@Article{info:doi/10.2196/52610, author="Skelton, Felicia and Grigoryan, Larissa and Pan, Joann and Collazo, Ashley and Trautner, Barbara", title="Development of a Risk Score to Aid With the Diagnosis of Infections After Spinal Cord Injury: Protocol for a Retrospective Cohort Study", journal="JMIR Res Protoc", year="2025", month="May", day="8", volume="14", pages="e52610", keywords="spinal cord injury", keywords="neurogenic bladder", keywords="asymptomatic bacteriuria", keywords="positive predictive value", keywords="risk assessment", keywords="diagnosis", keywords="SCI", keywords="risk score", keywords="urinary tract infection", keywords="UTI", keywords="quality of life", keywords="complication", keywords="urosepsis", keywords="management", keywords="vital sign", keywords="retrospective", keywords="cohort", keywords="physiology", keywords="bladder health", keywords="bladder", keywords="urinary tract", keywords="infection", abstract="Background: Patients with spinal cord injury (SCI) who develop urinary tract infection (UTI) present differently than the non-SCI population. UTIs can cause loss of quality of life and even lead to life-threatening complications including urosepsis. Challenges in SCI management include distinguishing symptomatic UTI from asymptomatic bacteriuria (ASB), which occurs often in patients with SCI, and the lack of standardization in UTI diagnosis in SCI. Objective: This study aims to set the foundation for the development of a risk score to improve diagnostic accuracy of UTI after SCI. Methods: This study will use data from the Veterans Health Administration Corporate Data Warehouse from national outpatient clinics. It will use 2 approaches: (1) a case-control study comparing frequency-matched healthy SCI cases (n=2000) with healthy non-SCI controls (n=2000) to establish a physiologic baseline for vital sign and lab measurements after SCI and (2) a retrospective cohort study of patients with SCI (n=400) to determine the positive predictive value of the baseline vital signs and lab measurements found in step 1, from which a threshold for clinically meaningful UTI after SCI will be established. Results: The study was funded in May 2023, and initial data extraction started in early 2024 and is expected to be completed in 2026. Data extraction, analysis, and results for aim 1 were completed as of manuscript submission. For aim 1, we hypothesize that SCI will be associated with lower temperature, heart rate, and systolic blood pressure when compared with non-SCI controls. SCI will also be associated with higher baseline levels of pyuria and peripheral white blood cells when compared with non-SCI controls. Data extraction for aim 2 will begin in year 1, and analysis and results will be completed in year 2. For aim 2, we hypothesize that pyuria, heart rate, and temperature measurements will have a high positive predictive value for clinically meaningful UTI. Conclusions: Once complete, this study will be the basis for our future work developing a risk score to aid with the diagnosis of UTI after SCI and prevent antibiotic overuse in patients with SCI. International Registered Report Identifier (IRRID): DERR1-10.2196/52610 ", doi="10.2196/52610", url="https://www.researchprotocols.org/2025/1/e52610", url="http://www.ncbi.nlm.nih.gov/pubmed/40338643" } @Article{info:doi/10.2196/66982, author="Guntur, Dole Robertus and Lobo, Maria and Sihotang, Martinus Dony and Bria, Paula Yulianti and Kusumaningrum, Damai", title="Health Education Campaign to Improve Malaria Knowledge, Prevention, and Treatment Behaviors in Rural East Nusa Tenggara Province, Indonesia: Protocol for a Cluster-Assigned Quasi-Experimental Study", journal="JMIR Res Protoc", year="2025", month="May", day="1", volume="14", pages="e66982", keywords="malaria awareness", keywords="local wisdom-based malaria education campaign", keywords="rural community", keywords="malaria elimination", keywords="malaria health policy", keywords="COVID-19", keywords="malaria knowledge", keywords="malaria prevention measure knowledge and practice", keywords="malaria treatment-seeking behavior", abstract="Background: Malaria is a major health issue that is distributed across 85 countries globally including Indonesia. Indonesia is in the process of achieving malaria elimination. Currently, a high burden of malaria exists in the rural eastern part of the nation, including East Nusa Tenggara Province where the number of malaria cases increased significantly during COVID-19. To achieve malaria elimination, malaria awareness must be measurable and integrated into malaria policy. Currently, malaria awareness among rural communities in the region is low, and interventional studies aiming at improving malaria awareness in rural areas in Indonesia are poorly documented. Objective: This study aims to investigate the impact of a local wisdom-based health education campaign combining local music, the voice of subdistrict leaders, and loudspeaker announcements on malaria-related behaviors in rural communities. Specifically, we aim to assess the effect of this intervention on (1) improvement in the malaria awareness index among rural communities and their associated factors, (2) changes in appropriate malaria treatment-seeking behavior (AMTSB) and its associated factors, (3) enhancements in knowledge and practice of malaria prevention measures and their associated factors, and (4) increased use of long-lasting insecticide-treated nets and their associated factors. Methods: This study used a cluster-assigned quasi-experimental design with pretest and posttest assessments in control and intervention groups. The control group, consisting of 12 villages, received malaria education integrated into routine health services provided by local health centers. The intervention group, comprising 13 villages, received the same education as the control group, in addition to a malaria campaign conducted once a week for 20 weeks. Before and after the campaign, a household survey was conducted to assess behavioral aspects of malaria, including general knowledge of malaria, AMTSB, and malaria prevention measures knowledge and practice. Improvement in the malaria awareness index, AMTSB, good level of malaria prevention measure knowledge, and good level of malaria prevention measure practice will be determined based on the difference scores for each index before and after the intervention in both groups. The chi-square test will be used to assess score differences. Binary logistic regression analysis will be conducted to identify key risk factors associated with changes in each index. Results: The intervention was conducted from the last week of August 2024 to the second week of January 2025. A total of 894 respondents participated before and after the intervention. The project is currently in progress, with multiple papers being drafted for publication in peer-reviewed journals. Conclusions: This study is expected to provide significant findings to comprehensively investigate the change in behavioral aspects of malaria due to a local wisdom-based malaria education campaign. The findings could assist stakeholders in Indonesia with developing malaria health policies that are contextually relevant, thereby supporting global efforts to achieve malaria-free status by 2030. International Registered Report Identifier (IRRID): DERR1-10.2196/66982 ", doi="10.2196/66982", url="https://www.researchprotocols.org/2025/1/e66982", url="http://www.ncbi.nlm.nih.gov/pubmed/40310678" } @Article{info:doi/10.2196/62756, author="Yau, Yui Sarah Tsz and Hung, Tim Chi and Leung, Man Eman Yee and Lee, Albert and Yeoh, Kiong Eng", title="Survival Tree Analysis of Interactions Among Factors Associated With Colorectal Cancer Risk in Patients With Type 2 Diabetes: Retrospective Cohort Study", journal="JMIR Public Health Surveill", year="2025", month="Apr", day="29", volume="11", pages="e62756", keywords="colorectal cancer", keywords="risk factor", keywords="interaction", keywords="type 2 diabetes", keywords="survival analysis", keywords="decision tree", keywords="recursive partitioning", keywords="segmentation", keywords="risk stratification", keywords="public health", abstract="Background: Colorectal cancer (CRC) and diabetes share many common lifestyle risk factors, such as obesity. However, it remains largely unknown how different factors interact to influence the risk of CRC development among patients with diabetes. Objective: This study aimed to identify the interaction patterns among factors associated with the risk of CRC incidence among patients with diabetes. Methods: This is a retrospective cohort study conducted using electronic health records from Hong Kong. Patients who were diagnosed with type 2 diabetes and received care in general outpatient clinics between 2010 and 2019 without cancer history were included and followed up until December 2019. A conditional inference survival tree was applied to examine the interaction patterns among factors associated with the risk of CRC. Results: A total of 386,325 patients were included. During a median follow-up of 6.2 years (IQR 3.3-8.0), 4199 patients developed CRC. Patients were first partitioned into 4 age groups by increased levels of CRC risk (?54 vs 55 to 61 vs 62 to 73 vs >73 years). Among patients aged more than 54 years, male sex was the dominant risk factor for CRC within each age stratum and the associations lessened with age. Abdominal obesity (waist-to-hip ratio >0.95) and longer duration of diabetes (median 12, IQR 7-18 vs median 4, IQR 1-11 years) were identified as key risk factor for CRC among men aged between 62 and 73 years and women aged more than 73 years, respectively. Conclusions: This study suggests the interaction patterns among age, sex, waist-to-hip ratio, and duration of diabetes on the risk of CRC incidence among patients with diabetes. Findings of the study may help identify target groups for public health intervention strategies. ", doi="10.2196/62756", url="https://publichealth.jmir.org/2025/1/e62756" } @Article{info:doi/10.2196/70997, author="Green, Andrew and Wu, Shishi and Di Pasquale, Alberta and Pang, Tikki", title="The Role of Digital Opinion Leaders in Dengue Prevention Through Health Promotion and Public Health Collaboration: Qualitative Semistructured Interview Study", journal="J Med Internet Res", year="2025", month="Apr", day="25", volume="27", pages="e70997", keywords="digital opinion leaders", keywords="dengue prevention", keywords="vaccine hesitancy", keywords="public health promotion", keywords="social media", keywords="health care providers", abstract="Background: Dengue fever is a significant public health concern. The advent of social media has introduced digital opinion leaders (DOLs), health care professionals with substantial online followings who play a pivotal role in disseminating health information and combating misinformation. Objective: We aimed to investigate the role of DOLs in dengue prevention and explore their preferences for collaboration with health sector entities to strengthen dengue prevention initiatives. Methods: A qualitative study was conducted using semistructured interviews with 37 purposively selected DOLs from 8 countries in Latin America and Southeast Asia. They were selected based on their active online presence, dissemination of dengue-related content, and substantial social media followings. Interviews took place either in person or online, according to the participants' chosen languages. Each session, lasting approximately 60 minutes, was audio recorded, transcribed verbatim, and subjected to thematic analysis to identify recurring themes. Results: The thematic analysis led to several key findings. First, DOLs used social media to enhance public health communication, focusing on raising awareness (16/37, 43\%), correcting misconceptions (17/37, 46\%), and modeling preventive behaviors (8/37, 22\%) for infectious diseases. They educated audiences on disease symptoms and prevention, addressed vaccine hesitancy, and shared personal practices to encourage similar actions among followers. Second, 35\% (13/37) of the DOLs reported a widespread lack of public knowledge about dengue and its prevention, with even less awareness of vaccine availability. In addition, 27\% (10/37) of them identified challenges due to antivaccination sentiments and misinformation, while 8\% (3/37) noted obstacles from perceived inadequate government leadership in dengue prevention. In response, DOLs leveraged their social media influence to educate the public. A significant number (22/37, 59\%) of the DOLs emphasized the importance of regular promotion of vector control measures as the cornerstone of dengue prevention and 68\% (25/37) highlighted the critical role of vaccines, particularly among vulnerable groups. Finally, collaboration was essential for expanding DOLs' reach and credibility, with 54\% (20/37) of them partnering with pharmaceutical companies, 43\% (16/37) with government agencies, and 27\% (10/37) with nongovernmental organizations. In these collaborations, 38\% (14/37) of the DOLs emphasized the importance of adhering to ethical standards, and 57\% (21/37) prioritized projects aligning with their personal values and professional standards, avoiding producing content that contradicted their beliefs or goals. Conclusions: DOLs are essential in disseminating dengue prevention information. They recognize their responsibility to raise awareness about dengue vaccines and dispel related misconceptions to combat vaccine hesitancy. Unlike nonmedical social media influencers, whose content may lack medical accuracy and be driven by monetization, DOLs provide evidence-based information, enhancing their credibility. Collaborations between DOLs and health sector stakeholders, although currently limited, hold significant potential for effective dengue prevention, provided they adhere to ethical standards and are supported by credible scientific evidence. ", doi="10.2196/70997", url="https://www.jmir.org/2025/1/e70997" } @Article{info:doi/10.2196/57749, author="Holm, Normann Nikolaj and Fr{\o}lich, Anne and Dominguez, Helena and Dalhoff, Peder Kim and Juul-Larsen, Gybel Helle and Andersen, Ove and Stockmarr, Anders", title="Co-Occurring Diseases and Mortality in Patients With Chronic Heart Disease, Modeling Their Dynamically Expanding Disease Portfolios: Nationwide Register Study", journal="JMIR Cardio", year="2025", month="Apr", day="25", volume="9", pages="e57749", keywords="survival analysis", keywords="interaction effects", keywords="chronic heart disease", keywords="multimorbidity", keywords="time-varying covariates", abstract="Background: Medical advances in managing patients with chronic heart disease (HD) permit the co-occurrence of other chronic diseases due to increased longevity, causing them to become multimorbid. Previous research on the effect of co-occurring diseases on mortality among patients with HD often considers disease counts or clusters at HD diagnosis, overlooking the dynamics of patients' disease portfolios over time, where new chronic diseases are diagnosed before death. Furthermore, these studies do not consider interactions among diseases and between diseases, biological and socioeconomic variables, which are essential for addressing health disparities among patients with HD. Therefore, a mapping of the effect of combinations of these co-occurring diseases on mortality among patients with HD considering such interactions in a dynamic setting is warranted. Objective: This study aimed to examine the effect of the co-occurring diseases of patients with HD on mortality, modeling their dynamically expanding chronic disease portfolios while identifying interactions between the co-occurring diseases, socioeconomic and biological variables. Methods: This study used data from the national Danish registries and algorithmic diagnoses of 15 chronic diseases to obtain a study population of all 766,596 adult patients with HD in Denmark from January 1, 1995, to December 31, 2015. The time from HD diagnosis until death was modeled using an extended Cox model involving chronic diseases and their interactions as time-varying covariates. We identified interactions between co-occurring diseases, socioeconomic and biological variables in a data-driven manner using a hierarchical forward-backward selection procedure and stability selection. We mapped the impact on mortality of (1) the most common disease portfolios, (2) the disease portfolios subject to the highest level of interaction, and (3) the most severe disease portfolios. Estimates from interaction-based models were compared to an additive model. Results: Cancer had the highest impact on mortality (hazard ratio=6.72 for male individuals and 7.59 for female individuals). Excluding cancer revealed schizophrenia and dementia as those with the highest mortality impact (top 5 hazard ratios in the 11.72-13.37 range for male individuals and 13.86-16.65 for female individuals for combinations of 4 diseases). The additive model underestimated the effects up to a factor of 1.4 compared to the interaction model. Stroke, osteoporosis, chronic obstructive pulmonary disease, dementia, and depression were identified as chronic diseases involved in the most complex interactions, which were of the fifth order. Conclusions: The findings of this study emphasize the importance of identifying and modeling disease interactions to gain a comprehensive understanding of mortality risk in patients with HD. This study illustrated that complex interactions are widespread among the co-occurring chronic diseases of patients with HD. Failing to account for these interactions can lead to an oversimplified attribution of risk to individual diseases, which may, in cases of multiple co-occurring diseases, result in an underestimation of mortality risk. ", doi="10.2196/57749", url="https://cardio.jmir.org/2025/1/e57749" } @Article{info:doi/10.2196/68355, author="Faccin, Mauro and Geenen, Caspar and Happaerts, Michiel and Ombelet, Sien and Migambi, Patrick and Andr{\'e}, Emmanuel", title="Analyzing Satellite Imagery to Target Tuberculosis Control Interventions in Densely Urbanized Areas of Kigali, Rwanda: Cross-Sectional Pilot Study", journal="JMIR Public Health Surveill", year="2025", month="Apr", day="24", volume="11", pages="e68355", keywords="tuberculosis", keywords="Rwanda", keywords="satellite image", keywords="TB", keywords="PCR testing", keywords="PCR", keywords="questionnaire", keywords="satellite", keywords="active case-finding", keywords="diagnostic", keywords="urban", keywords="Africa", keywords="TB screening", keywords="ACF", keywords="polymerase chain reaction", abstract="Background: Early diagnosis and treatment initiation for tuberculosis (TB) not only improve individual patient outcomes but also reduce circulation within communities. Active case-finding (ACF), a cornerstone of TB control programs, aims to achieve this by targeting symptom screening and laboratory testing for individuals at high risk of infection. However, its efficiency is dependent on the ability to accurately identify such high-risk individuals and communities. The socioeconomic determinants of TB include difficulties in accessing health care and high within-household contact rates. These two determinants are common in the poorest neighborhoods of many sub-Saharan cities, where household crowding and lack of health-care access often coincide with malnutrition and HIV infection, further contributing to the TB burden. Objective: In this study, we propose a new approach to enhance the efficacy of ACF with focused interventions that target subpopulations at high risk. In particular, we focus on densely inhabited urban areas, where the proximity of individuals represents a proxy for poorer neighborhoods with enhanced contact rates. Methods: To this end, we used satellite imagery of the city of Kigali, Rwanda, and computer-vision algorithms to identify areas with a high density of small residential buildings. We subsequently screened 10,423 people living in these areas for TB exposure and symptoms and referred patients with a higher risk score for polymerase chain reaction testing. Results: We found autocorrelation in questionnaire scores for adjacent areas up to 782 meters. We removed the effects of this autocorrelation by aggregating the results based on H3 hexagons with a long diagonal of 1062 meters. Out of 324 people with high questionnaire scores, 202 underwent polymerase chain reaction testing, and 9 people had positive test results. We observed a weak but statistically significant correlation (r=0.28; P=.04) between the mean questionnaire score and the mean urban density of each hexagonal area. Conclusions: Nine previously undiagnosed individuals had positive test results through this screening program. This limited number may be due to low TB incidence in Kigali, Rwanda, during the study period. However, our results suggest that analyzing satellite imagery may allow the identification of urban areas where inhabitants are at higher risk of TB. These findings could be used to efficiently guide targeted ACF interventions. ", doi="10.2196/68355", url="https://publichealth.jmir.org/2025/1/e68355" } @Article{info:doi/10.2196/50929, author="Liebst, Suonper{\"a} Lasse and Bernasco, Wim and Ejbye-Ernst, Peter and van Herwijnen, Nigel and van der Veen, Thomas and Koelma, Dennis and Snoek, M. Cees G. and Lindegaard, Rosenkrantz Marie", title="Association Between Social Distancing Compliance and Public Place Crowding During the COVID-19 Pandemic: Cross-Sectional Observational Study Using Computer Vision to Analyze Surveillance Footage", journal="JMIR Public Health Surveill", year="2025", month="Apr", day="17", volume="11", pages="e50929", keywords="social distancing", keywords="compliance", keywords="crowding", keywords="urban public spaces", keywords="computer vision", keywords="surveillance footage", keywords="COVID-19 pandemic", abstract="Background: Social distancing behavior has been a critical nonpharmaceutical measure for mitigating the COVID-19 pandemic. For this reason, there has been widespread interest in the factors determining social distancing violations, with a particular focus on individual-based factors. Objective: In this paper, we examine an alternative and less appreciated indicator of social distancing violations: the situational opportunity for maintaining interpersonal distance in crowded settings. This focus on situational opportunities is borrowed from criminology, where it offers an alternative to individual-based explanations of crime and rule violations. We extend this approach to the COVID-19 pandemic context, suggesting its relevance in understanding distancing compliance behavior. Methods: Our data comprise a large collection of video clips (n=56,429) from public places in Amsterdam, the Netherlands, captured by municipal surveillance cameras throughout the first year of the pandemic. We automatized the analysis of this footage using a computer vision algorithm designed for pedestrian detection and estimation of metric distances between individuals in the video still frames. This method allowed us to record social distancing violations of over half a million individuals (n=539,127) across more and less crowded street contexts. Results: The data revealed a clear positive association between crowding and social distancing violations, evident both at the individual level and when aggregated per still frame. At the individual level, the analysis estimated that each additional 10 people present increased the likelihood of a distancing violation by 9 percentage points for a given pedestrian. At the aggregated level, there was an estimated increase of approximately 6 additional violations for every 10 additional individuals present, with a very large R{\texttwosuperior} of 0.80. Additionally, a comparison with simulation data indicated that street spaces should, in principle, provide sufficient room for people to pass each other while maintaining a 1.5-meter distance. This suggests that pedestrians tend to gravitate toward others, even when ample space exists to maintain distance. Conclusions: The direct positive relationship between crowding and distancing violations suggests that potential transmission encounters can be identified by simply counting the number of people present in a location. Our findings thus provide a reliable and scalable proxy measure of distancing noncompliance that offers epidemiologists a tool to easily incorporate real-life behavior into predictive models of airborne contagious diseases. Furthermore, our results highlight the need for scholars and public health agencies to consider the situational factors influencing social distancing violations, especially those related to crowding in public settings. ", doi="10.2196/50929", url="https://publichealth.jmir.org/2025/1/e50929" } @Article{info:doi/10.2196/59783, author="Mugasha, Rodney and Kwiringira, Andrew and Ntono, Vivian and Nakiire, Lydia and Ayebazibwe, Immaculate and Kyozira, Caroline and Muruta, Niyonzima Allan and Kasule, Namugga Juliet and Byonanebye, M. Dathan and Nanyondo, Judith and Walwema, Richard and Kakooza, Francis and Lamorde, Mohammed", title="Scaling Up and Enhancing the Functionality of the Electronic Integrated Diseases Surveillance and Response System in Uganda, 2020-2022: Description of the Journey, Challenges, and Lessons Learned", journal="JMIR Public Health Surveill", year="2025", month="Apr", day="14", volume="11", pages="e59783", keywords="electronic Integrated Disease Surveillance and Response", keywords="eIDSR", keywords="disease surveillance", keywords="training of trainers", keywords="Uganda", keywords="digital surveillance systems", keywords="health worker", keywords="eHealth", keywords="public health", keywords="digital health", doi="10.2196/59783", url="https://publichealth.jmir.org/2025/1/e59783" } @Article{info:doi/10.2196/66062, author="Ong Hui Shan, Rebecca and Oh, Choon Hong and Goh Sook Kheng, Priscilla and Lee Sze Hui, Lyndia and Riza Bte Mohd Razali, Mas and Ahmad, Atikah Edris and Raghuram, Jagadesan and How, How Choon and Lim Hoon Chin, Steven", title="Evaluation of a Digital Media Campaign to Promote Knowledge and Awareness of the GPFirst Program for Nonurgent Conditions: Repeated Survey Study", journal="JMIR Public Health Surveill", year="2025", month="Apr", day="14", volume="11", pages="e66062", keywords="digital media campaign", keywords="public awareness campaign", keywords="primary care partnership", keywords="social media", keywords="nonurgent emergency department visits", keywords="Andersen model", abstract="Background: GPFirst is a primary care partnership program designed to encourage patients with nonurgent conditions to seek care at participating general practitioner clinics instead of visiting the emergency department. In 2019, a digital media campaign (DMC) was launched to raise awareness and knowledge about GPFirst among residents in eastern Singapore. Objective: This study aims to assess the DMC's impact on awareness and knowledge of GPFirst across different age groups, and the acceptability and satisfaction of GPFirst. Methods: The DMC, comprising Facebook posts and a website designed using the Andersen behavioral model, was evaluated through 2 repeated cross-sectional surveys. The first cross-sectional survey (CS1) was conducted with eastern Singapore residents aged 21 years and older, 2 1 year before the campaign's launch, and the second survey (CS2) 4 months after. Satisfaction was measured on a 5-point Likert scale (very poor to excellent) about GPFirst experiences. Acceptability was assessed with 3 yes or no questions on decisions to visit or recommend GPFirst clinics. Analyses used tests of proportions, adjusted multiregression models, and age-stratified secondary analyses. Results: The Facebook posts generated 38,404 engagements within 5 months, with ``\#ThankYourGP'' posts being the most viewed (n=24,602) and engaged (n=2618). Overall, 1191 and 1161 participants completed CS1 and CS2 respectively. Compared to CS1, CS2 participants were more aware (odds ratio [OR] 2.64, 95\% CI 2.11-3.31; P<.001) and knowledgeable of GPFirst (OR 4.20, 95\% CI 2.62-6.73; P<.001). Awareness was higher among married individuals (OR 1.31, 95\% CI 1.04-1.66; P=.03), those without a regular primary care physician (OR 1.79, 95\% CI 1.44-2.22; P<.001), and with higher education levels. Similarly, knowledge was greater among individuals with secondary (OR 2.88, 95\% CI 1.35-6.17; P=.006) and preuniversity education (OR 2.56, 95\% CI 1.14-5.70; P=.02), and those without a regular primary care physician (OR 1.54, 95\% CI 1.02-2.34; P=.04). For acceptability, among participants who visited a GPFirst clinic, 98.2\% (163/166) reported they would continue to visit a GPFirst clinic before the emergency department in the future, 95.2\% (158/166) would recommend the clinic, 60.2\% (100/166) cited the clinic's participation in GPFirst as a factor in their provider's choice and 87.3\% (145/166) were satisfied with GPFirst. Among those unaware of GPFirst, 88.3\% (1680/1903) would consider visiting a GPFirst clinic before the emergency department in the future. Conclusions: The DMC improved awareness and knowledge of GPFirst, with high satisfaction and acceptability among participants. Age-dependent strategies may improve GPFirst participation. The ``\#ThankYourGP'' campaign demonstrated the potential of user-generated content to boost social media engagement, a strategy that international health systems could adopt. ", doi="10.2196/66062", url="https://publichealth.jmir.org/2025/1/e66062", url="http://www.ncbi.nlm.nih.gov/pubmed/40228291" } @Article{info:doi/10.2196/56519, author="Burhan, Erlina and Azzumar, Farchan and Sinuraya, Gabriella Fira Alyssa and Rakasiwi, Dhiya Muhammad Ilham and Akbar, Ihya and Mubarak, Farhan and Rengganis, Tresna Anggit and Rachmadi, Abi Rizky and Afidjati, Hera", title="Real-World Effectiveness of COVID-19 Vaccines (ChAdOx-1s, CoronaVac, BBIBP-CorV, mRNA-1273, and BNT162b2) in