Barriers and Facilitators of Colorectal Cancer Screening During the COVID-19 Pandemic

BACKGROUND

COVID-19 introduced new barriers to health care including cancer screenings. This study evaluated the role of pandemic- and copay-related barriers to colonoscopy and the extent to which home-based testing methods were utilized.

METHODS

A cross-sectional survey assessed colorectal cancer (CRC) attitudes and screening early in the COVID-19 pandemic.

RESULTS

Respondents (342; 50.37% female) were 62.32 (SD = 6.87) years old. Roughly half were White/Caucasian (329; 48.45%); 29.75% were Black/African American (202); and 21.80% were another race (148). Roughly two-thirds were up-to-date with CRC screening (459; 67.59%). In an adjusted model, those with a higher agreement that concerns about COVID-19 delayed scheduling their colonoscopy (OR = .79; 95% CI: .08, .63; P = .045) and concerns about copays delayed scheduling their colonoscopy (OR = .73; 95% CI: .73, .57; P = .02) were less likely to be up-to-date on screening. In another adjusted model, those screened during the pandemic were significantly more likely to be screened via an at-home test (OR = 10.93; 95% CI: 5.95, 20.27; P < .001).

DISCUSSION

During the COVID-19 pandemic, screening copay-related concerns persisted and were significantly higher among those not up-to-date with CRC screening. Increased at-home testing and addressing copay barriers may increase CRC screening adherence now and in future infectious disease outbreaks.

#EndtheSTIgma: An Exploratory Analysis of the 2019 HPV Awareness Day Conversation on Twitter & Instagram

The current study explores the risk communication conversations on Twitter and Instagram in the context of the 2019 HPV Awareness Day, through the theoretical lenses of the stigma associated with HPV, HPV-related cancer, and the HPV vaccine. Our findings reveal that: 1) self and enacted stigma are present in these social media conversations, via nonprofits and official ambassadors, and via regular people; 2) other categories related to stigma, which can be seen as reactions to stigma and appeals to better individuals and society (i.e. stopping stereotypes) also emerged in these conversations, via official and not official sources, pro and against vaccine discourses; and 3) the same categories emerged from the data via both platforms, but differences exist in terms of narratives and messaging. Practical implications are discussed.

Promotion of an Algorithm-Based Tool for Pregnancy Prevention by Instagram Influencers

Objective: Despite growing concerns that some digital algorithm-reliant fertility awareness-based methods of pregnancy prevention are marketed in an inaccurate, opaque, and potentially harmful manner online, there has been limited systematic examination of such marketing practices. This article therefore provides an empirical examination of how social media influencers have promoted the fertility tracking tool Daysy on Instagram. We investigate: (1) how the tool is framed in relation to pregnancy prevention using Health Belief Model (HBM) constructs, and (2) the promotional and disclosure practices adopted by influencers. Materials and Methods: We collected Instagram posts mentioning Daysy made between June 2018 and May 2022 using the tool CrowdTangle. Using a qualitative content analysis approach, we coded a random sample of 400 Daysy posts. This yielded 122 Instagram influencer posts promoting Daysy for pregnancy prevention that we coded for promotional content and HBM constructs. Results: Posts originated primarily from Europe (n = 62, 50.82%) and the United States (n = 37, 30.33%). Findings indicate that barriers to use (n = 18, 15.57%) and the severity of risks from unplanned pregnancy (n = 8, 6.56%) were rarely conveyed, whereas benefits of use (n = 122, 100%) and the severity of risks of hormonal contraception (n = 31, 25.41%) were covered more extensively. Only about one third of posts disclosed any formal relationship to the brand Daysy. Conclusions: With many posts emphasizing benefits and obscuring potential limitations, we argue that accurate and transparent information about the effectiveness and limitations of fertility tracking technologies is critical for supporting informed decision-making and, as such, should remain a public health priority.

Oh Baby! A Content Analysis of Contraception Pins on Pinterest

BACKGROUND

Social media platforms have become a popular source for health information despite concerns about the quality of content shared. We examined how oral contraceptive pills and intrauterine devices are framed on the platform Pinterest using the Health Belief Model (HBM), as well as how fertility awareness methods are portrayed as an alternative to hormonal contraception.

METHODS

We collected pins in February 2021 using searches for birth control, oral contraceptives, and intrauterine devices. After excluding paid ads and pins not relevant to contraceptive use, we conducted a content analysis of 404 pins using a coding framework grounded in the HBM. We carried out descriptive statistics for all variables in the final sample.

RESULTS

Following coding, we found that 54.7% of pins mentioned oral contraceptive pills, 41.58% mentioned intrauterine devices, and 11.63% mentioned fertility awareness methods. Fertility awareness pins had the highest percentage of benefits conveyed (70.21%), followed by intrauterine devices (44.05%), then oral contraceptive pills (38.91%). Pill pins had the highest percentage of barriers conveyed (52.94%) and fertility awareness had the least (25.53%). Side effects were the most mentioned barrier among pill (37.10%) and intrauterine device pins (23.21%). Very few pins were made by (2.48%) or originated with medical institutions (5.45%).

CONCLUSIONS

Oral contraceptive pills are often negatively framed on Pinterest, whereas intrauterine devices and fertility awareness methods are more positively framed. This suggests a need for clear communication from clinicians regarding all contraceptive options and their relative merits and risks.

Tweeting a Pandemic: Communicating #COVID19 Across the Globe

The COVID-19 pandemic brought about an urgent need for public health departments to clearly communicate their prevention, testing, and treatment recommendations. Previous research supports that Twitter is an important platform that public health departments use to communicate crisis information to stakeholders. This study aimed to shed light on how international health departments shared relevant information about COVID-19 on Twitter in 2020. We conducted a quantitative content analysis of N = 1,200 tweets from twelve countries, across six continents. COVID-19 prevention behaviors were consistently referenced far more than testing or treatment recommendations across countries. Disease severity and susceptibility were referenced more than recommendation benefits, barriers, and efficacy. Results provide support for how public health departments can better communicate recommendations related to COVID-19 behaviors. Based on these results, implications for public health organizations and public relations practitioners worldwide are discussed, and hands-on action guidelines are provided.

