Avinainder Singh
- Department of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Raina Merchant
- University of Pennsylvania Center for Digital Health, Philadelphia, PA, USA
| | - Sharmila Dorbala
- Cardiac Amyloidosis Program, Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Radiology, Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, MA, USA
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31
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Schliemann D, Htay MNN, Dahlui M, Paramasivam D, Cardwell CR, Ibrahim Tamin NSB, Somasundaram S, Donnelly C, Su TT, Donnelly M. Impact of a mass media campaign on breast cancer symptoms awareness and screening uptake in Malaysia: findings from a quasi-experimental study. BMJ Open 2020; 10:e036503. [PMID: 32819988 PMCID: PMC7443282 DOI: 10.1136/bmjopen-2019-036503] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To evaluate the impact of a mass media campaign in terms of improving breast cancer (BC) symptoms awareness and screening uptake. DESIGN Before-and after-study with comparator groups. SETTING Selangor State, Malaysia. PARTICIPANTS Malaysian women aged >40 years (n=676) from randomly selected households. INTERVENTION A culturally adapted mass media campaign (TV, radio, print media and social media). PRIMARY AND SECONDARY OUTCOME MEASURES The primary endpoint was BC symptoms awareness, which was assessed with the Breast Cancer Awareness Measure precampaign and postcampaign. Secondary outcomes included campaign reach, self-efficacy to notice BC symptoms and clinical outcomes. Clinical breast examination and mammogram screening data were collected from hospitals and clinics. RESULTS Most participants recognised at least one of the campaign materials (65.2%). The odds of seeing the campaign were lowest for Chinese women (adjusted OR 0.25, 95% CI 0.15 to 0.40) compared with Malays and for women aged >70 years (adjusted OR 0.47, 95% CI 0.23 to 0.94) compared with younger women. Participants who recognised the campaign were significantly more likely to have improved awareness postcampaign compared with non-recognisers particularly for key symptoms such as 'a lump or thickening in your breast' (88.9% vs 62.1%) and 'discharge or bleeding from nipple' (79.7% vs 55.3%). Improvement in symptoms awareness scores was not associated with sociodemographic variables. CONCLUSIONS Implementation in Malaysia of an evidence-based mass media campaign from the UK that was culturally adapted appeared to lead to improved awareness about some BC symptoms, though various modes of media communication and perhaps other health education approaches may be required to extend the reach to diverse, multiethnic populations and all age groups.
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Affiliation(s)
- Désirée Schliemann
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Mila Nu Nu Htay
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Community Medicine, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia
| | - Maznah Dahlui
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Facultas Public Health, University Airlangga, Surabaya, Indonesia
| | - Darishiani Paramasivam
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Christopher R Cardwell
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | | | | | | | - Tin Tin Su
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Kuala Lumpur, Malaysia
| | - Michael Donnelly
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, United Kingdom
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Zepecki A, Guendelman S, DeNero J, Prata N. Using Application Programming Interfaces to Access Google Data for Health Research: Protocol for a Methodological Framework. JMIR Res Protoc 2020; 9:e16543. [PMID: 32442159 PMCID: PMC7381000 DOI: 10.2196/16543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/04/2020] [Accepted: 03/24/2020] [Indexed: 12/18/2022] Open
Abstract
Background Individuals are increasingly turning to search engines like Google to obtain health information and access resources. Analysis of Google search queries offers a novel approach, which is part of the methodological toolkit for infodemiology or infoveillance researchers, to understanding population health concerns and needs in real time or near-real time. While searches predominantly have been examined with the Google Trends website tool, newer application programming interfaces (APIs) are now available to academics to draw a richer landscape of searches. These APIs allow users to write code in languages like Python to retrieve sample data directly from Google servers. Objective The purpose of this paper is to describe a novel protocol to determine the top queries, volume of queries, and the top sites reached by a population searching on the web for a specific health term. The protocol retrieves Google search data obtained from three Google APIs: Google Trends, Google Health Trends (also referred to as Flu Trends), and Google Custom Search. Methods Our protocol consisted of four steps: (1) developing a master list of top search queries for an initial search term using Google Trends, (2) gathering information on relative search volume using Google Health Trends, (3) determining the most popular sites using Google Custom Search, and (4) calculating estimated total search volume. We tested the protocol following key procedures at each step and verified its usefulness by examining search traffic on birth control in 2017 in the United States. Two separate programmers working independently achieved similar results with insignificant variation due to sample variability. Results We successfully tested the methodology on the initial search term birth control. We identified top search queries for birth control, of which birth control pill was the most popular and obtained the relative and estimated total search volume for the top queries: relative search volume was 0.54 for the pill, corresponding to an estimated 9.3-10.7 million searches. We used the estimates of the proportion of search activity for the top queries to arrive at a generated list of the most popular websites: for the pill, the Planned Parenthood website was the top site. Conclusions The proposed methodological framework demonstrates how to retrieve Google query data from multiple Google APIs and provides thorough documentation required to systematically identify search queries and websites, as well as estimate relative and total search volume of queries in real time or near-real time in specific locations and time periods. Although the protocol needs further testing, it allows researchers to replicate the steps and shows promise in advancing our understanding of population-level health concerns. International Registered Report Identifier (IRRID) RR1-10.2196/16543