Jakarta: Protocol for Test-Negative Design of Health Care Data", journal="JMIR Res Protoc", year="2025", month="Apr", day="10", volume="14", pages="e56519", keywords="COVID-19", keywords="protocol", keywords="vaccine", keywords="vaccine effectiveness", keywords="Delta", keywords="Omicron", abstract="Background: ChAdOx-1s, CoronaVac, BBIBP-CorV, mRNA-1273, and BNT162b2 are the five common COVID-19 vaccines used in Jakarta. Randomized controlled trials have provided robust evidence of the safety and efficacy profile of these vaccines, but their real-world vaccine effectiveness against symptomatic COVID-19 and deaths in communities with social inequalities and health care constraints remains unclear. Objective: This study aims to evaluate the real-world effectiveness of these COVID-19 vaccines during the waves associated with the Delta and Omicron variants by analyzing existing electronic health care sources. Methods: A population-based study with a test-negative case-control design will be used to evaluate COVID-19 vaccine effectiveness in Jakarta, focusing on the Delta and Omicron waves. It includes adults 18 years and older who underwent reverse transcription polymerase chain reaction testing for symptomatic COVID-19, classifying them as cases or controls based on their test results. The analysis will consider multiple COVID-19 vaccines introduced during these periods, with participants categorized by vaccination status. Several potential confounders will be assessed, including demographic factors and comorbidities. Data will be linked from various health datasets, and statistical analyses will be performed to determine vaccine effectiveness and potential waning immunity over time. After data linkage, patients' identities will be encrypted. Results: The research, funded from 2022 to 2024, involved proposal preparation and ethical review in 2023 and enrollment from early 2024 to July 2024, resulting in about 4 million linked data points. Data analysis is ongoing, with initial results expected for publication in early 2025. Conclusions: This study will be the first to evaluate the effectiveness of different types of COVID-19 vaccines (inactivated, viral-vector, and mRNA) used in Jakarta during the pandemic, providing valuable scientific evidence to inform future vaccination strategies in the country. International Registered Report Identifier (IRRID): DERR1-10.2196/56519 ", doi="10.2196/56519", url="https://www.researchprotocols.org/2025/1/e56519", url="http://www.ncbi.nlm.nih.gov/pubmed/39902869" } @Article{info:doi/10.2196/66350, author="Mizan, Shazlina Nor and Al-Talib, Hassanain and Wang, Mui Seok", title="Epidemiological Characteristics of Intestinal Protozoal Infections and Their Risk Factors in Malaysia: Systematic Review and Meta-Analysis Protocol", journal="JMIR Res Protoc", year="2025", month="Apr", day="4", volume="14", pages="e66350", keywords="intestinal protozoa", keywords="infection", keywords="gastroenteritis", keywords="epidemiology", keywords="parasite", keywords="risk factor", keywords="Malaysia", keywords="contamination", keywords="diarrhea", keywords="outbreak", keywords="socioeconomic", keywords="sanitation", keywords="systematic review", keywords="meta-analysis", keywords="protocol", keywords="observational", keywords="PRISMA", abstract="Background: Intestinal protozoal infections caused by Entamoeba histolytica, Giardia lamblia, and Cryptosporidium parvum are prevalent in Malaysia. They cause severe diarrheal diseases with symptoms such as bloody stools, abdominal pain, stomach discomfort, and bloating. These infection outbreaks have been reported in diverse socioeconomic backgrounds and geographical regions usually during the rainy season or in areas with poor sanitation. Despite the importance of these infections, data on its overall prevalence, risk factors, and diagnostic methods remain limited. Objective: The aim of this study is to systematically review and synthesize evidence on the risk factors, prevalence, and detection methods for intestinal protozoal infections in Malaysia, offering insights that are applicable to other tropical and low-income regions. Methods: Studies on intestinal protozoal infections among Malaysian patients published after January 2010 up to November 2024 will be eligible for inclusion. The eligibility criteria include studies investigating infections caused by E. histolytica, G. lamblia, and C. parvum using validated diagnostic methods such as microscopy, molecular techniques, or immunoassays. Case reports, reviews, and studies without original data will be excluded. Comprehensive database searches will be conducted in PubMed/MEDLINE, Scopus, ProQuest, Web of Science, Google Scholar, and the Cochrane Library. The reference lists of selected papers are also checked. A standardized data extraction form will be used to record study characteristics, outcomes, and associated variables. Risk of bias will be assessed using the Joanna Briggs Institute tools and Newcastle-Ottawa Scale approach. Data synthesis will utilize a random effects model to estimate pooled prevalence and identify risk factors associated with these infections. Subgroup analyses will examine variations by geographic region and diagnostic method. Statistical heterogeneity will be assessed using I2 statistic and meta-regression. Publication bias will be assessed using Egger and Begg funnel plot test. The results are reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: This systematic review was funded in June 2024. Database searches were started in July 2024, and we identified 1652 papers as of December 2024 for screening. Completion of study screening is anticipated by May 2025, with data extraction and analysis expected to conclude by December 2025. Conclusions: Our study will address critical knowledge gaps in the epidemiology and risk factors of intestinal protozoal infections in Malaysia. Study limitations include potential bias in study selection, heterogeneity in diagnostic methods, and differences in the reporting quality of the included studies. Our findings will provide valuable insights into the prevalence of these infections, the associated risk factors, and the diagnostic techniques employed, which should strengthen public health measures, improve diagnostic procedures, and guide future research to reduce the prevalence of intestinal protozoal infections in Malaysia. Trial Registration: PROSPERO (International Prospective Registry of Systematic Reviews) registration CRD42023456199; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023456199 International Registered Report Identifier (IRRID): DERR1-10.2196/66350 ", doi="10.2196/66350", url="https://www.researchprotocols.org/2025/1/e66350", url="http://www.ncbi.nlm.nih.gov/pubmed/40184188" } @Article{info:doi/10.2196/59220, author="Yu, Wei-Ning and Cheng, Yih-Dih and Hou, Yu-Chi and Hsieh, Yow-Wen", title="Implementation of Medication-Related Technology and Its Impact on Pharmacy Workflow: Real-World Evidence Usability Study", journal="J Med Internet Res", year="2025", month="Mar", day="27", volume="27", pages="e59220", keywords="medication error", keywords="dispensing error", keywords="medication-related technology", keywords="pharmacy", keywords="smart dispensing counter", abstract="Background: Medication errors constitute a major contributor to patient harm, driving up health care costs and representing a preventable cause of medical incidents. Over the past decade, many hospitals have integrated various medication-related technologies into their pharmacy operations. However, real-world evidence of the impact of these advanced systems on clinical prescription dispensing error rates remains limited. Objective: This study aims to prospectively detect and record the categories and rates of dispensing errors to illustrate how medication-related technologies, such as automated dispensing cabinet (ADC), barcode medication administration (BCMA), and smart dispensing counter (SDC), can be used to minimize dispensing errors. Methods: This study used a before-and-after design at a 2202-bed academic medical center in Taiwan to assess the impact of implementing medication-related technologies (ADC, BCMA, and SDC) on patient medication safety. Dispensing error rates were analyzed from January 1, 2017, to December 31, 2023, using data from the China Medical University Hospital Patient Safety Database. The study periods were defined as stage 0 (preintervention, January to November 2017), stage 1 (post-ADC intervention, December 2017 to June 2018), stage 2 (post-BCMA intervention, July 2018 to October 2020), and stage 3 (post-SDC intervention, November 2020 to December 2023). Medication errors were defined according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). Chi-square or Fisher exact tests were used to analyze differences between intervention periods, with Bonferroni correction for multiple comparisons. Statistical significance was set at P<.05. Results: Following the introduction of medication-related technologies, the average dispensing error incidence rate significantly decreased by 39.68\%, 44.44\%, and 77.78\%, from 0.0063\% in stage 0 to 0.0038\%, 0.0035\%, and 0.0014\% in stages 1, 2, and 3, respectively (P<.001). The frequency of ``wrong drug'' errors, the most common error type in stage 0, significantly decreased by 51.15\%, 56.85\%, and 81.26\% in stages 1, 2, and 3, respectively. All error types, except for ``wrong dosage form,'' ``wrong strength,'' ``wrong time,'' and ``others,'' demonstrated statistically significant differences (P<.001). The majority of harm severities were categorized as ``A'' (no error; 97\%-98.8\%) and ``B-D'' (error, no harm; 1.2\%-3\%) according to the NCC MERP classification. The severity of ``no error'' (category A) significantly decreased at each stage (P<.001). Statistically significant differences in dispensing error rates were observed between all stages (P<.001), except between stages 2 and 1 (P>.99). Conclusions: This study provides significant evidence that the implementation of medication-related technologies, including ADC, BCMA, and SDC, effectively reduces dispensing errors in a hospital pharmacy setting. Specifically, we observed a substantial decrease in the average dispensing error rate across 3 stages of technology implementation. Importantly, this study appears to be the first to investigate the combined impact of these 3 specific technologies on dispensing error rates within a hospital pharmacy. ", doi="10.2196/59220", url="https://www.jmir.org/2025/1/e59220", url="http://www.ncbi.nlm.nih.gov/pubmed/40019479" } @Article{info:doi/10.2196/53849, author="Aisyah, Nur Dewi and Utami, Astri and Rahman, Mauly Fauziah and Adriani, Humaira Nathasya and Fitransyah, Fiqi and Endryantoro, Aziz M. Thoriqul and Hutapea, Yosephine Prima and Tandy, Gertrudis and Manikam, Logan and Kozlakidis, Zisis", title="Using an Electronic Immunization Registry (Aplikasi Sehat IndonesiaKu) in Indonesia: Cross-Sectional Study", journal="Interact J Med Res", year="2025", month="Mar", day="27", volume="14", pages="e53849", keywords="immunization", keywords="registry", keywords="digital", keywords="puskesmas", keywords="public health center", keywords="mobile app", abstract="Background: Electronic immunization registries (EIRs) are being increasingly used in low- and middle-income countries. In 2022, Indonesia's Ministry of Health introduced its first EIR, named Aplikasi Sehat IndonesiaKu (ASIK), as part of a comprehensive nationwide immunization program. This marked a conversion from traditional paper-based immunization reports to digital routine records encompassing a network of 10,000 primary health centers (puskesmas). Objective: This paper provides an overview of the use of ASIK as the first EIR in Indonesia. It describes the coverage of the nationwide immunization program (Bulan Imunisasi Anak Nasional) using ASIK data and assesses the implementation challenges associated with the adoption of the EIR in the context of Indonesia. Methods: Data were collected from primary care health workers' submitted reports using ASIK. The data were reported in real time, analyzed, and presented using a structured dashboard. Data on ASIK use were collected from the ASIK website. A quantitative assessment was conducted through a cross-sectional survey between September 2022 and October 2022. A set of questionnaires was used to collect feedback from ASIK users. Results: A total of 93.5\% (9708/10,382) of public health centers, 93.5\% (6478/6928) of subdistricts, and 97.5\% (501/514) of districts and cities in 34 provinces reported immunization data using ASIK. With >21 million data points recorded, the national coverage for immunization campaigns for measles-rubella; oral polio vaccine; inactivated polio vaccine; and diphtheria, pertussis, tetanus, hepatitis B, and Haemophilus influenzae type B vaccine were 50.1\% (18,301,057/36,497,694), 36.2\% (938,623/2,595,240), 30.7\% (1,276,668/4,158,289), and 40.2\% (1,371,104/3,407,900), respectively. The quantitative survey showed that, generally, users had a good understanding of ASIK as the EIR (650/809, 80.3\%), 61.7\% (489/793) of the users expressed that the user interface and user experience were overall good but could still be improved, 54\% (422/781) of users expressed that the ASIK variable fit their needs yet could be improved further, and 59.1\% (463/784) of users observed sporadic system interference. Challenges faced during the implementation of ASIK included a heavy workload burden for health workers, inadequate access to the internet at some places, system integration and readiness, and dual reporting using the paper-based format. Conclusions: The EIR is beneficial and helpful for monitoring vaccination coverage. Implementation and adoption of ASIK as Indonesia's first EIR still faces challenges related to human resources and digital infrastructure as the country transitions from paper-based reports to electronic or digital immunization reports. Continuous improvement, collaboration, and monitoring efforts are crucial to encourage the use of the EIR in Indonesia. ", doi="10.2196/53849", url="https://www.i-jmr.org/2025/1/e53849" } @Article{info:doi/10.2196/59953, author="Gicquelais, E. Rachel and Conway, Caitlin and Vjorn, Olivia and Genz, Andrew and Kirk, Gregory and Westergaard, Ryan", title="Mobile Health Tool to Capture Social Determinants of Health and Their Impact on HIV Treatment Outcomes Among People Who Use Drugs: Pilot Feasibility Study", journal="JMIR Form Res", year="2025", month="Mar", day="26", volume="9", pages="e59953", keywords="HIV", keywords="drug use", keywords="social determinants of health", keywords="mobile health", keywords="mHealth", keywords="smartphone", abstract="Background: Active substance use, food or housing insecurity, and criminal legal system involvement can disrupt HIV care for people living with HIV and opioid use disorder (OUD). These social determinants of health are not routinely captured in clinical settings. Objective: We evaluated whether real-time reports of social and behavioral factors using a smartphone app could predict viral nonsuppression and missed care visits to inform future mobile health interventions. Methods: We enrolled 59 participants from the AIDS Linked to the Intravenous Experience (ALIVE) Study in Baltimore, Maryland, into a 12-month substudy between February 2017 and October 2018. Participants were eligible if they had OUD and had either a measured HIV RNA ?1000 copies/mL or a ?1-month lapse in antiretroviral therapy in the preceding 2 years. Participants received a smartphone and reported HIV medication adherence, drug use or injection, and several disruptive life events, including not having a place to sleep at night, skipping a meal due to lack of income, being stopped by police, being arrested, or experiencing violence on a weekly basis, through a survey on a mobile health app. We described weekly survey completion and investigated which factors were associated with viral nonsuppression (HIV RNA ?200 copies/mL) or a missed care visit using logistic regression with generalized estimating equations adjusted for age, gender, smartphone comfort, and drug use. Results: Participants were predominantly male (36/59, 61\%), Black (53/59, 90\%), and had a median of 53 years old. At baseline, 16\% (6/38) were virally unsuppressed. Participants completed an average of 23.3 (SD 16.3) total surveys and reported missing a dose of antiretroviral therapy, using or injecting drugs, or experiencing any disruptive life events on an average of 13.1 (SD 9.8) weekly surveys over 1 year. Reporting use of any drugs (adjusted odds ratio [aOR] 2.3, 95\% CI 1.4?3.7), injecting drugs (aOR 2.3, 95\% CI 1.3?3.9), and noncompletion of all surveys (aOR 1.6, 95\% CI 1.1?2.2) were associated with missing a scheduled care visit over the subsequent 30 days. Missing ?2 antiretroviral medication doses within 1 week was associated with HIV viral nonsuppression (aOR 3.7, 95\% CI: 1.2?11.1) in the subsequent 30 days. Conclusions: Mobile health apps can capture risk factors that predict viral nonsuppression and missed care visits among people living with HIV who have OUD. Using mobile health tools to detect sociobehavioral factors that occur prior to treatment disengagement may facilitate early intervention by health care teams. ", doi="10.2196/59953", url="https://formative.jmir.org/2025/1/e59953" } @Article{info:doi/10.2196/67487, author="Li, Mingyan and Sun, Changxuan and Ji, Chai and Gao, Meiying and Wang, Xia and Yao, Dan and Guo, Junxia and Sun, Lidan and Rafay, Abdul and George, Shereen Antonita and Muhandiramge, Samararathna Sanduni Hasara Samararathna and Bai, Guannan", title="Vaccine Hesitancy and Associated Factors Among Caregivers of Children With Special Health Care Needs in the COVID-19 Era in China: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2025", month="Mar", day="26", volume="11", pages="e67487", keywords="COVID-19", keywords="caregivers", keywords="children with special health care needs", keywords="vaccination hesitancy", keywords="decision-making", abstract="Background: Immunization is a cost-effective way to prevent infectious diseases in children, but parental hesitancy leads to low vaccination rates, leaving children at risk. Caregivers of children with special health care needs are more hesitant about vaccines than those of healthy children. Objective: The aim of the study is to investigate the changes in caregivers' vaccination hesitation of children with special health care needs before, during, and after the COVID-19 pandemic in China and to identify associated factors for caregivers' attitudes toward National Immunization Program (NIP) and non-NIP vaccines. Methods: We included 7770 caregivers of children with special health care needs (median age 7.0, IQR 2.4-24.1 months) who visited the Vaccination Consultation Clinic at Children's Hospital, Zhejiang University School of Medicine (Hangzhou, China) from May 2017 to May 2023. General and clinical information was extracted from the immunization evaluation system for children with special health care needs and medical records. We compared the differences in caregivers' willingness and hesitation for vaccinating their children across the 3 stages of the COVID-19 pandemic using chi-square tests. Multinomial logistic regression models were used to identify independent variables that were associated with caregivers' willingness and hesitation toward NIP and non-NIP vaccines. Results: There is a statistically significant difference in caregivers' vaccine hesitancy before, during, and after the COVID-19 pandemic (P<.05). During the COVID-19 pandemic, the percentages of choosing NIP, alternative non-NIP, and non-NIP vaccines are highest (n=1428, 26\%, n=3148, 57.4\%, and n=3442, 62.7\%, respectively) than those at other 2 stages. In comparison, caregivers' hesitation toward NIP and non-NIP vaccines is lowest (n=911, 16.6\% and n=2045, 37.3\%, respectively). Despite the stages of the COVID-19 pandemic, multiple factors, including children's age and sex, parents' educational level, comorbidities, and history of allergy, were significantly associated with caregivers' attitude toward NIP and non-NIP vaccines (P<.05). The profiles of risk factors for hesitancy toward NIP and non-NIP vaccines are different, as indicated by the results from the logistic regression models. Conclusions: This study demonstrated that caregivers' willingness to vaccinate their children with special health care needs with NIP and non-NIP vaccines was highest during the COVID-19 pandemic in China, and their hesitancy was lowest. Additionally, we have identified multiple factors associated with caregivers' willingness and hesitancy to vaccinate their children. These findings provide evidence-based support for developing personalized health education strategies. ", doi="10.2196/67487", url="https://publichealth.jmir.org/2025/1/e67487" } @Article{info:doi/10.2196/55356, author="McNeil, Carrie and Divi, Nomita and Bargeron IV, Thomas Charles and Capobianco Dondona, Andrea and Ernst, C. Kacey and Gupta, S. Angela and Fasominu, Olukayode and Keatts, Lucy and Kelly, Terra and Leal Neto, B. Onicio and Lwin, O. May and Makhasi, Mvuyo and Mutagahywa, Beda Eric and Montecino-Latorre, Diego and Olson, Sarah and Pandit, S. Pranav and Paolotti, Daniela and Parker, C. Matt and Samad, Haiman Muhammad and Sewalk, Kara and Sheldenkar, Anita and Srikitjakarn, Lertrak and Suy Lan, Chann{\'e} and Wilkes, Michael and Yano, Terdsak and Smolinski, Mark", title="Data Parameters From Participatory Surveillance Systems in Human, Animal, and Environmental Health From Around the Globe: Descriptive Analysis", journal="JMIR Public Health Surveill", year="2025", month="Mar", day="26", volume="11", pages="e55356", keywords="participatory surveillance", keywords="One Health", keywords="citizen science", keywords="community-based surveillance", keywords="digital disease detection", keywords="environmental health", keywords="wildlife health", keywords="livestock health", keywords="human health", keywords="data standards", abstract="Background: Emerging pathogens and zoonotic spillover highlight the need for One Health surveillance to detect outbreaks as early as possible. Participatory surveillance empowers communities to collect data at the source on the health of animals, people, and the environment. Technological advances increase the use and scope of these systems. This initiative sought to collate information from active participatory surveillance systems to better understand parameters collected across the One Health spectrum. Objective: This study aims to develop a compendium of One Health data parameters by examining participatory surveillance systems active in 2023. The expected outcomes of the compendium were to pinpoint specific parameters related to human, animal, and environmental health collected globally by participatory surveillance systems and to detail how each parameter is collected. The compendium was designed to help understand which parameters are currently collected and serve as a reference for future systems and for data standardization initiatives. Methods: Contacts associated with the 60 systems identified through the One Health Participatory Surveillance System Map were invited by email to provide specific data parameters, methodologies used for data collection, and parameter-specific considerations. Information was received from 38 (63\%) active systems. Data were compiled into a searchable spreadsheet-based compendium organized into 5 sections: general, livestock, wildlife, environmental, and human parameters. An advisory group comprising experts in One Health participatory surveillance reviewed the collected parameters, refined the compendium structure, and contributed to the descriptive analysis. Results: A comprehensive compendium of data parameters from a diverse array of single-sector and multisector participatory surveillance systems was collated and reviewed. The compendium includes parameters from 38 systems used in Africa (n=3, 8\%), Asia (n=9, 24\%), Europe (n=12, 32\%), Australia (n=3, 8\%), and the Americas (n=12, 32\%). Almost one-third of the systems (n=11, 29\%) collect data across multiple sectors. Many (n=17, 45\%) focus solely on human health. Variations in data collection techniques were observed for commonly used parameters, such as demographics and clinical signs or symptoms. Most human health systems collected parameters from a cohort of users tracking their own health over time, whereas many wildlife and environmental systems incorporated event-based parameters. Conclusions: Several participatory surveillance systems have already adopted a One Health approach, enhancing traditional surveillance by identifying shared health threats among animals, people, and the environment. The compendium reveals substantial variation in how parameters are collected, underscoring the need for further work in system interoperability and data standards to allow for timely data sharing across systems during outbreaks. Parameters collated from across the One Health spectrum represent a valuable resource for informing the development of future systems and identifying opportunities to expand existing systems for multisector surveillance. ", doi="10.2196/55356", url="https://publichealth.jmir.org/2025/1/e55356" } @Article{info:doi/10.2196/70983, author="Schmit, D. Cason and O'Connell, Curry Meghan and Shewbrooks, Sarah and Abourezk, Charles and Cochlin, J. Fallon and Doerr, Megan and Kum, Hye-Chung", title="Dying in Darkness: Deviations From Data Sharing Ethics in the US Public Health System and the Data Genocide of American Indian and Alaska Native Communities", journal="J Med Internet Res", year="2025", month="Mar", day="26", volume="27", pages="e70983", keywords="ethics", keywords="information dissemination", keywords="indigenous peoples", keywords="public health surveillance", keywords="privacy", keywords="data sharing", keywords="deidentification", keywords="data anonymization", keywords="public health ethics", keywords="data governance", doi="10.2196/70983", url="https://www.jmir.org/2025/1/e70983" } @Article{info:doi/10.2196/64826, author="Inderstrodt, Jill and Stumpff, C. Julia and Smollen, C. Rebecca and Sridhar, Shreya and El-Azab, A. Sarah and Ojo, Opeyemi and Bowns, Brendan and Haggstrom, A. David", title="Informatics Interventions for Maternal Morbidity: Scoping Review", journal="Interact J Med Res", year="2025", month="Mar", day="25", volume="14", pages="e64826", keywords="scoping review", keywords="maternal morbidity", keywords="medical informatics", keywords="clinical informatics", keywords="mother", keywords="pregnant", keywords="perinatal", keywords="GDM", keywords="preeclampsia", keywords="maternity", keywords="gestational diabetes mellitus", abstract="Background: Women have been entering pregnancy less healthy than previous generations, placing them at increased risk for pregnancy complications. One approach to ensuring effective monitoring and treatment of at-risk women is designing technology-based interventions that prevent maternal morbidities and treat perinatal conditions. Objective: This scoping review evaluates what informatics interventions have been designed and tested to prevent and treat maternal morbidity. Methods: MEDLINE, Embase, and Cochrane Library were searched to identify relevant studies. The inclusion criteria were studies that tested a medical or clinical informatics intervention; enrolled adult women; and addressed preeclampsia, gestational diabetes mellitus (GDM), preterm birth, Centers for Disease Control and Prevention--defined severe maternal morbidity, or perinatal mental health conditions. Demographic, population, and intervention data were extracted to characterize the technologies, conditions, and populations addressed. Results: A total of 80 studies were identified that met the inclusion criteria. Many of the studies tested for multiple conditions. Of these, 73\% (60/82) of the technologies were tested for either GDM or perinatal mental health conditions, and 15\% (12/82) were tested for preeclampsia. For technologies, 32\% (28/87) of the technologies tested were smartphone or tablet applications, 26\% (23/87) were telehealth interventions, and 14\% (12/87) were remote monitoring technologies. Of the many outcomes measured by the studies, almost half (69/140, 49\%) were patient physical or mental health outcomes. Conclusions: Per this scoping review, most informatics interventions address three conditions: GDM, preeclampsia, and mental health. There may be opportunities to treat other potentially lethal conditions like postpartum hemorrhage using proven technologies such as mobile apps. Ample gaps in the literature exist concerning the use of informatics technologies aimed at maternal morbidity. There may be opportunities to use informatics for lesser-targeted conditions and populations. ", doi="10.2196/64826", url="https://www.i-jmr.org/2025/1/e64826" } @Article{info:doi/10.2196/60476, author="Diviani, Nicola and Chadha, Shelly and Mulas, Peter and Rubinelli, Sara", title="Safe Listening Beliefs, Attitudes, and Practices Among Gamers and Esports Participants: International Web-Based Survey", journal="JMIR Form Res", year="2025", month="Mar", day="25", volume="9", pages="e60476", keywords="video gaming", keywords="esports", keywords="hearing health", keywords="safe listening", keywords="auditory risk", keywords="health behavior", keywords="intervention design", keywords="games", keywords="listening", keywords="auditory", keywords="survey", keywords="college", keywords="data analysis", keywords="awareness", keywords="listening behavior", keywords="gaming", abstract="Background: The global rise of video gaming and esports has raised significant concerns about hearing loss due to loud sound exposure. While these activities provide entertainment and have applications in health care, the auditory health risks and behavioral factors influencing listening habits among gamers remain