Pandemic coping and COVID-19 preventive behaviors among cancer survivors

BACKGROUND

Cancer survivors are at greater risk for COVID-19 complications, emphasizing the importance of adherence to COVID-19 prevention. Active coping mechanisms can help manage pandemic stress but disengaged coping practices can have adverse effects.

OBJECTIVES

1) Identify differences in COVID-19 coping styles and COVID-19 preventive behaviors among cancer survivors in active treatment, survivors not in treatment, and a comparison group without a cancer history. 2) Exploring variables that may predict adherence to COVID-19 preventative behaviors.

PATIENT INVOLVEMENT & METHODS

This study used an online survey among two categories of cancer survivors - one group in active treatment and one group no longer in treatment - and one group without a cancer history (N = 897 total).

RESULTS AND DISCUSSION

Cancer survivors in treatment were more likely to utilize both active and disengaged coping (p < .001). This could indicate that the additional COVID-19 strain is making survivors more likely to engage in coping in any way possible. Cancer survivors not in treatment were less likely to report intent to carry out COVID- 19 preventative behaviors compared to the comparison group (p = .009). Providers should understand how survivors may use both coping mechanism types because these coping strategies predict both depression and adherence to COVID-19 preventive behaviors.

Predicting and comparing COVID-19 risk perceptions across the Netherlands and Belgium: A cross-sectional survey among university students

People's risk perception of COVID-19 is an important predictor for adopting protective behavior. Although risk perceptions, and factors influencing these, may vary between countries, less attention has been paid to differences between adjacent regions from neighboring countries. In the midst of the first wave of the corona outbreak (March-April-May 2020), we measured risk perceptions as perceived threat (consisting of perceived severity and susceptibility) among university students (N = 668) in two connected countries: the Netherlands and Belgium. Theory-based predictor variables included experiential, efficacy-related, socio-cultural, cognitive, and demographic factors. While demographic variables and country were not significant predictors of perceived threat level, all other constructs were. Personal and indirect experiences with COVID-19, as well as higher scores on personal (self) efficacy to carry out recommended preventive behaviors were all associated with higher perceived threat. However, low collective efficacy and lower levels of trust in government were both also significantly associated with higher perceived threat, as was a low level of "lack of COVID-19 knowledge". These results hold implications for suitable risk communication strategies for increasing students' COVID-19 risk perceptions.

Reading, sharing, creating Pinterest recipes: Parental engagement and feeding behaviors

Pediatric overweight and obesity are associated with serious health concerns both during childhood and in adulthood. Visual social media platform Pinterest is often used to curate recipe content, but little is known about how, if at all, parents use the platform as a resource for meal planning for their families. This study focused on (1) describing how Pinterest using parents use the platform related to recipe searches and meal planning and (2) examining the association between parental feeding behaviors and frequency of Pinterest use related to recipes. Survey research firm Qualtrics was used to collect a nationwide sample of 659 Pinterest-using parents with children between ages 3-11 years of age. Data collection was initiated and completed in February of 2019. Measures included both parent and child demographics, Pinterest recipe use and engagement, and parental feeding practices using the Child Feeding Questionnaire (CFQ). Results showed that 26.9% of the respondents reported using Pinterest daily to read recipes, 17.9% to share recipes; 14.9% to comment on recipes on Pinterest; 10.3% reported creating and posting new recipes; and 13.8% mentioned making a recipe they find on Pinterest daily. Pinterest engagement was significantly negatively associated with parental age and with income insecurity, while positively associated with level of education. Hispanic participants showed higher levels of engagement as compared to White non-Hispanic participants. Among the CFQ subscales, Pressure and Perceived responsibility were significantly positively associated with Pinterest engagement while Monitoring and Restriction were not.

Mental health disorder symptom prevalence and rates of help-seeking among University-Enrolled, emerging adults

Objective. Examine mental health symptom prevalence and rates of campus services utilization among Black male, White male and Black female college students. Participants. 2500 students from an ongoing, student survey at a public university; launched in 2011. Methods. Measures included data for anxiety and depressive symptoms and utilization of campus health services (counseling center, health services, etc.). Descriptive analyses determined prevalence and utilization rates. Mann Whitney U tests compared prevalence. Chi-squared tests compared utilization rates. Results. Anxiety prevalence: greater than 60% of students from each ethnic group reported symptoms; reporting rates decreased significantly for Black men (49.6%); p < 0.001. Depression prevalence: greater than 80% reported symptoms; there were significant differences in reporting between Black men and Black women (72.7% vs. 87.1%, p < 0.001). Utilization: Black men utilized counseling services less than White men (20.4% vs. 37.8%, p = 0.024). Conclusion. Black men report depressive and anxiety symptoms but underutilize campus health resources.

Between Healthcare Practitioners and Clergy: Evangelicals and COVID-19 Vaccine Hesitancy

Evangelical Christians are among the most hesitant to get the COVID-19 vaccine. This study examined the extent to which COVID-19 vaccination uptake among Evangelicals is explained by demographic characteristics, Health Belief Model constructs, and faith-based support factors. Survey research firm Qualtrics recruited 531 U.S. adults and conducted a survey to explore predictors of COVID-19 vaccine uptake among people who self-identified as Evangelicals in September 2021. A logistic regression showed that those reporting high perceived benefits of the COVID-19 vaccine were more likely to be vaccinated, while those reporting high perceived barriers were less likely to be vaccinated. Those whose healthcare provider asked them about the vaccine were more likely to be vaccinated than those whose healthcare provider did not ask. Finally, while those who reported information seeking from religious leaders were less likely to be vaccinated, those who reported more faith-based support for vaccination were more likely to be vaccinated. In addition to beliefs about benefits and barriers to vaccination, the role of healthcare providers and clergy were important factors influencing vaccination status. Intervention efforts that capitalize on partnerships between health providers and clergy in supportive congregations may be able to reach undecided Evangelicals.

