TikTok: a far-reaching opportunity for health professionals to address weight loss

OBJECTIVES

Recent behavioral research indicates that social media may be successfully integrated into weight loss interventions to mitigate the obesity epidemic that has been linked with type two diabetes, cardiovascular diseases, cancers, as well as poor psychological health. This study aimed to examine the content and characteristics of 100 most trending TikTok videos related to weight loss.

STUDY DESIGN

This was a cross-sectional, descriptive study.

METHODS

Videos were analyzed for source, predominant theme, and inclusion of specific content. Independent two-tailed t-tests assessed the effect of content on number of comments, likes, and forwards garnered by the videos.

RESULTS

More than 90% of the videos were consumer generated, indicating a missed opportunity by health professionals to use social media to provide accurate information regarding weight loss. Less than one-fifth of the videos were informational but significantly influenced the number of comments (P < .001) and likes (P = .002). Videos mentioning benefits ((P < .001) and speed of weight loss (P = .003) significantly influenced the number of forwards, whereas those that mentioned recipes (P = .005) and how to lose weight (P = .003) significantly affected the number of comments.

CONCLUSION

The results underscore the need for further research to elucidate the effectiveness of social media in impacting weight loss, as well as how they may supplement traditional health promotion and behavior interventions for weight loss.

Readability analysis of online health information on preexposure prophylaxis (PrEP)

OBJECTIVES

When considering PreExposure Prophylaxis (PrEP) as a HIV prevention method, many rely on information available online. Limited research has examined the quality, including readability, of PrEP information on the Internet. The current study evaluates the readability of PrEP information online employing six commonly used readability tests.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Using the Google Chrome browser, a search for articles was conducted using two terms: "pre-exposure prophylaxis" and "Truvada." The URLs of the first 50 English language websites for each term were recorded to create the overall study sample of 100 unique websites. Using six established readability scales, we determined the readability scores for each examined website. Websites were stratified by .com, .org, and .gov URL extensions to compare readability metrics.

RESULTS

Mean Flesch-Kincaid Grade Level (FKGL) was 9.5 (SD = 2.2), mean Gunning Fog Index (GFI) was 11.1 (SD = 2.7), mean Coleman-Liau Index (CLI) was 11.3 (SD = 2.0), while mean Simple Measure of Gobbledygook (SMOG) Grade Level was 12.1 (SD = 1.8). Using Flesch-Kincaid Reading Ease (FRE), one article was found easy to read, while 23 were found of average difficulty to read. Mean New Dale-Chall (NDS) score was 7.3 (SD = 1.3), or grade 9-10. Mean reading levels were significantly different among the commercial, organization, and government sites, however, no category was at the recommended sixth-grade level.

CONCLUSIONS

PrEP information online surpasses the reading ability of most U.S. adults. Improving the readability of PrEP information online may help to increase uptake of PrEP among populations at risk for HIV.

Violence depicted in advertisements on LinkNYC kiosks in Manhattan, New York City

Violence has a profound negative impact on the lives of youth. Exposure to violence may be a precursor to violence later in life. The purpose of this study was two-fold: (1) to estimate the prevalence of violence depicted in advertisements on LinkNYC kiosks in Manhattan, NYC, and (2) to determine if violent advertising varied based on the median annual income of the zip code in which the kiosk was located. This cross-sectional study involved observations of advertisements on 100 LinkNYC kiosks that were selected randomly from 500 that were listed in Manhattan, NYC. The frequency and type of violent depictions were recorded. The kiosks were grouped into quartiles of median annual income (1) $40,782 and below (2) $40,783 to $86,801 (3) $86,802 to $105,500 and (4) $105,501 and above. Of the 2025 total advertisements observed, including duplicates, a total of 190 (9.4%) included violent content. These 190 advertisements were observed on 68 of the 100 kiosks and included 339 depictions of violence. The overwhelming majority (n = 136; 71.6%) of violent depictions were for movies. There were significant differences in the frequency of violent content based on income quartiles, χ² (3, n = 190) = 19.00, p < 0.001. The highest two income quartiles had fewer violent advertisements than would be expected and the lowest quartile had more violent advertisements than expected. Symbols of violence were the most frequent type of violence portrayed observed in 85% of the violent advertisements observed (n = 161). Weapons, crime and fighting were observed in 5-11% of the advertisements. Our study suggests that greater alignment between the city's aims to improve community health and reduce health disparities and advertising policies on LinkNYC warrants consideration.

Readability of online material related to skin cancer

OBJECTIVES

The key to reducing mortality from skin cancer depends on early detection and treatment, which, in many cases, means a patient should be informed and possess the self-efficacy necessary to seek expert opinion. The purpose of this study was to determine the readability of skin cancer materials on the Internet using the commonly used readability tests.