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Affiliation(s)
- Anne Zepecki
- The Wallace Center for Maternal, Child, and Adolescent Health, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Sylvia Guendelman
- The Wallace Center for Maternal, Child, and Adolescent Health, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - John DeNero
- Department of Electrical Engineering and Computer Sciences, College of Engineering, University of California, Berkeley, Berkeley, CA, United States
| | - Ndola Prata
- The Wallace Center for Maternal, Child, and Adolescent Health, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
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Bach RL, Wenz A. Studying health-related internet and mobile device use using web logs and smartphone records. PLoS One 2020; 15:e0234663. [PMID: 32530937 PMCID: PMC7292384 DOI: 10.1371/journal.pone.0234663] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/30/2020] [Indexed: 11/19/2022] Open
Abstract
Many people use the internet to seek information that will help them understand their body and their health. Motivations for such behaviors are numerous. For example, users may wish to figure out a medical condition by searching for symptoms they experience. Similarly, they may seek more information on how to treat conditions they have been diagnosed with or seek resources on how to live a healthy life. With the ubiquitous availability of the internet, searching and finding relevant information is easier than ever before and a widespread phenomenon. To understand how people use the internet for health-related information, we use data from a sample of 1,959 internet users. A unique combination of data containing four months of users' browsing histories and mobile application use on computers and mobile devices allows us to study which health websites they visited, what information they searched for and which health applications they used. Survey data inform us about users' socio-demographic background, medical conditions and other health-related behaviors. Results show that women, young users, users with a university education and nonsmokers are most likely to use the internet and mobile applications for health-related purposes. On search engines, internet users most frequently search for pharmacies, symptoms of medical conditions and pain. Moreover, users seem most interested in information on how to live a healthy life, alternative medicine, mental health and women's health. With this study, we extend the field's understanding of who seeks and consumes health information online, what users look for as well as how individuals use mobile applications to monitor their health. Moreover, we contribute to methodological research by exploring new sources of data for understanding humans, their preferences and behaviors.
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Affiliation(s)
- Ruben L. Bach
- Collaborative Research Center 884 Political Economy of Reforms, University of Mannheim, Mannheim, Germany
- * E-mail:
| | - Alexander Wenz
- Collaborative Research Center 884 Political Economy of Reforms, University of Mannheim, Mannheim, Germany
- Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom
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Mavragani A. Infodemiology and Infoveillance: Scoping Review. J Med Internet Res 2020; 22:e16206. [PMID: 32310818 PMCID: PMC7189791 DOI: 10.2196/16206] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/05/2020] [Accepted: 02/08/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Web-based sources are increasingly employed in the analysis, detection, and forecasting of diseases and epidemics, and in predicting human behavior toward several health topics. This use of the internet has come to be known as infodemiology, a concept introduced by Gunther Eysenbach. Infodemiology and infoveillance studies use web-based data and have become an integral part of health informatics research over the past decade. OBJECTIVE The aim of this paper is to provide a scoping review of the state-of-the-art in infodemiology along with the background and history of the concept, to identify sources and health categories and topics, to elaborate on the validity of the employed methods, and to discuss the gaps identified in current research. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to extract the publications that fall under the umbrella of infodemiology and infoveillance from the JMIR, PubMed, and Scopus databases. A total of 338 documents were extracted for assessment. RESULTS Of the 338 studies, the vast majority (n=282, 83.4%) were published with JMIR Publications. The Journal of Medical Internet Research features almost half of the publications (n=168, 49.7%), and JMIR Public Health and Surveillance has more than one-fifth of the examined studies (n=74, 21.9%). The interest in the subject has been increasing every year, with 2018 featuring more than one-fourth of the total publications (n=89, 26.3%), and the publications in 2017 and 2018 combined accounted for more than half (n=171, 50.6%) of the total number of publications in the last decade. The most popular source was Twitter with 45.0% (n=152), followed by Google with 24.6% (n=83), websites and platforms with 13.9% (n=47), blogs and forums with 10.1% (n=34), Facebook with 8.9% (n=30), and other search engines with 5.6% (n=19). As for the subjects examined, conditions and diseases with 17.2% (n=58) and epidemics and outbreaks with 15.7% (n=53) were the most popular categories identified in this review, followed by health care (n=39, 11.5%), drugs (n=40, 10.4%), and smoking and alcohol (n=29, 8.6%). CONCLUSIONS The field of infodemiology is becoming increasingly popular, employing innovative methods and approaches for health assessment. The use of web-based sources, which provide us with information that would not be accessible otherwise and tackles the issues arising from the time-consuming traditional methods, shows that infodemiology plays an important role in health informatics research.