Examining Hashtag Use of #blackboyjoy and #theblackmancan and Related Content on Instagram: Descriptive Content Analysis

BACKGROUND

Social media is widely accessible and increasingly utilized. Social media users develop hashtags and visual, text-based imagery to challenge misrepresentations, garner social support, and discuss a variety of mental health issues. Understanding how Black men are represented on social media and are using social media may be an avenue for promoting their engagement with and uptake of digital mental health interventions.

OBJECTIVE

The aim of this study was to conduct a content analysis of posts containing visual and text-based components related to representations of Black men's race, gender, and behaviors.

METHODS

An exploratory, descriptive content analysis was conducted for 500 Instagram posts to examine characteristics, content, and public engagement of posts containing the hashtags #theblackmancan and #blackboyjoy. Posts were selected randomly and extracted from Instagram using a social network mining tool during Fall 2018 and Spring 2019. A codebook was developed, and all posts were analyzed by 2 independent coders. Analyses included frequency counts and descriptive analysis to determine content and characteristics of posts. Mann-Whitney U tests and Kruskal-Wallis H tests were conducted to assess engagement associated with posts via likes, comments, and video views.

RESULTS

Of the 500 posts extracted, most were image based (368/500, 73.6%), 272/500 (54.4%) were posted by an individual and 135/500 (27.0%) by a community organization, 269/500 (53.8%) were posted by individuals from Black populations, and 177/500 (35.4%) posts contained images of only males. Posts depicted images of Black men as fathers (100/500, 20.0%), Black men being celebrated (101/500, 20.2%), and Black men expressing joy (217/500, 43.4%). Posts (127/500, 25.4%) also depicted Black men in relation to gender atypical behavior, such as caring for children or styling their children's hair. Variables related to education and restrictive affection did not show up often in posts. Engagement via likes (median 1671, P<.001), comments (P<.001), and views (P<.001) for posts containing #theblackmancan was significantly higher compared with posts containing #blackboyjoy (median 140). Posts containing elements of celebrating Black men (P=.02) and gender atypical behavior (P<.001) also had significantly higher engagement.

CONCLUSIONS

This is one of the first studies to look at hashtag use of #blackboyjoy and #theblackmancan. Posts containing #blackboyjoy and #theblackmancan promoted positive user-generated visual and text-based content on Instagram and promoted positive interactions among Black and diverse communities. With the popularity of social media and hashtag use increasing, researchers and future interventional research should investigate the potential for such imagery to serve as culturally relevant design components for digital mental health prevention efforts geared towards Black men and the communities they exist and engage with.

Pinning Pink: Messages About Hereditary Breast Cancer Risk on Pinterest

Social media messages and conversations provide an opportunity to study what users post about cancer risk and preventive behaviors. Personal stories of early detection, treatment, and survivorship are often shared. The purpose of this study was to examine the hereditary breast cancer-focused posts on the understudied visual social media platform Pinterest. Using systematic random sampling, n = 500 Pinterest posts (referred to as "pins") were collected using the keywords "breast cancer" and "genetic testing" in the late 2017. Using a quantitative content analysis, pins were coded for a variety of categories including poster identity, pin characteristics and content, the presence of Health Belief Model constructs, and engagement variables (i.e., repins/saves and comments). The primary findings of this study reveal that most pins were published by individuals and relatively few messages contained specific information about genetic testing. Study results also describe how Pinterest users interact with the content, including higher engagement with information-rich visuals and traditional breast cancer awareness symbols. The information gained from this study may serve as the foundation for better understanding how social media can be used to communicate with women about heritable breast health-related cancers, risks, and protective behaviors. Study results prompt practical recommendations for public health organizations interested in reaching women seeking information about heritable breast cancer on Pinterest.

State Health Department Communication about Long COVID in the United States on Facebook: Risks, Prevention, and Support

Greater public awareness of long COVID severity and susceptibility is needed to support those with long COVID and encourage preventive behaviors. It is not yet known to what extent health departments have informed the public about long COVID risks or offered guidance and support for those with long COVID. The objective of this research was to determine how and to what extent US state health departments have communicated with the public about long COVID via Facebook. Facebook posts with COVID-19 and long COVID terms made by 50 US state health departments plus Washington, DC, from 1 January 2020 to 31 January 2022, were collected using CrowdTangle. The first long COVID post appeared on 15 July 2020. From 15 July 2020 to 31 January 2022, state health departments made 49,310 COVID-19 posts and 137 long COVID posts. Using quantitative content analysis methods, long COVID posts were coded for health belief model constructs. Among long COVID posts, 75.18% included language about susceptibility, 64.96% severity, and 64.23% benefits of prevention. Cues to preventive action appeared in 54.01% of posts. 19.71% of posts provided guidance for those with long COVID. While health departments posted extensively about COVID-19, posts about long COVID were rare. This represents a missed opportunity to bolster arguments for preventive behaviors and support those experiencing long COVID.

Endorsement of COVID-19 related misinformation among cancer survivors

OBJECTIVES

To determine whether cancer survivors currently in treatment are more or less likely to endorse COVID-19 related misinformation compared to their counterparts no longer in treatment and those without a cancer history.

METHODS

We conducted a Qualtrics survey among 897 adults to determine differences in endorsement of COVID-19 misinformation among cancer survivors in active treatment, cancer survivors no longer in treatment, and a control group with no cancer history.

RESULTS

Cancer survivors currently undergoing treatment were more likely to believe misinformation related to COVID-19 than those without a cancer history. Least likely to endorse COVID-19 misinformation were cancer survivor no longer in treatment.

CONCLUSION

These results alert healthcare professionals to overall high levels of endorsement of COVID-19 misinformation among cancer survivors on active treatment. Oncologists and other providers working with patients undergoing treatment for cancer should be particularly mindful of the potential elevated beliefs in misinformation among this group.

