E-commerce licensing loopholes: a case study of online shopping for tobacco products following a statewide sales restriction on flavoured tobacco in California

INTRODUCTION

Retailer licensing programmes can be an effective method of enforcing tobacco control laws, but most programmes do not require e-commerce retailers to obtain licenses. California's implementation of a statewide flavour restriction (Senate Bill 793 (SB-793)) in December 2022 enforced through its tobacco retailer licensing programme presented an opportunity to assess whether the exclusion of e-commerce in the definition of 'tobacco retailer' might have resulted in a shift in consumer behaviour towards e-commerce.

METHODS

To examine the association between SB-793 implementation and online shopping for tobacco, we collected weekly Google search rates related to online shopping for cigarettes and vaping products in California from January 2018 to May 2023. We compared observed rates of shopping queries after SB-793 implementation to counterfactual expected rates and prediction intervals (PI) calculated from autoregressive iterative moving average models fit to historical trends. Content analysis was performed on the search results to identify websites marketing flavoured vaping products and menthol cigarettes.

RESULTS

The week SB-793 was implemented, shopping queries were 194.4% (95% PI 100.8% to 451.5%) and 161.7% (95% PI 81.7% to 367.5%) higher than expected for cigarettes and vapes, respectively. Cigarette shopping queries remained elevated significantly for 11 weeks and vape shopping queries for 6 weeks. All search results contained links to websites that offered flavoured vaping products or menthol cigarettes to Californian consumers.

DISCUSSION

These findings raise concerns about potential loopholes in policy enforcement created by the absence of explicit regulations on e-commerce sales in retailer licensing programmes. Strengthening regulations to include e-commerce and monitoring e-commerce compliance are recommended to enhance the impact of laws enforced through retailer licensing programmes.

Evaluating Artificial Intelligence Responses to Public Health Questions

This cross-sectional study analyzes the quality of ChatGPT responses to public health questions.

Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum

Importance

The rapid expansion of virtual health care has caused a surge in patient messages concomitant with more work and burnout among health care professionals. Artificial intelligence (AI) assistants could potentially aid in creating answers to patient questions by drafting responses that could be reviewed by clinicians.

Objective

To evaluate the ability of an AI chatbot assistant (ChatGPT), released in November 2022, to provide quality and empathetic responses to patient questions.

Design, Setting, and Participants

In this cross-sectional study, a public and nonidentifiable database of questions from a public social media forum (Reddit's r/AskDocs) was used to randomly draw 195 exchanges from October 2022 where a verified physician responded to a public question. Chatbot responses were generated by entering the original question into a fresh session (without prior questions having been asked in the session) on December 22 and 23, 2022. The original question along with anonymized and randomly ordered physician and chatbot responses were evaluated in triplicate by a team of licensed health care professionals. Evaluators chose "which response was better" and judged both "the quality of information provided" (very poor, poor, acceptable, good, or very good) and "the empathy or bedside manner provided" (not empathetic, slightly empathetic, moderately empathetic, empathetic, and very empathetic). Mean outcomes were ordered on a 1 to 5 scale and compared between chatbot and physicians.

Results

Of the 195 questions and responses, evaluators preferred chatbot responses to physician responses in 78.6% (95% CI, 75.0%-81.8%) of the 585 evaluations. Mean (IQR) physician responses were significantly shorter than chatbot responses (52 [17-62] words vs 211 [168-245] words; t = 25.4; P < .001). Chatbot responses were rated of significantly higher quality than physician responses (t = 13.3; P < .001). The proportion of responses rated as good or very good quality (≥ 4), for instance, was higher for chatbot than physicians (chatbot: 78.5%, 95% CI, 72.3%-84.1%; physicians: 22.1%, 95% CI, 16.4%-28.2%;). This amounted to 3.6 times higher prevalence of good or very good quality responses for the chatbot. Chatbot responses were also rated significantly more empathetic than physician responses (t = 18.9; P < .001). The proportion of responses rated empathetic or very empathetic (≥4) was higher for chatbot than for physicians (physicians: 4.6%, 95% CI, 2.1%-7.7%; chatbot: 45.1%, 95% CI, 38.5%-51.8%; physicians: 4.6%, 95% CI, 2.1%-7.7%). This amounted to 9.8 times higher prevalence of empathetic or very empathetic responses for the chatbot.