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Affiliation(s)
- Amaryllis Mavragani
- Department of Computing Science and Mathematics, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
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35
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Barros JM, Duggan J, Rebholz-Schuhmann D. The Application of Internet-Based Sources for Public Health Surveillance (Infoveillance): Systematic Review. J Med Internet Res 2020; 22:e13680. [PMID: 32167477 PMCID: PMC7101503 DOI: 10.2196/13680] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 09/18/2019] [Accepted: 11/26/2019] [Indexed: 12/30/2022] Open
Abstract
Background Public health surveillance is based on the continuous and systematic collection, analysis, and interpretation of data. This informs the development of early warning systems to monitor epidemics and documents the impact of intervention measures. The introduction of digital data sources, and specifically sources available on the internet, has impacted the field of public health surveillance. New opportunities enabled by the underlying availability and scale of internet-based sources (IBSs) have paved the way for novel approaches for disease surveillance, exploration of health communities, and the study of epidemic dynamics. This field and approach is also known as infodemiology or infoveillance. Objective This review aimed to assess research findings regarding the application of IBSs for public health surveillance (infodemiology or infoveillance). To achieve this, we have presented a comprehensive systematic literature review with a focus on these sources and their limitations, the diseases targeted, and commonly applied methods. Methods A systematic literature review was conducted targeting publications between 2012 and 2018 that leveraged IBSs for public health surveillance, outbreak forecasting, disease characterization, diagnosis prediction, content analysis, and health-topic identification. The search results were filtered according to previously defined inclusion and exclusion criteria. Results Spanning a total of 162 publications, we determined infectious diseases to be the preferred case study (108/162, 66.7%). Of the eight categories of IBSs (search queries, social media, news, discussion forums, websites, web encyclopedia, and online obituaries), search queries and social media were applied in 95.1% (154/162) of the reviewed publications. We also identified limitations in representativeness and biased user age groups, as well as high susceptibility to media events by search queries, social media, and web encyclopedias. Conclusions IBSs are a valuable proxy to study illnesses affecting the general population; however, it is important to characterize which diseases are best suited for the available sources; the literature shows that the level of engagement among online platforms can be a potential indicator. There is a necessity to understand the population’s online behavior; in addition, the exploration of health information dissemination and its content is significantly unexplored. With this information, we can understand how the population communicates about illnesses online and, in the process, benefit public health.
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Affiliation(s)
- Joana M Barros
- Insight Centre for Data Analytics, National University of Ireland Galway, Galway, Ireland.,School of Computer Science, National University of Ireland Galway, Galway, Ireland
| | - Jim Duggan
- School of Computer Science, National University of Ireland Galway, Galway, Ireland
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Xu C, Yang H, Sun L, Cao X, Hou Y, Cai Q, Jia P, Wang Y. Detecting Lung Cancer Trends by Leveraging Real-World and Internet-Based Data: Infodemiology Study. J Med Internet Res 2020; 22:e16184. [PMID: 32163035 PMCID: PMC7099398 DOI: 10.2196/16184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/28/2019] [Accepted: 02/22/2020] [Indexed: 01/13/2023] Open
Abstract
Background Internet search data on health-related terms can reflect people’s concerns about their health status in near real time, and hence serve as a supplementary metric of disease characteristics. However, studies using internet search data to monitor and predict chronic diseases at a geographically finer state-level scale are sparse. Objective The aim of this study was to explore the associations of internet search volumes for lung cancer with published cancer incidence and mortality data in the United States. Methods We used Google relative search volumes, which represent the search frequency of specific search terms in Google. We performed cross-sectional analyses of the original and disease metrics at both national and state levels. A smoothed time series of relative search volumes was created to eliminate the effects of irregular changes on the search frequencies and obtain the long-term trends of search volumes for lung cancer at both the national and state levels. We also performed analyses of decomposed Google relative search volume data and disease metrics at the national and state levels. Results The monthly trends of lung cancer-related internet hits were consistent with the trends of reported lung cancer rates at the national level. Ohio had the highest frequency for lung cancer-related search terms. At the state level, the relative search volume was significantly correlated with lung cancer incidence rates in 42 states, with correlation coefficients ranging from 0.58 in Virginia to 0.94 in Oregon. Relative search volume was also significantly correlated with mortality in 47 states, with correlation coefficients ranging from 0.58 in Oklahoma to 0.94 in North Carolina. Both the incidence and mortality rates of lung cancer were correlated with decomposed relative search volumes in all states excluding Vermont. Conclusions Internet search behaviors could reflect public awareness of lung cancer. Research on internet search behaviors could be a novel and timely approach to monitor and estimate the prevalence, incidence, and mortality rates of a broader range of cancers and even more health issues.