PRACTICAL IMPLICATIONS

Since patients undergoing cancer treatment seem to be particularly vulnerable to COVID-19 misinformation, oncologists and other healthcare providers working with this patient population should help address patients' concerns about the pandemic and how it relates to their course of treatment.

Development and evaluation of the red flag campaign for the primary prevention of sexual and dating violence on college campuses

Objective Sexual and dating violence (SV/DV) on college campuses is a pervasive problem with far-reaching implications for public health. This paper describes the development and evaluation of a widely disseminated SV/DV primary prevention program, the Red Flag Campaign (RFC). Participants and Methods: An online survey was administered to 203 freshmen at a southeastern US university, of whom 82% reported exposure to the RFC in the previous month. Results: College students exposed to the RFC reported greater efficacy for intervening as a bystander compared to those students who were not exposed. These results held when looking at exposure to RFC messages specifically, but not RFC events. Conclusions: This evaluation offers preliminary evidence that the RFC is effective at increasing determinants of prosocial bystander behavior, the enactment of which could reduce SV/DV on college campuses. Implications and recommendations for college personnel implementing the RFC are discussed.

#Arabhealth on Instagram: Examining Public Health Messages to Arabian Gulf State Audiences

Instagram is a social media platform used for communicating health information to audiences in the member states of the Gulf Cooperation Council (GCC), but little is known about the specific use of the platform for this purpose. This study, focused on 1,000 Instagram posts by the GCC Ministries of Health, analyzed how public health information is discussed differently across the GCC on Instagram, as well as the extent to which Health Belief Model (HBM) variables - a frequently used health behavior theory focused on understanding individual adoption of certain health behaviors - are present in these posts. Results showed that a majority of messages did not include HBM constructs other that perceived benefits and calls to action, limiting their potential for effective public health communication. Results also showed a minority of posts deal with mental health. Recommendations for future best practices are discussed.

At home and online during the early months of the COVID-19 pandemic and the relationship to alcohol consumption in a national sample of U.S. adults

Introduction

The current study aimed to understand the links between social media use and alcohol consumption during the early months of the COVID-19 pandemic.

Method

Data were from the national Understanding American Study, a probability-based Internet panel weighted to represent the U.S. population. Subjects (N = 5874; 51% female) were adults, 18 years and older, who completed a March survey (wave 1) and a follow-up survey one month later (wave 3). Analyses assessed the relationships of social media use at wave 1 with wave 3 alcohol use frequency, accounting for wave 1 alcohol use frequency and the sociodemographic characteristics of the sample. Two alcohol use change variables were also assessed as outcomes–increased and decreased alcohol use between waves. We considered the effect of work status changes (working/studying from home and job loss) as potential moderators.

Results

Twitter and Instagram users and users of multiple social media platforms, but not Facebook users, drank more frequently at wave 3. The results were similar when assessing relationships between social media use and increased alcohol use between waves. For Instagram users, more frequent alcohol use at wave 3 was at least partially attributed to drinking frequency at wave 1. Additionally, working/studying from home at wave 3 and employment (rather than job loss) were associated with greater consumption. The interaction effect between Twitter use and working/studying from home was statistically significant in association with alcohol use frequency at wave 3, as was the interaction effect between using multiple platforms and working/studying from home in association with decreased alcohol use between waves.

Discussion

Exposure to content about COVID-19 and increased alcohol consumption during the pandemic may have contributed to more frequent alcohol use for some social media users. The study of public health messaging via social media to change alcohol use behaviors during traumatic events is warranted.

Social distancing during COVID-19: threat and efficacy among university students in seven nations

COVID-19 has been spreading fast worldwide, and until effective and safe vaccines have been widely adopted, preventive measures such as social distancing are crucial to keep the pandemic under control. The study's research questions asked which psychosocial factors predict social distancing behavior and whether there are country-level differences in social distancing? Using the Extended Parallel Process Model (EPPM) as a theoretical lens, we examined the predictive effects of threat and efficacy and demographic variables on adherence to the COVID-19 preventive behavior of social distancing using a survey among an international sample of university students. Using path modeling and analysis of covariance, we confirmed the predictive effects of the EPPM on social distancing behavior. Our final model showed that perceived susceptibility to COVID-19 was both directly and indirectly (through response efficacy) associated with social distancing behavior; that perceived severity of COVID-19 yielded a significant indirect effect on social distancing behavior through both self-efficacy and response efficacy; that perceived susceptibility is indirectly and positively associated with social distancing behavior through response efficacy; and that self-efficacy and response efficacy were directly associated with social distancing behavior. Additionally, there were country-level differences in social distancing. Possible explanations for and implications of these findings are discussed.

#WhyIDidntReport: Women Speak Out About Sexual Assault on Twitter

BACKGROUND

In September 2018, Dr. Christine Blasey Ford accused then-nominee to the U.S. Supreme Court Brett Kavanaugh of sexual assault. When then-U.S. President Donald Trump questioned her credibility on Twitter, sexual assault survivors began tweeting their reasons for not reporting using the hashtag #WhyIDidntReport. This study examined how these posts were discussed on Twitter and to what extent the tweets fit within levels of the Social Ecological Model (SEM).

METHOD

This study used quantitative content analysis to code 1,000 tweets with #WhyIDidntReport for violence type, reasons for not reporting, and SEM levels.

RESULTS

Overall, 68.7% of posts mentioned a specific reason for not reporting; of these, 24.1% referred to the perpetrator being in a position of power, 36.3% feared not being believed, and 20.6% mentioned that others invalidated the assault. In addition, 47.6% mentioned a specific form of violence. Within the SEM, 47.6% referred to individual, 52.6% to relational, 43.2% to community, and 21.7% to societal reasons for not reporting.

CONCLUSION

Reading social media content allows healthcare providers to directly discover how survivors talk about their experiences, priorities in the care environment, and how to support a patient-centered and trauma-informed approach.

IMPLICATIONS

Understanding reasons people do not report sexual assault is critical for healthcare professionals to engage patients in open, honest screening and intervention efforts.