underexplored. Research is needed to develop tailored interventions that address the unique barriers, attitudes, and beliefs of gamers and esports participants, promoting safer listening practices and minimizing auditory health risks. Objective: This study aimed to explore listening behaviors, attitudes, and awareness regarding hearing health risks among video gamers and esports participants. The findings are intended to guide the design and implementation of technological features that encourage safer listening practices, in alignment with the World Health Organization's Safe Listening initiative. Methods: An open web-based survey was conducted from September 2022 to January 2023, targeting video gamers and esports enthusiasts. Participants were recruited via World Health Organization social media platforms and outreach to stakeholders. The survey assessed gaming behaviors, listening habits, awareness about hearing health, beliefs, readiness to change listening behaviors, and communication preferences. Data were analyzed using descriptive statistics and multinomial logistic regression. Results: A total of 488 responses were collected, with 67.2\% (n=328) of participants identifying as male, and 56.4\% (n=275) having a college degree or higher. Of the respondents, 90.8\% (n=443) were actively engaged in video gaming, while 54.9\% (n=268) viewed esports, and 13.9\% (n=68) participated in esports events. Notably, 24.8\% (n=110) of gamers, 18.3\% (n=49) of esports viewers, and 37.1\% (n=23) of esports players reported using high or very high volume settings. Despite around half of the participants experiencing symptoms indicative of hearing damage (eg, ringing in the ears), only 34.3\% (n=152) of gamers, 35.8\% (n=92) of esports players, and 39.7\% (n=27) of esports viewers reported taking sound breaks every hour. The study identified a balanced distribution across readiness-to-change stages, with 30.3\% (n=148) in the precontemplation stage, 35.3\% (n=173) in the contemplation stage, and 34.2\% (n=167) in the action stage. Factors such as perceived susceptibility to hearing loss, perceived benefits of preventive action, and self-efficacy significantly influenced readiness to change. Communication preferences indicated that 51\% (n=249) of participants were interested in receiving more information on hearing health, with health care professionals and governmental agencies being the most trusted sources. Conclusions: The findings highlight an urgent need for interventions to promote safe listening practices among gamers, emphasizing a gap between awareness and preventive action. The integration of safe listening features into video games and esports platforms, along with targeted communication strategies, can enhance auditory health awareness and protective behaviors. Future research should evaluate the effectiveness of these interventions to ensure comprehensive auditory health protection in the digital entertainment sector. ", doi="10.2196/60476", url="https://formative.jmir.org/2025/1/e60476", url="http://www.ncbi.nlm.nih.gov/pubmed/40131338" } @Article{info:doi/10.2196/57084, author="Eguchi, Kana and Kubota, Takeaki and Koyanagi, Tomoyoshi and Muto, Manabu", title="Real-World Data on Alcohol Consumption Behavior Among Smartphone Health Care App Users in Japan: Retrospective Study", journal="Online J Public Health Inform", year="2025", month="Mar", day="25", volume="17", pages="e57084", keywords="alcohol consumption", keywords="individual behavior", keywords="mobile health", keywords="mobile health app", keywords="mobile health care app log-based survey", keywords="real-world data", keywords="RWD", keywords="RWD analysis", keywords="smartphone health care app", keywords="surveillance system", keywords="health care app", abstract="Background: Although many studies have used smartphone apps to examine alcohol consumption, none have clearly delineated long-term (>1 year) consumption among the general population. Objective: The objective of our study is to elucidate in detail the alcohol consumption behavior of alcohol drinkers in Japan using individual real-world data. During the state of emergency associated with the COVID-19 outbreak, the government requested that people restrict social gatherings and stay at home, so we hypothesize that alcohol consumption among Japanese working people decreased during this period due to the decrease in occasions for alcohol consumption. This analysis was only possible with individual real-world data. We also aimed to clarify the effects of digital interventions based on notifications about daily alcohol consumption. Methods: We conducted a retrospective study targeting 5-year log data from January 1, 2018, to December 31, 2022, obtained from a commercial smartphone health care app (CALO mama Plus). First, to investigate the possible size of the real-world data, we investigated the rate of active users of this commercial smartphone app. Second, to validate the individual real-world data recorded in the app, we compared individual real-world data from 9991 randomly selected users with government-provided open data on the number of daily confirmed COVID-19 cases in Japan and with nationwide alcohol consumption data. To clarify the effects of digital interventions, we investigated the relationship between 2 types of notification records (ie, ``good'' and ``bad'') and a 3-day daily alcohol consumption log following the notification. The protocol of this retrospective study was approved by the Ethics Committee of the Kyoto University Graduate School and Faculty of Medicine (R4699). ", doi="10.2196/57084", url="https://ojphi.jmir.org/2025/1/e57084", url="http://www.ncbi.nlm.nih.gov/pubmed/40131328" } @Article{info:doi/10.2196/58586, author="Jalaludin, Yazid Muhammad and Kiau, Bee Ho and Hasim, Suriati and Lee, Khew Wai and Low, Angie and Kazim, Nik Nik Harlina and Hoi, Tse Jia and Taher, Wahyu Sri", title="A Noninvasive Approach to Assess the Prevalence of and Factors Associated With Anemia Risk in Malaysian Children Under Three Years of Age: Cross-Sectional Study", journal="JMIR Pediatr Parent", year="2025", month="Mar", day="24", volume="8", pages="e58586", keywords="anemia", keywords="iron deficiency", keywords="children", keywords="Masimo Rad-67", keywords="noninvasive assessment", keywords="Malaysia", abstract="Background: Anemia remains a significant public health concern with adverse effects among children. Noninvasive screening assessments enable the early detection and prompt treatment of anemia. However, there is limited literature on the use of such screening assessments. Objective: The study aimed to assess the prevalence of and factors associated with being at risk of anemia among Malaysian children aged ?6 months to ?36 months by using a noninvasive hemoglobin assessment. Methods: This was a cross-sectional study (from July to December 2022) of outpatient Malaysian children, aged ?6 months to ?36 months, who were selected from five maternal-and-child health clinics by convenience sampling. At risk of anemia was defined as a total hemoglobin level of <12 g/dL, measured using the Masimo Rad-67, a noninvasive screening device for total hemoglobin levels. The $\chi$2 and multiple logistic regression analyses were used to assess the prevalence and factors associated with being at risk of anemia, using R-Studio (version 4.0.0). Results: The study included 1201 participants, of whom 30\% (95\% CI 28?33) were at risk of anemia. Children aged 6?12 months (210/364, 57.7\%, P<.001), those of Asian Malay race (238/364, 65.4\%, P<.05), those residing in the Klang district (123/371, 33.9\%, P<.05), those born via a normal vaginal delivery (275/364, 75.5\%, P<.05), those without a family history of thalassemia (284/364, 78.0\%, P<.05), and those with lower weight-for-age Z scores (P<.05) were associated with being at risk of anemia. Children aged 6?12 months (adjusted odds ratio=1.73; 95\% CI 1.34?2.24) had higher odds of being at risk of anemia compared to children aged >12?36 months. However, weight-for-age (adjusted odds ratio=0.88; 95\% CI 0.80?0.98) was associated with lower odds of being at risk of anemia. Conclusions: The current study revealed a substantial prevalence of Malaysian children being at risk of developing anemia. The study results therefore imply a need for more community education and awareness on anemia, including nutrition education, as well as targeted community screening to enable the early detection and prompt treatment of anemia cases. Anemia reduction strategies in Malaysia should consider the highlighted factors indicative of higher risk of anemia. Trial Registration: Clinicaltrials.gov NCT05181436, https://clinicaltrials.gov/study/NCT05181436 ", doi="10.2196/58586", url="https://pediatrics.jmir.org/2025/1/e58586" } @Article{info:doi/10.2196/67119, author="John, N. Jennifer and Gorman, Sara and Scales, David", title="Understanding Interventions to Address Infodemics Through Epidemiological, Socioecological, and Environmental Health Models: Framework Analysis", journal="JMIR Infodemiology", year="2025", month="Mar", day="24", volume="5", pages="e67119", keywords="infodemics", keywords="misinformation", keywords="disinformation", keywords="Covid-19", keywords="infodemic management", keywords="health communication", keywords="pandemic preparedness", abstract="Background: The COVID-19 pandemic was accompanied by a barrage of false, misleading, and manipulated information that inhibited effective pandemic response and led to thousands of preventable deaths. Recognition of the urgent public health threat posed by this infodemic led to the development of numerous infodemic management interventions by a wide range of actors. The need to respond rapidly and with limited information sometimes came at the expense of strategy and conceptual rigor. Given limited funding for public health communication and growing politicization of countermisinformation efforts, responses to future infodemics should be informed by a systematic and conceptually grounded evaluation of the successes and shortcomings of existing interventions to ensure credibility of the field and evidence-based action. Objectives: This study sought to identify gaps and opportunities in existing infodemic management interventions and to assess the use of public health frameworks to structure responses to infodemics. Methods: We expanded a previously developed dataset of infodemic management interventions, spanning guidelines, policies, and tools from governments, academic institutions, nonprofits, media companies, and other organizations, with 379 interventions included in total. We applied framework analysis to describe and interpret patterns within these interventions through their alignment with codes derived from 3 frameworks selected for their prominence in public health and infodemic-related scholarly discourse: the epidemiological model, the socioecological model, and the environmental health framework. Results: The epidemiological model revealed the need for rigorous, transparent risk assessments to triage misinformation. The socioecological model demonstrated an opportunity for greater coordination across levels of influence, with only 11\% of interventions receiving multiple socioecological codes, and more robust partnerships with existing organizations. The environmental health framework showed that sustained approaches that comprehensively address all influences on the information environment are needed, representing only 19\% of the dataset. Conclusions: Responses to future infodemics would benefit from cross-sector coordination, adoption of measurable and meaningful goals, and alignment with public health frameworks, which provide critical conceptual grounding for infodemic response approaches and ensure comprehensiveness of approach. Beyond individual interventions, a funded coordination mechanism can provide overarching strategic direction and promote collaboration. ", doi="10.2196/67119", url="https://infodemiology.jmir.org/2025/1/e67119" } @Article{info:doi/10.2196/63584, author="Bataineh, S. Bara and Marti, Nathan C. and Murthy, Dhiraj and Badillo, David and Chow, Sherman and Loukas, Alexandra and Wilkinson, V. Anna", title="Vaping, Acculturation, and Social Media Use Among Mexican American College Students: Protocol for a Mixed Methods Web-Based Cohort Study", journal="JMIR Res Protoc", year="2025", month="Mar", day="24", volume="14", pages="e63584", keywords="vaping", keywords="social media", keywords="Mexican American", keywords="college students", keywords="marketing", keywords="acculturation", keywords="protocol", keywords="artificial intelligence", abstract="Background: The tobacco industry has a history of targeting minority communities, including Hispanic individuals, by promoting vaping through social media. This marketing increases the risk of vaping among Hispanic young adults, including college students. In Texas, college enrollment among Mexican Americans has significantly increased over recent years. However, little research exists on the link between social media and vaping and the underlying mechanisms (ie, outcome expectations, attitudes, and beliefs) explaining how vaping-related social media impacts vaping among Mexican American college students. Moreover, there is limited knowledge about how acculturation moderates the association between social media and vaping. Hispanic individuals, particularly Mexican Americans, are the largest ethnic group in Texas colleges; thus, it is crucial to understand the impact of social media and acculturation on their vaping behaviors. Objective: We outline the mixed methods used in Project Vaping, Acculturation, and Media Study (VAMoS). We present descriptive analyses of the participants enrolled in the study, highlight methodological strengths, and discuss lessons learned during the implementation of the study protocol related to recruitment and data collection and management. Methods: Project VAMoS is being conducted with Mexican American students attending 1 of 6 Texas-based colleges: University of Texas (UT) Arlington, UT Dallas, UT El Paso, UT Rio Grande Valley, UT San Antonio, and the University of Houston System. This project has 2 phases. Phase 1 included an ecological momentary assessment (EMA) study and qualitative one-on-one interviews (years 1-2), and phase 2 includes cognitive interviews and a 4-wave web-based survey study (years 2-4) with objective assessments of vaping-related social media content to which participants are exposed. Descriptive statistics summarized participants' characteristics in the EMA and web-based survey. Results: The EMA analytic sample comprised 51 participants who were primarily female (n=37, 73\%), born in the United States (n=48, 94\%), of middle socioeconomic status (n=38, 75\%), and aged 21 years on average (SD 1.7 years). The web-based survey cohort comprised 1492 participants self-identifying as Mexican American; Tejano, Tejana, or Tejanx; or Chicano, Chicana, or Chicanx heritage who were primarily female (n=1042, 69.8\%), born in the United States (n=1366, 91.6\%), of middle socioeconomic status (n=1174, 78.7\%), and aged 20.1 years on average at baseline (SD 2.2 years). Of the baseline cohort, the retention rate in wave 2 was 74.7\% (1114/1492). Conclusions: Project VAMoS is one of the first longitudinal mixed methods studies exploring the impact of social media and acculturation on vaping behaviors specifically targeting Mexican American college students. Its innovative approach to objectively measuring social media exposure and engagement related to vaping enhances the validity of self-reported data beyond what national surveys can achieve. The results can be used to develop evidence-based, culturally relevant interventions to prevent vaping among this rapidly growing minority population. International Registered Report Identifier (IRRID): DERR1-10.2196/63584 ", doi="10.2196/63584", url="https://www.researchprotocols.org/2025/1/e63584" } @Article{info:doi/10.2196/68085, author="Rutstein, E. Sarah and Ferguson, Ella and Mansour, Odai and Brown, Nicole and Stocks, B. Jacob and Washington, Anja and Mobley, Victoria and Dowler, Shannon and Edwards, Jessie and Hightow-Weidman, B. Lisa and Hurt, B. Christopher and Pence, Brian and Muessig, E. Kathryn", title="Multilevel Intervention to Support Tailored and Responsive HIV Pre-Exposure Prophylaxis Care in Rural North Carolina: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Mar", day="21", volume="14", pages="e68085", keywords="pre-exposure prophylaxis navigation", keywords="PrEP navigation", keywords="digital health app", keywords="mobile health", keywords="mHealth", keywords="telehealth", keywords="public health", keywords="sexually transmitted infection", keywords="HIV prevention", keywords="mobile phone", abstract="Background: While access to pre-exposure prophylaxis (PrEP) is an important tool for reducing HIV incidence in the United States, disparities in uptake by race, sex, socioeconomic status, and geography persist. In 2018, the US South accounted for more than half of all new HIV diagnoses but only one-third of PrEP users. PrEP use in North Carolina (NC) similarly lags, with uptake being the lowest among young, sexual and gender minority populations, who account for nearly two-thirds of the state's incident infections. The PrEP-to-need ratio, a metric of PrEP equity that measures PrEP uptake relative to new HIV diagnoses, highlights disparities in PrEP uptake among specific demographic groups such as women and Black, Hispanic, and Southern people, indicating that these groups are underserved relative to their epidemic need. Despite behavioral risk overlap of incident sexually transmitted infections (STIs) and HIV, in NC, PrEP is only offered at a few primarily urban health department--affiliated STI clinics. The lack of robust health care infrastructure in these areas presents challenges for HIV prevention services. Objective: This protocol describes a randomized controlled trial of a multilevel PrEP intervention recruiting from rural and periurban STI clinics. Methods: This trial aims to enroll up to 336 participants and randomly assign them 1:1 to either the intervention or control group. The intervention consists of access to a digital health app, linkage to a remote PrEP navigator, and the option of referral to telehealth-based PrEP services. Persons randomly assigned to the control condition will receive an enhanced standard of care, including access to a limited version of the digital health app. All participants will be followed up on quarterly for at least 3 months. The primary outcome is the initiation of PrEP within 3 months of an index STI clinic visit; secondary outcomes evaluate PrEP care engagement and adherence, incident HIV and bacterial STI infections, PrEP stigma, and cost-effectiveness. Binary outcome analyses will estimate the proportion of participants achieving an event (eg, PrEP uptake) in each arm and a probability difference and the corresponding 95\% CI to compare the intervention versus control arm at each time point. Continuous end points will use nonparametric Wilcoxon rank sum tests comparing the intervention and control groups. Results: Enrollment opened on August 31, 2023, at 15 health departments in NC and subsequently expanded to 21 facilities in 20 counties by July 2024. Completion of the enrollment and data collection phases is expected by May 2025. Results will be published thereafter. Conclusions: This study directly addresses multiple barriers to PrEP use in rural and periurban areas of the Southeastern United States and can inform policy and programming that seek to expand PrEP access and promote use in underserved communities. Trial Registration: ClinicalTrials.gov NCT05984030; https://clinicaltrials.gov/study/NCT05984030 International Registered Report Identifier (IRRID): DERR1-10.2196/68085 ", doi="10.2196/68085", url="https://www.researchprotocols.org/2025/1/e68085" } @Article{info:doi/10.2196/59971, author="Keshavamurthy, Ravikiran and Pazdernik, T. Karl and Ham, Colby and Dixon, Samuel and Erwin, Samantha and Charles, E. Lauren", title="Meeting Global Health Needs via Infectious Disease Forecasting: Development of a Reliable Data-Driven Framework", journal="JMIR Public Health Surveill", year="2025", month="Mar", day="21", volume="11", pages="e59971", keywords="disease forecasting", keywords="machine learning", keywords="deep learning", keywords="epidemiology", keywords="One Health", keywords="decision-making", keywords="data visualization", abstract="Background: Infectious diseases (IDs) have a significant detrimental impact on global health. Timely and accurate ID forecasting can result in more informed implementation of control measures and prevention policies. Objective: To meet the operational decision-making needs of real-world circumstances, we aimed to build a standardized, reliable, and trustworthy ID forecasting pipeline and visualization dashboard that is generalizable across a wide range of modeling techniques, IDs, and global locations. Methods: We forecasted 6 diverse, zoonotic diseases (brucellosis, campylobacteriosis, Middle East respiratory syndrome, Q fever, tick-borne encephalitis, and tularemia) across 4 continents and 8 countries. We included a wide range of statistical, machine learning, and deep learning models (n=9) and trained them on a multitude of features (average n=2326) within the One Health landscape, including demography, landscape, climate, and socioeconomic factors. The pipeline and dashboard were created in consideration of crucial operational metrics---prediction accuracy, computational efficiency, spatiotemporal generalizability, uncertainty quantification, and interpretability---which are essential to strategic data-driven decisions. Results: While no single best model was suitable for all disease, region, and country combinations, our ensemble technique selects the best-performing model for each given scenario to achieve the closest prediction. For new or emerging diseases in a region, the ensemble model can predict how the disease may behave in the new region using a pretrained model from a similar region with a history of that disease. The data visualization dashboard provides a clean interface of important analytical metrics, such as ID temporal patterns, forecasts, prediction uncertainties, and model feature importance across all geographic locations and disease combinations. Conclusions: As the need for real-time, operational ID forecasting capabilities increases, this standardized and automated platform for data collection, analysis, and reporting is a major step forward in enabling evidence-based public health decisions and policies for the prevention and mitigation of future ID outbreaks. ", doi="10.2196/59971", url="https://publichealth.jmir.org/2025/1/e59971" } @Article{info:doi/10.2196/51524, author="Vey, Trinity and Kinnicutt, Eleonora and Day, G. Andrew and West, Nicola and Sleeth, Jessica and Nchimbi, Bernard Kenneth and Yeates, Karen", title="Targeted Behavior Change Communication Using a Mobile Health Platform to Increase Uptake of Long-Lasting Insecticidal Nets Among Pregnant Women in Tanzania: Hati Salama ``Secure Voucher'' Study Cluster Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Mar", day="19", volume="27", pages="e51524", keywords="malaria prevention", keywords="pregnant", keywords="mHealth", keywords="mobile health", keywords="short message service", keywords="behaviour change communication", keywords="long-lasting insecticidal nets", keywords="protozoan infections", keywords="parasitic diseases", keywords="vector borne diseases", keywords="randomized controlled trial", keywords="morbidity", keywords="mortality", keywords="intervention", abstract="Background: Malaria remains a significant cause of maternal and neonate morbidity and mortality in sub-Saharan Africa. Long-lasting insecticidal nets (LLINs) represent an important component of malaria prevention and can decrease the adverse health outcomes associated with malaria infection during pregnancy. Voucher programs have been successfully implemented for a variety of initiatives across sub-Saharan Africa, including the distribution of subsidized LLINs in Tanzania. However, mobile messaging for behavior change communication (BCC), in combination with an e-voucher program, has not been explored for malaria prevention. Objective: This study aimed to assess the efficacy of mobile messaging in increasing the redemption of e-vouchers for LLINs for pregnant women and adolescents in Tanzania. Methods: This study was a blinded, 2-arm, cluster randomized controlled trial implemented in 100 antenatal health facilities in Tanzania (both urban and rural settings), with 50 clusters in both intervention and control groups. Clusters were antenatal clinics with e-voucher capabilities, with randomization stratified such that 25 urban and 25 rural clinics were randomized to each arm. Participants were pregnant females aged 13 years or older. Participants in both intervention and control groups were issued e-vouchers on their mobile phones that could be redeemed for LLINs at registered retailers within a 14-day redemption period. Participants in the intervention group received targeted BCC messages about the importance of malaria prevention and LLIN use during pregnancy, while participants in the control group did not receive BCC messages. Analyses were by intention to treat. The primary outcome was the redemption rate of e-vouchers for LLINs from retailers. Outcome measures pertain to clinic sites and individual participant-level data. Results: The study enrolled 5449 participants; the analysis included 2708 participants in the intervention arm and 2740 participants in the control arm (49 clusters in each group analyzed). There was no significant difference in the raw redemption rate of e-vouchers between pregnant participants in the intervention group (70\%) and the control group (67\%). Younger participants were less likely to redeem e-vouchers. Conclusions: The use of a BCC mobile messaging intervention did not result in a significant increase in LLIN uptake for pregnant individuals. However, the study shows that e-voucher distribution through nurses in antenatal clinics in partnership with local retailers is feasible on a large scale. Consideration of women and adolescents who are low-income and live in rural areas is needed for future interventions leveraging e-vouchers or mHealth technology in low-resource settings. Trial Registration: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624 ", doi="10.2196/51524", url="https://www.jmir.org/2025/1/e51524" } @Article{info:doi/10.2196/66487, author="Guo, Yan and Gong, Hui and Yan, Xiangyu and Zhang, Xinying and Ning, Tielin and Liu, Zhongquan and Li, Long and Yang, Jie and Li, Liu and Ma, Changxu and Cui, Zhuang and Yu, Maohe", title="HIV Incidence and Associated Risk Factors Among Young Men Who Have Sex With Men in Tianjin, China: Retrospective Cohort Study", journal="JMIR Public Health Surveill", year="2025", month="Mar", day="19", volume="11", pages="e66487", keywords="young men who have sex with men", keywords="YMSM", keywords="incidence", keywords="HIV", keywords="cohort study", keywords="risk factor", abstract="Background: Young men who have sex with men (YMSM) have a higher risk of HIV infection. However, evidence of HIV incidence from large cohort studies is limited in this key population, particularly among Chinese YMSM. Objective: This study aimed to investigate the HIV incidence and associated risk factors among YMSM aged 16?24 years in Tianjin, China. Methods: We conducted a retrospective cohort study among men who have sex with men aged 16?24 years from October 2017 to December 2022 through the largest local nongovernmental organization serving men who have sex with men in Tianjin. Participants who responded to the investigations at least twice during the study period were included. They completed questionnaires on demographic information, sexual behaviors, psychoactive substance use, and sexually transmitted infection status. Simultaneously, their blood samples were collected for HIV testing. HIV incidence was calculated by dividing the sum of observed HIV seroconversions by the observed person-years (PYs). A Cox proportional hazards regression model was used to identify risk factors associated with HIV incidence. Results: A total of 1367 HIV-negative YMSM were included in the cohort, among whom 62 seroconversions occurred, contributing 2384.2 observed PYs; the total incidence was 2.6 (95\% CI 2.0?3.2) per 100 PYs. The segmented HIV incidence rates were 3 (95\% CI 1.5?4.5), 2.4 (95\% CI 1.5?3.3), and 2.7 (95\% CI 1.5?3.9) per 100 PYs for 2017?2018, 2019?2020, and 2021?2022, respectively. Compared to YMSM who had been followed up fewer than three times, those followed up three or more times had a relatively lower risk of HIV infection (Adjusted hazard ratio [AHR] 0.553, 95\% CI 0.325?0.941). YMSM who preferred finding sexual partners offline had a higher risk of HIV infection compared to those who preferred finding sexual partners online (AHR 2.207, 95\% CI 1.198?4.066). Compared to YMSM without syphilis, those infected with syphilis had an increased risk of HIV infection (AHR 2.234, 95\% CI 1.137?4.391). Additionally, YMSM who used psychoactive substances had a higher risk of HIV infection compared to those who did not use such substances (AHR 2.467, 95\% CI 1.408?4.321). Conclusions: Our study complements data on HIV incidence among YMSM in large cities across China. Syphilis infection and the use of psychoactive substances were risk factors associated with HIV occurrence, demonstrating an urgent need for tailored prevention and control interventions for this key population. ", doi="10.2196/66487", url="https://publichealth.jmir.org/2025/1/e66487" } @Article{info:doi/10.2196/65576, author="Ashtree, N. Deborah and Orr, Rebecca and Lane, M. Melissa and Akbaraly, N. Tasnime and Bonaccio, Marialaura and Costanzo, Simona and Gialluisi, Alessandro and Grosso, Giuseppe