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Affiliation(s)
- Chenjie Xu
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hongxi Yang
- School of Public Health, Tianjin Medical University, Tianjin, China.,School of Public Health, Yale University, New Haven, CT, United States
| | - Li Sun
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xinxi Cao
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yabing Hou
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Qiliang Cai
- School of Public Health, Tianjin Medical University, Tianjin, China.,The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Peng Jia
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China.,International Initiative on Spatial Lifecourse Epidemiology, Hong Kong, China.,Faculty of Geo-information Science and Earth Observation, University of Twente, Enschede, Netherlands
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
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Memon SA, Razak S, Weber I. Lifestyle Disease Surveillance Using Population Search Behavior: Feasibility Study. J Med Internet Res 2020; 22:e13347. [PMID: 32012050 PMCID: PMC7011125 DOI: 10.2196/13347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 10/08/2019] [Accepted: 11/29/2019] [Indexed: 12/27/2022] Open
Abstract
Background As the process of producing official health statistics for lifestyle diseases is slow, researchers have explored using Web search data as a proxy for lifestyle disease surveillance. Existing studies, however, are prone to at least one of the following issues: ad-hoc keyword selection, overfitting, insufficient predictive evaluation, lack of generalization, and failure to compare against trivial baselines. Objective The aims of this study were to (1) employ a corrective approach improving previous methods; (2) study the key limitations in using Google Trends for lifestyle disease surveillance; and (3) test the generalizability of our methodology to other countries beyond the United States. Methods For each of the target variables (diabetes, obesity, and exercise), prevalence rates were collected. After a rigorous keyword selection process, data from Google Trends were collected. These data were denormalized to form spatio-temporal indices. L1-regularized regression models were trained to predict prevalence rates from denormalized Google Trends indices. Models were tested on a held-out set and compared against baselines from the literature as well as a trivial last year equals this year baseline. A similar analysis was done using a multivariate spatio-temporal model where the previous year’s prevalence was included as a covariate. This model was modified to create a time-lagged regression analysis framework. Finally, a hierarchical time-lagged multivariate spatio-temporal model was created to account for subnational trends in the data. The model trained on US data was, then, applied in a transfer learning framework to Canada. Results In the US context, our proposed models beat the performances of the prior work, as well as the trivial baselines. In terms of the mean absolute error (MAE), the best of our proposed models yields 24% improvement (0.72-0.55; P<.001) for diabetes; 18% improvement (1.20-0.99; P=.001) for obesity, and 34% improvement (2.89-1.95; P<.001) for exercise. Our proposed across-country transfer learning framework also shows promising results with an average Spearman and Pearson correlation of 0.70 for diabetes and 0.90 and 0.91 for obesity, respectively. Conclusions Although our proposed models beat the baselines, we find the modeling of lifestyle diseases to be a challenging problem, one that requires an abundance of data as well as creative modeling strategies. In doing so, this study shows a low-to-moderate validity of Google Trends in the context of lifestyle disease surveillance, even when applying novel corrective approaches, including a proposed denormalization scheme. We envision qualitative analyses to be a more practical use of Google Trends in the context of lifestyle disease surveillance. For the quantitative analyses, the highest utility of using Google Trends is in the context of transfer learning where low-resource countries could benefit from high-resource countries by using proxy models.
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Affiliation(s)
- Shahan Ali Memon
- Language Technologies Institute, School of Computer Science, Carnegie Mellon University, Pittsburgh, PA, United States
| | | | - Ingmar Weber
- Social Computing Department, Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha, Qatar
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Weitzman ER, Magane KM, Chen PH, Amiri H, Naimi TS, Wisk LE. Online Searching and Social Media to Detect Alcohol Use Risk at Population Scale. Am J Prev Med 2020; 58:79-88. [PMID: 31806270 DOI: 10.1016/j.amepre.2019.08.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Harnessing engagement in online searching and social media may provide complementary information for monitoring alcohol use, informing prevention and policy evaluation, and extending knowledge available from national surveys. METHODS Relative search volumes for 7 alcohol-related keywords were estimated from Google Trends (data, 2014-2017), and the proportion of alcohol use-related Twitter posts (data, 2014-2015) was estimated using natural language processing. Searching/posting measures were created for all 50 U.S. states plus Washington, D.C. Survey reports of alcohol use and summaries of state alcohol policies were obtained from the Behavioral Risk Factor Surveillance System (data, 2014-2016) and the Alcohol Policy Scale. In 2018-2019, associations among searching/posting measures and same state/year Behavioral Risk Factor Surveillance System reports of recent (past-30-day) alcohol use and maximum number of drinks consumed on an occasion were estimated using logistic and linear regression, adjusting for sociodemographics and Internet use, with moderation tested in regressions that included interactions of select searching/posting measures and the Alcohol Policy Scale. RESULTS Recent alcohol use was reported by 52.93% of 1,297,168 Behavioral Risk Factor Surveillance System respondents, which was associated with all state-level searching/posting measures in unadjusted and adjusted models (p<0.0001). Among drinkers, most searching/posting measures were associated with maximum number of drinks consumed (p<0.0001). Associations varied with exposure to high versus low levels of state policy controls on alcohol. CONCLUSIONS Strong associations were found among individual alcohol use and state-level alcohol-related searching/posting measures, which were moderated by the strength of state alcohol policies. Findings support using novel personally generated data to monitor alcohol use and possibly evaluate effects of alcohol control policies.