Conclusions

In this cross-sectional study, a chatbot generated quality and empathetic responses to patient questions posed in an online forum. Further exploration of this technology is warranted in clinical settings, such as using chatbot to draft responses that physicians could then edit. Randomized trials could assess further if using AI assistants might improve responses, lower clinician burnout, and improve patient outcomes.

Internet Searches for Abortion Medications Following the Leaked Supreme Court of the United States Draft Ruling

This cross-sectional study evaluates whether internet searches for abortion medications increased following the leak of a draft Supreme Court of the United States ruling that would overturn the 1973 Roe v Wade decision.

Suicide-Related Internet Searches During the Early Stages of the COVID-19 Pandemic in the US

This cross-sectional study assesses trends in suicide-related internet search rates in the early stages of the COVID-19 pandemic in the US.

Internet Searches for Acute Anxiety During the Early Stages of the COVID-19 Pandemic

This cross-sectional study analyzes internet search data to evaluate the association of COVID-19 with anxiety.

Quantifying Public Interest in Police Reforms by Mining Internet Search Data Following George Floyd's Death

BACKGROUND

The death of George Floyd while in police custody has resurfaced serious questions about police conduct that result in the deaths of unarmed persons.

OBJECTIVE

Data-driven strategies that identify and prioritize the public's needs may engender a public health response to improve policing. We assessed how internet searches indicative of interest in police reform changed after Mr Floyd's death.

METHODS

We monitored daily Google searches (per 10 million total searches) that included the terms "police" and "reform(s)" (eg, "reform the police," "best police reforms," etc) originating from the United States between January 1, 2010, through July 5, 2020. We also monitored searches containing the term "police" with "training," "union(s)," "militarization," or "immunity" as markers of interest in the corresponding reform topics.

RESULTS

The 41 days following Mr Floyd's death corresponded with the greatest number of police "reform(s)" searches ever recorded, with 1,350,000 total searches nationally. Searches increased significantly in all 50 states and Washington DC. By reform topic, nationally there were 1,220,000 total searches for "police" and "union(s)"; 820,000 for "training"; 360,000 for "immunity"; and 72,000 for "militarization." In terms of searches for all policy topics by state, 33 states searched the most for "training," 16 for "union(s)," and 2 for "immunity." States typically in the southeast had fewer queries related to any police reform topic than other states. States that had a greater percentage of votes for President Donald Trump during the 2016 election searched more often for police "union(s)" while states favoring Secretary Hillary Clinton searched more for police "training."

CONCLUSIONS

The United States is at a historical juncture, with record interest in topics related to police reform with variability in search terms across states. Policy makers can respond to searches by considering the policies their constituencies are searching for online, notably police training and unions. Public health leaders can respond by engaging in the subject of policing and advocating for evidence-based policy reforms.

Sling operation for recurrent stress incontinence using the tendon of the palmaris longus

A sling procedure is described for recurrent stress incontinence in women who had been previously treated, unsuccessfully, by one or more surgical interventions. The procedure consists of combining a vaginal Kelly urethral plication with a sling prosthesis, using the tendon of the palmaris longus. The former will correct the bladder neck funneling while the latter will restore its position to a high retropubic point, in a hammock suspended from Cooper's ligament. The palmaris longus is one of the superficial groups of flexors. Its advantages are in the tendon's availability, its location for accessibility, its relative ease of removal, and the fact that it is functionally nonessential. Six patients have been treated with this technique with excellent results after one to three years of follow-up.

Recurrent endometrial malakoplakia

The microscopic diagnosis of endometrial malakoplakia was made in a 69-year-old diabetic woman with metrorrhagia. Eight months later, her clinical symptoms returned. Repeat curettage confirmed the original diagnosis and established the case as the first example of recurrent endometrial malakoplakia.

Laparoscopy for the confirmation and prognostic evaluation of pelvic inflammatory disease

A presumptive diagnosis of pelvic inflammatory disease (PID) is usually made in our gynecologic clinics when obscure, acute lower abdominal pain is accompained by fever and abnormal vaginal discharge, urinary and rectal discomfort, marked tenderness of the pelvic organs to palpation, or pelvic masses. In the present study, during a 2-year period, 223 women underwent laparoscopy to confirm this diagnosis. PID was confirmed in 103 (46.2%) of the cases; other serious conditions were diagnosed in 69 (30.9%) of the cases; and no evidence of disease was found in 51 (22.9%) of the cases. The authors conclude that laparoscopy is a valuable tool in the diagnosis of PID.