and Lassale, Camille and Martini, Daniela and Monasta, Lorenzo and Santomauro, Damian and Stanaway, Jeffrey and Jacka, N. Felice and O'Neil, Adrienne", title="Estimating the Burden of Common Mental Disorders Attributable to Lifestyle Factors: Protocol for the Global Burden of Disease Lifestyle and Mental Disorder (GLAD) Project", journal="JMIR Res Protoc", year="2025", month="Mar", day="14", volume="14", pages="e65576", keywords="mental health", keywords="depression", keywords="anxiety", keywords="diet", keywords="lifestyle", keywords="mental disorders", keywords="epidemiology", keywords="burden of disease", abstract="Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) collects and calculates risk-outcome data for modifiable lifestyle exposures (eg, dietary intake) and physical health outcomes (eg, cancers). These estimates form a critical digital resource tool, the GBD VizHub data visualization tool, for governments and policy makers to guide local, regional, and global health decisions. Despite evidence showing the contributions of lifestyle exposures to common mental disorders (CMDs), such as depression and anxiety, GBD does not currently generate these lifestyle exposure-mental disorder outcome pairings. This gap is due to a lack of uniformly collected and analyzed data about these exposures as they relate to CMDs. Such data are required to quantify whether, and to what degree, the global burden of CMDs could be reduced by targeting lifestyle factors at regional and global levels. We have established the Global burden of disease Lifestyle And mental Disorder (GLAD) Taskforce to address this gap. Objective: This study aims to generate the necessary estimates to afford the inclusion of lifestyle exposures as risk factors for CMDs in the GBD study and the GBD digital visualization tools, initially focusing on the relationship between dietary intake and CMDs. Methods: The GLAD project is a multicenter, collaborative effort to integrate lifestyle exposures as risk factors for CMDs in the GBD study. To achieve this aim, global epidemiological studies will be recruited to conduct harmonized data analyses estimating the risk, odds, or hazards of lifestyle exposures with CMD outcomes. Initially, these models will focus on the relationship between dietary intake, as defined by the GBD, and anxiety and depression. Results: As of August 2024, 18 longitudinal cohort studies from 9 countries (Australia: n=4; Brazil: n=1; France: n=1; Italy: n=3; The Netherlands: n=3; New Zealand: n=1; South Africa: n=1; Spain: n=1; and United Kingdom: n=3) have agreed to participate in the GLAD project. Conclusions: Our comprehensive, collaborative approach allows for the concurrent execution of a harmonized statistical analysis protocol across multiple, internationally renowned epidemiological cohorts. These results will be used to inform the GBD study and incorporate lifestyle risk factors for CMD in the GBD digital platform. Consequently, given the worldwide influence of the GBD study, findings from the GLAD project can offer valuable insights to policy makers worldwide around lifestyle-based mental health care. International Registered Report Identifier (IRRID): DERR1-10.2196/65576 ", doi="10.2196/65576", url="https://www.researchprotocols.org/2025/1/e65576" } @Article{info:doi/10.2196/58767, author="Baliatsas, Christos and van Summeren, Jojanneke and van Beusekom, Sander and Matser, Amy and Hooiveld, Mariette", title="Monitoring Public Health Through a Comprehensive Primary Care Database in the Netherlands: Overview of the Nivel Syndromic Surveillance System", journal="JMIR Public Health Surveill", year="2025", month="Mar", day="12", volume="11", pages="e58767", keywords="surveillance", keywords="monitoring", keywords="general practice", keywords="public health", abstract="Background: Syndromic surveillance systems are crucial for the monitoring of population health and the early detection of emerging health problems. Internationally, there are numerous established systems reporting on different types of data. In the Netherlands, the Nivel syndromic surveillance system provides real-time monitoring on all diseases and symptoms presented in general practice. Objective: The present article introduces the national syndromic surveillance system in primary care, emphasizing its role in providing real-time information on infectious diseases and various health problems at the population level, in the Netherlands. In addition, we report on the central role of the participating general practices in data provision, and discuss the applicability of the syndromic surveillance data in different contexts of public health research. Methods: The Nivel syndromic surveillance system is part of the Nivel Primary Care Database (Nivel-PCD) that collects routinely recorded data from electronic health records of about 10\% of the Dutch population, on the basis of approximately 500 practices. This translates to approximately 1.9 million citizens. Since 2010, the surveillance system relies on representative, pseudonymized data collected on a weekly basis from a subset of about 400 practices in the Nivel-PCD, for the entire practice population. Health problems are registered according to the International Classification of Primary Care, applied in all general practices in the Netherlands. Prevalence rates are recalculated and reported every week in the form of figures, also stratified by age, sex, and region. Weekly rates are defined as the number of people that consulted the general practitioner in a certain week for a specific health problem, divided by the total number of registered individuals in the practice. Results: While utilizing data from general practitioners' electronic health records, the system allows for the timely monitoring and identification of symptom and disease patterns and trends, not only among individuals who seek primary health care, but the entire registered population. Besides their use in disease monitoring, syndromic surveillance data are useful in various public health research contexts, such as environmental health and disaster research. Conclusions: The Nivel syndromic surveillance system serves as a valuable tool for health monitoring and research, offering valuable insights into public health. ", doi="10.2196/58767", url="https://publichealth.jmir.org/2025/1/e58767" } @Article{info:doi/10.2196/66321, author="La Sala, Louise and Sabo, Amanda and Michail, Maria and Thorn, Pinar and Lamblin, Michelle and Browne, Vivienne and Robinson, Jo", title="Online Safety When Considering Self-Harm and Suicide-Related Content: Qualitative Focus Group Study With Young People, Policy Makers, and Social Media Industry Professionals", journal="J Med Internet Res", year="2025", month="Mar", day="10", volume="27", pages="e66321", keywords="young people", keywords="suicide prevention", keywords="self-harm", keywords="social media", keywords="online safety", keywords="policy", abstract="Background: Young people are disproportionately impacted by self-harm and suicide, and concerns exist regarding the role of social media and exposure to unsafe content. Governments and social media companies have taken various approaches to address online safety for young people when it comes to self-harm and suicide; however, little is known about whether key stakeholders believe current approaches are fit-for-purpose. Objective: From the perspective of young people, policy makers and professionals who work within the social media industry, this study aimed to explore (1) the perceived challenges and views regarding young people communicating on social media about self-harm and suicide, and (2) what more social media companies and governments could be doing to address these issues and keep young people safe online. Methods: This qualitative study involved 6 focus groups with Australian young people aged 12-25 years (n=7), Australian policy makers (n=14), and professionals from the global social media industry (n=7). Framework analysis was used to summarize and chart the data for each stakeholder group. Results: In total, 3 primary themes and six subthemes are presented: (1) challenges and concerns, including the reasons for, and challenges related to, online communication about self-harm and suicide as well as reasoning with a deterministic narrative of harm; (2) roles and responsibilities regarding online safety and suicide prevention, including who is responsible and where responsibility starts and stops, as well as the need for better collaborations; and (3) future approaches and potential solutions, acknowledging the limitations of current safety tools and policies, and calling for innovation and new ideas. Conclusions: Our findings highlight tensions surrounding roles and responsibilities in ensuring youth online safety and offer perspectives on how social media companies can support young people discussing self-harm and suicide online. They also support the importance of cross-industry collaborations and consideration of social media in future suicide prevention solutions intended to support young people. ", doi="10.2196/66321", url="https://www.jmir.org/2025/1/e66321" } @Article{info:doi/10.2196/64307, author="Shao, Anqi and Chen, Kaiping and Johnson, Branden and Miranda, Shaila and Xing, Qidi", title="Ubiquitous News Coverage and Its Varied Effects in Communicating Protective Behaviors to American Adults in Infectious Disease Outbreaks: Time-Series and Longitudinal Panel Study", journal="J Med Internet Res", year="2025", month="Mar", day="10", volume="27", pages="e64307", keywords="risk communication", keywords="panel study", keywords="computational method", keywords="intermedia agenda setting", keywords="protective behaviors", keywords="infectious disease", abstract="Background: Effective communication is essential for promoting preventive behaviors during infectious disease outbreaks like COVID-19. While consistent news can better inform the public about these health behaviors, the public may not adopt them. Objective: This study aims to explore the role of different media platforms in shaping public discourse on preventive measures to infectious diseases such as quarantine and vaccination, and how media exposure influences individuals' intentions to adopt these behaviors in the United States. Methods: This study uses data from 3 selected top national newspapers in the United States, Twitter discussions, and a US nationwide longitudinal panel survey from February 2020 to April 2021. We used the Intermedia Agenda-Setting Theory and the Protective Action Decision Model to develop the theoretical framework. Results: We found a 2-way agenda flow between selected national newspapers and the social media platform Twitter, particularly in controversial topics like vaccination (F1,426=16.39; P<.001 for newspapers; F1,426=44.46; P<.001 for Twitter). Exposure to media coverage increased individuals' perceived benefits of certain behaviors like vaccination but did not necessarily translate into behavioral adoption. For example, while individuals' media exposure increased perceived benefits of mask-wearing ($\beta$=.057; P<.001 for household benefits; $\beta$=.049; P<.001 for community benefits), it was not consistently linked to higher intentions to wear masks ($\beta$=--.026; P=.04). Conclusions: This study integrates media flow across platforms with US national panel survey data, offering a comprehensive view of communication dynamics during the early stage of an infectious disease outbreak. The findings caution against a one-size-fits-all approach in communicating different preventive behaviors, especially where individual and community benefits may not always align. ", doi="10.2196/64307", url="https://www.jmir.org/2025/1/e64307" } @Article{info:doi/10.2196/63755, author="Li, Wanxin and Hua, Yining and Zhou, Peilin and Zhou, Li and Xu, Xin and Yang, Jie", title="Characterizing Public Sentiments and Drug Interactions in the COVID-19 Pandemic Using Social Media: Natural Language Processing and Network Analysis", journal="J Med Internet Res", year="2025", month="Mar", day="5", volume="27", pages="e63755", keywords="COVID-19", keywords="natural language processing", keywords="drugs", keywords="social media", keywords="pharmacovigilance", keywords="public health", abstract="Background: While the COVID-19 pandemic has induced massive discussion of available medications on social media, traditional studies focused only on limited aspects, such as public opinions, and endured reporting biases, inefficiency, and long collection times. Objective: Harnessing drug-related data posted on social media in real-time can offer insights into how the pandemic impacts drug use and monitor misinformation. This study aimed to develop a natural language processing (NLP) pipeline tailored for the analysis of social media discourse on COVID-19--related drugs. Methods: This study constructed a full pipeline for COVID-19--related drug tweet analysis, using pretrained language model--based NLP techniques as the backbone. This pipeline is architecturally composed of 4 core modules: named entity recognition and normalization to identify medical entities from relevant tweets and standardize them to uniform medication names for time trend analysis, target sentiment analysis to reveal sentiment polarities associated with the entities, topic modeling to understand underlying themes discussed by the population, and drug network analysis to dig potential adverse drug reactions (ADR) and drug-drug interactions (DDI). The pipeline was deployed to analyze tweets related to the COVID-19 pandemic and drug therapies between February 1, 2020, and April 30, 2022. Results: From a dataset comprising 169,659,956 COVID-19--related tweets from 103,682,686 users, our named entity recognition model identified 2,124,757 relevant tweets sourced from 1,800,372 unique users, and the top 5 most-discussed drugs: ivermectin, hydroxychloroquine, remdesivir, zinc, and vitamin D. Time trend analysis revealed that the public focused mostly on repurposed drugs (ie, hydroxychloroquine and ivermectin), and least on remdesivir, the only officially approved drug among the 5. Sentiment analysis of the top 5 most-discussed drugs revealed that public perception was predominantly shaped by celebrity endorsements, media hot spots, and governmental directives rather than empirical evidence of drug efficacy. Topic analysis obtained 15 general topics of overall drug-related tweets, with ``clinical treatment effects of drugs'' and ``physical symptoms'' emerging as the most frequently discussed topics. Co-occurrence matrices and complex network analysis further identified emerging patterns of DDI and ADR that could be critical for public health surveillance like better safeguarding public safety in medicines use. Conclusions: This study shows that an NLP-based pipeline can be a robust tool for large-scale public health monitoring and can offer valuable supplementary data for traditional epidemiological studies concerning DDI and ADR. The framework presented here aspires to serve as a cornerstone for future social media--based public health analytics. ", doi="10.2196/63755", url="https://www.jmir.org/2025/1/e63755", url="http://www.ncbi.nlm.nih.gov/pubmed/40053730" } @Article{info:doi/10.2196/52119, author="Tighe, Carlos and Ngongalah, Lem and Sent{\'i}s, Alexis and Orchard, Francisco and Pacurar, Gheorghe-Aurel and Hayes, Conor and Hayes, S. Jessica and Toader, Adrian and Connolly, A. M{\'a}ire", title="Building and Developing a Tool (PANDEM-2 Dashboard) to Strengthen Pandemic Management: Participatory Design Study", journal="JMIR Public Health Surveill", year="2025", month="Mar", day="5", volume="11", pages="e52119", keywords="pandemic preparedness and response", keywords="COVID-19", keywords="cross-border collaboration", keywords="surveillance", keywords="data collection", keywords="data standardization", keywords="data sharing", keywords="dashboard", keywords="IT system", keywords="IT tools", abstract="Background: The COVID-19 pandemic exposed challenges in pandemic management, particularly in real-time data sharing and effective decision-making. Data protection concerns and the lack of data interoperability and standardization hindered the collection, analysis, and interpretation of critical information. Effective data visualization and customization are essential to facilitate decision-making. Objective: This study describes the development of the PANDEM-2 dashboard, a system providing a standardized and interactive platform for decision-making in pandemic management. It outlines the participatory approaches used to involve expert end users in its development and addresses key considerations of privacy, data protection, and ethical and social issues. Methods: Development was informed by a review of 25 publicly available COVID-19 dashboards, leading to the creation of a visualization catalog. User requirements were gathered through workshops and consultations with 20 experts from various health care and public health professions in 13 European Union countries. These were further refined by mapping variables and indicators required to fulfill the identified needs. Through a participatory design process, end users interacted with a preprototype platform, explored potential interface designs, and provided feedback to refine the system's components. Potential privacy, data protection, and ethical and social risks associated with the technology, along with mitigation strategies, were identified through an iterative impact assessment. Results: Key variables incorporated into the PANDEM-2 dashboard included case rates, number of deaths, mortality rates, hospital resources, hospital admissions, testing, contact tracing, and vaccination uptake. Cases, deaths, and vaccination uptake were prioritized as the most relevant and readily available variables. However, data gaps, particularly in contact tracing and mortality rates, highlighted the need for better data collection and reporting mechanisms. User feedback emphasized the importance of diverse data visualization formats combining different data types, as well as analyzing data across various time frames. Users also expressed interest in generating custom visualizations and reports, especially on the impact of government interventions. Participants noted challenges in data reporting, such as inconsistencies in reporting levels, time intervals, the need for standardization between member states, and General Data Protection Regulation concerns for data sharing. Identified risks included ethical concerns (accessibility, user autonomy, responsible use, transparency, and accountability), privacy and data protection (security and access controls and data reidentification), and social issues (unintentional bias, data quality and accuracy, dependency on technology, and collaborative development). Mitigation measures focused on designing user-friendly interfaces, implementing robust security protocols, and promoting cross-member state collaboration. Conclusions: The PANDEM-2 dashboard provides an adaptable, user-friendly platform for pandemic preparedness and response. Our findings highlight the critical role of data interoperability, cross-border collaboration, and custom IT tools in strengthening future health crisis management. They also offer valuable insights into the challenges and opportunities in developing IT solutions to support pandemic preparedness. ", doi="10.2196/52119", url="https://publichealth.jmir.org/2025/1/e52119", url="http://www.ncbi.nlm.nih.gov/pubmed/40053759" } @Article{info:doi/10.2196/64020, author="Takahashi, Noriaki and Nakao, Mutsuhiro and Nakayama, Tomio and Yamazaki, Tsutomu", title="Breast Cancer Screening Participation and Internet Search Activity in a Japanese Population: Decade-Long Time-Series Study", journal="JMIR Cancer", year="2025", month="Mar", day="4", volume="11", pages="e64020", keywords="breast cancer", keywords="cancer screening", keywords="internet use", keywords="mass media", keywords="public health surveillance", keywords="health belief model", keywords="mammography", keywords="awareness", keywords="Japanese", keywords="Google", abstract="Background: Breast cancer is a major health concern in various countries. Routine mammography screening has been shown to reduce breast cancer mortality, and Japan has set national targets to improve screening participation and increase public attention. However, collecting nationwide data on public attention and activity is not easy. Google Trends can reveal changes in societal interest, yet there are no reports on the relationship between internet search volume and nationwide participation rates in Japan. Objective: This study aims to reveal and discuss the relationship between public awareness and actual behavior in breast cancer screening by examining trends in internet search volume for the keyword ``breast cancer screening'' and participation rates over a decade-long period. Methods: This time-series study evaluated the association between internet search volume and breast cancer screening participation behavior among women aged 60?69 years in Japan from 2009 to 2019. Relative search volume (RSV) data for the search term ``breast cancer screening (nyuugan-kenshin)'' were extracted from Google Trends as internet search volume. Breast cancer screening and further assessment participation rates were based on government municipal screening data. Joinpoint regression analyses were conducted with weighted BIC to evaluate the time trends. An ethics review was not required because all data were open. Results: The RSV for ``breast cancer screening (nyuugan-kenshin)'' peaked in June 2017 (100) and showed clear spikes in June 2016 (94), September (69), and October (77) 2015. No RSVs above 60 were observed except around these three specific periods, and the average RSV for the entire period was 30.7 (SD 16.2). Two statistically significant joinpoints were detected, rising in December 2013 and falling in June 2017. Screening participation rates showed a temporary increase in 2015 in a slowly decreasing trend, and no joinpoints were detected. Further assessment participation rates showed a temporary spike in 2015 in the middle of an increasing trend, with a statistically significant point of slowing increase detected in 2015. Post hoc manual searches revealed that Japanese celebrities' breast cancer diagnoses were announced on the relevant dates, and many Japanese media reports were found. Conclusions: This study found a notable association between internet search activity and celebrity cancer media reports and a temporal association with screening participation in breast cancer screening in Japan. Celebrity cancer media reports triggered internet searches for cancer screening, but this did not lead to long-term changes in screening participation behavior. This finding suggests what information needs to be provided to citizens to encourage participation in screening. ", doi="10.2196/64020", url="https://cancer.jmir.org/2025/1/e64020" } @Article{info:doi/10.2196/58797, author="Bazaco, C. Michael and Carstens, K. Christina and Greenlee, Tiffany and Blessington, Tyann and Pereira, Evelyn and Seelman, Sharon and Ivory, Stranjae and Jemaneh, Temesgen and Kirchner, Margaret and Crosby, Alvin and Viazis, Stelios and van Twuyver, Sheila and Gwathmey, Michael and Malais, Tanya and Ou, Oliver and Kenez, Stephanie and Nolan, Nichole and Karasick, Andrew and Punzalan, Cecile and Schwensohn, Colin and Gieraltowski, Laura and Chen Parker, Cary and Jenkins, Erin and Harris, Stic", title="Recent Use of Novel Data Streams During Foodborne Illness Cluster Investigations by the United States Food and Drug Administration: Qualitative Review", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="28", volume="11", pages="e58797", keywords="foodborne illness surveillance", keywords="novel data streams", keywords="outbreak investigations", keywords="novel data", keywords="foodborne illness", keywords="foodborne", keywords="illness", keywords="United States", keywords="public health", keywords="prevention", keywords="outbreaks", keywords="social media", keywords="product review", keywords="cluster", keywords="product information", keywords="surveillance", keywords="epidemiology", doi="10.2196/58797", url="https://publichealth.jmir.org/2025/1/e58797" } @Article{info:doi/10.2196/66184, author="Ram, Sharan and Corbin, Marine and 't Mannetje, Andrea and Eng, Amanda and Kvalsvig, Amanda and Baker, G. Michael and Douwes, Jeroen", title="Antibiotic Use In Utero and Early Life and Risk of Chronic Childhood Conditions in New Zealand: Protocol for a Data Linkage Retrospective Cohort Study", journal="JMIR Res Protoc", year="2025", month="Feb", day="28", volume="14", pages="e66184", keywords="early childhood", keywords="chronic childhood conditions", keywords="antibiotics", keywords="data linkage", keywords="study protocol", keywords="routine data", abstract="Background: The incidence of many common chronic childhood conditions has increased globally in the past few decades, which has been suggested to be potentially attributed to antibiotic overuse leading to dysbiosis in the gut microbiome. Objective: This linkage study will assess the role of antibiotic use in utero and in early life in the development of type 1 diabetes (T1D), attention-deficit/hyperactive disorder (ADHD), and inflammatory bowel disease. Methods: The study design involves several retrospective cohort studies using linked administrative health and social data from Statistics New Zealand's Integrated Data Infrastructure. It uses data from all children who were born in New Zealand between October 2005 and December 2010 (N=334,204) and their mothers. Children's antibiotic use is identified for 4 time periods (at pregnancy, at ?1 year, at ?2 years, and at ?5 years), and the development of T1D, ADHD, and inflammatory bowel disease is measured from the end of the antibiotic use periods until death, emigration, or the end of the follow-up period (2021), whichever came first. Children who emigrated or died before the end of the antibiotic use period are excluded. Cox proportional hazards regression models are used while adjusting for a range of potential confounders. Results: As of September 2024, data linkage has been completed, involving the integration of antibiotic exposure and outcome variables for 315,789 children. Preliminary analyses show that both prenatal and early life antibiotic consumption is associated with T1D. Full analyses for all 3 outcomes will be completed by the end of 2025. Conclusions: This series of linked cohort studies using detailed, complete, and systematically collected antibiotic prescription data will provide critical new knowledge regarding the role of antibiotics in the development of common chronic childhood conditions. Thus, this study has the potential to contribute to the development of primary prevention strategies through, for example, targeted changes in antibiotic use. International Registered Report Identifier (IRRID): DERR1-10.2196/66184 ", doi="10.2196/66184", url="https://www.researchprotocols.org/2025/1/e66184", url="http://www.ncbi.nlm.nih.gov/pubmed/40053783" } @Article{info:doi/10.2196/63938, author="Hansen, T. Bo and Klungs{\o}yr, Ole and Labberton, S. Angela and S{\"a}{\"a}ksvuori, Lauri and Rydland, M. Kjersti and {\O}deskaug, E. Liz and Wisl{\o}ff, Torbj{\o}rn and Meijerink, Hinta", title="Effectiveness of Text Messaging Nudging to Increase Coverage of Influenza Vaccination Among Older Adults in Norway (InfluSMS Study): Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Feb", day="25", volume="14", pages="e63938", keywords="influenza vaccination", keywords="coverage", keywords="uptake", keywords="behavioral nudging", keywords="vaccine hesitancy", keywords="randomized controlled trial", keywords="undervaccination", keywords="migrant health", keywords="mobile health", keywords="mHealth", keywords="smartphones", keywords="eHealth", keywords="SMS", abstract="Background: The coverage of influenza vaccination among older adults in Norway is insufficient, especially in some immigrant groups. To improve public health, there is a need for an intervention that can increase influenza vaccination coverage. Further, interventions tailored to reduce potential barriers among immigrants can reduce health inequities. Objective: InfluSMS aims to determine if SMS nudging increases vaccination coverage among those aged 65 years or older (1) in Norway's general population; (2) among immigrants born in Poland; and (3) among immigrants born in Ukraine; and evaluate the impact of SMS nudging in Norwegian versus in the official language of the native country of immigrants born in Poland or Ukraine. Methods: InfluSMS is a pragmatic randomized controlled trial conducted among people aged 65 years or older residing in Norway. Influenza vaccination coverage is the main outcome, measured in control and intervention arms for each of the 3 populations listed earlier. In all 3 populations, the control arm is standard care, that is, no individual reminder for influenza vaccination. All populations have an intervention arm that will receive an SMS nudge in the Norwegian language. In addition, the Polish and Ukrainian immigrant populations include a second intervention arm that will receive an SMS nudge in Polish or Ukrainian, respectively. In the general population, at least 23,485 individuals will be randomized to the SMS intervention arm while the rest of the population constitutes the control arm. In each of the 2 immigrant populations, we will randomize all eligible individuals 1:1:1 into the 3 arms. The intervention will take place at the start of the 2025-2026 influenza season. All eligible individuals will be passively followed up through the National Immunisation Registry, SYSVAK, from which individual influenza vaccination status 3 months after the SMS nudge will be collected. Coverage rates between arms within each population and effect sizes between the populations will be compared. The