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Affiliation(s)
- Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts.
| | - Kara M Magane
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Po-Hua Chen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Hadi Amiri
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Timothy S Naimi
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Lauren E Wisk
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, California
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Association of sociodemographic factors and internet query data with pertussis infections in Shandong, China. Epidemiol Infect 2019; 147:e302. [PMID: 31727192 PMCID: PMC6873159 DOI: 10.1017/s0950268819001924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This study explored how internet queries vary in facilitating monitoring of pertussis, and the effects of sociodemographic characteristics on such variation by city in Shandong province, China. We collected weekly pertussis notifications, Baidu Index (BI) data and yearly sociodemographic data at the city level between 1 January 2009 and 31 December 2017. Spearman's correlation was performed for temporal risk indices, generalised linear models and regression tree models were developed to identify the hierarchical effects and the threshold between sociodemographic factors and internet query data with pertussis surveillance. The BI was correlated with pertussis notifications, with a strongly spatial variation among cities in temporal risk indices (composite temporal risk metric (CTRM) range: 0.59–1.24). The percentage of urban population (relative risk (RR): 1.05, 95% confidence interval (CI) 1.03–1.07), the proportion of highly educated population (RR: 1.27, 95% CI 1.16–1.39) and the internet access rate (RR: 1.04, 95% CI 1.02–1.05) were correlated with CTRM. Higher RRs in the three identified sociodemographic factors were associated with higher stratified CTRM. The percentage of highly educated population was the most important determinant in the BI with pertussis surveillance. The findings may lead to spatially-specific criteria to inform development of an early warning system of pertussis infections using internet query data.
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Mimura W, Akazawa M. The Association Between Internet Searches and Moisturizer Prescription in Japan: Retrospective Observational Study. JMIR Public Health Surveill 2019; 5:e13212. [PMID: 31596248 PMCID: PMC6812878 DOI: 10.2196/13212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/30/2019] [Accepted: 08/02/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Heparinoid is a medication prescribed in Japan for skin diseases, such as atopic dermatitis and dry skin. Heparinoid prescription has increased with instances of internet blogs recommending its use as a cosmetic. OBJECTIVE This study aimed to examine the prescription trends in moisturizer use and analyze their association with internet searches. METHODS We used a claims database to identify pharmacy claims of heparinoid-only prescriptions in Japan. Additionally, we used Google Trends to obtain internet search data for the period between October 1, 2007, and September 31, 2017. To analyze the association between heparinoid prescriptions and internet searches, we performed an autoregressive integrated moving average approach for each time series. RESULTS We identified 155,733 patients who had been prescribed heparinoid. The number of prescriptions increased from 2011 onward, and related internet searches increased from 2012 onward. Internet searches were significantly correlated with total heparinoid prescription (correlation coefficient=.25, P=.005). In addition, internet searches were significantly correlated with heparinoid prescription in those aged 20-59 years at -1-month lag in Google Trends (correlation coefficient=.30, P=.001). CONCLUSIONS Google searches related to heparinoid prescriptions showed a seasonal pattern and increased gradually over the preceding several years. Google searches were positively correlated with prescription trends. In addition, in a particular age group (20-59 years), prescriptions increased with the increase in internet searches. These results suggest that people obtained health-related information on the internet and that this affected their behavior and prescription requests.
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Affiliation(s)
- Wataru Mimura
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan
| | - Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan
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Quintanilha LF, Souza LN, Sanches D, Demarco RS, Fukutani KF. The impact of cancer campaigns in Brazil: a Google Trends analysis. Ecancermedicalscience 2019; 13:963. [PMID: 31645890 PMCID: PMC6786828 DOI: 10.3332/ecancer.2019.963] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 12/15/2022] Open
Abstract
It is estimated that more than 600,000 new cases of cancer will be reported in Brazil during the 2018-2019 biennium, especially with regard to prostate, breast, lung and colorectal cancers. Due to the high prevalence, incidence and mortality rates of these diseases, cancer campaigns such as 'Pink October' and 'Blue November' were strongly promoted in the past decade throughout the country to raise awareness of breast and prostate cancer, respectively. Nevertheless, whether the implementation of these campaigns has been proven efficient is still unknown. In the present study, we analysed the effectiveness of these campaigns on eliciting population online interest for cancer information. The Google Trends database was evaluated for the relative Internet search popularity for the terms 'breast cancer' and 'prostate cancer' from 2014 to 2019. Aside from some regional differences, we found that there was a high demand for 'breast cancer' and, to a lesser extent, 'prostate cancer' searches in a seasonal fashion (during October and November, respectively). Despite the worldwide high incidence of lung and colorectal cancers, searches including these keywords did not show increases in any specific period of the year, demonstrating the efficiency of the 'Pink October' and 'Blue November' campaigns in engaging the interest of the Brazilian population on the subject. These results allow us to infer that campaigns are effective in mobilising the attention of the Brazilian population with regard to breast and prostate cancers, but the practical aspects in reducing incidence and mortality should still be discussed.