Stay Socially Distant and Wash Your Hands: Using the Health Belief Model to Determine Intent for COVID-19 Preventive Behaviors at the Beginning of the Pandemic

BACKGROUND

The COVID-19 pandemic has quickly spread around the world, and since currently no treatments that are safe and effective for large groups of people nor a vaccine are available, the best way to prevent the illness is to avoid being exposed to the virus causing it. The purpose of this study was to examine the predictive effects of both demographic and psychosocial factors originating with the Health Belief Model on reported intent to adhere to COVID-19 preventive behaviors (e.g., social distancing, hand washing, and not attending large gatherings).

METHOD

A Qualtrics survey of 500 U.S. adults was conducted to explore the relationships of demographics and psychosocial factors with the intent to adhere to COVID-19 preventive measures.

RESULTS

Gender was a predictor of taking preventive action, with women more likely to take action. Health Belief Model constructs predicted uptake of most COVID-19 preventive actions, but the constructs often appeared to work independent of the model. Race/ethnicity was an infrequent predictor, but when it did, minorities were less likely to report intent to adhere to COVID-19 preventive behaviors.

CONCLUSION/IMPLICATIONS

While not a perfect model for this pandemic, the Health Belief Model and its constructs should continue to be considered for use by public health communicators focusing on preventive measure campaign design in both the COVID-19 pandemic era and beyond.

Recipes for Prevention: An Analysis of Intimate Partner Violence Messages on Pinterest

Social media platforms such as Pinterest are often used as venues for discussing relationships, making them ideal channels for promoting healthy relationships and preventing intimate partner violence (IPV). This is particularly relevant for IPV, which has been historically understood as a personal issue and lacked support as a significant public health issue. To explore its potential as a platform for prevention, this study examines the ways in which IPV messages on Pinterest reflect public health understandings of, and approaches to, prevention, and how Pinterest users engage with these posts. We analyzed 750 Pinterest posts about IPV using the Social Ecological Model as a theoretical framework for conceptualizing framing devices. The majority of pins (82.9%) used contextually focused thematic framing, while only 8.0% used individually focused episodic framing, and 4.4% used both. The predominance of thematic framing is contrary to findings in examinations of traditional media portrayals of IPV and is likely to facilitate sharing information and education about IPV. However, posts that mention individual causal attribution and individual solution responsibility elicit more engagement than pins that do not. Overall, the Pinterest sample was more reflective of the range of IPV experiences than previous, older analyses of traditional media content, possibly indicating that the public health approach to this issue is gaining momentum. Encouragingly, the study showed increased engagement with posts that discuss psychological abuse, indicating a potentially promising transition from an emphasis on physical abuse to the neglect of psychological abuse. Although Pinterest does still show some stereotypical portrayals of IPV similar to traditional media stories, it also shows much promise for shifting the narrative around IPV in line with the current public health approach and public health professionals should be encouraged to enter the dialogue on IPV on Pinterest.

U.S. public support for COVID-19 vaccine donation to low- and middle-income countries during the COVID-19 pandemic

As COVID-19 vaccines become available to the public, there will be a massive worldwide distribution effort. Vaccine distribution has historically been unequal primarily due to the inability of nations with developing economies to purchase enough vaccine to fully vaccinate their populations. Inequitable access to COVID-19 vaccines will not just cause humanitarian suffering, it will likely also be associated with increased economic suffering worldwide. This study focuses on the U.S. population and its beliefs about future COVID-19 vaccine donation by the U.S. to low- and middle-income countries.

This study carried out a survey among 788 U.S. adults. Variables include demographics, COVID-19 vaccine priority status, COVID-19 vaccine donation beliefs, and Social Dominance Orientation.

Analyses showed that older respondents were both less likely to endorse higher levels of COVID-19 vaccine donations and were more likely to want to wait until all in the U.S. who want the vaccine have received it; those who identified as Democrats were more likely to endorse higher levels of future COVID-19 vaccine donation than Republicans; and those scoring higher on SDO were both less likely to endorse higher levels of COVID-19 vaccine donations as well as more likely to want to wait until all in the U.S. who want the vaccine have received it. Policymakers, as well as healthcare providers and public health communication professionals, should give consideration to those messages most likely to engender support for global prevention efforts with each audience segment.

Risk, Protective, and Associated Factors of Anxiety and Depressive Symptoms and Campus Health Services Utilization Among Black Men on a College Campus

OBJECTIVE

The aim of this study is to analyze relationships among social and environmental determinants serving as risk, protective, and important covariate factors for mental health risk and help-seeking among Black men on a college campus.

METHODS

A secondary data analysis was conducted utilizing an ongoing, campus-wide survey at a large, urban, public university. Measures included depressive and anxiety symptoms; campus service utilization; risk factors (e.g., financial status); protective factors (social support/religiosity); and additional covariates (substance use/GPA). Multiple linear regressions were conducted to examine relationships between these factors, symptoms and help-seeking.

RESULTS

Data is included for 681 students. Findings indicated that stressful life events were associated with higher levels of anxiety symptoms (B = 0.39, p < 0.001) and depressive symptoms (B = 0.33, p = 0.013). Cannabis use (B = 1.14, p = .020) was also associated with higher levels of depressive symptoms. We found that financial status (B = 0.21, p = 0.041) was positively associated with higher levels of depressive symptoms and endorsement of religiosity was associated with lower levels anxiety (B = - 0.23, p = 0.019) and depressive symptoms (B = - 0.32, p = 0.035). Religiosity predicted lower utilization of campus health services.

CONCLUSIONS

The key findings indicated that Black men's mental health is negatively influenced by stressful live events and cannabis use. As religiosity was associated with lower levels of symptoms and utilization, it may be beneficial to assess this in future work. Further research is needed to address and improve mental health and help-seeking among these men.

COVID-19-Related Misinformation among Parents of Patients with Pediatric Cancer

We conducted a survey among 735 parents to determine differences in endorsement of misinformation related to the coronavirus disease pandemic between parents of children in cancer treatment and those with children who had no cancer history. Parents of children with cancer were more likely to believe misinformation than parents of children without cancer.

