BackgroundIn January 2014, the Chicago City Council scheduled a vote on local regulation of electronic cigarettes as tobacco products. One week prior to the vote, the Chicago Department of Public Health (CDPH) released a series of messages about electronic cigarettes (e-cigarettes) through its Twitter account. Shortly after the messages, or tweets, were released, the department’s Twitter account became the target of a “Twitter bomb” by Twitter users sending more than 600 tweets in one week against the proposed regulation.ObjectiveThe purpose of our study was to examine the messages and tweet patterns in the social media response to the CDPH e-cigarette campaign.MethodsWe collected all tweets mentioning the CDPH in the week between the e-cigarette campaign and the vote on the new local e-cigarette policy. We conducted a content analysis of the tweets, used descriptive statistics to examine characteristics of involved Twitter users, and used network visualization and descriptive statistics to identify Twitter users prominent in the conversation.ResultsOf the 683 tweets mentioning CDPH during the week, 609 (89.2%) were anti-policy. More than half of anti-policy tweets were about use of electronic cigarettes for cessation as a healthier alternative to combustible cigarettes (358/609, 58.8%). Just over one-third of anti-policy tweets asserted that the health department was lying or disseminating propaganda (224/609, 36.8%). Approximately 14% (96/683, 14.1%) of the tweets used an account or included elements consistent with “astroturfing”—a strategy employed to promote a false sense of consensus around an idea. Few Twitter users were from the Chicago area; Twitter users from Chicago were significantly more likely than expected to tweet in support of the policy.ConclusionsOur findings may assist public health organizations to anticipate, recognize, and respond to coordinated social media campaigns.

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PURPOSE More effective strategies are needed to improve rates of colorectal cancer screening, particularly among the poor, racial and ethnic minorities, and individuals with limited English profi ciency. We examined whether the direct mailing of fecal occult blood testing (FOBT) kits to patients overdue for such screening is an effective way to improve screening in this population. METHODSAll adults aged 50 to 80 years who did not have documentation of being up to date with colorectal cancer screening as of December 31, 2009, and who had had at least 2 visits to the community health center in the prior 18 months were randomized to the outreach intervention or usual care. Patients in the outreach group were mailed a colorectal cancer fact sheet and FOBT kit. Patients in the usual care group could be referred for screening during usual clinician visits. The primary outcome was completion of colorectal cancer screening (by FOBT, sigmoidoscopy, or colonoscopy) 4 months after initiation of the outreach protocol. Outcome measures were compared using the Fisher exact test.RESULTS Analyses were based on 104 patients assigned to the outreach intervention and 98 patients assigned to usual care. In all, 30% of patients in the outreach group completed colorectal cancer screening during the study period, compared with 5% of patients in the usual care group (P <.001). Nearly all of the screenings were by FOBT. The groups did not differ signifi cantly with respect to the percentage of patients making a clinician visit or the percentage for whom a clinician placed an order for a screening test. CONCLUSIONSThe mailing of FOBT kits directly to patients was effi cacious for promoting colorectal cancer screening among a population with high levels of poverty, limited English profi ciency, and racial and ethnic diversity. Non-visit-based outreach to patients may be an important strategy to address suboptimal rates of colorectal cancer screening among populations most at risk for not being screened. Appropriate screening and early detection can greatly reduce colorectal cancer-associated morbidity and mortality, and several national guidelines recommend regular screening for colorectal cancer among adults aged 50 years and older with high-sensitivity fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy.2-4 Nearly one-half of eligible adults are not up to date on colorectal cancer screening, however. 5Moreover, despite overall improvements in the rate of colorectal cancer screening, marked disparities persist, with lower rates of colorectal cancer screening among racial and ethnic minorities, individuals with lower income or lower educational attainment, the uninsured, and individuals Muriel Jean-Jacques, MD The direct mailing of FOBT kits to patients who are due for colorectal cancer screening has been shown to be both clinically effective 9-14 and cost-effective 15,16 for increasing colorectal cancer screening rates. The vast majority of studies assessing the effi cacy of this strategy have not included sizable...

BackgroundOne of the essential services provided by the US local health departments is informing and educating constituents about health. Communication with constituents about public health issues and health risks is among the standards required of local health departments for accreditation. Past research found that only 61% of local health departments met standards for informing and educating constituents, suggesting a considerable gap between current practices and best practice.ObjectiveSocial media platforms, such as Twitter, may aid local health departments in informing and educating their constituents by reaching large numbers of people with real-time messages at relatively low cost. Little is known about the followers of local health departments on Twitter. The aim of this study was to examine characteristics of local health department Twitter followers and the relationship between local health department characteristics and follower characteristics.MethodsIn 2013, we collected (using NodeXL) and analyzed a sample of 4779 Twitter followers from 59 randomly selected local health departments in the United States with Twitter accounts. We coded each Twitter follower for type (individual, organization), location, health focus, and industry (eg, media, government). Local health department characteristics were adopted from the 2010 National Association of City and County Health Officials Profile Study data.ResultsLocal health department Twitter accounts were followed by more organizations than individual users. Organizations tended to be health-focused, located outside the state from the local health department being followed, and from the education, government, and non-profit sectors. Individuals were likely to be local and not health-focused. Having a public information officer on staff, serving a larger population, and “tweeting” more frequently were associated with having a higher percentage of local followers.ConclusionsSocial media has the potential to reach a wide and diverse audience. Understanding audience characteristics can help public health organizations use this new tool more effectively by tailoring tweet content and dissemination strategies for their audience.