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Affiliation(s)
- Luiz Fernando Quintanilha
- Universidade Salvador, Laureate Universities, Salvador 41770-235, Brazil
- Centro Universitário FTC, Faculdade de Medicina, Salvador 41741-590, Brazil
| | - Laumar Neves Souza
- Universidade Salvador, Laureate Universities, Salvador 41770-235, Brazil
| | - Daniel Sanches
- Division of Arts and Sciences, South Florida State College, Avon Park, FL 33825, USA
| | | | - Kiyoshi Ferreira Fukutani
- Centro Universitário FTC, Faculdade de Medicina, Salvador 41741-590, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador 40210-320, Brazil
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Phillips CA, Hunt A, Salvesen-Quinn M, Guerra J, Schapira MM, Bailey LC, Merchant RM. Health-related Google searches performed by parents of pediatric oncology patients. Pediatr Blood Cancer 2019; 66:e27795. [PMID: 31069926 PMCID: PMC6588432 DOI: 10.1002/pbc.27795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Little is known about the specific information parents of children with cancer search for online. Understanding the content of parents' searches over time could offer insight into what matters most to parents and identify knowledge gaps that could inform more comprehensive approaches to family education and support. METHODS We describe parents' health-related Google searches starting six months before cancer diagnosis and extending through the date of study enrollment, which was at least one month after initiating cancer treatment. Searches were obtained retrospectively and grouped into health-related and non-health-related categories. The median time to parent enrollment from date of cancer diagnosis was 264 days. RESULTS Parents searched for health-related topics more frequently than the general population (13% vs 5%). Health-related searches increased in the months preceding the child's cancer diagnosis and most commonly pertained to symptoms and logistics, "directions to hospital." Health-related search volume peaked about a month after cancer diagnosis when general health-related searches were present in addition to cancer-specific searches. Eighteen percent of health-related searches were cancer specific, and of these cancer-specific searches, 54% pertained to support, for example "cancer quote for son." CONCLUSIONS Google search content offers insight into what matters to parents of cancer patients. Understanding search content could inform more comprehensive approaches to family education and support initiatives.
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Affiliation(s)
- Charles A. Phillips
- Division of Oncology and Center for Applied Clinical Research, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Alaina Hunt
- University of Pennsylvania, Philadelphia, PA, United States
| | - Mikaela Salvesen-Quinn
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States
| | - Jorge Guerra
- Enterprise Analytics and Reporting, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Marilyn M. Schapira
- Department of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States,Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, United States
| | - L. Charles Bailey
- Division of Oncology and Center for Applied Clinical Research, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States,Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Raina M. Merchant
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States,Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States
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Mavragani A, Ochoa G. Google Trends in Infodemiology and Infoveillance: Methodology Framework. JMIR Public Health Surveill 2019; 5:e13439. [PMID: 31144671 PMCID: PMC6660120 DOI: 10.2196/13439] [Citation(s) in RCA: 220] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/17/2019] [Accepted: 03/23/2019] [Indexed: 02/06/2023] Open
Abstract
Internet data are being increasingly integrated into health informatics research and are becoming a useful tool for exploring human behavior. The most popular tool for examining online behavior is Google Trends, an open tool that provides information on trends and the variations of online interest in selected keywords and topics over time. Online search traffic data from Google have been shown to be useful in analyzing human behavior toward health topics and in predicting disease occurrence and outbreaks. Despite the large number of Google Trends studies during the last decade, the literature on the subject lacks a specific methodology framework. This article aims at providing an overview of the tool and data and at presenting the first methodology framework in using Google Trends in infodemiology and infoveillance, including the main factors that need to be taken into account for a strong methodology base. We provide a step-by-step guide for the methodology that needs to be followed when using Google Trends and the essential aspects required for valid results in this line of research. At first, an overview of the tool and the data are presented, followed by an analysis of the key methodological points for ensuring the validity of the results, which include selecting the appropriate keyword(s), region(s), period, and category. Overall, this article presents and analyzes the key points that need to be considered to achieve a strong methodological basis for using Google Trends data, which is crucial for ensuring the value and validity of the results, as the analysis of online queries is extensively integrated in health research in the big data era.
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Affiliation(s)
- Amaryllis Mavragani
- Department of Computing Science and Mathematics, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Gabriela Ochoa
- Department of Computing Science and Mathematics, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
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Marcu A, Muller C, Ream E, Whitaker KL. Online Information-Seeking About Potential Breast Cancer Symptoms: Capturing Online Behavior With an Internet Browsing Tracking Tool. J Med Internet Res 2019; 21:e12400. [PMID: 30724741 PMCID: PMC6381403 DOI: 10.2196/12400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 01/18/2023] Open
Abstract
Background People engage in health information-seeking online when experiencing unusual or unfamiliar bodily changes. It is not well understood how people consult the internet for health information after the onset of unfamiliar symptoms and before receiving a potential diagnosis and how online information-seeking can help people appraise their symptoms. This lack of evidence may be partly due to methodological limitations in capturing in real time the online information-seeking process. Objective We explored women’s symptom attribution and online health information-seeking in response to a hypothetical and unfamiliar breast change suggestive of cancer (nipple rash). We also aimed to establish the feasibility of capturing in real time the online information-seeking process with a tool designed to track participant online searches and visited websites, the Vizzata browser tracker. Methods An online survey was completed by 56 cancer-free women (mean age 60.34 [SD 7.73] years) responding to a scenario asking them to imagine noticing a red scaly rash on the nipple. Participants were asked to make symptom attributions when presented with the scenario (T1) and again after seeking information online (T2). The online tracking tool, embedded in the survey, was used to capture in real time participant search terms and accessed websites. Results The tracking tool captured the search terms and accessed websites of most of the participants (46/56, 82%). For the rest (10/56, 18%), there was evidence of engagement in online information-seeking (eg, medical terminology and cancer attribution at T2) despite their searching activity not being recorded. A total of 25 participants considered cancer as a potential cause for the nipple rash at T1, yet only one of these used cancer as a search term. Most participants (40/46, 87%) used rash-related search terms, particularly nipple rash and rash on nipple. The majority (41/46, 89%) accessed websites containing breast cancer information, with the National Health Service webpage “Paget disease of the nipple” being the most visited one. At T2, after engaging in the internet search task, more participants attributed the nipple rash to breast cancer than at T1 (37/46, 66% vs 25/46, 45%), although a small number of participants (6/46) changed from making a cancer attribution at T1 to a noncancer one at T2. Conclusions Making a cancer attribution for an unfamiliar breast change did not necessarily translate into cancer-termed searches. Equally, not all internet searches led to a cancer attribution. The findings suggest that online information-seeking may not necessarily help women who experience unfamiliar breast cancer symptoms understand their condition. Despite some technical issues, this study showed that it is feasible to use an online browser tracking tool to capture in real time information-seeking about unfamiliar symptoms.