Willingness to get the COVID-19 vaccine with and without emergency use authorization

BACKGROUND

This study assessed psychosocial predictors of U.S. adults' willingness to get a future COVID-19 vaccine and whether these predictors differ under an emergency use authorization (EUA) release of the vaccine.

METHODS

A survey of 788 U.S. adults was conducted to explore the relationships between demographics and psychosocial predictors of intent to get a future COVID-19 vaccine as well as willingness to get such a vaccine under EUA.

RESULTS

Significant predictors of COVID-19 vaccine uptake intentions were education, having insurance, scoring high on subjective norms, a positive attitude toward the vaccine, as well as high perceived susceptibility to COVID-19, high perceived benefits of the vaccine, scoring low on barriers to the vaccine, and scoring high on self-efficacy. Predictors of willingness to take a COVID-19 vaccine under EUA were age, race/ethnicity, positive subjective norms, high perceived behavioral control, positive attitudes toward the vaccine, as well as high perceived susceptibility to COVID-19, high perceived benefits of the vaccine, low barriers to the vaccine, and scoring high on self-efficacy for getting the vaccine. Concerns about rushed vaccine development appear to reduce vaccine uptake intent, as well as willingness to get the vaccine under EUA.

CONCLUSIONS

COVID-19 vaccine-related messages should both address concerns about the vaccine and its development and reinforce benefits of the vaccine (both factors significant in both models). Vaccine efforts may need to go beyond just communications campaigns correcting misinformation about a COVID-19 vaccine to also focus on re-establishing public trust in government agencies.

#TripleNegativeBreastCancer on Instagram

Little is known about how triple negative breast cancer (TNBC) is discussed on the visual social media platform, Instagram. A greater understanding of the experiences of TNBC survivors that are documented on this platform may inform us of how this group of survivors cope with this rare, but aggressive form of breast cancer. This study analyzed a random sample (N = 501) of Instagram posts using the hashtag #triplenegativebreastcancer. Using a quantitative content analysis, posts were coded for the presence of health belief model constructs as well as the presence of treatment-related experiences, social support, and hereditary breast cancer genetic mutations (BRCA 1/2). Our findings suggest that health organizations and agencies are not utilizing Instagram as a conduit of health communications about TNBC to reach individuals worldwide. This article provides insights into potential strategies that can be used by these entities to promote user engagement with posts about TNBC, such as utilizing health messaging that is episodic in nature, uses supportive and encouraging words, and provides information about chemotherapy.

The skills required for entry-level public relations: An analysis of skills required in 1,000 PR job ads

Preparing professionals to work in any industry means linking educational competencies and career requirements. With its own career-defining skills, the field of public relations is no different. Knowing the demands of the industry creates an opportunity to supply the most relevant education that gets early professionals hired. By analyzing 1000 job postings, this study unearths the most frequently requested entry-level public relations job skills by employers. While the study reaffirms the relevance of traditional skills like written communication, it also highlights advancing skills in digital and social media. It further demonstrates a clear call for soft skills like organizational skills, leadership abilities and ability to work in teams.

HPV Vaccine Searches on Pinterest: Before and After Pinterest's Actions to Moderate Content

Objectives. To compare how human papillomavirus (HPV) vaccination was portrayed on Pinterest before and after the platform acted to moderate vaccine-related search results to understand (1) what the information environment looked like previously and (2) whether Pinterest's policy decisions improved this environment in terms of sources and content.Methods. In this quantitative content analysis, we compared 2 samples of 500 HPV vaccine-focused Pinterest posts ("pins") collected before and after Pinterest's actions to provide more reliable vaccine-related information. Pins were based on search results and were analyzed using the Health Belief Model.Results. The majority of preaction search results leaned toward vaccine skepticism, specifically focused on perceived vaccine barriers. Few pins were published by public health-related Pinterest accounts. Postaction search results showed a significant shift to HPV vaccination benefits, and the number of pins by government or medical accounts increased. However, the proportion of pins in search results containing HPV content of any type was significantly lower.Conclusions. Pinterest's efforts to moderate vaccination discussions were largely successful. However, the ban also appeared to limit HPV vaccination search results overall, which may contribute to confusion or an information vacuum.

Pinning Despair and Distress - Suicide-Related Content on Visual Social Media Platform Pinterest

Background: The World Health Organization (WHO) estimates that an individual dies by suicide every 40 s. Aim: Our aim was to analyze how suicide is portrayed on the visual social media platform Pinterest. Method: This study used a quantitative content analysis of 500 suicide-related Pinterest posts. Content codes included the presence of factors related to the WHO media reporting guidelines. Results: The majority of posts were published by individual Pinterest users, with public and mental health entities rarely present. Suicidal ideation content was more prevalent in visuals than in accompanying text on Pinterest. Considering the WHO media suicide-reporting guidelines, posts featured more helpful than harmful content, but explicit details of suicides and suicide attempts were still prevalent. Finally, comments were more likely to identify with suicidal ideation or post negative content than post supportive content. Limitations: Content analysis cannot discern motivations behind posts; future studies should include other methods. Conclusion: This study suggests there is a critical need for further research into Pinterest and suicide-related topics.

#BeTheMatch: Assessing How Testimonials on Reddit Promote the Importance of Donating Bone Marrow

This study explores how sharing testimonials on the social media network Reddit may encourage individuals to donate bone marrow. The theory of planned behavior guided a quantitative content analysis of 1,015 Reddit comments about donation. Research questions asked how individuals post about donation and how Redditors engage with this content. Overall, comments addressed more positive than negative outcome, efficacy, and normative beliefs. Comments that discussed beliefs related to registering to donate and the process of donating received significantly higher engagement than other comments. Additionally, comments that included positive outcome beliefs related to registering, positive efficacy beliefs related to registering and donating, and positive normative beliefs related to donating received higher engagement than other comments. Results suggest testimonials may be most effective if they focus on behavior facilitators and if they present donation as a positive norm deviant behavior. Finally, the Reddit forums functioned as places for individuals to seek out and share information. Comments included calls to action and hyperlinks for health resources. This research reveals how organic conversations on Reddit may promote health information seeking and advocacy behavior adoption. Implications for the theory of planned behavior and the use of Reddit as a platform for health promotion are discussed.