cost-effectiveness of SMS nudging will also be assessed. Results: The inclusion of participants will start in the third quarter of 2025, and the registry data will be available in the first quarter of 2026. Coverage rates of each strategy and coverage differences between strategies will be presented. Conclusions: SMS nudging is a scalable, inexpensive, and nonintrusive intervention that could be integrated into the national influenza vaccination program if the trial shows it effectively increases influenza vaccination coverage among older adults. Further, the trial will establish whether language is a barrier to influenza vaccination uptake among recent immigrant groups that have low influenza vaccination coverage, and to what extent this potential barrier can be diminished by SMS nudging in the official language of their native country. Trial Registration: ClinicalTrials.gov NCT06486766; https://clinicaltrials.gov/study/NCT06486766 International Registered Report Identifier (IRRID): PRR1-10.2196/63938 ", doi="10.2196/63938", url="https://www.researchprotocols.org/2025/1/e63938", url="http://www.ncbi.nlm.nih.gov/pubmed/39998878" } @Article{info:doi/10.2196/64111, author="Hore-Lacy, Fiona and Dimitriadis, Christina and Hoy, F. Ryan and Jimenez-Martin, Javier and Sim, R. Malcolm and Fisher, Jane and Glass, C. Deborah and Walker-Bone, Karen", title="Screening Workers for Occupational Exposure to Respirable Crystalline Silica: Development and Usability of an Electronic Data Capture Tool", journal="JMIR Hum Factors", year="2025", month="Feb", day="24", volume="12", pages="e64111", keywords="silicosis", keywords="occupational history", keywords="electronic data capture tool (EDCT)", keywords="REDCap", keywords="occupational respiratory screening", keywords="occupational hazard", keywords="exposure", keywords="silica", keywords="fibrotic lung disease", keywords="lung disease", keywords="respirable crystalline silica", keywords="mining", keywords="construction", keywords="workers", keywords="occupational lung disease", keywords="occupational", keywords="Australia", keywords="screening", abstract="Background: Cases of the occupational lung disease silicosis have been identified in workers processing artificial stone in the stone benchtop industry (SBI). In the Australian state of Victoria, the Regulator commissioned a screening program for all workers in this industry. Objective: To facilitate systematic data collection, including high-quality exposure assessment, an electronic data capture tool (EDCT) was developed. Methods: A multidisciplinary team developed an EDCT using Research Electronic Data Capture (REDCap; Vanderbilt University). The needs of the EDCT were (1) data entry by multiple clinicians and the workers attending for screening and (2) systematic collection of data for clinical and research purposes. The comprehensibility and utility of the tool were investigated with a sample of workers, and the EDCT was subsequently refined. Results: The EDCT was used in clinical practice, with capacity for data extraction for research. Testing of comprehension and utility was undertaken with 15 workers, and the refined version of the Occupational Silica Exposure Assessment Tool (OSEAT) was subsequently developed. Conclusions: The refined OSEAT has been determined to be comprehensible to workers and capable of collecting exposure data suitable for assessment of risk of silicosis. It was developed for workers in the SBI in Australia and is adaptable, including translation into other languages. It can also be modified for SBI workers in other countries and for use by workers from other industries (mining, construction) at risk of silica exposure, including in lower-income settings. ", doi="10.2196/64111", url="https://humanfactors.jmir.org/2025/1/e64111" } @Article{info:doi/10.2196/64653, author="Atanasova, Sara and Kamin, Tanja and Perger, Nina", title="Predictors of COVID-19 Vaccination Intention and Behavior Among Young People in a European Union Country With Low COVID-19 Vaccination Rates: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="21", volume="11", pages="e64653", keywords="vaccine uptake", keywords="young people", keywords="COVID-19 vaccine", keywords="health belief model", keywords="theory of planned behavior", abstract="Background: Vaccination against COVID-19 is a critical measure for managing the pandemic and achieving herd immunity. In 2021, Slovenia had a significantly lower COVID-19 vaccination rate compared to the average rate in the European Union, with individuals aged younger than 37 years showing the highest hesitancy. Previous studies primarily explored vaccination willingness before vaccines were available to young people, leaving a gap in understanding the factors influencing vaccination behavior and differences within the population of young people. Objective: This study aimed to investigate a wide set of predictors influencing COVID-19 vaccination intention and behavior among young people in Slovenia. Specifically, we aimed to compare vaccinated and unvaccinated young people, further categorizing the unvaccinated group into those who were hesitant, those who intended to vaccinate in the near future, and those who refused vaccination. Methods: An integrated model, based on the health belief model and theory of planned behavior, was developed, and it included additional contextual factors (such as trust in science, trust in vaccines, conspiracy theory tendencies, etc) and health-related and sociodemographic characteristics. Data were collected in August 2021 via the online access survey panel JazVem (Valicon), targeting individuals aged 15-30 years in Slovenia. Quotas ensured that the sample (n=507) was quasi-representative according to age, gender, education, and region. Bivariate analyses and multinomial logistic regression were performed to explore the determinants of vaccination intention and behavior. Results: Among respondents, 45.8\% (232/507) were vaccinated, 30.0\% (152/507) refused vaccination, 12.4\% (63/507) were hesitant, and 11.8\% (60/507) intended to undergo vaccination in the near future. Vaccinated individuals were predominantly aged 23-26 years, had higher education, and reported above-average material status. Refusers were more common among the youngest (15-18 years) and oldest (27-30 years) groups, had lower education, and showed higher conspiracy theory tendencies. Multinomial regression analysis revealed that unvaccinated respondents who perceived greater COVID-19--related health consequences were more likely to delay vaccination (adjusted odds ratio [aOR] 2.0, 95\% CI 1.2-3.3) or exhibit hesitancy (aOR 1.9, 95\% CI 1.1-3.2) compared with vaccinated respondents. Subjective norms were less influential among hesitant individuals (aOR 0.4, 95\% CI 0.2-0.7) and refusers (aOR 0.3, 95\% CI 0.2-0.7) than among vaccinated individuals. Self-efficacy in managing health problems was less evident among those who delayed vaccination to the near future (aOR 0.5, 95\% CI 0.3-0.9) than among vaccinated individuals. Conclusions: This study underscores the complexity of vaccination intentions and behaviors among young people, emphasizing the necessity for public health strategies promoting vaccination to be tailored to the specific reasons for nonvaccination within different subgroups. Interventions aimed at addressing vaccine hesitancy and delays should particularly focus on individuals with lower education and material disadvantages. By fostering trust and enhancing self-efficacy, these interventions could more effectively promote vaccine uptake. ", doi="10.2196/64653", url="https://publichealth.jmir.org/2025/1/e64653", url="http://www.ncbi.nlm.nih.gov/pubmed/39983109" } @Article{info:doi/10.2196/67050, author="Florentino, Veras Pilar Tavares and Bertoldo Junior, Juracy and Barbosa, Gouveia George Caique and Cerqueira-Silva, Thiago and Oliveira, Ara{\'u}jo Vinicius de and Garcia, Oliveira Marcio Henrique de and Penna, Oliveira Gerson and Boaventura, Viviane and Ramos, Pereira Pablo Ivan and Barral-Netto, Manoel and Marcilio, Izabel", title="Impact of Primary Health Care Data Quality on Infectious Disease Surveillance in Brazil: Case Study", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="21", volume="11", pages="e67050", keywords="primary health care", keywords="data quality", keywords="infectious disease surveillance", keywords="Brazil", keywords="early warning system", abstract="Background: The increase in emerging and re-emerging infectious disease outbreaks underscores the need for robust early warning systems (EWSs) to guide mitigation and response measures. Administrative health care databases provide valuable epidemiological insights without imposing additional burdens on health services. However, these datasets are primarily collected for operational use, making data quality assessment essential to ensure an accurate interpretation of epidemiological analysis. This study focuses on the development and implementation of a data quality index (DQI) for surveillance integrated into an EWS for influenza-like illness (ILI) outbreaks using Brazil's a nationwide Primary Health Care (PHC) dataset. Objective: We aimed to evaluate the impact of data completeness and timeliness on the performance of an EWS for ILI outbreaks and establish optimal thresholds for a suitable DQI, thereby improving the accuracy of outbreak detection and supporting public health surveillance. Methods: A composite DQI was established to measure the completeness and timeliness of PHC data from the Brazilian National Information System on Primary Health Care. Completeness was defined as the proportion of weeks within an 8-week rolling window with any register of encounters. Timeliness was calculated as the interval between the date of encounter and its corresponding registry in the information system. The backfilled PHC dataset served as the gold standard to evaluate the impact of varying data quality levels from the weekly updated real-time PHC dataset on the EWS for ILI outbreaks across 5570 Brazilian municipalities from October 10, 2023, to March 10, 2024. Results: During the study period, the backfilled dataset recorded 198,335,762 ILI-related encounters, averaging 8,623,294 encounters per week. The EWS detected a median of 4 (IQR 2?5) ILI outbreak warnings per municipality using the backfilled dataset. Using the real-time dataset, 12,538 (65\%) warnings were concordant with the backfilled dataset. Our analysis revealed that 100\% completeness yielded 76.7\% concordant warnings, while 80\% timeliness resulted in at least 50\% concordant warnings. These thresholds were considered optimal for a suitable DQI. Restricting the analysis to municipalities with a suitable DQI increased concordant warnings to 80.4\%. A median of 71\% (IQR 54\%-71.9\%) of municipalities met the suitable DQI threshold weekly. Municipalities with ?60\% of weeks achieving a suitable DQI demonstrated the highest concordance between backfilled and real-time datasets, with those achieving ?80\% of weeks showing 82.3\% concordance. Conclusions: Our findings highlight the critical role of data quality in improving the EWS' performance based on PHC data for detecting ILI outbreaks. The proposed framework for real-time DQI monitoring is a practical approach and can be adapted to other surveillance systems, providing insights for similar implementations. We demonstrate that optimal completeness and timeliness of data significantly impact the EWS' ability to detect ILI outbreaks. Continuous monitoring and improvement of data quality should remain a priority to strengthen the reliability and effectiveness of surveillance systems. ", doi="10.2196/67050", url="https://publichealth.jmir.org/2025/1/e67050" } @Article{info:doi/10.2196/53214, author="Lundberg, L. Alexander and Soetikno, G. Alan and Wu, A. Scott and Ozer, Egon and Welch, B. Sarah and Liu, Yingxuan and Hawkins, Claudia and Mason, Maryann and Murphy, Robert and Havey, J. Robert and Moss, B. Charles and Achenbach, J. Chad and Post, Ann Lori", title="Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in East Asia and the Pacific Region: Longitudinal Trend Analysis", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="21", volume="11", pages="e53214", keywords="SARS-CoV-2", keywords="COVID-19", keywords="East Asia", keywords="Pacific", keywords="American Samoa", keywords="Australia", keywords="Brunei Darussalam", keywords="Cambodia", keywords="China", keywords="Fiji", keywords="French Polynesia", keywords="Guam", keywords="Hong Kong", keywords="Indonesia", keywords="Japan", keywords="Kiribati", keywords="People's Democratic Republic of Korea", keywords="Republic of Korea", keywords="Lao People's Democratic Republic", keywords="Macao", keywords="Malaysia", keywords="Marshall Islands", keywords="Federated States of Micronesia", keywords="Mongolia", keywords="Myanmar", keywords="Nauru, New Caledonia", keywords="New Zealand", keywords="Northern Mariana Islands", keywords="Palau", keywords="Papua New Guinea", keywords="Philippines", keywords="Samoa", keywords="Singapore", keywords="Solomon Islands", keywords="Thailand", keywords="Timor-Leste", keywords="Tonga", keywords="Tuvalu", keywords="Vanuatu", keywords="Vietnam", keywords="pandemic", keywords="surveillance", keywords="public health", keywords="speed", keywords="acceleration", keywords="deceleration", keywords="jerk", keywords="dynamic panel", keywords="generalized method of moments", keywords="Arellano-Bond", keywords="7-day lag", abstract="Background: This study updates the COVID-19 pandemic surveillance in East Asia and the Pacific region that we first conducted in 2020 with 2 additional years of data for the region. Objective: First, we aimed to measure whether there was an expansion or contraction of the pandemic in East Asia and the Pacific region when the World Health Organization (WHO) declared the end of the COVID-19 public health emergency of international concern on May 5, 2023. Second, we used dynamic and genomic surveillance methods to describe the dynamic history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Finally, we aimed to provide historical context for the course of the pandemic in East Asia and the Pacific region. Methods: In addition to updates of traditional surveillance data and dynamic panel estimates from the original study, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t test to determine whether the regional weekly speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. Results: Several countries in East Asia and the Pacific region had COVID-19 transmission rates above an outbreak threshold at the point of the WHO declaration (Brunei, New Zealand, Australia, and South Korea). However, the regional transmission rate had remained below the outbreak threshold for 4 months. In the rolling 6-month window t test for regional outbreak status, the final P value ?.10 implies a rejection of the null hypothesis (at the $\alpha$=.10 level) that the region as a whole was not in an outbreak for the period from November 5, 2022, to May 5, 2023. From January 2022 onward, nearly every sequenced SARS-CoV-2 specimen in the region was identified as the Omicron variant. Conclusions: While COVID-19 continued to circulate in East Asia and the Pacific region, transmission rates had fallen below outbreak status by the time of the WHO declaration. Compared to other global regions, East Asia and the Pacific region had the latest outbreaks driven by the Omicron variant. COVID-19 appears to be endemic in the region, no longer reaching the threshold for a pandemic definition. However, the late outbreaks raise uncertainty about whether the pandemic was truly over in the region at the time of the WHO declaration. ", doi="10.2196/53214", url="https://publichealth.jmir.org/2025/1/e53214", url="http://www.ncbi.nlm.nih.gov/pubmed/39804185" } @Article{info:doi/10.2196/59101, author="Lin, Bing and Liu, Jiaxiu and Li, Kangjie and Zhong, Xiaoni", title="Predicting the Risk of HIV Infection and Sexually Transmitted Diseases Among Men Who Have Sex With Men: Cross-Sectional Study Using Multiple Machine Learning Approaches", journal="J Med Internet Res", year="2025", month="Feb", day="20", volume="27", pages="e59101", keywords="HIV", keywords="sexually transmitted diseases", keywords="men who have sex with men", keywords="machine learning", keywords="web application", keywords="risk stratification", abstract="Background: Men who have sex with men (MSM) are at high risk for HIV infection and sexually transmitted diseases (STDs). However, there is a lack of accurate and convenient tools to assess this risk. Objective: This study aimed to develop machine learning models and tools to predict and assess the risk of HIV infection and STDs among MSM. Methods: We conducted a cross-sectional study that collected individual characteristics of 1999 MSM with negative or unknown HIV serostatus in Western China from 2013 to 2023. MSM self-reported their STD history and were tested for HIV. We compared the accuracy of 6 machine learning methods in predicting the risk of HIV infection and STDs using 7 parameters for a comprehensive assessment, ranking the methods according to their performance in each parameter. We selected data from the Sichuan MSM for external validation. Results: Of the 1999 MSM, 72 (3.6\%) tested positive for HIV and 146 (7.3\%) self-reported a history of previous STD infection. After taking the results of the intersection of the 3 feature screening methods, a total of 7 and 5 predictors were screened for predicting HIV infection and STDs, respectively, and multiple machine learning prediction models were constructed. Extreme gradient boost models performed optimally in predicting the risk of HIV infection and STDs, with area under the curve values of 0.777 (95\% CI 0.639-0.915) and 0.637 (95\% CI 0.541-0.732), respectively, demonstrating stable performance in both internal and external validation. The highest combined predictive performance scores of HIV and STD models were 33 and 39, respectively. Interpretability analysis showed that nonadherence to condom use, low HIV knowledge, multiple male partners, and internet dating were risk factors for HIV infection. Low degree of education, internet dating, and multiple male and female partners were risk factors for STDs. The risk stratification analysis showed that the optimal model effectively distinguished between high- and low-risk MSM. MSM were classified into HIV (predicted risk score <0.506 and ?0.506) and STD (predicted risk score <0.479 and ?0.479) risk groups. In total, 22.8\% (114/500) were in the HIV high-risk group, and 43\% (215/500) were in the STD high-risk group. HIV infection and STDs were significantly higher in the high-risk groups (P<.001 and P=.05, respectively), with higher predicted probabilities (P<.001 for both). The prediction results of the optimal model were displayed in web applications for probability estimation and interactive computation. Conclusions: Machine learning methods have demonstrated strengths in predicting the risk of HIV infection and STDs among MSM. Risk stratification models and web applications can facilitate clinicians in accurately assessing the risk of infection in individuals with high risk, especially MSM with concealed behaviors, and help them to self-monitor their risk for targeted, timely diagnosis and interventions to reduce new infections. ", doi="10.2196/59101", url="https://www.jmir.org/2025/1/e59101" } @Article{info:doi/10.2196/56306, author="Starke, Georg and Gille, Felix and Termine, Alberto and Aquino, James Yves Saint and Chavarriaga, Ricardo and Ferrario, Andrea and Hastings, Janna and Jongsma, Karin and Kellmeyer, Philipp and Kulynych, Bogdan and Postan, Emily and Racine, Elise and Sahin, Derya and Tomaszewska, Paulina and Vold, Karina and Webb, Jamie and Facchini, Alessandro and Ienca, Marcello", title="Finding Consensus on Trust in AI in Health Care: Recommendations From a Panel of International Experts", journal="J Med Internet Res", year="2025", month="Feb", day="19", volume="27", pages="e56306", keywords="expert consensus", keywords="trust", keywords="artificial intelligence", keywords="clinical decision support", keywords="assistive technologies", keywords="public health surveillance", keywords="framework analysis", abstract="Background: The integration of artificial intelligence (AI) into health care has become a crucial element in the digital transformation of health systems worldwide. Despite the potential benefits across diverse medical domains, a significant barrier to the successful adoption of AI systems in health care applications remains the prevailing low user trust in these technologies. Crucially, this challenge is exacerbated by the lack of consensus among experts from different disciplines on the definition of trust in AI within the health care sector. Objective: We aimed to provide the first consensus-based analysis of trust in AI in health care based on an interdisciplinary panel of experts from different domains. Our findings can be used to address the problem of defining trust in AI in health care applications, fostering the discussion of concrete real-world health care scenarios in which humans interact with AI systems explicitly. Methods: We used a combination of framework analysis and a 3-step consensus process involving 18 international experts from the fields of computer science, medicine, philosophy of technology, ethics, and social sciences. Our process consisted of a synchronous phase during an expert workshop where we discussed the notion of trust in AI in health care applications, defined an initial framework of important elements of trust to guide our analysis, and agreed on 5 case studies. This was followed by a 2-step iterative, asynchronous process in which the authors further developed, discussed, and refined notions of trust with respect to these specific cases. Results: Our consensus process identified key contextual factors of trust, namely, an AI system's environment, the actors involved, and framing factors, and analyzed causes and effects of trust in AI in health care. Our findings revealed that certain factors were applicable across all discussed cases yet also pointed to the need for a fine-grained, multidisciplinary analysis bridging human-centered and technology-centered approaches. While regulatory boundaries and technological design features are critical to successful AI implementation in health care, ultimately, communication and positive lived experiences with AI systems will be at the forefront of user trust. Our expert consensus allowed us to formulate concrete recommendations for future research on trust in AI in health care applications. Conclusions: This paper advocates for a more refined and nuanced conceptual understanding of trust in the context of AI in health care. By synthesizing insights into commonalities and differences among specific case studies, this paper establishes a foundational basis for future debates and discussions on trusting AI in health care. ", doi="10.2196/56306", url="https://www.jmir.org/2025/1/e56306", url="http://www.ncbi.nlm.nih.gov/pubmed/39969962" } @Article{info:doi/10.2196/64914, author="Pullano, Giulia and Alvarez-Zuzek, Gisele Lucila and Colizza, Vittoria and Bansal, Shweta", title="Characterizing US Spatial Connectivity and Implications for Geographical Disease Dynamics and Metapopulation Modeling: Longitudinal Observational Study", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="18", volume="11", pages="e64914", keywords="geographical disease dynamics", keywords="spatial connectivity", keywords="mobility data", keywords="metapopulation modeling", keywords="COVID-19", keywords="human mobility", keywords="infectious diseases", keywords="social distancing", keywords="epidemic", keywords="mobile apps", keywords="SafeGraph", keywords="SARS-CoV-2", keywords="coronavirus", keywords="pandemic", keywords="spatio-temporal", keywords="US", keywords="public health", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="health informatics", abstract="Background: Human mobility is expected to be a critical factor in the geographic diffusion of infectious diseases, and this assumption led to the implementation of social distancing policies during the early fight against the COVID-19 emergency in the United States. Yet, because of substantial data gaps in the past, what still eludes our understanding are the following questions: (1) How does mobility contribute to the spread of infection within the United States at local, regional, and national scales? (2) How do seasonality and shifts in behavior affect mobility over time? (3) At what geographic level is mobility homogeneous across the United States? Objective: This study aimed to address the questions that are critical for developing accurate transmission models, predicting the spatial propagation of disease across scales, and understanding the optimal geographical and temporal scale for the implementation of control policies. Methods: We analyzed high-resolution mobility data from mobile app usage from SafeGraph Inc, mapping daily connectivity between the US counties to grasp spatial clustering and temporal stability. Integrating this into a spatially explicit transmission model, we replicated SARS-CoV-2's first wave invasion, assessing mobility's spatiotemporal impact on disease predictions. Results: Analysis from 2019 to 2021 showed that mobility patterns remained stable, except for a decline in April 2020 due to lockdowns, which reduced daily movements from 45 million to approximately 25 million nationwide. Despite this reduction, intercounty connectivity remained seasonally stable, largely unaffected during the early COVID-19 phase, with a median Spearman coefficient of 0.62 (SD 0.01) between daily connectivity and gravity networks. We identified 104 geographic clusters of US counties with strong internal mobility connectivity and weaker links to counties outside these clusters. These clusters were stable over time, largely overlapping state boundaries (normalized mutual information=0.82) and demonstrating high temporal stability (normalized mutual information=0.95). Our findings suggest that intercounty connectivity is relatively static and homogeneous at the substate level. Furthermore, while county-level, daily mobility data best captures disease invasion, static mobility data aggregated to the cluster level also effectively models spatial diffusion. Conclusions: Our work demonstrates that intercounty mobility was negligibly affected outside the lockdown period in April 2020, explaining the broad spatial distribution of COVID-19 outbreaks in the United States during the early phase of the pandemic. Such geographically dispersed outbreaks place a significant strain on national public health resources and necessitate complex metapopulation modeling approaches for predicting disease dynamics and control design. We thus inform the design of such metapopulation models to balance high disease predictability with low data requirements. ", doi="10.2196/64914", url="https://publichealth.jmir.org/2025/1/e64914" } @Article{info:doi/10.2196/62835, author="Chen, Raphael Hui Lionel and Chong, Dawn Qingqing and Tay, Brenda and Zhou, Siqin and Wong, Ting Evelyn Yi and Seow-En, Isaac and Tan, Kan Ker and Wang, Yi and Seow, Adeline and Tan, Emile Kwong-Wei and Tan, Iain Bee Huat and Tan, Huey Sze", title="Trends in Early-Onset Colorectal Cancer in Singapore: Epidemiological Study of a Multiethnic Population", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="14", volume="11", pages="e62835", keywords="early-onset colorectal cancer", keywords="epidemiology", keywords="Singapore", keywords="joinpoint regression", keywords="age-period-cohort", keywords="public health", keywords="health disparity", abstract="Background: Colorectal cancer (CRC) incidence and mortality in those aged 50 years and above have decreased over the past 2 decades. However, there is a rising incidence of CRC among individuals under 50 years of age, termed early-onset colorectal cancer (EOCRC). Patients with EOCRC are diagnosed at an advanced stage and may be in more psychosocial, emotional, and financial distress. Objective: Our study examined the epidemiological shifts in CRC in Singapore, a multiethnic country. Methods: CRCs diagnosed at age 20 years and above were identified from the Singapore Cancer Registry (SCR) from 1968 to 2019. Patient characteristics included gender, ethnicity, and age of CRC diagnosis. Population information was obtained from the Department of Statistics Singapore (SingStat). Age-specific incidence rates (ASRs) and age-standardized incidence rates (ASIRs) were calculated. The cohort was divided into 3 age groups: 20-49, 50-64, and ?65 years. Temporal trends in incidence rates were modeled with joinpoint regression. Birth cohort models were fitted using the National Cancer Institute (NCI) age-period-cohort analysis tool. Cancer-specific survival analysis was performed with the Cox proportional hazards model. Results: In total, 53,044 CRCs were included, and 6183 (11.7\%) adults aged 20-49 years were diagnosed with EOCRC. The ASR of EOCRC rose from 5 per 100,000 population in 1968 to 9 per 100,000 population in 1996 at 2.1\% annually and rose to 10 per 100,000 population in 2019 at 0.64\% annually. The ASR for CRC among adults aged 50-64 years rose at 3\% annually from 1968 to 1987 and plateaued from 1987, while the ASR for adults aged 65 years and above rose at 4.1\% annually from 1968 to 1989 and 1.3\% annually from 1989 to 2003 but decreased from 2003 onwards at 1\% annually. The ASR of early-onset rectal cancer increased significantly at 1.5\% annually. There was a continued rise in the ASR of EOCRC among males (annual percentage change [APC] 1.5\%) compared to females (APC 0.41\%). Compared to the 1950-1954 reference birth cohort, the 1970-1984 birth cohort had a significantly higher incidence rate ratio (IRR) of 1.17-1.36 for rectal cancer, while there was no significant change for colon cancer in later cohorts. There were