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Affiliation(s)
- Afrodita Marcu
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Cecile Muller
- School of Psychology, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Emma Ream
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Katriina L Whitaker
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
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Xu C, Wang Y, Yang H, Hou J, Sun L, Zhang X, Cao X, Hou Y, Wang L, Cai Q, Wang Y. Association Between Cancer Incidence and Mortality in Web-Based Data in China: Infodemiology Study. J Med Internet Res 2019; 21:e10677. [PMID: 30694203 PMCID: PMC6371071 DOI: 10.2196/10677] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/04/2018] [Accepted: 01/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background Cancer poses a serious threat to the health of Chinese people, resulting in a major challenge for public health work. Today, people can obtain relevant information from not only medical workers in hospitals, but also the internet in any place in real-time. Search behaviors can reflect a population’s awareness of cancer from a completely new perspective, which could be driven by the underlying cancer epidemiology. However, such Web-retrieved data are not yet well validated or understood. Objective This study aimed to explore whether a correlation exists between the incidence and mortality of cancers and normalized internet search volumes on the big data platform, Baidu. We also assessed whether the distribution of people who searched for specific types of cancer differed by gender. Finally, we determined whether there were regional disparities among people who searched the Web for cancer-related information. Methods Standard Boolean operators were used to choose search terms for each type of cancer. Spearman’s correlation analysis was used to explore correlations among monthly search index values for each cancer type and their monthly incidence and mortality rates. We conducted cointegration analysis between search index data and incidence rates to examine whether a stable equilibrium existed between them. We also conducted cointegration analysis between search index data and mortality data. Results The monthly Baidu index was significantly correlated with cancer incidence rates for 26 of 28 cancers in China (lung cancer: r=.80, P<.001; liver cancer: r=.28, P=.016; stomach cancer: r=.50, P<.001; esophageal cancer: r=.50, P<.001; colorectal cancer: r=.81, P<.001; pancreatic cancer: r=.86, P<.001; breast cancer: r=.56, P<.001; brain and nervous system cancer: r=.63, P<.001; leukemia: r=.75, P<.001; Non-Hodgkin lymphoma: r=.88, P<.001; Hodgkin lymphoma: r=.91, P<.001; cervical cancer: r=.64, P<.001; prostate cancer: r=.67, P<.001; bladder cancer: r=.62, P<.001; gallbladder and biliary tract cancer: r=.88, P<.001; lip and oral cavity cancer: r=.88, P<.001; ovarian cancer: r=.58, P<.001; larynx cancer: r=.82, P<.001; kidney cancer: r=.73, P<.001; squamous cell carcinoma: r=.94, P<.001; multiple myeloma: r=.84, P<.001; thyroid cancer: r=.77, P<.001; malignant skin melanoma: r=.55, P<.001; mesothelioma: r=.79, P<.001; testicular cancer: r=.57, P<.001; basal cell carcinoma: r=.83, P<.001). The monthly Baidu index was significantly correlated with cancer mortality rates for 24 of 27 cancers. In terms of the whole population, the number of women who searched for cancer-related information has slowly risen over time. People aged 30-39 years were most likely to use search engines to retrieve cancer-related knowledge. East China had the highest Web search volumes for cancer. Conclusions Search behaviors indeed reflect public awareness of cancer from a different angle. Research on internet search behaviors could present an innovative and timely way to monitor and estimate cancer incidence and mortality rates, especially for cancers not included in national registries.