Tweeting about #Diseases and #Publichealth: Communicating Global Health Issues across Nations

Twitter is playing an increasing role in health communications, but little is known about the Twitter use of national health departments in general and across different nations in particular. This quantitative content analysis of 1,200 tweets from 12 national health departments showed that the topics covered in these tweets are often lacking in broad coverage - cardiovascular disease is barely mentioned, while infectious diseases are often highlighted - and the tweets do not try to initiate engagement through creating a two-way dialogue with followers. However, the tweets appear to use Health Belief Model constructs, such as initiating cues to action, mentioning self-efficacy and highlighting perceived benefits of health preventative, treatment or screening options, and this is associated with increased Twitter engagement. The paper ends with recommendations for both future studies and new challenges for the use of Twitter by national health departments.

Intimate Partner Violence on Instagram: Visualizing a Public Health Approach to Prevention

Social media platforms like Instagram are often used as venues for discussing relationships, making them ideal channels for promoting healthy relationships and preventing intimate partner violence (IPV). This is particularly relevant for IPV, which has been historically understood as a personal issue and lacked support for consideration as a significant public health issue. To explore a potential platform for IPV prevention, this study examines the ways in which IPV messages on Instagram reflect public health understandings of, and approaches to, prevention and how Instagram users engage with these posts. We analyzed 700 Instagram posts about IPV using the social ecological model as the theoretical framework for conceptualizing framing devices. Posts that mentioned individual causal attribution and individual solution responsibility were both present in the majority of posts and elicited more engagement than posts that did not. Encouragingly, the Instagram sample was more reflective of a range of different types of IPV experiences than previous analyses of traditional media content, possibly indicating that a public health approach to this issue is gaining traction.

(S)pin the flu vaccine: Recipes for concern

Influenza epidemics happen yearly, and the World Health Organization estimates that the virus is connected to between 290,000 and 650,000 annual deaths. The most effective way to prevent seasonal influenza is vaccination. The prevalence of vaccine misinformation on social media is increasing, but the visual platform Pinterest is understudied in this area. The current study is the first to explore the content and nature of influenza information that is shared on Pinterest. Using a quantitative content analysis, Pinterest messages were theoretically analyzed for Health Belief Model variables as well as for message source, engagement, and position on vaccination. Findings showed concerning trends but also promising opportunities for health organizations and professionals.

Male Body Image Portrayals on Instagram

Men are faced with trends that give rise to the desire for a muscular and lean body; this may result in body dissatisfaction. Body dissatisfaction is associated with a plethora of health consequences. Social media has been named as one contributing factor for male body dissatisfaction. Up till now, women have been the focus of body image-related social media studies. Therefore, we conducted a quantitative content analysis of 1,000 relevant Instagram posts that were posted by men (and/or depicted men) to understand how the male body is depicted on Instagram and how user respond to those images. The majority of sampled posts showed high levels of muscularity and leanness. In addition, posts depicting men adhering to this specific body type received significantly more responses (likes and comments). Norms and outcomes related to health (i.e., training to be healthy) were more commonly shown than appearance-related constructs (i.e., training to become attractive), and promotion of physical activity was more common than dietary behavior. However, findings are potential harmful to men's body image, even if one considers that health-related messaging and physical active promotion was prominent. It remains debatable if men need to view very lean and very muscular men to encourage health-related behaviors.

A Tale of Two Diverse Qualtrics Samples: Information for Online Survey Researchers

BACKGROUND

There is often a lack of transparency in research using online panels related to recruitment methods and sample derivation. The purpose of this study was to describe the recruitment and participation of respondents from two disparate surveys derived from the same online research panel using quota sampling.

METHODS

A commercial survey sampling and administration company, Qualtrics, was contracted to recruit participants and implement two Internet-based surveys. The first survey targeted adults aged 50 to 75 years and used sampling quotas to obtain diversity with respect to household income and race/ethnicity. The second focused on women aged 18 to 49 years and utilized quota sampling to achieve a geographically balanced sample.

RESULTS

A racially and economically diverse sample of older adults (n = 419) and a geographically diverse sample of younger women (n = 530) were acquired relatively quickly (within 12 and 4 days, respectively). With exception of the highest income level, quotas were implemented as requested. Recruitment of older adults took longer (vs. younger female adults). Although survey completion rates were reasonable in both studies, there were inconsistencies in the proportion of incomplete survey responses and quality fails.

CONCLUSIONS

Cancer researchers, and researchers in general, should consider ways to leverage the use of online panels for future studies. To optimize novel and innovative strategies, researchers should proactively ask questions about panels and carefully consider the strengths and drawbacks of online survey features including quota sampling and forced response.

IMPACT

Results provide practical insights for cancer researchers developing future online surveys and recruitment protocols.See all articles in this CEBP Focus section, "Modernizing Population Science."

Breast Cancer Voices on Pinterest: Raising Awareness or Just an Inspirational Image?

The public increasingly searches for and discusses health information online, but few studies have examined breast cancer-related posts on visual social media platforms. To shed light on cancer-focused posts on the visual social media platform Pinterest, this study analyzed a random sample of 476 breast cancer-related posts (also referred to as "pins"). Using a quantitative content analysis, pins were coded for type of visual and textual information included and user engagement with pins (i.e., frequency of repins and comments). This novel research supports the current use and potential future utility of Pinterest as a venue for health communication related to breast cancer. Study results have important implications for the development of future health promotion programs on Pinterest aimed at reducing breast cancer risk among women.