differences in CRC trends across the 3 ethnic groups: Malays had a rapid and persistent rise in the ASR of CRC across all age groups (APC 1.4\%-3\%), while among young Chinese, only the ASR of rectal cancer was increasing (APC 1.5\%). Patients with EOCRC had better survival compared to patients diagnosed at 65 years and above (hazard ratio [HR] 0.73, 95\% CI 0.67-0.79, P<.001) after adjusting for covariates. Conclusions: The rise in the incidence of rectal cancer among young adults, especially among Chinese and Malays, in Singapore highlights the need for further research to diagnose CRC earlier and reduce cancer-related morbidity and mortality. ", doi="10.2196/62835", url="https://publichealth.jmir.org/2025/1/e62835" } @Article{info:doi/10.2196/66702, author="He, Lin and Jiang, Shaoqiang and Jiang, Tingting and Chen, Wanjun and Zheng, Jinlei and Wang, Hui and Chai, Chengliang", title="A Comparison of Mobile Social Media Promotion and Volunteer-Driven Strategies for Community Organizations Recruiting Men Who Have Sex with Men for HIV Testing in Zhejiang Province, China: Cross-Sectional Study Based on a Large-Scale Survey", journal="J Med Internet Res", year="2025", month="Feb", day="13", volume="27", pages="e66702", keywords="men who have sex with men", keywords="MSM", keywords="internet", keywords="recruit", keywords="HIV testing", keywords="community organization", keywords="strategy", keywords="China", keywords="mobile phone", abstract="Background: China has recently implemented a strategy to promote and facilitate community organization involvement in HIV prevention among men who have sex with men (MSM). Although community-based strategies have been shown to increase HIV testing uptake, the relative effectiveness of mobile social media promotion compared with volunteer-driven recruitment remains underexplored. Limited research has investigated how these strategies differentially affect MSM who have not undergone previous HIV testing. Objective: This study aimed to compare the differences between a mobile social media promotion strategy and a volunteer-driven strategy for community organizations to recruit MSM for HIV testing. Methods: A cross-sectional study was conducted from July to December 2023 among MSM in Zhejiang Province, China. Participants aged 16 years with an HIV-negative or unknown status were recruited either through a mobile social media promotion strategy or through a volunteer-driven strategy by a community organization. They completed a questionnaire that collected information on demographics, sexual behavior, and HIV testing history. All participants were tested for HIV after completing the questionnaire. A multivariate logistic regression model was used to identify factors associated with recruitment through mobile social media promotion. Results: The study included 4600 MSM, of whom 3035 (66\%) were recruited through the mobile social media strategy. Overall, 1.4\% (66/4600) of participants tested positive for HIV, and 18.8\% (865/4600) underwent HIV testing for the first time. Recruitment via the mobile social media promotion strategy was significantly associated with several factors: having only gay sexual partners (adjusted OR [aOR] 1.23, 95\% CI 1.05-1.45), having more than 2 sexual partners in the past 3 months (aOR 1.74, 95\% CI 1.42-2.11), frequently using rush poppers during sex (aOR 1.39, 95\% CI 1.14-1.99), having a history of sexually transmitted infections (aOR 1.56, 95\% CI 1.02-2.39), having awareness of pre-exposure prophylaxis (aOR 1.42, 95\% CI 1.19-1.71), having awareness of postexposure prophylaxis (PEP; aOR 1.49, 95\% CI 1.24-1.79), using mail-in HIV self-testing kits (aOR 2.02, 95\% CI 1.77-2.31), testing HIV-positive (aOR 2.02, 95\% CI 1.10-3.72), and first-time HIV testing (aOR 1.28, 95\% CI 1.09-1.52). Conclusions: Community organizations play a critical role in expanding HIV testing and identifying undiagnosed individuals infected with HIV. Compared to the volunteer-driven outreach, mobile social media promotion strategies had a higher proportion of first-time testers and a higher rate of HIV positivity. We recommend prioritizing mobile social media strategies in regions with limited LGBTQ+ organizations or HIV health services to increase HIV testing coverage and interventions among MSM. ", doi="10.2196/66702", url="https://www.jmir.org/2025/1/e66702" } @Article{info:doi/10.2196/62802, author="Zhang, Kehe and Hunyadi, V. Jocelyn and de Oliveira Otto, C. Marcia and Lee, Miryoung and Zhang, Zitong and Ramphul, Ryan and Yamal, Jose-Miguel and Yaseen, Ashraf and Morrison, C. Alanna and Sharma, Shreela and Rahbar, Hossein Mohammad and Zhang, Xu and Linder, Stephen and Marko, Dritana and Roy, White Rachel and Banerjee, Deborah and Guajardo, Esmeralda and Crum, Michelle and Reininger, Belinda and Fernandez, E. Maria and Bauer, Cici", title="Increasing COVID-19 Testing and Vaccination Uptake in the Take Care Texas Community-Based Randomized Trial: Adaptive Geospatial Analysis", journal="JMIR Form Res", year="2025", month="Feb", day="11", volume="9", pages="e62802", keywords="COVID-19 testing", keywords="COVID-19 vaccination", keywords="study design", keywords="community-based interventions", keywords="geospatial analysis", keywords="public health", keywords="social determinants of health", keywords="data dashboard", abstract="Background: Geospatial data science can be a powerful tool to aid the design, reach, efficiency, and impact of community-based intervention trials. The project titled Take Care Texas aims to develop and test an adaptive, multilevel, community-based intervention to increase COVID-19 testing and vaccination uptake among vulnerable populations in 3 Texas regions: Harris County, Cameron County, and Northeast Texas. Objective: We aimed to develop a novel procedure for adaptive selections of census block groups (CBGs) to include in the community-based randomized trial for the Take Care Texas project. Methods: CBG selection was conducted across 3 Texas regions over a 17-month period (May 2021 to October 2022). We developed persistent and recent COVID-19 burden metrics, using real-time SARS-CoV-2 monitoring data to capture dynamic infection patterns. To identify vulnerable populations, we also developed a CBG-level community disparity index, using 12 contextual social determinants of health (SDOH) measures from US census data. In each adaptive round, we determined the priority CBGs based on their COVID-19 burden and disparity index, ensuring geographic separation to minimize intervention ``spillover.'' Community input and feedback from local partners and health workers further refined the selection. The selected CBGs were then randomized into 2 intervention arms---multilevel intervention and just-in-time adaptive intervention---and 1 control arm, using covariate adaptive randomization, at a 1:1:1 ratio. We developed interactive data dashboards, which included maps displaying the locations of selected CBGs and community-level information, to inform the selection process and guide intervention delivery. Selection and randomization occurred across 10 adaptive rounds. Results: A total of 120 CBGs were selected and followed the stepped planning and interventions, with 60 in Harris County, 30 in Cameron County, and 30 in Northeast Texas counties. COVID-19 burden presented substantial temporal changes and local variations across CBGs. COVID-19 burden and community disparity exhibited some common geographical patterns but also displayed distinct variations, particularly at different time points throughout this study. This underscores the importance of incorporating both real-time monitoring data and contextual SDOH in the selection process. Conclusions: The novel procedure integrated real-time monitoring data and geospatial data science to enhance the design and adaptive delivery of a community-based randomized trial. Adaptive selection effectively prioritized the most in-need communities and allowed for a rigorous evaluation of community-based interventions in a multilevel trial. This methodology has broad applicability and can be adapted to other public health intervention and prevention programs, providing a powerful tool for improving population health and addressing health disparities. ", doi="10.2196/62802", url="https://formative.jmir.org/2025/1/e62802" } @Article{info:doi/10.2196/68881, author="Liu, Junyu and Niu, Qian and Nagai-Tanima, Momoko and Aoyama, Tomoki", title="Understanding Human Papillomavirus Vaccination Hesitancy in Japan Using Social Media: Content Analysis", journal="J Med Internet Res", year="2025", month="Feb", day="11", volume="27", pages="e68881", keywords="human papillomavirus", keywords="HPV", keywords="HPV vaccine", keywords="vaccine confidence", keywords="large language model", keywords="stance analysis", keywords="topic modeling", abstract="Background: Despite the reinstatement of proactive human papillomavirus (HPV) vaccine recommendations in 2022, Japan continues to face persistently low HPV vaccination rates, which pose significant public health challenges. Misinformation, complacency, and accessibility issues have been identified as key factors undermining vaccine uptake. Objective: This study aims to examine the evolution of public attitudes toward HPV vaccination in Japan by analyzing social media content. Specifically, we investigate the role of misinformation, public health events, and cross-vaccine attitudes (eg, COVID-19 vaccines) in shaping vaccine hesitancy over time. Methods: We collected tweets related to the HPV vaccine from 2011 to 2021. Natural language processing techniques and large language models (LLMs) were used for stance analysis of the collected data. Time series analysis and latent Dirichlet allocation topic modeling were used to identify shifts in public sentiment and topic trends over the decade. Misinformation within opposed-stance tweets was detected using LLMs. Furthermore, we analyzed the relationship between attitudes toward HPV and COVID-19 vaccines through logic analysis. Results: Among the tested models, Gemini 1.0 pro (Google) achieved the highest accuracy (0.902) for stance analysis, improving to 0.968 with hyperparameter tuning. Time series analysis identified significant shifts in public stance in 2013, 2016, and 2020, corresponding to key public health events and policy changes. Topic modeling revealed that discussions around vaccine safety peaked in 2015 before declining, while topics concerning vaccine effectiveness exhibited an opposite trend. Misinformation in topic ``Scientific Warnings and Public Health Risk'' in the sopposed-stance tweets reached a peak of 2.84\% (47/1656) in 2012 and stabilized at approximately 0.5\% from 2014 onward. The volume of tweets using HPV vaccine experiences to argue stances on COVID-19 vaccines was significantly higher than the reverse. Conclusions: Based on observation on the public attitudes toward HPV vaccination from social media contents over 10 years, our findings highlight the need for targeted public health interventions to address vaccine hesitancy in Japan. Although vaccine confidence has increased slowly, sustained efforts are necessary to ensure long-term improvements. Addressing misinformation, reducing complacency, and enhancing vaccine accessibility are key strategies for improving vaccine uptake. Some evidence suggests that confidence in one vaccine may positively influence perceptions of other vaccines. This study also demonstrated the use of LLMs in providing a comprehensive understanding of public health attitudes. Future public health strategies can benefit from these insights by designing effective interventions to boost vaccine confidence and uptake. ", doi="10.2196/68881", url="https://www.jmir.org/2025/1/e68881" } @Article{info:doi/10.2196/66448, author="Kim, I. Sol and Jin, Jae-Chan and Yoo, Seo-Koo and Han, Hyun Doug", title="Changes in Internet Activities and Influencing Factors for Problematic Internet Use During the COVID-19 Pandemic in Korean Adolescents: Repeated Cross-Sectional Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="11", volume="8", pages="e66448", keywords="coronavirus pandemic", keywords="internet use pattern", keywords="internet games", keywords="short-form videos", keywords="social network system", keywords="depressed mood", keywords="internet use", keywords="pandemic", keywords="internet", keywords="COVID-19", keywords="video", keywords="internet behavior", keywords="social media", keywords="internet addiction", keywords="depression", keywords="anxiety", keywords="digital platforms", keywords="mobile phone", abstract="Background: As adolescents increasingly engage with digital experiences, the internet serves as a platform for social interaction, entertainment, and learning. The COVID-19 pandemic accelerated this trend, with remote learning and restricted physical interactions driving changes in internet behavior. Adolescents spent more time on gaming and social media, reflecting a notable shift in use patterns. Objective: We hypothesized that the COVID-19 pandemic changed internet use patterns among Korean adolescents, including content types, time spent on web-based activities, and pathological use prevalence. Additionally, we anticipated that these changes would correlate with shifts in adolescents' psychological status during the pandemic. Methods: Data from 827 adolescents aged 12 to 15 years (n=144 in 2018, n=142 in 2019, n=126 in 2020, n=130 in 2021, n=143 in 2022, and n=142 in 2023) were gathered over 6 years from 43 middle schools across 16 regions and 1 hospital in South Korea. The demographic data collected included age, sex, and school year. Participants also provided information on their internet use patterns and levels of internet addiction. Additionally, psychological status, including mood, anxiety, attention, and self-esteem, was assessed. Results: There were significant differences in the depression scale (Patient Health Questionnaire 9). The Patient Health Questionnaire 9 scores for 2018, 2019, and 2023 decreased compared to those in 2020, 2021, and 2022 (F5=3.07; P=.007). Regarding changes in internet use behavior, game playing among adolescents decreased after the pandemic compared to before, while watching videos increased. Additionally, the rate of problematic internet use was highest for games before COVID-19, but after COVID-19, it was highest for videos, and this trend continued until 2023 ($\chi$23=8.16, P=.04). Furthermore, this study showed that the Young's Internet Addiction Scale (YIAS) score was highest in the game group in 2018 compared to other groups before COVID-19 (F5=14.63; P<.001). In 2019, both the game and video groups had higher YIAS scores than other groups (F5=9.37; P<.001), and by 2022, the YIAS scores among the game, video, and Social Network Service groups did not differ significantly. The degree of influence on the severity of internet addiction was also greatest for games before COVID-19, but after COVID-19, the effect was greater for videos than for games. Conclusions: During the COVID-19 pandemic, internet use for academic and commercial purposes, including remote classes and videoconferences, increased rapidly worldwide, leading to a significant rise in overall internet use time. The demand for and dependence on digital platforms is expected to grow even further in the coming era. Until now, concerns have primarily focused on the use of games, but it is now necessary to consider what types of internet behaviors cause problems and how to address them. ", doi="10.2196/66448", url="https://pediatrics.jmir.org/2025/1/e66448" } @Article{info:doi/10.2196/63881, author="Selcuk, Yesim and Kim, Eunhui and Ahn, Insung", title="InfectA-Chat, an Arabic Large Language Model for Infectious Diseases: Comparative Analysis", journal="JMIR Med Inform", year="2025", month="Feb", day="10", volume="13", pages="e63881", keywords="large language model", keywords="Arabic large language models", keywords="AceGPT", keywords="multilingual large language model", keywords="infectious disease monitoring", keywords="public health", abstract="Background: Infectious diseases have consistently been a significant concern in public health, requiring proactive measures to safeguard societal well-being. In this regard, regular monitoring activities play a crucial role in mitigating the adverse effects of diseases on society. To monitor disease trends, various organizations, such as the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC), collect diverse surveillance data and make them publicly accessible. However, these platforms primarily present surveillance data in English, which creates language barriers for non--English-speaking individuals and global public health efforts to accurately observe disease trends. This challenge is particularly noticeable in regions such as the Middle East, where specific infectious diseases, such as Middle East respiratory syndrome coronavirus (MERS-CoV), have seen a dramatic increase. For such regions, it is essential to develop tools that can overcome language barriers and reach more individuals to alleviate the negative impacts of these diseases. Objective: This study aims to address these issues; therefore, we propose InfectA-Chat, a cutting-edge large language model (LLM) specifically designed for the Arabic language but also incorporating English for question and answer (Q\&A) tasks. InfectA-Chat leverages its deep understanding of the language to provide users with information on the latest trends in infectious diseases based on their queries. Methods: This comprehensive study was achieved by instruction tuning the AceGPT-7B and AceGPT-7B-Chat models on a Q\&A task, using a dataset of 55,400 Arabic and English domain--specific instruction--following data. The performance of these fine-tuned models was evaluated using 2770 domain-specific Arabic and English instruction--following data, using the GPT-4 evaluation method. A comparative analysis was then performed against Arabic LLMs and state-of-the-art models, including AceGPT-13B-Chat, Jais-13B-Chat, Gemini, GPT-3.5, and GPT-4. Furthermore, to ensure the model had access to the latest information on infectious diseases by regularly updating the data without additional fine-tuning, we used the retrieval-augmented generation (RAG) method. Results: InfectA-Chat demonstrated good performance in answering questions about infectious diseases by the GPT-4 evaluation method. Our comparative analysis revealed that it outperforms the AceGPT-7B-Chat and InfectA-Chat (based on AceGPT-7B) models by a margin of 43.52\%. It also surpassed other Arabic LLMs such as AceGPT-13B-Chat and Jais-13B-Chat by 48.61\%. Among the state-of-the-art models, InfectA-Chat achieved a leading performance of 23.78\%, competing closely with the GPT-4 model. Furthermore, the RAG method in InfectA-Chat significantly improved document retrieval accuracy. Notably, RAG retrieved more accurate documents based on queries when the top-k parameter value was increased. Conclusions: Our findings highlight the shortcomings of general Arabic LLMs in providing up-to-date information about infectious diseases. With this study, we aim to empower individuals and public health efforts by offering a bilingual Q\&A system for infectious disease monitoring. ", doi="10.2196/63881", url="https://medinform.jmir.org/2025/1/e63881" } @Article{info:doi/10.2196/70071, author="BinHamdan, Hamdan Rahaf and Alsadhan, Abdulrahman Salwa and Gazzaz, Zohair Arwa and AlJameel, Hassan AlBandary", title="Social Media Use and Oral Health--Related Misconceptions in Saudi Arabia: Cross-Sectional Study", journal="JMIR Form Res", year="2025", month="Feb", day="10", volume="9", pages="e70071", keywords="social media", keywords="oral health", keywords="health misinformation", keywords="digital health", keywords="Saudi Arabia", keywords="public health", keywords="Instagram", keywords="Snapchat", keywords="TikTok", keywords="Twitter", abstract="Background: Social media has become a central tool in health communication, offering both opportunities and challenges. In Saudi Arabia, where platforms like WhatsApp, Snapchat, and Instagram are widely used, the quality and credibility of oral health information shared digitally remain critical issues. Misconceptions about oral health can negatively influence individuals' behaviors and oral health outcomes. Objective: This study aimed to describe the patterns of social media use and estimate the prevalence of oral health--related misconceptions among adults in Saudi Arabia. Additionally, it assessed the associations between engagement with oral health information, self-reported oral health, and the presence and count of these misconceptions. Methods: A cross-sectional survey was conducted over 10 weeks, targeting adults aged 15 years and older in Saudi Arabia. Data were collected from a total sample size (n=387) via a questionnaire distributed through targeted advertisements on Instagram, TikTok, Snapchat, and X (Twitter). The prevalence of oral health--related misconceptions was estimated using descriptive statistics, including counts and percentages. Chi-square tests described sociodemographic, social media engagement, and self-reported oral health. Logistic and Poisson regression analyses were used to assess associations between engagement and self-reported oral health with misconceptions. Logistic regression models provided odds ratios and adjusted odds ratios with 95\% CI to assess the presence of oral health misconceptions. Poisson regression was used to calculate mean ratios and adjusted mean ratios (AMRs) for the count of misconceptions. Results: WhatsApp (n=344, 89.8\%) and Instagram (n=304, 78.9\%) were the most frequently used social media platforms daily. Common oral health misconceptions included beliefs that ``Pregnancy causes calcium loss in teeth'' (n=337, 87\%) and ``Dental treatment should be avoided during pregnancy'' (n=245, 63.3\%). Following dental-specific accounts was significantly associated with lower odds of having any misconceptions (adjusted odds ratio 0.41, 95\% CI 0.22-0.78) and a lower count of misconceptions (AMR 0.87, 95\% CI 0.77-0.98). Conversely, trust in social media as a source of oral health information was associated with a higher count of misconceptions (AMR 1.16, 95\% CI 1.02-1.31). Conclusions: Social media platforms are essential yet double-edged tools for oral health information dissemination in Saudi Arabia. Participants who followed dental-specific accounts had significantly lower misconceptions, while trust in social media as a source of information was linked to higher counts of misconceptions. These findings highlight the importance of promoting credible content from verified sources to combat misconceptions. Strategic collaborations with dental professionals are necessary to enhance the dissemination of accurate oral health information and public awareness and reduce the prevalence of oral health--related misconceptions. ", doi="10.2196/70071", url="https://formative.jmir.org/2025/1/e70071" } @Article{info:doi/10.2196/60467, author="Kinoshita, Ryo and Miyamoto, Sho and Suzuki, Tadaki and Suzuki, Motoi and Yoneoka, Daisuke", title="Interpreting the Influence of Using Blood Donor Residual Samples for SARS-CoV-2 Seroprevalence Studies in Japan: Cross-Sectional Survey Study", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="10", volume="11", pages="e60467", keywords="SARS-CoV-2", keywords="COVID-19", keywords="seroprevalence", keywords="blood donor", keywords="selection bias", keywords="healthy donor effect", keywords="coronavirus", keywords="pandemic", keywords="Japan", keywords="cross-sectional study", keywords="residual blood", keywords="epidemiology", keywords="blood donation", keywords="web-based", keywords="logistic regression", keywords="social economic", keywords="comorbidity", keywords="COVID-19 vaccination", keywords="public health", doi="10.2196/60467", url="https://publichealth.jmir.org/2025/1/e60467" } @Article{info:doi/10.2196/66446, author="Zhang, Zhongmin and Xu, Hengyi and Pan, Jing and Song, Fujian and Chen, Ting", title="Spatiotemporal Characteristics and Influential Factors of Electronic Cigarette Web-Based Attention in Mainland China: Time Series Observational Study", journal="J Med Internet Res", year="2025", month="Feb", day="10", volume="27", pages="e66446", keywords="electronic cigarettes", keywords="Baidu index", keywords="web-based attention", keywords="spatiotemporal characteristics", keywords="China", abstract="Background: The popularity of electronic cigarettes (e-cigarettes) has steadily increased, prompting a considerable number of individuals to search for relevant information on them. Previous e-cigarette infodemiology studies have focused on assessing the quality and reliability of website content and quantifying the impact of policies. In reality, most low-income countries and low- and middle-income countries have not yet conducted e-cigarette use surveillance. Data sourced from web-based search engines related to e-cigarettes have the potential to serve as cost-effective supplementary means to traditional monitoring approaches. Objective: This study aimed to analyze the spatiotemporal distribution characteristics and associated sociodemographic factors of e-cigarette searches using trends from the Baidu search engine. Methods: The query data related to e-cigarettes for 31 provinces in mainland China were retrieved from the Baidu index database from January 1, 2015, to December 31, 2022. Concentration ratio methods and spatial autocorrelation analysis were applied to analyze the temporal aggregation and spatial aggregation of the e-cigarette Baidu index, respectively. A variance inflation factor test was performed to avoid multicollinearity. A spatial panel econometric model was developed to assess the determinants of e-cigarette web-based attention. Results: The daily average Baidu index for e-cigarettes increased from 53,234.873 in 2015 to 85,416.995 in 2021 and then declined to 52,174.906 in 2022. This index was concentrated in the southeastern coastal region, whereas the hot spot shifted to the northwestern region after adjusting for population size. Positive spatial autocorrelation existed in the per capita Baidu index of e-cigarettes from 2015 to 2022. The results of the local Moran's I showed that there were mainly low-low cluster areas of the per capita Baidu index, especially in the central region. Furthermore, the male-female ratio, the proportion of high school and above education, and the per capita gross regional domestic product were positively correlated with the per capita Baidu index for e-cigarettes. A higher urbanization rate was associated with a reduced per capita Baidu index. Conclusions: With the increasing popularity of web-based searches for e-cigarettes, a targeted e-cigarette health education program for individuals in the northwest, males, rural populations, high school and above educated individuals, and high-income groups is warranted. ", doi="10.2196/66446", url="https://www.jmir.org/2025/1/e66446", url="http://www.ncbi.nlm.nih.gov/pubmed/39928402" } @Article{info:doi/10.2196/58858, author="Muliokela, K. Rosemary and Banda, Kuwani and Hussen, Mohammed Abdulaziz and Malumo, Bvulani Sarai and Kashoka, Andrew and Mwiche, Angel and Chiboma, Innocent and Barreix, Maria and Nyirenda, Muyereka and Sithole, Zvanaka and Ratanaprayul, Natschja and Endehabtu, Fikadie Berhanu and Telake, Abayneh Hanna and Weldeab, Adane and Probert, M. William J. and Tun{\c{c}}alp, ?zge and Maya, Ernest and Woldetsadik, Mulatu and Tilahun, Binyam and Guure, Chris and Senya, Kafui and Say, Lale and Tamrat, Tigest", title="Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons Learned", journal="JMIR Med Inform", year="2025", month="Feb", day="7", volume="13", pages="e58858", keywords="guidelines", keywords="reproductive health", keywords="maternal health", keywords="antenatal care", keywords="clinical decision support", keywords="clinical decision support systems", keywords="digital health", keywords="HIV/AIDS", keywords="family planning", keywords="electronic medical records", keywords="electronic health record", keywords="standards", keywords="interoperability", keywords="system uptake", keywords="digital health governance", abstract="Background: The adoption of digital systems requires processes for quality assurance and uptake of standards to achieve universal health coverage. The World Health Organization developed the Digital Adaptation Kits (DAKs) within the SMART (Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable) guidelines framework to support the uptake of standards and recommendations through digital systems. DAKs are a software-neutral mechanism for translating narrative guidelines to support the design of digital systems. However, a systematic process is needed to implement and ensure the impact of DAKs in country contexts. Objective: This paper details the structured process and stepwise approach to customize the DAKs to the national program and digital context in 5 countries in Africa with diverse program guideline uptake and significant digital health investments: Ethiopia, Ghana, Malawi, Zambia, and Zimbabwe. All these countries have existing digital systems, which have the potential to be updated with the DAKs. Methods: A DAK assessment tool was developed and used to assess guideline digitization readiness and opportunities for system uptake in each country. Multistakeholder teams were established to conduct the content review and alignment of the generic DAK to national guidelines and protocols through a series of stakeholder consultations, including stakeholder orientation, content review and alignment, content validation, and software update meetings. Implementation (Results): Country adaptation processes identified requirements for national-level contextualization and highlighted opportunities for refinement of DAKs. Quality assurance of the content during the content review and validation processes ensured alignment with national protocols. Adaptation