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Affiliation(s)
- Chenjie Xu
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yi Wang
- Tandon School of Engineering, New York University, New York, NY, United States
| | - Hongxi Yang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jie Hou
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Li Sun
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xinyu Zhang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xinxi Cao
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yabing Hou
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Lan Wang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Qiliang Cai
- The Second Hospital of Tianjin Medical University, Tianjin Medical University, Tianjin, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
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Lippi G, Cervellin G. Is digital epidemiology reliable?-insight from updated cancer statistics. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:15. [PMID: 30788362 DOI: 10.21037/atm.2018.11.55] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Mavragani A, Ochoa G, Tsagarakis KP. Assessing the Methods, Tools, and Statistical Approaches in Google Trends Research: Systematic Review. J Med Internet Res 2018; 20:e270. [PMID: 30401664 PMCID: PMC6246971 DOI: 10.2196/jmir.9366] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 05/07/2018] [Accepted: 06/21/2018] [Indexed: 01/12/2023] Open
Abstract
Background In the era of information overload, are big data analytics the answer to access and better manage available knowledge? Over the last decade, the use of Web-based data in public health issues, that is, infodemiology, has been proven useful in assessing various aspects of human behavior. Google Trends is the most popular tool to gather such information, and it has been used in several topics up to this point, with health and medicine being the most focused subject. Web-based behavior is monitored and analyzed in order to examine actual human behavior so as to predict, better assess, and even prevent health-related issues that constantly arise in everyday life. Objective This systematic review aimed at reporting and further presenting and analyzing the methods, tools, and statistical approaches for Google Trends (infodemiology) studies in health-related topics from 2006 to 2016 to provide an overview of the usefulness of said tool and be a point of reference for future research on the subject. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for selecting studies, we searched for the term “Google Trends” in the Scopus and PubMed databases from 2006 to 2016, applying specific criteria for types of publications and topics. A total of 109 published papers were extracted, excluding duplicates and those that did not fall inside the topics of health and medicine or the selected article types. We then further categorized the published papers according to their methodological approach, namely, visualization, seasonality, correlations, forecasting, and modeling. Results All the examined papers comprised, by definition, time series analysis, and all but two included data visualization. A total of 23.1% (24/104) studies used Google Trends data for examining seasonality, while 39.4% (41/104) and 32.7% (34/104) of the studies used correlations and modeling, respectively. Only 8.7% (9/104) of the studies used Google Trends data for predictions and forecasting in health-related topics; therefore, it is evident that a gap exists in forecasting using Google Trends data. Conclusions The monitoring of online queries can provide insight into human behavior, as this field is significantly and continuously growing and will be proven more than valuable in the future for assessing behavioral changes and providing ground for research using data that could not have been accessed otherwise.
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Affiliation(s)
- Amaryllis Mavragani
- Department of Computing Science and Mathematics, University of Stirling, Stirling, Scotland, United Kingdom
| | - Gabriela Ochoa
- Department of Computing Science and Mathematics, University of Stirling, Stirling, Scotland, United Kingdom
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Shlykov MA, Ghani KR. EDITORIAL COMMENT. Urology 2018; 121:78. [DOI: 10.1016/j.urology.2018.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/19/2018] [Accepted: 05/08/2018] [Indexed: 12/01/2022]
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Park HA, Jung H, On J, Park SK, Kang H. Digital Epidemiology: Use of Digital Data Collected for Non-epidemiological Purposes in Epidemiological Studies. Healthc Inform Res 2018; 24:253-262. [PMID: 30443413 PMCID: PMC6230537 DOI: 10.4258/hir.2018.24.4.253] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 02/03/2023] Open
Abstract
Objectives We reviewed digital epidemiological studies to characterize how researchers are using digital data by topic domain, study purpose, data source, and analytic method. Methods We reviewed research articles published within the last decade that used digital data to answer epidemiological research questions. Data were abstracted from these articles using a data collection tool that we developed. Finally, we summarized the characteristics of the digital epidemiological studies. Results We identified six main topic domains: infectious diseases (58.7%), non-communicable diseases (29.4%), mental health and substance use (8.3%), general population behavior (4.6%), environmental, dietary, and lifestyle (4.6%), and vital status (0.9%). We identified four categories for the study purpose: description (22.9%), exploration (34.9%), explanation (27.5%), and prediction and control (14.7%). We identified eight categories for the data sources: web search query (52.3%), social media posts (31.2%), web portal posts (11.9%), webpage access logs (7.3%), images (7.3%), mobile phone network data (1.8%), global positioning system data (1.8%), and others (2.8%). Of these, 50.5% used correlation analyses, 41.3% regression analyses, 25.6% machine learning, and 19.3% descriptive analyses. Conclusions Digital data collected for non-epidemiological purposes are being used to study health phenomena in a variety of topic domains. Digital epidemiology requires access to large datasets and advanced analytics. Ensuring open access is clearly at odds with the desire to have as little personal data as possible in these large datasets to protect privacy. Establishment of data cooperatives with restricted access may be a solution to this dilemma.
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Affiliation(s)
- Hyeoun-Ae Park
- College of Nursing, Seoul National University, Seoul, Korea
| | - Hyesil Jung
- College of Nursing, Seoul National University, Seoul, Korea
| | - Jeongah On
- College of Nursing, Seoul National University, Seoul, Korea
| | - Seul Ki Park
- College of Nursing, Seoul National University, Seoul, Korea
| | - Hannah Kang
- College of Nursing, Seoul National University, Seoul, Korea
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Google searches do not correlate with melanoma incidence in majority English speaking countries. NPJ Digit Med 2018; 1:44. [PMID: 31304324 PMCID: PMC6550200 DOI: 10.1038/s41746-018-0050-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 11/21/2022] Open
Abstract
Recent reports have suggested that internet search behaviour may be a valuable tool to estimate melanoma incidence and mortality. Previous studies have used incorrect statistical methods, were focussed on the United States and/or did not use non-cancer control search terms to provide a context for interpreting the effects seen with the cancer-related terms. Using more robust statistical methods we found that no cancer search terms were significantly, or strongly correlated with melanoma incidence in 6 countries.
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