STUDY DESIGN

This is a cross-sectional study.

METHODS

A search was conducted using the key words 'skin cancer.' The first 15 pages of websites that contained English language articles on skin cancer comprised the sample for this study. All English language articles appearing on these websites were analyzed using the Readable.io service to automate popular readability scores. For each article, it was determined if it was generated from a .org, .com, .gov, .net, .edu or other source. Five readability tests were conducted on the materials to determine the ease with which one can read each article.

RESULTS

Of the 102 websites sampled, none received an acceptable score on all five assessments. In fact, more than 90% of the websites sampled received an unacceptable score on any one of the five assessments, and more than 78% of the websites sampled received an unacceptable level on all five assessments. All five readability assessments demonstrated statistically significant results; each P-value obtained from the t-tests was substantially below 0.01 and, hence, below the α = 0.05 threshold. These results indicate that it is unlikely that skin cancer websites are being written at the recommended level. Of the websites sampled, roughly 42% were .com, and slightly more than 36% were .org. Statistical evidence indicated that neither .com nor .org websites are likely to be written at the acceptable level.

CONCLUSIONS

Both for-profit and non-profit agencies which aim to provide health information to consumers should be mindful of the readability levels of the materials they disperse.

Missed opportunities: Do states require screening of children for health conditions that interfere with learning?

METHODS

Investigators reviewed websites of state departments of health and education, and legislation for all 50 states and DC. For states with mandated screenings and a required form, investigators applied structured analysis to assess HBL inclusion.

RESULTS

No state mandated that schools require screening for all 7 HBLs. Less than half (49%) required comprehensive school health examinations and only 12 states plus DC required a specific form. Of these, 12 of the forms required documentation of vision screening, 11 of hearing screening, and 12 of dental screening. Ten forms asked about asthma and 9 required documentation of lead testing. Seven asked about general well-being, emotional problems, or mental health. None addressed hunger. When including states without comprehensive school health examination requirements, the most commonly required HBL screenings were for vision (80% of states; includes DC), hearing (75% of states; includes DC) and dental (24% of state; includes DC).

CONCLUSION

The lack of state mandated requirements for regular student health screening represents a missed opportunity to identify children with HBLs. Without state mandates, accompanying comprehensive forms, and protocols, children continue to be at risk of untreated health conditions that can undermine their success in school.

TMJ online: Investigating temporomandibular disorders as "TMJ" on YouTube

As the understanding of temporomandibular disorders' (TMDs) aetiologies and treatments develops from non-evidence-based to evidence-based approaches, the availability of sound information will likewise grow and need to be disseminated. The purpose of this study is to describe the content most commonly viewed in YouTube videos related to TMDs or "TMJ" and see whether videos from different sources have different content. Video information was gathered by searching YouTube for the term "TMJ," and data were recorded related to descriptive information as well as content. Statistical analyses included Kruskal-Wallis H Test, Spearman's Rho and univariate logistic regression. The sources of upload were Consumer (n = 62), Professional (n = 29) and News (n = 9). There were almost no statistically significant differences in content distribution among video sources. Videos garnered a total of 4 749 360 views, with an overall median of 7014.5 views. About two-thirds of the videos (68/100) explained what "TMJ" is, with a surprising third of Professional videos (9/29) not covering the subject. Roughly half of the videos mentioned at least one reason "TMJ" occurs (55/100), and seven in ten mentioned some kind of treatment (70/100). Video names mentioned a cure or treatment in 64 cases, while the other 36 referred to TMJ anatomy or "TMJ" aetiology. Future research should focus on ways to popularise professional videos with reliable information for those who are searching on YouTube for advice related to "TMJ."

What do popular YouTubeTM videos say about vaccines?

BACKGROUND

The unregulated social network YouTube ^TM has become an increasingly popular source of information on health topics such as vaccine safety. With a reach of over one billion users per month, the potential for misinformation is significant.

METHODS

Using the keywords 'vaccine safety' and 'vaccines and children', 87 of the most widely viewed YouTube^TM videos were identified and analyzed for content, author status and view count.

RESULTS

The range of view counts was 25 532 to 6 229 835, with a median of 62 075 views per video. Most videos (n = 74, 85.1%) were devoted exclusively to the topic of vaccination. The three most common sources of these YouTube^TM videos were consumers (27.6%), TV-based or Internet-based news (26.4%) and individual health professionals (25.3%). Top topics covered were autism causality (47.1% of videos), undisclosed or poorly understood risks (42.5%), adverse reactions (40.2%) and thimerosol or mercury in vaccines (36.8%). The majority of videos (65.5%) discouraged the use of vaccines.

