In the US Instagram posts with the hashtag #hookah regularly depicted waterpipe use in conjunction with alcohol use. Instagram's focus on images facilitates picture-based advertising where hookah lounges promote drink specials at the same time nightclubs promote waterpipe specials. Instagram users often document the variety of shapes, sizes, and styles, of waterpipes, suggesting users take pride in their purchases and like to show their customized, and often times elaborate, waterpipes to their followers. Instagram has been underutilized in understanding tobacco related-behaviors and identifying tobacco-related promotional material.
Purpose The increasing popularity of the JUUL electronic nicotine delivery system among youth poses several potential public health concerns. Social media can be used to better understand the spread of information related to JUUL. This study examined whether adolescents (age < 18) are following JUUL’s official Twitter account and subsequently sharing (retweeting) JUUL’s posts to their followers. We also assessed various patterns in which adolescents share information on JUUL with each other. Methods We collected 3,239 tweets from JUUL’s official Twitter account (@JUULVapor) for one full year from February 2017 to January 2018. These tweets were shared by Twitter users to their followers 1,124 times by 721 unique users. Users were determined to be either adolescent (age <18) or adult (≥18) based on a systematic procedure involving double-coding. We used social network analysis to explore the relationships between users retweeting JUUL. Results One-quarter (25%) of users were determined to be adolescents. Social network analysis revealed a maximum path length of 4 and a positive assortativity (r=0.29). There were 25 (9%) instances of an adolescent retweeting content from another adolescent, 35 (12%) of an adolescent retweeting from an adult, and 30 (11%) of an adult retweeting from an adolescent. Conclusions JUUL’s official Twitter account is being followed—and its messages are being shared—by adolescents. Rigorous policies and prevention programs are needed to curb adolescent exposure to JUUL content and discussions online.
Background Economic stressors have been retrospectively associated with net population increases in nonspecific psychological distress (PD). However, no sentinels exist to evaluate contemporaneous associations. Aggregate Internet search query surveillance was used to monitor population changes in PD around the United States’ Great Recession. Methods Monthly PD query trends were compared with unemployment, underemployment, homes in delinquency and foreclosure, median home value or sale prices, and S&P 500 trends for 2004–2010. Time series analyses, where economic indicators predicted PD one to seven months into the future, were performed in 2011. Results PD queries surpassed 1,000,000 per month, of which 300,000 may be attributable to the Great Recession. A one percentage point increase in mortgage delinquencies and foreclosures was associated with a 16% (95%CI, 9–24) increase in PD queries one-month, and 11% (95%CI, 3–18) four months later, in reference to a pre-Great Recession mean. Unemployment and underemployment had similar associations half and one-quarter the intensity. “Anxiety disorder,” “what is depression,” “signs of depression,” “depression symptoms,” and “symptoms of depression” were the queries exhibiting the strongest associations with mortgage delinquencies and foreclosures, unemployment or underemployment. Housing prices and S&P 500 trends were not associated with PD queries. Limitations A non-traditional measure of PD was used. It is unclear if actual clinically significant depression or anxiety increased during the Great Recession. Alternative explanations for strong associations between the Great Recession and PD queries, such as media, were explored and rejected. Conclusions Because the economy is constantly changing, this work not only provides a snapshot of recent associations between the economy and PD queries but also a framework and toolkit for real-time surveillance going forward. Health resources, clinician screening patterns, and policy debate may potentially be informed by changes in PD query trends.
BackgroundWorld No Tobacco Day (WNTD), commemorated annually on May 31, aims to inform the public about tobacco harms. Because tobacco control surveillance is usually annualized, the effectiveness of WNTD remains unexplored into its 25th year.ObjectiveTo explore the potential of digital surveillance (infoveillance) to evaluate the impacts of WNTD on population awareness of and interest in cessation.MethodsHealth-related news stories and Internet search queries were aggregated to form a continuous and real-time data stream. We monitored daily news coverage of and Internet search queries for cessation in seven Latin American nations from 2006 to 2011.ResultsCessation news coverage peaked around WNTD, typically increasing 71% (95% confidence interval [CI] 61–81), ranging from 61% in Mexico to 83% in Venezuela. Queries indicative of cessation interest peaked on WNTD, increasing 40% (95% CI 32–48), ranging from 24% in Colombia to 84% in Venezuela. A doubling in cessation news coverage was associated with approximately a 50% increase in cessation queries. To gain a practical perspective, we compared WNTD-related activity with New Year’s Day and several cigarette excise tax increases in Mexico. Cessation queries around WNTD were typically greater than New Year’s Day and approximated a 2.8% (95% CI –0.8 to 6.3) increase in cigarette excise taxes.ConclusionsThis novel evaluation suggests WNTD had a significant impact on popular awareness (media trends) and individual interest (query trends) in smoking cessation. Because WNTD is constantly evolving, our work is also a model for real-time surveillance and potential improvement in WNTD and similar initiatives.
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