Social Media and Health Promotion

Effects of a Social Media Intervention on Vaping Intentions: Randomized Dose-Response Experiment

BACKGROUND

e-Cigarette use, especially by young adults, is at unacceptably high levels and represents a public health risk factor. Digital media are increasingly being used to deliver antivaping campaigns, but little is known about their effectiveness or the dose-response effects of content delivery.

OBJECTIVE

The objectives of this study were to evaluate (1) the effectiveness of a 60-day antivaping social media intervention in changing vaping use intentions and beliefs related to the stimulus content and (2) the dose-response effects of varying levels of exposure to the intervention on vaping outcomes, including anti-industry beliefs, vaping intentions, and other attitudes and beliefs related to vaping.

METHODS

Participants were adults aged 18 to 24 years in the United States. They were recruited into the study through Facebook (Meta Platforms) and Instagram (Meta Platforms), completed a baseline survey, and then randomized to 1 of the 5 conditions: 0 (control), 4, 8, 16, and 32 exposures over a 15-day period between each survey wave. Follow-up data were collected 30 and 60 days after randomization. We conducted stratified analyses of the full sample and in subsamples defined by the baseline vaping status (never, former, and current). Stimulus was delivered through Facebook and Instagram in four 15-second social media videos focused on anti-industry beliefs about vaping. The main outcome measures reported in this study were self-reported exposure to social media intervention content, attitudes and beliefs about vaping, and vaping intentions. We estimated a series of multivariate linear regressions in Stata 17 (StataCorp). To capture the dose-response effect, we assigned each study arm a numerical value corresponding to the number of advertisements (exposures) delivered to participants in each arm and used this number as our focal independent variable. In each model, the predictor was the treatment arm to which each participant was assigned.

RESULTS

The baseline sample consisted of 1491 participants, and the final analysis sample consisted of 57.28% (854/1491) of the participants retained at the 60-day follow-up. We compared the retained participants with those lost to follow-up and found no statistically significant differences across demographic variables. We found a significant effect of the social media treatment on vaping intentions (β=-0.138, 95% CI -0.266 to -0.010; P=.04) and anti-industry beliefs (β=-0.122, 95% CI 0.008-0.237; P=.04) targeted by the intervention content among current vapers but not among the full sample or other strata. We found no significant effects of self-reported exposure to the stimulus.

CONCLUSIONS

Social media interventions are a promising approach to preventing vaping among young adults. More research is needed on how to optimize the dosage of such interventions and the extent to which long-term exposure may affect vaping use over time.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04867668; https://clinicaltrials.gov/study/NCT04867668.

Discussing health while seeking community: A descriptive study of celiac disease on TikTok

Background: For individuals suffering from chronic disease, more than being an information source for health information, social media serves as a dynamic forum for shared goals, emotional and practical support through the sharing of lived experiences. Aim: This study envisaged a content analysis of the 100 most widely-viewed English language videos related to celiac disease posted on TikTok. Methods: TikTok was searched using the hashtag #celiacdisease. This search term was chosen as it represented the broadest summation of the desired topic with the most views (80 million) of any related hashtag. The first 100 English language videos were selected. The video content was analyzed against predetermined descriptive categories, deductively derived content related to facts about celiac disease from a reliable source, and inductive content categories derived during the coding process. Results: The 100 videos included in this study received a total of 44,056,600 likes. The average number of likes across all videos was 440,566 with a standard deviation of 656,642.06. Two of the three categories were present in a majority (>50) of the videos. They were practical information on diet therapy management (n = 63) and challenges in managing celiac disease (n = 73). In both instances, videos featuring this content also garnered a majority of the likes, 74.18% and 82.9% respectively. Independent one-tailed t-tests (α = .05) returned significant results for the diagnosis-related information (p = .0390) and practical information in diet therapy management (p = .0358) categories. On average, videos that included diagnosis-related information received more likes than those that did not: 672,983.33 vs. 340,958.57. Similarly, the average number of likes was significantly higher for videos that included practical information on diet therapy management (518,715.87) vs. those that did not (307,500). Conclusions: This study further confirms the growing trend of people using social media to discuss health issues in a way that is free and easily accessible among communities with shared experiences. The long-term effects of using personal narratives as credible sources of behavioral change for health, medical, or professional resources can be further investigated.