processes also facilitated the adoption of the DAKs approach into national guidelines and strategic documents for sexual and reproductive health. Conclusions: Country experiences offered early insights into the opportunities and benefits of a structured approach to digitalizing primary health care services. They also highlighted how this process can be continuously refined and sustained to enhance country-level impact. ", doi="10.2196/58858", url="https://medinform.jmir.org/2025/1/e58858" } @Article{info:doi/10.2196/64069, author="Liu, Yingxin and Zhang, Jingyi and Thabane, Lehana and Bai, Xuerui and Kang, Lili and Lip, H. Gregory Y. and Van Spall, C. Harriette G. and Xia, Min and Li, Guowei", title="Data-Sharing Statements Requested from Clinical Trials by Public, Environmental, and Occupational Health Journals: Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Feb", day="7", volume="27", pages="e64069", keywords="data sharing", keywords="clinical trial", keywords="public health", keywords="International Committee of Medical Journal Editors", keywords="ICMJE", keywords="journal request", keywords="clinical trials", keywords="decision-making", keywords="occupational health", keywords="health informatics", keywords="patient data", abstract="Background: Data sharing plays a crucial role in health informatics, contributing to improving health information systems, enhancing operational efficiency, informing policy and decision-making, and advancing public health surveillance including disease tracking. Sharing individual participant data in public, environmental, and occupational health trials can help improve public trust and support by enhancing transparent reporting and reproducibility of research findings. The International Committee of Medical Journal Editors (ICMJE) requires all papers to include a data-sharing statement. However, it is unclear whether journals in the field of public, environmental, and occupational health adhere to this requirement. Objective: This study aims to investigate whether public, environmental, and occupational health journals requested data-sharing statements from clinical trials submitted for publication. Methods: In this bibliometric survey of ``Public, Environmental, and Occupational Health'' journals, defined by the Journal Citation Reports (as of June 2023), we included 202 journals with clinical trial reports published between 2019 and 2022. The primary outcome was a journal request for a data-sharing statement, as identified in the paper submission instructions. Multivariable logistic regression analysis was conducted to evaluate the relationship between journal characteristics and journal requests for data-sharing statements, with results presented as odds ratios (ORs) and corresponding 95\% CIs. We also investigated whether the journals included a data-sharing statement in their published trial reports. Results: Among the 202 public, environmental, and occupational health journals included, there were 68 (33.7\%) journals that did not request data-sharing statements. Factors significantly associated with journal requests for data-sharing statements included open access status (OR 0.43, 95\% CI 0.19-0.97), high journal impact factor (OR 2.31, 95\% CI 1.15-4.78), endorsement of Consolidated Standards of Reporting Trials (OR 2.43, 95\% CI 1.25-4.79), and publication in the United Kingdom (OR 7.18, 95\% CI 2.61-23.4). Among the 134 journals requesting data-sharing statements, 26.9\% (36/134) did not have statements in their published trial reports. Conclusions: Over one-third of the public, environmental, and occupational health journals did not request data-sharing statements in clinical trial reports. Among those journals that requested data-sharing statements in their submission guidance pages, more than one quarter published trial reports with no data-sharing statements. These results revealed an inadequate practice of requesting data-sharing statements by public, environmental, and occupational health journals, requiring more effort at the journal level to implement ICJME recommendations on data-sharing statements. ", doi="10.2196/64069", url="https://www.jmir.org/2025/1/e64069" } @Article{info:doi/10.2196/62861, author="Zhou, Xuelian and Zhang, Xiaochi and Bai, Guannan and Dong, Guanping and Li, Xinyi and Chen, Ruimin and Chen, Shaoke and Zheng, Rongxiu and Wang, Chunlin and Wei, Haiyan and Cao, Bingyan and Liang, Yan and Yao, Hui and Su, Zhe and Maimaiti, Mireguli and Luo, Feihong and Li, Pin and Zhu, Min and Du, Hongwei and Yang, Yu and Cui, Lanwei and Wang, Jinling and Yuan, Jinna and Liu, Zhuang and Wu, Wei and Zhao, Qi and Fu, Junfen", title="Long-Term Exposure to Fine Particulate Matter (PM2.5) Components and Precocious Puberty Among School-Aged Children: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="7", volume="11", pages="e62861", keywords="fine particulate matter", keywords="PM2.5", keywords="PM2.5 components", keywords="air pollution", keywords="precocious puberty", keywords="children", keywords="long-term exposure", abstract="Background: The increasing incidence of precocious puberty is a major health challenge for Chinese children, while related risk factors remain less well explored. Exposure to ambient fine particulate matter (PM2.5) is a leading environmental hazard in China. Although certain components of PM2.5 have been reported to be endocrine disruptors for sex hormones, population-based evidence is still lacking on the association between PM2.5 exposure and precocious puberty in China. Objective: Based on a cross-sectional survey covering 30 cities in 2017 to 2019, this study was designed to explore the association between long-term exposure to PM2.5 and its 5 major components with precocious puberty in China and to check the potential modifying effects of family-related and personal factors. Methods: We included 34,105 children aged 6 to 9 years. We collected the 5-year average concentrations of PM2.5 and its 5 major components (sulfate, nitrate, ammonium, organic matter, and black carbon) in the area (at a spatial resolution of 0.1{\textdegree} {\texttimes} 0.1{\textdegree}) where each school was located. We used mixed effect logistic regression to estimate the effect sizes of the total mass of PM2.5 and each of its components on precocious puberty, and we examined the modifying effects of family-related and personal factors using an additional interactive term. A weighted quantile sum (WQS) regression model was applied to identify the weights of each component in explaining the effect size of the total mass of PM2.5. Results: We found that the odds ratio (OR) for precocious puberty per IQR increase in the concentration of total PM2.5 mass was 1.27 (95\% CI 0.92-1.75) for the whole population, 2.12 (95\% CI 1.27-3.55) for girls, and 0.90 (95\% CI 0.62-1.30) for boys. Similarly, the effect sizes of the 5 major components were all substantial for girls but minimal for boys. Results of the WQS analysis showed that organic matter could explain the highest proportion of the effect of PM2.5, with the weight of its contribution being 0.71. Modification effects of family income and dietary habits were only observed in certain population subgroups. Conclusions: Long-term exposure to total PM2.5 mass was significantly associated with precocious puberty in girls, with organic matter identified as the major effect contributor. The results add evidence on the detrimental effects of PM2.5 on children's development and growth. ", doi="10.2196/62861", url="https://publichealth.jmir.org/2025/1/e62861" } @Article{info:doi/10.2196/64739, author="Oono, Fumi and Matsumoto, Mai and Ogata, Risa and Suga, Mizuki and Murakami, Kentaro", title="Description of Weight-Related Content and Recommended Dietary Behaviors for Weight Loss Frequently Reposted on X (Twitter) in English and Japanese: Content Analysis", journal="J Med Internet Res", year="2025", month="Feb", day="7", volume="27", pages="e64739", keywords="social networking service", keywords="X, Twitter", keywords="web-based health information", keywords="dieting", keywords="weight loss", keywords="content analysis", keywords="digital health", keywords="weight control", keywords="weight", keywords="social media", keywords="diet", keywords="dietary behavior", keywords="obesity", keywords="eating disorders", keywords="public perceptions", abstract="Background: Both obesity and underweight are matters of global concern. Weight-related content frequently shared on social media can reflect public recognition and affect users' behaviors and perceptions. Although X (Twitter) is a popular social media platform, few studies have revealed the content of weight-related posts or details of dietary behaviors for weight loss shared on X. Objective: This study aims to describe body weight--related content frequently reposted on X, with a particular focus on dietary behaviors for weight loss, in English and Japanese. Methods: We collected English and Japanese X posts related to human body weight having over 100 reposts in July 2023 using an application programming interface tool. Two independent researchers categorized the contents of the posts into 7 main categories and then summarized recommended weight loss strategies. Results: We analyzed 815 English and 1213 Japanese posts. The most popular main category of the content was ``how to change weight'' in both languages. The Japanese posts were more likely to mention ``how to change weight'' (n=571, 47.1\%) and ``recipes to change weight'' (n=114, 9.4\%) than the English posts (n=195, 23.9\% and n=10, 1.2\%, respectively), whereas the English posts were more likely to mention ``will or experience to change weight'' (n=167, 20.5\%), ``attitudes toward weight status'' (n=78, 9.6\%), and ``public health situation'' (n=44, 5.4\%) than Japanese posts. Among 146 English and 541 Japanese posts about weight loss strategies, the predominant strategies were diet (n=76, 52.1\% in English and n=170, 31.4\% in Japanese) and physical activities (n=56, 38.4\% and n=295, 54.5\%, respectively). The proportion of posts mentioning both diet and physical activity was smaller in Japanese (n=62, 11.5\%) than in English (n=31, 21.2\%). Among 76 English and 170 Japanese posts about dietary behaviors for weight loss, more than 60\% of posts recommended increasing intakes of specific nutrients or food groups in both languages. The most popular dietary component recommended to increase was vegetables in both English (n=31, 40.8\%) and Japanese (n=48, 28.2\%), followed by protein and fruits in English and grains or potatoes and legumes in Japanese. Japanese posts were less likely to mention reducing energy intake; meal timing or eating frequency; or reducing intakes of specific nutrients or food groups than the English posts. The most popular dietary component recommended to decrease was alcohol in English and confectioneries in Japanese. Conclusions: This study characterized user interest in weight management and suggested the potential of X as an information source for weight management. Although weight loss strategies related to diet and physical activity were popular in both English and Japanese, some differences in the details of the strategies were present, indicating that X users are exposed to different information in English and Japanese. ", doi="10.2196/64739", url="https://www.jmir.org/2025/1/e64739", url="http://www.ncbi.nlm.nih.gov/pubmed/39918849" } @Article{info:doi/10.2196/65439, author="Liu, Han and Zong, Huiying and Yang, Yang and Schwebel, C. David and Xie, Bin and Ning, Peishan and Rao, Zhenzhen and Li, Li and Hu, Guoqing", title="Consistency of Daily Number of Reported COVID-19 Cases in 191 Countries From 2020 to 2022: Comparative Analysis of 2 Major Data Sources", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="6", volume="11", pages="e65439", keywords="COVID-19", keywords="pandemic", keywords="data consistency", keywords="World Health Organization", keywords="data quality", abstract="Background: The COVID-19 pandemic represents one of the most challenging public health emergencies in recent world history, causing about 7.07 million deaths globally by September 24, 2024. Accurate, timely, and consistent data are critical for early response to situations like the COVID-19 pandemic. Objective: This study aimed to evaluate consistency of daily reported COVID-19 cases in 191 countries from the Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE) and the World Health Organization (WHO) dashboards during 2020?2022. Methods: We retrieved data concerning new daily COVID-19 cases in 191 countries covered by both data sources from January 22, 2020, to December 31, 2022. The ratios of numbers of daily reported cases from the 2 sources were calculated to measure data consistency. We performed simple linear regression to examine significant changes in the ratio of numbers of daily reported cases during the study period. Results: Of 191 WHO member countries, only 60 displayed excellent data consistency in the number of daily reported COVID-19 cases between the WHO and JHU CSSE dashboards (mean ratio 0.9-1.1). Data consistency changed greatly across the 191 countries from 2020 to 2022 and differed across 4 types of countries, categorized by income. Data inconsistency between the 2 data sources generally decreased slightly over time, both for the 191 countries combined and within the 4 types of income-defined countries. The absolute relative difference between the 2 data sources increased in 84 countries, particularly for Malta (R2=0.25), Montenegro (R2=0.30), and the United States (R2=0.29), but it decreased significantly in 40 countries. Conclusions: The inconsistency between the 2 data sources warrants further research. Construction of public health surveillance and data collection systems for public health emergencies like the COVID-19 pandemic should be strengthened in the future. ", doi="10.2196/65439", url="https://publichealth.jmir.org/2025/1/e65439" } @Article{info:doi/10.2196/65546, author="Insani, Norma Widya and Zakiyah, Neily and Puspitasari, Melyani Irma and Permana, Yorga Muhammad and Parmikanti, Kankan and Rusyaman, Endang and Suwantika, Abdurrohim Auliya", title="Digital Health Technology Interventions for Improving Medication Safety: Systematic Review of Economic Evaluations", journal="J Med Internet Res", year="2025", month="Feb", day="5", volume="27", pages="e65546", keywords="digital health technology", keywords="drug safety", keywords="adverse drug events", keywords="medication errors", keywords="patient safety", abstract="Background: Medication-related harm, including adverse drug events (ADEs) and medication errors, represents a significant iatrogenic burden in clinical care. Digital health technology (DHT) interventions can significantly enhance medication safety outcomes. Although the clinical effectiveness of DHT for medication safety has been relatively well studied, much less is known about the cost-effectiveness of these interventions. Objective: This study aimed to systematically review the economic impact of DHT interventions on medication safety and examine methodological challenges to inform future research directions. Methods: A systematic search was conducted across 3 major electronic databases (ie, PubMed, Scopus, and EBSCOhost). The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. Two independent investigators conducted a full-text review after screening preliminary titles and abstracts. We adopted recommendations from the Panel on Cost-Effectiveness in Health and Medicine for data extraction. A narrative analysis was conducted to synthesize clinical and economic outcomes. The quality of reporting for the included studies was assessed using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. Results: We included 13 studies that assessed the cost-effectiveness (n=9, 69.2\%), cost-benefit (n=3, 23.1\%), and cost-utility (n=1, 7.7\%) of DHT for medication safety. Of the included studies, more than half (n=7, 53.9\%) evaluated a clinical decision support system (CDSS)/computerized provider order entry (CPOE), 4 (30.8\%) examined automated medication-dispensing systems, and 2 (15.4\%) focused on pharmacist-led outreach programs targeting health care professionals. In 12 (92.3\% ) studies, DHT was either cost-effective or cost beneficial compared to standard care. On average, DHT interventions reduced ADEs by 37.12\% (range 8.2\%-66.5\%) and medication errors by 54.38\% (range 24\%-83\%). The key drivers of cost-effectiveness included reductions in outcomes, the proportion of errors resulting in ADEs, and implementation costs. Despite a significant upfront cost, DHT showed a return on investment within 3-4.25 years due to lower cost related with ADE treatment and improved workflow efficiency. In terms of reporting quality, the studies were classified as good (n=10, 76.9\%) and moderate (n=3, 23.1\%). Key methodological challenges included short follow-up periods, the absence of alert compliance tracking, the lack of ADE and error severity categorization, and omission of indirect costs. Conclusions: DHT interventions are economically viable to improve medication safety, with a substantial reduction in ADEs and medication errors. Future studies should prioritize incorporating alert compliance tracking, ADE and error severity classification, and evaluation of indirect costs, thereby increasing clinical benefits and economic viability. ", doi="10.2196/65546", url="https://www.jmir.org/2025/1/e65546" } @Article{info:doi/10.2196/64479, author="Beuken, JM Maik and Kleynen, Melanie and Braun, Susy and Van Berkel, Kees and van der Kallen, Carla and Koster, Annemarie and Bosma, Hans and Berendschot, TJM Tos and Houben, JHM Alfons and Dukers-Muijrers, Nicole and van den Bergh, P. Joop and Kroon, A. Abraham and and Kanera, M. Iris", title="Identification of Clusters in a Population With Obesity Using Machine Learning: Secondary Analysis of The Maastricht Study", journal="JMIR Med Inform", year="2025", month="Feb", day="5", volume="13", pages="e64479", keywords="Maastricht Study", keywords="participant clusters", keywords="cluster analysis", keywords="factor probabilistic distance clustering", keywords="FPDC algorithm", keywords="statistically equivalent signature", keywords="SES feature selection", keywords="unsupervised machine learning", keywords="obesity", keywords="hypothesis free", keywords="risk factor", keywords="physical inactivity", keywords="poor nutrition", keywords="physical activity", keywords="chronic disease", keywords="type 2 diabetes", keywords="diabetes", keywords="heart disease", keywords="long-term behavior change", abstract="Background: Modern lifestyle risk factors, like physical inactivity and poor nutrition, contribute to rising rates of obesity and chronic diseases like type 2 diabetes and heart disease. Particularly personalized interventions have been shown to be effective for long-term behavior change. Machine learning can be used to uncover insights without predefined hypotheses, revealing complex relationships and distinct population clusters. New data-driven approaches, such as the factor probabilistic distance clustering algorithm, provide opportunities to identify potentially meaningful clusters within large and complex datasets. Objective: This study aimed to identify potential clusters and relevant variables among individuals with obesity using a data-driven and hypothesis-free machine learning approach. Methods: We used cross-sectional data from individuals with abdominal obesity from The Maastricht Study. Data (2971 variables) included demographics, lifestyle, biomedical aspects, advanced phenotyping, and social factors (cohort 2010). The factor probabilistic distance clustering algorithm was applied in order to detect clusters within this high-dimensional data. To identify a subset of distinct, minimally redundant, predictive variables, we used the statistically equivalent signature algorithm. To describe the clusters, we applied measures of central tendency and variability, and we assessed the distinctiveness of the clusters through the emerged variables using the F test for continuous variables and the chi-square test for categorical variables at a confidence level of $\alpha$=.001 Results: We identified 3 distinct clusters (including 4128/9188, 44.93\% of all data points) among individuals with obesity (n=4128). The most significant continuous variable for distinguishing cluster 1 (n=1458) from clusters 2 and 3 combined (n=2670) was the lower energy intake (mean 1684, SD 393 kcal/day vs mean 2358, SD 635 kcal/day; P<.001). The most significant categorical variable was occupation (P<.001). A significantly higher proportion (1236/1458, 84.77\%) in cluster 1 did not work compared to clusters 2 and 3 combined (1486/2670, 55.66\%; P<.001). For cluster 2 (n=1521), the most significant continuous variable was a higher energy intake (mean 2755, SD 506.2 kcal/day vs mean 1749, SD 375 kcal/day; P<.001). The most significant categorical variable was sex (P<.001). A significantly higher proportion (997/1521, 65.55\%) in cluster 2 were male compared to the other 2 clusters (885/2607, 33.95\%; P<.001). For cluster 3 (n=1149), the most significant continuous variable was overall higher cognitive functioning (mean 0.2349, SD 0.5702 vs mean --0.3088, SD 0.7212; P<.001), and educational level was the most significant categorical variable (P<.001). A significantly higher proportion (475/1149, 41.34\%) in cluster 3 received higher vocational or university education in comparison to clusters 1 and 2 combined (729/2979, 24.47\%; P<.001). Conclusions: This study demonstrates that a hypothesis-free and fully data-driven approach can be used to identify distinguishable participant clusters in large and complex datasets and find relevant variables that differ within populations with obesity. ", doi="10.2196/64479", url="https://medinform.jmir.org/2025/1/e64479" } @Article{info:doi/10.2196/52351, author="Mashilo, Johannah Nkoleleng and Oladimeji, Elizabeth Kelechi and Gumede, Siphamandla and Lalla-Edward, Tresha Samanta", title="Access to Health Care and Use of Health Care Services Among Males in Africa: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2025", month="Jan", day="31", volume="14", pages="e52351", keywords="health-seeking behavior", keywords="health care", keywords="access", keywords="uptake", keywords="services", keywords="men", keywords="boys", keywords="scoping review", keywords="Africa", keywords="male", keywords="health care services", keywords="accessibility", keywords="use", keywords="noncommunicable disease", keywords="depression", keywords="substance abuse", keywords="overdose", keywords="physical disability", keywords="stress", keywords="older men", keywords="men's health", keywords="well-being", keywords="health literacy", keywords="perception", keywords="systematic reviews", keywords="meta-analysis", keywords="electronic database", keywords="EHR", keywords="electronic health record", keywords="narrative synthesis", abstract="Background: There is a scarcity of data on males' health-seeking behavior, as well as their access to and use of health care services, in Africa. According to some studies, men are less likely than women to seek medical help for issues such as communicable and noncommunicable diseases, depression, substance abuse, physical disabilities, and stressful life events. The study of males' health-seeking behaviors is important, because it allows us to learn about male health, how masculinity encourages underuse of health care services, how this affects males' overall health and well-being, and how cultural values and backgrounds may impact older men's health-seeking behaviors. Objective: The objective of this review is to assess evidence on how males access and use health care services and their health knowledge, attitudes, and perceptions to identify gaps for targeted, context-specific strategies to improve males' health and outcomes, particularly in Africa. Methods: The scoping review process will be guided by the methodology frameworks of the Joanna Briggs Institute and Arksey and O'Malley and will follow the Preferred Reporting Items for Systematic reviews and Meta-analysis Protocols Extension for Scoping Reviews guidelines. The following electronic databases will be systematically searched for evidence published between January 2010 and 2023: PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar. Two reviewers will independently screen full texts and chart the data; a third reviewer will be engaged in the event of disagreement between the 2 independent reviewers. The results of this scoping review will be summarized quantitatively through numerical counts and qualitatively through a narrative synthesis. Results: The electronic database search was conducted between March and April 2023 and redone in April 2024 to include the most recent articles. A total of 114,737 articles were retrieved and 4258 removed as duplicates. After title screening, 337 results remained, and after abstract selection, 140 results remained. As of December 2024, the scoping review was in the full-text screening phase. We plan to complete data extraction, synthesis, and writing of the entire manuscript of the review in January 2025, and then submit it to a journal for peer review and publication in February 2025. Conclusions: The scoping review results will advance the current knowledge about health-seeking behavior and access to and uptake of health care services among African males. To our knowledge, this scoping review is the first on this topic, and it will identify vital information on the barriers to and facilitators of African males' health care access and uptake. It will also provide information on successful health care programs for males that may be tailored and adopted across different African contexts. Trial Registration: OSF Registries https://osf.io/xz6sr International Registered Report Identifier (IRRID): DERR1-10.2196/52351 ", doi="10.2196/52351", url="https://www.researchprotocols.org/2025/1/e52351" } @Article{info:doi/10.2196/53188, author="Bragg, A. Marie and Lutfeali, Samina and Gabler, Godoy Daniela and Quintana Licona, A. Diego and Harris, L. Jennifer", title="Latinx and White Adolescents' Preferences for Latinx-Targeted Celebrity and Noncelebrity Food Advertisements: Experimental Survey Study", journal="J Med Internet Res", year="2025", month="Jan", day="31", volume="27", pages="e53188", keywords="Latinx", keywords="Hispanic", keywords="adolescents", keywords="marketing", keywords="celebrities", keywords="Spanish", keywords="advertisements", keywords="products", keywords="brands", keywords="food", keywords="unhealthy", keywords="beverages", keywords="diet", keywords="nutrition", keywords="consumers", keywords="intention", keywords="purchasing", keywords="attitudes", keywords="perceptions", keywords="preferences", keywords="youth", abstract="Background: Exposure to food advertisements is a major driver of childhood obesity, and food companies disproportionately target Latinx youth with their least healthy products. This study assessed the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents. Objective: This web-based within-subjects study aims to assess the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents' preferences for the advertisements and featured products. Methods: Participants (N=903) were selected from a volunteer sample of adolescents, aged 13-17 years, who self-identified as Latinx or White, had daily internet access, and could read and write in English. They participated in a web-based Qualtrics study where each participant viewed 8 advertisements for novel foods and beverages, including 4 advertisements that featured Latinx celebrities and the same 4 advertisements that featured Latinx noncelebrities (matched on all other attributes), in addition to 2 neutral advertisements (featuring bland, nontargeted products and did not feature people). Primary outcomes were participants' ratings of 4 advertisements for food and beverage brands featuring a Latinx celebrity and the same 4 advertisements featuring a Latinx noncelebrity. Multilevel linear regression models compared the effects of celebrities and differences between Latinx and White participants on attitudes (advertisement likeability; positive affect; and brand perceptions) and behavioral intentions (consumption; social media engagement---``liking;'' following; commenting; tagging a friend). Results: Latinx (n=436; 48.3\%) and White (n=467; 51.7\%) participants rated advertisements featuring Latinx celebrities more positively than advertisements featuring noncelebrities on attitude measures except negative affect (Ps?.002), whereas only negative affect differed between Latinx and White participants. Two of the 5 behavioral intention measures differed by celebrity advertisement status (P=.02; P<.001). Additionally, the interaction between celebrity and participant ethnicity was significant for 4 behavioral intentions; Latinx, but not White, participants reported higher willingness to consume the product (P<.001), follow brands (P<.001), and tag friends (P<.001). While White and Latinx adolescents both reported higher likelihoods of ``liking'' advertisements on social media endorsed by Latinx celebrities versus noncelebrities, the effect was significantly larger among Latinx adolescents (P<.01). Conclusions: This study demonstrates the power of Latinx celebrities in appealing to both Latinx and White adolescents but may be particularly persuasive in shaping behavioral intentions among Latinx adolescents. These findings suggest an urgent need to reduce celebrity endorsements in ethnically targeted advertisements that promote unhealthy food products to communities disproportionately affected by obesity and diabetes. The food industry limits food advertising to children ages 12 years and younger, but industry self-regulatory efforts and policies should expand to include adolescents and address disproportionate marketing of unhealthy food to Latinx youth and