CONCLUSION

Health professionals should be aware of the widely disseminated vaccination information available on the Internet and should appreciate its possible effect on the public.

Widely Viewed English Language YouTube Videos Relating to Diabetic Retinopathy: A Cross-Sectional Study

Background

An emergent source of information on health issues is the Internet. One such platform with 1 billion users is YouTube, the global video-sharing service.

Objective

The purpose of this study was to describe the content and characteristics of the most widely viewed YouTube videos related to diabetic retinopathy.

Methods

Videos were sorted according to number of views using the key words “diabetic retinopathy.” For each video, general descriptive information was collected. This information included date and source of upload (news, professional, or consumer), length, and total number of views as of July 18, 2016. Content categories were largely informed by a National Eye Institute fact sheet. Each video was viewed to determine which, if any, of the given content categories were present.

Results

Of the 98 most widely viewed videos related to diabetic retinopathy, 42 were generated by consumers, 40 were generated by professionals, and 16 were generated from news-based sources. The largest number of views were generated from professionals (624,770/994,494, 63.82%). Compared with professional videos, consumer videos were viewed less frequently (W=622, P=.04). The main purpose of the majority of videos was to provide information (59/98, 60%), and most of the videos showed or mentioned retinopathy in general (75/98, 77%). Smaller numbers offered information about specific types of retinopathy, namely proliferative (26/98, 27%) and nonproliferative (17/98, 17%). Compared with consumer-generated videos, professional videos were 5.57 times more likely to mention that diabetic retinopathy can go unnoticed (95% CI 1.59-26.15). More than 80% (80/98) of the most widely viewed videos did not address the asymptomatic nature of the disease, only about one-third (33/98) mentioned prevention, and only 58 of the 98 videos (59%) mentioned screening.

Conclusion

Future research is needed to identify aspects of YouTube videos that attract viewer attention and best practices for using this medium to increase diabetic retinopathy screening among people with diabetes.

An Analysis of Electronic Cigarette and Cigarette Advertising in US Women's Magazines

Background:

Traditional cigarette advertising has existed in the US for over 200 years. Studies suggest that advertising has an impact on the initiation and maintenance of smoking behaviors. In recent years, electronic cigarettes (e-cigarettes) emerged on the market as an alternative to the traditional tobacco cigarette. The purpose of this study was to describe advertisements in popular US magazines marketed to women for cigarettes and e-cigarettes.

Methods:

This study involved analyzing 99 issues of 14 popular US magazines marketed to women.

Results:

Compared to advertisements for traditional cigarettes, advertisements for e-cigarettes were more often found in magazines geared toward the 31–40-year-old audience (76.5% vs. 53.1%, P = 0.011) whereas traditional cigarette advertisements were nearly equally distributed among women 31–40 and ≥40 years. More than three-quarters of the e-cigarette advertisements presented in magazines aimed at the higher median income households compared to a balanced distribution by income for traditional cigarettes (P = 0.033).

Conclusions:

Future studies should focus on specific marketing tactics used to promote e-cigarette use as this product increases in popularity, especially among young women smokers.

An analysis of sodium, total fat and saturated fat contents of packaged food products advertised in Bronx-based supermarket circulars

Americans' consumption of sodium, fat, and saturated fat exceed federally recommended limits for these nutrients and has been identified as a preventable leading cause of hypertension and cardiovascular disease. More than 40% of the Bronx population comprises African-Americans, who have increased risk and earlier onset of hypertension and are also genetically predisposed to salt-sensitive hypertension. This study analyzed nutrition information for packaged foods advertised in Bronx-based supermarket circulars. Federally recommended limits for sodium, saturated fat and total fat contents were used to identify foods that were high in these nutrients. The proportion of these products with respect to the total number of packaged foods was calculated. More than a third (35%) and almost a quarter (24%) of the 898 advertised packaged foods were high in saturated fat and sodium respectively. Such foods predominantly included processed meat and fish products, fast foods, meals, entrees and side dishes. Dairy and egg products were the greatest contributors of high saturated fat. Pork and beef products, fast foods, meals, entrees and side dishes had the highest median values for sodium, total fat and saturated fat content. The high proportion of packaged foods that are high in sodium and/or saturated fat promoted through supermarket circulars highlights the need for nutrition education among consumers as well as collaborative public health measures by the food industry, community and government agencies to reduce the amounts of sodium and saturated fat in these products and limit the promotion of foods that are high in these nutrients.