"The potential of social media in health promotion beyond creating awareness: an integrative review"

BACKGROUND

Developing strategies to change health behaviour is one of the biggest challenges of health promotion programs. Social media, as a popular and innovative communication and education tool, offers opportunities to modify health behaviour. While literature on using social media for health promotion campaigns is growing, there is a need to evaluate the approaches used to change health behaviour, rather than only creating awareness.

OBJECTIVE

The paper reviewed the literature on application of social media in health promotion campaigns with a particular focus on the methodologies used in assessing the outcome of the programs for behaviour change. This fills the void in collating evidence to extend health promotion campaigns to effect sustainable behavioural change.

METHOD

Peer-reviewed articles were identified through multiple science databases. A systematic electronic search was conducted to retrieve review and original papers published between January 2010 and April 2022. The titles and abstracts of the articles were screened according to inclusion and exclusion criteria. All authors independently read the full texts and discussed them to reach a consensus about the themes. Concept mapping was used to present results from analysis of the included papers.

RESULTS

Of the 674 citations, 28 (4.1%) studies were included in this review. The methodology approaches of 18 (2.7%) papers, that aimed to evaluate the impact of social media in health promotion campaigns towards behaviour change, were analysed further using concept mapping. The results showed that 10 studies (55.5%) adopted quantitative methods and five studies (27.7%) used mixed methods and three studies (16.6%) used qualitative methods. Facebook and YouTube were used more for intervention purposes to change health behaviour. Twitter and Instagram were used more to observe the trend of changes in health behaviour. Six studies (33.3%) adopted Social Cognitive Theory and one study (5.5%) applied the Transtheoretical Model as the framework to evaluate the outcome. Overall, the results show that though social media has potential in promoting behaviour change, the estimation of this change in long-term lies outside the scope of social media health campaigns. This is also reflected in the methodologies used in existing studies to assess such sustainable changes. The employed measures usually target immediate behaviour or social media engagement rather than addressing the change on a behavioural level.

CONCLUSION

Evaluating the performance of social media campaigns to promote health behaviours towards a sustainable outcome is a complex process. Emerging research is focused on evaluating the potential of social media as an opportunity to create awareness. Such measures require less effort in quantifying and isolating the effect. The design of the campaigns is required to be aligned in relation to stages of the behaviour change. The study provides suggestions on how this can be achieved.

Deep Learning for Identification of Alcohol-Related Content on Social Media (Reddit and Twitter): Exploratory Analysis of Alcohol-Related Outcomes

BACKGROUND

Many social media studies have explored the ability of thematic structures, such as hashtags and subreddits, to identify information related to a wide variety of mental health disorders. However, studies and models trained on specific themed communities are often difficult to apply to different social media platforms and related outcomes. A deep learning framework using thematic structures from Reddit and Twitter can have distinct advantages for studying alcohol abuse, particularly among the youth in the United States.

OBJECTIVE

This study proposes a new deep learning pipeline that uses thematic structures to identify alcohol-related content across different platforms. We apply our method on Twitter to determine the association of the prevalence of alcohol-related tweets with alcohol-related outcomes reported from the National Institute of Alcoholism and Alcohol Abuse, Centers for Disease Control Behavioral Risk Factor Surveillance System, county health rankings, and the National Industry Classification System.

METHODS

The Bidirectional Encoder Representations From Transformers neural network learned to classify 1,302,524 Reddit posts as either alcohol-related or control subreddits. The trained model identified 24 alcohol-related hashtags from an unlabeled data set of 843,769 random tweets. Querying alcohol-related hashtags identified 25,558,846 alcohol-related tweets, including 790,544 location-specific (geotagged) tweets. We calculated the correlation between the prevalence of alcohol-related tweets and alcohol-related outcomes, controlling for confounding effects of age, sex, income, education, and self-reported race, as recorded by the 2013-2018 American Community Survey.

RESULTS

Significant associations were observed: between alcohol-hashtagged tweets and alcohol consumption (P=.01) and heavy drinking (P=.005) but not binge drinking (P=.37), self-reported at the metropolitan-micropolitan statistical area level; between alcohol-hashtagged tweets and self-reported excessive drinking behavior (P=.03) but not motor vehicle fatalities involving alcohol (P=.21); between alcohol-hashtagged tweets and the number of breweries (P<.001), wineries (P<.001), and beer, wine, and liquor stores (P<.001) but not drinking places (P=.23), per capita at the US county and county-equivalent level; and between alcohol-hashtagged tweets and all gallons of ethanol consumed (P<.001), as well as ethanol consumed from wine (P<.001) and liquor (P=.01) sources but not beer (P=.63), at the US state level.

