Objectives Childhood obesity more than doubled in the last 20 years, suggesting a need for evidence-based public health strategies. The use of social media to share health information is increasing among the public and public health professionals. However, little is known about the use of social media as a tool for health communication. We used a mixed-methods design to examine communication about childhood obesity on Twitter. Methods NodeXL was used to collect tweets sent in June 2013 containing the hashtag #childhoodobesity. Tweets were coded for content; tweeters were classified by sector and health focus. The network of follower connections among the tweeters was also collected. We used descriptive statistics and exponential random graph modeling to examine tweet content, tweeter characteristics, and the composition and structure of the network of connections facilitating communication among the tweeters. Results We collected 1,110 tweets originating from 576 unique Twitter users. More individuals (65.6%) than organizations (32.9%) tweeted. Tweets were more likely to focus on individual behavior than environment or policy as a cause of, and strategy to combat, childhood obesity. Few government and educational tweeters were in the network. Network members affiliated with government and media were more likely than private individuals to be followed by others in the network, suggesting an important dissemination role. Conclusion There is an opportunity to better disseminate evidence-based information to a broad audience through Twitter by increasing the presence of credible sources in the #childhoodobesity conversation and focusing the content of tweets on scientific evidence.

Implementing and growing a public health program that benefits society takes considerable time and effort. To ensure that positive outcomes are maintained over time, program managers and stakeholders should plan and implement activities to build sustainability capacity within their programs. We describe a 3-part sustainability planning process that programs can follow to build their sustainability capacity. First, program staff and stakeholders take the Program Sustainability Assessment Tool to measure their program’s sustainability across 8 domains. Next, managers and stakeholders use results from the assessment to inform and prioritize sustainability action planning. Lastly, staff members implement the plan and keep track of progress toward their sustainability goals. Through this process, staff can more holistically address the internal and external challenges and pressures associated with sustaining a program. We include a case example of a chronic disease program that completed the Program Sustainability Assessment Tool and engaged in program sustainability planning.

BackgroundThe belief that early detection is the best protection against cancer underlies cancer screening. Emerging research now suggests harms associated with early detection may sometimes outweigh the benefits. Governments, cancer agencies, and organizations that publish screening guidelines have found it is difficult to “un-ring the bell” on the message that “early detection is your best protection” because of its widespread communication and enduring resonance. This study explores affective factors—and their interplay with relevant analytical factors—in public/laypersons’ decision making about cancer screening.MethodsA total of 93 people (47 men, 46 women) attended focus groups about, respectively, prostate cancer screening and breast cancer screening in two Canadian cities.ResultsAffective factors were a major influence on many focus group participants’ decision making about cancer screening, including fear of cancer and a generalized enthusiasm for prevention/screening, and they were often inspired by anecdotes about the cancer experiences of family and friends. Affect also existed alongside more analytical factors including assessments of reduced risk in the management of any cancer diagnosis if caught early, and, for men, the belief that an unreliable test is “better than nothing,” and that men deserve prostate cancer screening because women have breast and cervical cancer screening. Affective factors were particularly noticeable in the sub-groups most supportive of screening and the “early detection” message: older women who felt that mammogram screening should begin at age 40 rather than 50, and older men who felt that prostate cancer screening should be expanded beyond its current unorganized, opportunistic usage. In contrast, younger participants displayed less affective attachments to “early detection” messages and had greater concerns about harms of screening and were more receptive to nuanced messages informed by evidence.ConclusionPolicymakers attempting to communicate more nuanced versions of the “early detection” message need to understand the role of affect alongside other judgments brought into laypersons’ decision making processes and anticipate how affective responses to their messages will be shaped, transformed, and potentially subverted by external forces beyond their control. Particularly overt external factors are campaigns by cancer advocacy organizations actively promoting breast and prostate cancer awareness and screening to younger women and men using affectively-charged messages.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3596-7) contains supplementary material, which is available to authorized users.

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.

During the 2003 SARS outbreak in Toronto, Canada, communication with the public was poorly executed by health authorities. Key problems included mixed and unclear messages, widespread public confusion, and attributions of incompetence toward health officials. Subsequently, Canadian health officials developed pandemic plans that included specific sections dedicated to communication. Plans counseled a strategy of transparent risk messaging to give people the information they need and build public trust. When the H1N1 influenza pandemic arrived in Canada in 2009, these plans were put to their first test in a major public health event. However, many of the same problems that existed during SARS arose again during pH1N1. This study investigates the dissonances between the ideals and reality of communication during pH1N1 based on analyses of two data sources: (1) key informant interviews with senior health officials (n = 28) from federal and three provincial (Alberta, Manitoba, Ontario) health jurisdictions in Canada; and (2) focus groups (n = 15) with general population Canadians (n = 140) in Alberta, Manitoba, and Ontario. Discussions with participants showed that even with a transparent communication approach, aspects of the pandemic, such as its 'risk' and the complexities of the immunization campaign, proved difficult to convey without causing public confusion. Members of the public often resorted to their own inventories of knowledgeusually those related to seasonal influenzato interpret and make sense of pandemic messaging, but these did not guarantee accurate understandings. The inherent uncertainty of a real-time pandemic was also a difficult concept to communicate to a public with little prior experience of such an event. While transparent communication was intended to build trust, resulting confusion fueled a loss of confidence in health officials. A more 'reasoned' approach to transparency needs to inform future pandemic communication and further research is required to determine how to refine such an approach. ARTICLE HISTORYDuring the H1N1 pandemic in Canada, health authorities across the country implemented pandemic plans which emphasized the importance of communicating with the public in an open,