An examination of marketing techniques used to promote children's vitamins in parenting magazines

More than a third of children and adolescents in the United States take vitamins even though professional medical organizations do not endorse their use in healthy children. Regardless of their efficacy, children's vitamin products are aggressively promoted. Therefore, the goal of this study was to describe and analyze advertisements related to vitamins in the following three popular parenting magazines, Parents, Parenting Early Years, and Parenting School Years. A total of 135 magazines across four years were reviewed.  There were 207 advertisements for children's vitamins, all in the form of chewy or gummy.  None of these advertisements included a dosage or a warning.  Almost all (92.3%) included a cartoon in the advertisement.  Almost a quarter (23.2%) of the advertisements promoted their product with the theme of prevention and more than half (51.2%) included the theme of peace of mind.  Parenting magazines are a popular medium for providing exposure to products geared towards children.  Companies that market children's vitamins in these magazines can increase awareness among parents of the risks by providing warning and dosage information in their advertisements.  Magazines can also play a role by encouraging responsible marketing and providing editorial content on children's vitamins and potential consequences of pediatric overdose.

Marketing strategies and warning labels on children's toothpaste

The overconsumption of toothpaste has negative consequences, particularly for children. This study's objectives were to describe misleading marketing strategies used in selling children's fluoridated toothpaste and identify warning label characteristics. Two researchers independently coded the packaging from 26 over-the-counter toothpastes that are specifically marketed for children. Aggressive marketing strategies targeting children were identified: every toothpaste in this sample displayed at least 1 children's animated character, 50% had at least 1 picture of a food item, 92.3% stated they were flavored and 26.9% depicted a full swirl of toothpaste, directly contradicting dentist recommendations for young children. Further, on most toothpaste tubes, warnings regarding fluoride overconsumption for young children were only listed on the back and in very small font. Misleading marketing strategies are regularly used in selling children's toothpaste as if it is a food product, while warnings regarding overconsumption among youth are minimized. Dental hygienists are in an important position to help parents of young children implement safe oral care practices.

Analysis of YouTube™ videos related to bowel preparation for colonoscopy

AIM: To examine YouTube™ videos about bowel preparation procedure to better understand the quality of this information on the Internet.

METHODS: YouTube™ videos related to colonoscopy preparation were identified during the winter of 2014; only those with ≥ 5000 views were selected for analysis (n = 280). Creator of the video, length, date posted, whether the video was based upon personal experience, and theme was recorded. Bivariate analysis was conducted to examine differences between consumers vs healthcare professionals-created videos.

RESULTS: Most videos were based on personal experience. Half were created by consumers and 34% were ≥ 4.5 min long. Healthcare professional videos were viewed more often (> 19400, 59.4% vs 40.8%, P = 0.037, for healthcare professional and consumer, respectively) and more often focused on the purgative type and completing the preparation. Consumer videos received more comments (> 10 comments, 62.2% vs 42.7%, P = 0.001) and more often emphasized the palatability of the purgative, disgust, and hunger during the procedure. Content of colonoscopy bowel preparation YouTube™ videos is influenced by who creates the video and may affect views on colon cancer screening.

CONCLUSION: The impact of perspectives on the quality of health-related information found on the Internet requires further examination.

A comparative study of the sodium content and calories from sugar in toddler foods sold in low- and high-income New York City supermarkets

Information from the nutrition facts labels of toddler foods marketed in low- and high-income New York City zip codes were analyzed for sodium content, the proportion of sugar-derived calories, and presence of sugar and/or high-fructose corn syrup as an added sweetener in the list of ingredients. Among the 272 toddler foods analyzed, more than a quarter were high in sodium, over one-third derived at least 20% their calories from sugar, and more than 41% of the foods had sugar and/or high-fructose corn syrup listed among the first five ingredients. The proportion of foods with such nutritional characteristics did not significantly differ between the low- and high-income neighborhood supermarkets. Median sodium content was highest among “side dishes” and “meals.” The proportion of calories derived from sugar was found to be highest among “snacks and yogurt blends” in both low- and high-income neighborhoods and “breakfast foods and cereals” in low-income neighborhoods. When compared to high-income neighborhoods, more than three times the proportion of total calories in “breakfast foods and cereals” sold in low-income neighborhoods were derived from sugar. Since taste preferences established during childhood can have long-lasting influence on dietary habits, it is imperative to limit the promotion of toddler foods that are high in sodium and sugar as well as educate parents to make nutritionally sound decisions at the point of purchase.