CONCLUSIONS

Here, we present a novel natural language processing pipeline developed using Reddit's alcohol-related subreddits that identify highly specific alcohol-related Twitter hashtags. The prevalence of identified hashtags contains interpretable information about alcohol consumption at both coarse (eg, US state) and fine-grained (eg, metropolitan-micropolitan statistical area level and county) geographical designations. This approach can expand research and deep learning interventions on alcohol abuse and other behavioral health outcomes.

Overview of Facebook Use by Hospitals in Italy: A Nationwide Survey during the COVID-19 Emergency

Background: Facebook is the most popular social network across the world and also allows users access to health information. Our study presents an overview of the official Facebook profiles of hospitals in Italy (n = 1351) and how much they are used. Methods: All hospitals were surveyed on the number of Facebook posts in May (post-lockdown) and October (second pandemic wave) 2020. The number of followers, the creation date of the official page, and the frequency of publication—that is, the average number of days between two subsequent posts—were determined. Results: In Italy, only 28% (n = 379) of the hospitals had official Facebook pages, of which 20.6% (n = 78) were public hospitals, and 79.4% (n = 301) were private hospitals. Of the hospitals with Facebook pages, 49.1% used them every week, and public hospitals published more often. Conclusions: Despite the differences between regions and types of management, the number of hospitals in Italy that use Facebook as a tool for the public dissemination of health information is still low. Hospitals should adopt an effective communication strategy using social networks to improve the quality of health care.

Health Literacy, Digital Health Literacy, and COVID-19 Pandemic Attitudes and Behaviors in U.S. College Students: Implications for Interventions

The COVID-19 pandemic has been accompanied by rapidly emerging evidence, changing guidance, and misinformation, which present new challenges for health literacy (HL) and digital health literacy (DHL) skills. This study explored whether COVID-19-related information access, attitudes, and behaviors were associated with health literacy and digital health literacy among college students in the United States. Self-reported measures of health literacy, along with items on pandemic-related attitudes, behaviors, information sources, and social networks, were collected online using a managed research panel. In July 2020, 256 responses were collected, which mirrored the racial/ethnic and gender diversity of U.S. colleges. Only 49% reported adequate HL, and 57% found DHL tasks easy overall. DHL did not vary by HL level. In multivariable models, both HL and DHL were independently associated with overall compliance with basic preventive practices. Higher DHL, but not HL, was significantly associated with greater willingness to get a COVID-19 vaccine and the belief that acquiring the disease would negatively impact their life. On average, respondents discussed health with 4-5 people, which did not vary by HL or DHL measures. The usage of online information sources varied by HL and DHL. The study findings can inform future student-focused interventions, including identifying the distinct roles of HL and DHL in pandemic information access, attitudes, and behaviors.

Investigating the Role of Customer Co-Creation Behavior on Social Media Platforms in Rendering Innovative Services

The emergence of social media platforms as the main representatives of Web 3.0 applications significantly impacts the co-creation activities among enterprises, customers, and other stakeholders, and has enabled firms to benefit from creativity and ideas of their users and customers for developing and rendering innovative services. This study aims to investigate how the co-creation activities of users on social media platforms have an effect on the enterprises’ innovative services. For this purpose, the authors surveyed customers of innovative services who used social media platforms to meet their needs from the enterprises that innovatively offer such services. An online questionnaire was designed and distributed among the sample of customers, and 505 completed questionnaires were analyzed following the PLS-SEM approach. The findings revealed that customer citizenship behavior and customer participation behavior on social media platforms positively affect the rendering of innovative services. Findings also highlighted that an increase in social co-creation activities, as moderator, positively affects customer citizenship behavior on service innovativeness, and negatively affects customer participation behavior on service innovativeness. The findings of this research could be useful for entrepreneurs and managers of the enterprises that offer innovative services to efficiently use social media tools to benefit from the customers’ co-creation activities and to perform more competitively and sustainably in a hostile business environment.