Pinning to Cope: Using Pinterest for Chronic Pain Management

Chronic pain is an increasing public health concern, with an associated poor quality of life. Social media platforms play an increasing role in health communication issues, but visual platforms such as Pinterest are understudied. This study analyzed 502 Pinterest posts for chronic pain–related variables, including health belief model constructs, as well as measures of social support and coping mechanisms. Most pins mentioned the high severity of chronic pain, and a third mentioned self-efficacy related to self-care, while almost 50% referred to cues to action related to self-care. This study positions Pinterest as a social media platform with the potential to both transfer knowledge and provide social support for patients with chronic pain. Health care and public health practitioners should consider participating in these conversations as well as providing quality information to ensure that reputably sourced information is available.

A path model of psychosocial constructs predicting future Zika vaccine uptake intent

OBJECTIVE

The recent Zika virus outbreak, while no longer an international public health emergency, is still a serious threat, particularly to pregnant women and babies born to pregnant women infected with the virus. This study examined the predictive effects of psychosocial constructs on self-reported intent to get a future Zika vaccine among women of reproductive age.

METHODS

Data were collected using an online survey with a representative sample of 339 women ages 18-49 from the continental United States. The survey addressed variables originating with the Extended Parallel Processing Model (EPPM) as related to future Zika vaccine uptake intent.

RESULTS

Three quarters of all respondents reported intention to get a future Zika vaccine. Path modeling revealed a direct effect of perceived susceptibility, self-efficacy, and response efficacy on future Zika vaccine uptake intent, as well as an indirect effect of perceived susceptibility through both self-efficacy and response efficacy. In addition, the final model showed an indirect effect of perceived severity on Zika vaccine uptake intent through self-efficacy and response efficacy and accounted for 54.6% of the variance in vaccination intent.

CONCLUSIONS

These findings have implications for future Zika vaccine promotion campaigns. This study confirms the importance of perceived susceptibility, self-efficacy, and response efficacy for use in Zika vaccine uptake campaigns; in addition, when using perceived severity, both self-efficacy and response efficacy should be considered in message design.

Using the Health Belief Model to Analyze Instagram Posts about Zika for Public Health Communications

We analyzed Instagram posts about Zika by using the Health Belief Model. We found a high presence of threat messages, yet little engagement with these posts. Public health professionals should focus on posting messages to increase self-efficacy and benefits of protective behavior, especially when a vaccine becomes available.

Making "Weedish Fish": An Exploratory Analysis of Cannabis Recipes on Pinterest

Background: The expansion of legalized medical and recreational cannabis has created growing interest in cannabis infused edibles. Information about the preparation of edibles is readily available to the public on social media with little to no oversight. Objectives: To determine how recipes for cannabis edibles are promoted on the social media platform Pinterest. Methods: We performed a content analysis of 500 cannabis edible recipe pins collected in December 2017. Pins were coded for promotional content, user engagement, recipe presence and type, cannabis dosage and serving size, and presence of health and risk information. Results: A plurality of pins showed visuals of cannabis content (47.8%), and pins frequently depicted images of desserts infused with cannabis (40.0%). Almost half of all of pins (46.8%) included or linked out to a recipe for edibles, with recipes for desserts and baked goods being most common (40.0%). Cannabis dosages and serving sizes were often vague or missing, and health and safety warnings were almost entirely absent from pins. Conclusion/importance: Recipes for cannabis edibles are easily accessible through Pinterest. Information about dosage, serving size, health effects, and responsible usage are all but absent. Pins largely originate in locations where cannabis is legalized; however, content is accessible without regard to state or national borders. Public health agencies and organizations should consider publishing information about health effects and responsible usage that flow parallel to social media content promoting edibles.

Framing and visual type: Effect on future Zika vaccine uptake intent

Introduction

The Zika virus is associated with the birth defect microcephaly, and while a vaccine was not available in early- 2017, several were under development. This study's purpose was to identify effective communication strategies to promote uptake of a new vaccine, particularly among women of reproductive age.

Design and methods

In order to study the effects of Zika message framing (gain vs. loss) and visual type (photo vs. infographic) on future Zika vaccine uptake intent, a 2×2 between-subjects experiment was performed via an online survey in 2017 among 339 U.S. women of reproductive age (18-49 years). Participants were exposed to one of four messages, all resembling Instagram posts: gain-framed vs. loss-framed infographic, and gain-framed vs. loss-framed photo. These messages were followed by questions about Zika vaccine uptake intent as well as intermediate psychosocial variables that could lead to intent.

Results

There was no interaction between framing and visual type (P=0.116), and there was no effect for framing (P=0.185) or visual type (P=0.724) on future Zika vaccine uptake intent, which is likely indicative of insufficient dosage of the intervention. However, when focusing on intermediate psychosocial constructs that are known to influence behavior and intent, gain-framed messages were more effective in increasing subjective norms (P=0.005) as related to a future Zika vaccine, as well as perceived benefits (P=0.016) and self-efficacy (P=0.032).

Conclusions

Gain-framed messages seem to be more effective than loss-framed messages to increase several constructs that could, in turn, affect future Zika vaccine uptake intent. This is a novel finding since, traditionally, loss-framed messages are considered more beneficial in promoting vaccine-related health behaviors.

On pins and needles: how vaccines are portrayed on Pinterest

Vaccination is an effective public health tool for reducing morbidity and mortality caused by infectious diseases. However, increasing numbers of parents question the safety of vaccines or refuse to vaccinate their children outright. The Internet is playing a significant role in the growing voice of the anti-vaccination movement as a growing number of people use the Internet to obtain health information, including information about vaccines. Given the role the Internet plays in providing vaccination-related communication, coupled with limited research in this area, this study focused on the social media platform Pinterest, analyzing 800 vaccine-related pins through a quantitative content analysis. The majority of the pins were anti-vaccine, and most were original posts as opposed to repins. Concerns about vaccine safety and side effects were oft-repeated themes, as was the concept of conspiracy theory. Pro-vaccine pins elicited consistently more engagement than anti-vaccine pins. Health educators and public health organizations should be aware of these dynamics, since a successful health communication campaign should start with an understanding of what and how publics communicate about the topic at hand.