Skin cancer prevention coverage in popular US women's health and fitness magazines: an analysis of advertisements and articles

The desire to be tan is a phenomenon that public health researchers have investigated, as exposure to UV radiation increases the chances of developing skin cancer. Media messages in women’s magazines have been shown to contribute to this problem. Much less is known about the prevalence of skin cancer prevention messages in these magazines. This study’s aim was to identify the number and type of articles and advertised products devoted to skin health (sun protection and skin cancer prevention in particular) within five popular U.S. greater than women’s health and fitness magazines. We analyzed articles and advertisements over seven months of issues of the following popular women’s health and fitness magazines: Fitness, Health, Self, Shape, and Women’s Health, March 2013 through September 2013. Overall, 31 issues of the five magazines with a total of 780 articles and 1,986 advertisements were analyzed. Of the 780 articles, a mere 2.9% (n=23) were devoted to skin. Of the 258 skin product advertisements, less than 20% of the products contained sun protection factor (SPF). These findings suggest that women’s health and fitness magazines can improve their efforts in informing women of skin cancer risks and preventive measures to minimize these risks. The role of these magazines in building health literacy among their readers is also discussed.

Food advertisements in two popular U.S. parenting magazines: results of a five-year analysis

Obesity rates among American youth have prompted an examination of food advertisements geared towards children. Research indicates children’s high exposure to these advertisements and their influence on food preferences. Less is known about the presence of these advertisements in parenting magazines. This study’s objective was to examine prevalence of food advertisements in popular parenting magazines and identify products by USDA food category. We analyzed 116 issues of two popular U.S. parenting magazines across five years. All food and beverage advertisements for USDA Food Category were coded. Breakfast cereals were coded for nutritional quality. The coding took place at varied libraries in New Jersey, in the United States. A total of 19,879 food and beverage products were analyzed. One-third of advertisements (32.5%) were for baked goods, snacks, and sweets -- products generally low in nutrient density. Two-thirds of the breakfast cereals were low in nutritional quality (64.6%). Beverages comprised 11% of the advertisements, fruit juices the highest proportion. Less than 3% of advertisements were for fruits and vegetables combined. No significant food product trends were evident across the five-year period. Food advertisements identified in parenting magazines were generally low in nutritional value. Additional research is necessary to determine the influence of food advertisements on parents’ purchasing habits.

Price, promotion, and availability of nutrition information: a descriptive study of a popular fast food chain in New York City

Legislation in NYC requires chain restaurants to post calorie information on menu boards in an effort to help consumers make more informed decisions about food and beverage items they are purchasing. While this is a step in the right direction in light of the current obesity epidemic, there are other issues that warrant attention in a fast food setting, namely the pricing of healthy food options, promotional strategies, and access to comprehensive nutrition information. This study focused on a popular fast-food chain in NYC. The study’s aims were threefold: (1) to determine the cost differential between the healthiest meal item on the chain’s general menu and meal items available specifically on a reduced cost menu for one dollar (US$1.00); (2) to identify and describe the promotions advertised in the windows of these restaurants, as well as the nutrition content of promoted items; and (3) to ascertain availability of comprehensive nutrition information to consumers within the restaurants. We found the healthiest meal item to be significantly higher in price than less nutritious meal items available for $1.00 (t = 146.9, p < .001), with the mean cost differential equal to $4.33 (95% CI $4.27, $4.39). Window promotions generally advertised less healthful menu items, which may aid in priming customers to purchase these versus more healthful options. Comprehensive nutrition information beyond calorie counts was not readily accessible prior to purchasing. In addition to improving access to comprehensive nutrition information, advertising more of and lowering the prices of nutritious options may encourage consumers to purchase healthier foods in a fast food setting. Additional research in this area is needed in other geographic locations and restaurant chains.

Improving understanding about tanning behaviors in college students: a pilot study

OBJECTIVE

Melanoma is the second most common cancer diagnosed among 15- to 29-year-olds. This pilot study assessed behaviors, barriers, and beliefs relevant to sun exposure and protective behaviors.

PARTICIPANTS

The sample comprised 153 undergraduate students at a large state university in western New York.

METHODS

Participants completed an online survey about sun safety habits, barriers to using sunblock, and beliefs about tanning and sun exposure.

RESULTS

Response rate was 90.8% (n = 139). Most students (87.8%) reportedly spent ≥ 3 hours per day outside in the summer, but only 17.3% reported always using sunblock during this time. Sixty percent reported recent indoor tanning and 41% reported more than 10 lifetime sunburns. The greatest barrier to using sunblock was forgetting (84.2%).

CONCLUSIONS

Demographics coupled with inconsistent and low levels of sunblock use, high annual prevalence of indoor tanning, and multiple lifetime sunburns indicate that this sample is at high risk for skin cancer.