celebrity endorsements of unhealthy products. ", doi="10.2196/53188", url="https://www.jmir.org/2025/1/e53188" } @Article{info:doi/10.2196/63560, author="Qiu, Abram and Meadows, Kristopher and Ye, Fei and Iyawe, Osasu and Kenneth-Nwosa, Kenneth", title="Quantifying Patient Demand for Orthopedics Care by Region Through Google Trends Analysis: Descriptive Epidemiology Study", journal="Online J Public Health Inform", year="2025", month="Jan", day="31", volume="17", pages="e63560", keywords="orthopedics", keywords="geographic factors", keywords="health care disparities", keywords="medical schools", keywords="internship and residency", keywords="epidemiology", keywords="public health informatics", keywords="physicians", keywords="assessment of health care needs", keywords="resource allocation", abstract="Background: There is a growing gap between the supply of surgeons and the demand for orthopedic services in the United States. Objective: We analyzed publicly available online data to assess the correlation between the supply of orthopedic surgeons and patient demand across the United States. The geographic trends of this gap were assessed by using the relative demand index (RDI) to guide precision public health interventions such as resource allocation, residency program expansion, and workforce planning to specific regions. Methods: The data used were from the US Census Bureau, Association of American Medical Colleges (AAMC) through their 2024 Electronic Residency Application Service (ERAS) directory, AAMC State Physician Workforce Data Report, and Google Trends. We calculated the normalized relative search volume (RSV) and the RDI and compared them to the densities of orthopedic surgeons across the United States. We examined the disparities with the Spearman rank correlation coefficient. Results: The supply of orthopedic surgeons varied greatly across the United States, with a significantly higher demand for them in southern states (P=.02). The orthopedic surgeon concentration, normalized to the highest density, was the highest in Alaska (n=100), the District of Columbia (n=96), and Wyoming (n=72); and the lowest in Texas (n=0), Arkansas (n=6), and Oklahoma (n=64). The highest RDI values were observed in Utah (n=97), Florida (n=88), and Texas (n=83), while the lowest were observed in Alaska (n=0), the District of Columbia (n=5), and New Hampshire (n=7). The 7 states of Alaska, Maine, South Dakota, Wyoming, Montana, Delaware, and Idaho lacked orthopedic surgery residencies. In 2023, New York (n=19), Michigan (n=17), Ohio (n=17), Pennsylvania (n=16), and California (n=16) had the most residency programs. Demand and supply, represented by the RDI and orthopedic surgeon concentration, respectively, were strongly correlated negatively ($\rho$=?0.791, P<.001). States that were in the top quartile of residency programs (?4 residency programs) exhibited a high demand for orthopedic surgeons ($\rho$=.6035, P=.02). Conclusions: This study showed that regional disparities in access to orthopedic care can be addressed by increasing orthopedic residencies. The study highlights the novel application of the RDI to mapping the regional need for orthopedics, and this map allows for better targeted resource allocation to expand orthopedic surgery training. ", doi="10.2196/63560", url="https://ojphi.jmir.org/2025/1/e63560" } @Article{info:doi/10.2196/58539, author="Arifi, Dorian and Resch, Bernd and Santillana, Mauricio and Guan, Wendy Weihe and Knoblauch, Steffen and Lautenbach, Sven and Jaenisch, Thomas and Morales, Ivonne and Havas, Clemens", title="Geosocial Media's Early Warning Capabilities Across US County-Level Political Clusters: Observational Study", journal="JMIR Infodemiology", year="2025", month="Jan", day="30", volume="5", pages="e58539", keywords="spatiotemporal epidemiology", keywords="geo-social media data", keywords="digital disease surveillance", keywords="political polarization", keywords="epidemiological early warning", keywords="digital early warning", abstract="Background: The novel coronavirus disease (COVID-19) sparked significant health concerns worldwide, prompting policy makers and health care experts to implement nonpharmaceutical public health interventions, such as stay-at-home orders and mask mandates, to slow the spread of the virus. While these interventions proved essential in controlling transmission, they also caused substantial economic and societal costs and should therefore be used strategically, particularly when disease activity is on the rise. In this context, geosocial media posts (posts with an explicit georeference) have been shown to provide a promising tool for anticipating moments of potential health care crises. However, previous studies on the early warning capabilities of geosocial media data have largely been constrained by coarse spatial resolutions or short temporal scopes, with limited understanding of how local political beliefs may influence these capabilities. Objective: This study aimed to assess how the epidemiological early warning capabilities of geosocial media posts for COVID-19 vary over time and across US counties with differing political beliefs. Methods: We classified US counties into 3 political clusters, democrat, republican, and swing counties, based on voting data from the last 6 federal election cycles. In these clusters, we analyzed the early warning capabilities of geosocial media posts across 6 consecutive COVID-19 waves (February 2020-April 2022). We specifically examined the temporal lag between geosocial media signals and surges in COVID-19 cases, measuring both the number of days by which the geosocial media signals preceded the surges in COVID-19 cases (temporal lag) and the correlation between their respective time series. Results: The early warning capabilities of geosocial media data differed across political clusters and COVID-19 waves. On average, geosocial media posts preceded COVID-19 cases by 21 days in republican counties compared with 14.6 days in democrat counties and 24.2 days in swing counties. In general, geosocial media posts were preceding COVID-19 cases in 5 out of 6 waves across all political clusters. However, we observed a decrease over time in the number of days that posts preceded COVID-19 cases, particularly in democrat and republican counties. Furthermore, a decline in signal strength and the impact of trending topics presented challenges for the reliability of the early warning signals. Conclusions: This study provides valuable insights into the strengths and limitations of geosocial media data as an epidemiological early warning tool, particularly highlighting how they can change across county-level political clusters. Thus, these findings indicate that future geosocial media based epidemiological early warning systems might benefit from accounting for political beliefs. In addition, the impact of declining geosocial media signal strength over time and the role of trending topics for signal reliability in early warning systems need to be assessed in future research. ", doi="10.2196/58539", url="https://infodemiology.jmir.org/2025/1/e58539" } @Article{info:doi/10.2196/56820, author="Januraga, Putu Pande and Lukitosari, Endang and Luhukay, Lanny and Hasby, Rizky and Sutrisna, Aang", title="Mapping Key Populations to Develop Improved HIV and AIDS Interventions: Multiphase Cross-Sectional Observational Mapping Study Using a District and City Approach", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="30", volume="11", pages="e56820", keywords="Indonesia", keywords="key population", keywords="mapping", keywords="pandemic", keywords="HIV", keywords="AIDS", keywords="hotspot", abstract="Background: Indonesia's vast archipelago and substantial population size present unique challenges in addressing its multifaceted HIV epidemic, with 90\% of its 514 districts and cities reporting cases. Identifying key populations (KPs) is essential for effectively targeting interventions and allocating resources to address the changing dynamics of the epidemic. Objective: We examine the 2022 mapping of Indonesia's KPs to develop improved HIV and AIDS interventions. Methods: In 2022, a district-based mapping of KPs was conducted across 201 districts and cities chosen for their HIV program intensity. This multiphase process included participatory workshops for hotspot identification, followed by direct hotspot observation, then followed by a second direct observation in selected hotspots for quality control. Data from 49,346 informants (KPs) were collected and analyzed. The results from individual hotspots were aggregated at the district or city level, and a formula was used to estimate the population size. Results: The mapping initiative identified 18,339 hotspots across 201 districts and cities, revealing substantial disparities in hotspot distribution. Of the 18,339 hotspots, 16,964 (92.5\%) were observed, of which 1822 (10.74\%) underwent a second review to enhance data accuracy. The findings mostly aligned with local stakeholders' estimates, but showed a lower median. Interviews indicated a shift in KP dynamics, with a median decline in hotspot attendance since the pandemic, and there was notable variation in mapping results across district categories. In ``comprehensive'' areas, the average results for men who have sex with men (MSM), people who inject drugs, transgender women, and female sex workers (FSWs) were 1008 (median 694, IQR 317-1367), 224 (median 114, IQR 59-202), 196 (median 167, IQR 81-265), and 775 (median 573, IQR 352-1131), respectively. ``Medium'' areas had lower averages: MSM at 381 (median 199, IQR 91-454), people who inject drugs at 51 (median 54, IQR 15-63), transgender women at 101 (median 55, IQR 29-127), and FSWs at 304 (median 231, IQR 118-425). ``Basic'' areas showed the lowest averages: MSM at 161 (median 73, IQR 49-285), people who inject drugs at 7 (median 7, IQR 7-7), transgender women at 59 (median 26, IQR 12-60), and FSWs at 161 (median 131, IQR 59-188). Comparisons with ongoing outreach programs revealed substantial differences: the mapped MSM population was >50\% lower than program coverage; the estimates for people who inject drugs were twice as high as the program coverage. Conclusions: The mapping results highlight significant variations in hotspots and KPs across districts and cities and underscore the necessity of adaptive HIV prevention strategies. The findings informed programmatic decisions, such as reallocating resources to underserved districts and recalibrating outreach strategies to better match KP dynamics. Developing strategies beyond identified hotspots, integrating mapping data into planning, and adopting a longitudinal approach to understand KP behavior over time are critical for effective HIV and AIDS prevention and control. ", doi="10.2196/56820", url="https://publichealth.jmir.org/2025/1/e56820", url="http://www.ncbi.nlm.nih.gov/pubmed/39883483" } @Article{info:doi/10.2196/63114, author="Budhwani, Henna and Yigit, Ibrahim and Bruce, Josh and Bond, Lily Christyenne and Johnson, Andrea", title="Adolescent Youth Survey on HIV Prevention and Sexual Health Education in Alabama: Protocol for a Web-Based Survey With Fraud Protection Study", journal="JMIR Res Protoc", year="2025", month="Jan", day="29", volume="14", pages="e63114", keywords="HIV knowledge", keywords="PrEP", keywords="pre-exposure prophylaxis", keywords="adolescents", keywords="teenagers", keywords="transgender", keywords="MSM", keywords="men who have sex with men", keywords="south", keywords="bot protection", keywords="bots", keywords="fraud protection", keywords="survey protocol", abstract="Background: In Alabama, the undiagnosed HIV rate is over 20\%; youth and young adults, particularly those who identify as sexual and gender minority individuals, are at elevated risk for HIV acquisition and are the only demographic group in the United States with rising rates of new infections. Adolescence is a period marked by exploration, risk taking, and learning, making comprehensive sexual health education a high-priority prevention strategy for HIV and sexually transmitted infections. However, in Alabama, school-based sexual health and HIV prevention education is strictly regulated and does not address the unique needs of sexual and gender minority teenagers. Objective: To understand knowledge gaps related to sexual health, HIV prevention, and pre-exposure prophylaxis (PrEP), we conducted the Alabama Youth Survey with individuals aged 14-17 years. In the survey, we also evaluated young sexual and gender minority individuals' preferences related to prevention modalities and trusted sources of health information. Methods: Between September 2023 and March 2024, we conducted a web-based survey with 14- to 17-year-olds who are assigned male at birth, are sexually attracted to male youth, and lived in Alabama. Half of the study's participants were recruited through community partners, the Magic City Acceptance Academy and Magic City Acceptance Center. The other half were recruited on the web via social media. A 7-step fraud and bot detection protocol was implemented and applied to web-based recruitment to reduce the likelihood of collecting false information. Once data are ready, we will compute frequencies for each measure and construct summary scores of scales, such as HIV and PrEP knowledge, to determine internal consistency. Using multivariable logistic regression, we will examine associations between personal characteristics of survey respondents and key constructs using SPSS 29 (IBM Corp) or SAS 9.4 (SAS Institute). Results: Analyses are ongoing (N=206) and will conclude in June 2025. Preliminary results include a sample mean age of 16.21 (SD 0.88) years; about a quarter identified as transgender or gender nonconforming, with 6\% stating their gender as a transgender woman. A total of 30\% self-reported their race as African American or Black; 12\% were Hispanic or Latinx. More than half reported being sexually active in the past 6 months. Primary data analyses will be completed in mid-2025. If findings are promising, results will be used as preliminary data to support the development of an intervention to address knowledge gaps and prevention preferences. Conclusions: If the study is successful, it will yield information on HIV knowledge, PrEP awareness, PrEP preferences, and related outcomes among sexual and gender minority teenagers in Alabama, an underserved, hard-to-reach, but also high-priority population for public health efforts to Ending the HIV Epidemic. International Registered Report Identifier (IRRID): DERR1-10.2196/63114 ", doi="10.2196/63114", url="https://www.researchprotocols.org/2025/1/e63114" } @Article{info:doi/10.2196/66330, author="Choomung, Pichsinee and He, Yupeng and Matsunaga, Masaaki and Sakuma, Kenji and Kishi, Taro and Li, Yuanying and Tanihara, Shinichi and Iwata, Nakao and Ota, Atsuhiko", title="Estimating the Prevalence of Schizophrenia in the General Population of Japan Using an Artificial Neural Network--Based Schizophrenia Classifier: Web-Based Cross-Sectional Survey", journal="JMIR Form Res", year="2025", month="Jan", day="29", volume="9", pages="e66330", keywords="schizophrenia", keywords="schizophrenic", keywords="prevalence", keywords="artificial neural network", keywords="neural network", keywords="neural networks", keywords="ANN", keywords="deep learning", keywords="machine learning", keywords="SZ classifier", keywords="web-based survey", keywords="epidemiology", keywords="epidemiological", keywords="Japan", keywords="classifiers", keywords="mental illness", keywords="mental disorder", keywords="mental health", abstract="Background: Estimating the prevalence of schizophrenia in the general population remains a challenge worldwide, as well as in Japan. Few studies have estimated schizophrenia prevalence in the Japanese population and have often relied on reports from hospitals and self-reported physician diagnoses or typical schizophrenia symptoms. These approaches are likely to underestimate the true prevalence owing to stigma, poor insight, or lack of access to health care among respondents. To address these issues, we previously developed an artificial neural network (ANN)--based schizophrenia classification model (SZ classifier) using data from a large-scale Japanese web-based survey to enhance the comprehensiveness of schizophrenia case identification in the general population. In addition, we also plan to introduce a population-based survey to collect general information and sample participants matching the population's demographic structure, thereby achieving a precise estimate of the prevalence of schizophrenia in Japan. Objective: This study aimed to estimate the prevalence of schizophrenia by applying the SZ classifier to random samples from the Japanese population. Methods: We randomly selected a sample of 750 participants where the age, sex, and regional distributions were similar to Japan's demographic structure from a large-scale Japanese web-based survey. Demographic data, health-related backgrounds, physical comorbidities, psychiatric comorbidities, and social comorbidities were collected and applied to the SZ classifier, as this information was also used for developing the SZ classifier. The crude prevalence of schizophrenia was calculated through the proportion of positive cases detected by the SZ classifier. The crude estimate was further refined by excluding false-positive cases and including false-negative cases to determine the actual prevalence of schizophrenia. Results: Out of 750 participants, 62 were classified as schizophrenia cases by the SZ classifier, resulting in a crude prevalence of schizophrenia in the general population of Japan of 8.3\% (95\% CI 6.6\%-10.1\%). Among these 62 cases, 53 were presumed to be false positives, and 3 were presumed to be false negatives. After adjustment, the actual prevalence of schizophrenia in the general population was estimated to be 1.6\% (95\% CI 0.7\%-2.5\%). Conclusions: This estimated prevalence was slightly higher than that reported in previous studies, possibly due to a more comprehensive disease classification methodology or, conversely, model limitations. This study demonstrates the capability of an ANN-based model to improve the estimation of schizophrenia prevalence in the general population, offering a novel approach to public health analysis. ", doi="10.2196/66330", url="https://formative.jmir.org/2025/1/e66330" } @Article{info:doi/10.2196/63053, author="Lin, Fu-Huang and Chou, Yu-Ching and Hsieh, Chi-Jeng and Yu, Chia-Peng", title="Epidemiological Features, Clinical Symptoms, and Environmental Risk Factors for Notifiable Japanese Encephalitis in Taiwan From 2008 to 2020: Retrospective Study", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="28", volume="11", pages="e63053", keywords="epidemiology", keywords="Japanese encephalitis virus", keywords="domestic", keywords="environmental factor", keywords="retrospective study", abstract="Background: Japanese encephalitis (JE) is a zoonotic parasitic disease caused by the Japanese encephalitis virus (JEV), and may cause fever, nausea, headache, or meningitis. It is currently unclear whether the epidemiological characteristics of the JEV have been affected by the extreme climatic conditions that have been observed in recent years. Objective: This study aimed to examine the epidemiological characteristics, trends, and potential risk factors of JE in Taiwan from 2008 to 2020. Specifically, the study focused on gender, age, season, residential area, clinical manifestations, high-risk areas, and the impact of environmental and climate factors. Methods: This study reviewed publicly available annual summary data on reported JE cases in the Taiwan Centers for Diseases Control between 2008 and 2020. Results: This study collected 309 confirmed domestic patients and 4 patients with imported JE. There was an increasing trend in the incidence of JE, 0.69?1.57 cases per 1,000,000 people, peaking in 2018. Case fatality rate was 7.7\% (24/313). Comparing sex, age, season, and place of residence, the incidence rate was highest in males, 40? to 59-year-old patients, summer, and the Eastern region, with 1.89, 3.27, 1.25, and 12.2 cases per million people, respectively. The average coverage rate of the JE vaccine for children in Taiwan is 94.9\%. Additionally, the major clinical manifestations of the cases included fever, unconsciousness, headache, stiff necks, psychological symptoms, vomiting, and meningitis. The major occurrence places of JE included paddy fields, pig farms, pigeon farms, poultry farms, and ponds. For air pollution factors, linear regression analysis showed that SO2 (ppb) concentration was positively associated with JE cases ($\beta$=2.184, P=.02), but O3 (ppb) concentration was negatively associated with them ($\beta$=?0.157, P=.01). For climate factors, relative humidity (\%) was positively associated with JE cases ($\beta$=.380, P=.02). Conclusions: This study is the first to report confirmed cases of JE from the surveillance data of the Taiwan Centers for Diseases Control between 2008 and 2020. It identified residence, season, and age as risk factors for JE in Taiwan. Air pollution and climatic factors also influenced the rise in JE cases. This study confirmed that JE remains a prevalent infectious disease in Taiwan, with its epidemic gradually increasing in severity. These findings empower clinicians and health care providers to make informed decisions, guiding their care and resource allocation for patients with JE, a disease that significantly impacts the health and well-being of the Taiwanese population. ", doi="10.2196/63053", url="https://publichealth.jmir.org/2025/1/e63053" } @Article{info:doi/10.2196/59916, author="Jaiteh, Musa and Phalane, Edith and Shiferaw, A. Yegnanew and Phaswana-Mafuya, Nancy Refilwe", title="The Application of Machine Learning Algorithms to Predict HIV Testing in Repeated Adult Population--Based Surveys in South Africa: Protocol for a Multiwave Cross-Sectional Analysis", journal="JMIR Res Protoc", year="2025", month="Jan", day="27", volume="14", pages="e59916", keywords="predictive modelling", keywords="testing", keywords="support vector machines", keywords="random forest", keywords="supervised machine learning", keywords="decision trees", keywords="adult", keywords="population-based", keywords="South Africa", keywords="protocol", keywords="HIV/AIDS", keywords="HIV testing", keywords="retrospective analysis", keywords="cross-sectional survey", keywords="chi-square test", keywords="logistic regression", keywords="public health", keywords="epidemiology", keywords="infectious disease", abstract="Background: HIV testing is the cornerstone of HIV prevention and a pivotal step in realizing the Joint United Nations Program on HIV/AIDS (UNAIDS) goal of ending AIDS by 2030. Despite the availability of relevant survey data, there exists a research gap in using machine learning (ML) to analyze and predict HIV testing among adults in South Africa. Further investigation is needed to bridge this knowledge gap and inform evidence-based interventions to improve HIV testing. Objective: This study aims to determine consistent predictors of HIV testing by applying supervised ML algorithms in repeated adult population-based surveys in South Africa. Methods: A retrospective analysis of multiwave cross-sectional survey data will be conducted to determine the predictors of HIV testing among South African adults aged 18 years and older. A supervised ML technique will be applied across the five cycles of the South African National HIV Prevalence, Incidence, Behavior, and Communication Survey (SABSSM) surveys. The Human Science Research Council (HSRC) conducted the SABSSM surveys in 2002, 2005, 2008, 2012, and 2017. The available SABSSM datasets will be imported to RStudio (version 4.3.2; Posit Software, PBC) to clean and remove outliers. A chi-square test will be conducted to select important predictors of HIV testing. Each dataset will be split into 80\% training and 20\% test samples. Logistic regression, support vector machines, random forests, and decision trees will be used. A cross-validation technique will be used to divide the training sample into k-folds, including a validation set, and models will be trained on each fold. The models' performance will be evaluated on the validation set using evaluation metrics such as accuracy, precision, recall, F1-score, area under curve-receiver operating characteristics, and confusion matrix. Results: The SABSSM datasets are open access datasets available on the HSRC database. Ethics approval for this study was obtained from the University of Johannesburg Research and Ethics Committee on April 23, 2024 (REC-2725-2024). The authors were given access to all five SABSSM datasets by the HSRC on August 20, 2024. The datasets were explored to identify the independent variables likely influencing HIV testing uptake. The findings of this study will determine consistent variables predicting HIV testing uptake among the South African adult population over the course of 20 years. Furthermore, this study will evaluate and compare the performance metrics of the 4 different ML algorithms, and the best model will be used to develop an HIV testing predictive model. Conclusions: This study will contribute to existing knowledge and deepen understanding of factors linked to HIV testing beyond traditional methods. Consequently, the findings would inform evidence-based policy recommendations that can guide policy makers to formulate more effective and targeted public health approaches toward strengthening HIV testing. International Registered Report Identifier (IRRID): DERR1-10.2196/59916 ", doi="10.2196/59916", url="https://www.researchprotocols.org/2025/1/e59916" } @Article{info:doi/10.2196/59845, author="Sood, Akshay and ``Cotton'' Jarrell, William and Shore, W. Xin and Sosa, Nestor and Parada, Alisha and Edwardson, Nicholas and Yingling, V. Alexandra and Amirkabirian, Teah and Cheng, Qiuying and Hurwitz, Ivy and Cook, S. Linda and Leng, Shuguang and Myers, B. Orrin and Perkins, J. Douglas", title="Effectiveness of Frequent Point-of-Care Molecular COVID-19 Surveillance in a Rural Workplace: Nonrandomized Controlled Clinical Trial Among Miners", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="27", volume="11", pages="e59845", keywords="point-of-care", keywords="seroprevalence", keywords="SARS-CoV-2", keywords="coronavirus", keywords="COVID-19", keywords="surveillance", keywords="rural workplace", keywords="miners", keywords="infectious disease", keywords="pandemic", keywords="antigen testing", keywords="midnasal swabs", keywords="public health", abstract="Background: Numerous studies have assessed the risk of SARS-CoV-2 exposure and infection among health care workers during the pandemic. However, far fewer studies have investigated the impact of SARS-CoV-2 on essential workers in other sectors. Moreover, guidance for maintaining a safely operating workplace in sectors outside of health care remains limited. Workplace surveillance has been recommended by the Centers for Disease Control and Prevention, but few studies have examined the feasibility or effectiveness of this approach. Objective: The objective of this study was to investigate the feasibility and effectiveness of using frequent point-of-care molecular workplace surveillance as an intervention strategy to prevent the spread of SARS-CoV-2 at essential rural workplaces (mining sites) where physical distancing, remote work, and flexible schedules are not possible. Methods: In this nonrandomized controlled clinical trial conducted from February 2021, to March 2022, 169 miners in New Mexico (intervention cohort) and 61 miners in Wyoming (control cohort) were enrolled. Investigators performed point-of-care rapid antigen testing on midnasal swabs (NSs) self-collected by intervention miners. Our first outcome was the intervention acceptance rate in the intervention cohort. Our second outcome was the rate of cumulative postbaseline seropositivity to SARS-CoV-2 nucleocapsid protein, which was analyzed in the intervention cohort and compared to the control cohort between baseline and 12 months. The diagnostic accuracy of detecting SARS-CoV-2 using rapid antigen testing on NSs was compared to laboratory-based reverse transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swabs (NPSs) in a subset of 68 samples. Results: Our intervention had a mean acceptance rate of 96.4\% (11,413/11,842). The intervention miners exhibited a lower cumulative postbaseline incident seropositivity at 12 months compared to control miners (14/97, 14\% vs 17/45, 38\%; P=.002). Analysis of SARS-CoV-2 antigen detection in self-administered NSs revealed 100\% sensitivity and specificity compared to laboratory-based RT-PCR testing on NPSs. Conclusions: Our findings establish frequent point-of-care molecular workplace COVID-19 surveillance as a feasible option for keeping essential rural workplaces open and preventing SARS-CoV-2 spread. These findings extend beyond this study, providing valuable insights for designing interventions to maintain employees' safety at other essential workplaces during an infectious disease outbreak. Trial Registration: ClinicalTrials.gov NCT04977050; https://clinicaltrials.gov/study/NCT04977050 ", doi="10.2196/59845", url="https://publichealth.jmir.org/2025/1/e59845" } @Article{info:doi/10.2196/58656, author="Kahlawi, Adham and Masri, Firas and Ahmed, Wasim and Vidal-Alaball, Josep", title="Cross-Cultural Sense-Making of Global Health Crises: A Text Mining Study of Public Opinions on Social Media Related to the COVID-19 Pandemic in Developed and Developing Economies", journal="J Med Internet Res", year="2025", month="Jan", day="27", volume="27", pages="e58656", keywords="COVID-19", keywords="SARS-CoV-2", keywords="pandemic", keywords="citizen opinion", keywords="text mining", keywords="LDA", keywords="health crisis", keywords="developing economies", keywords="Italy", keywords="Egypt", keywords="UK", keywords="dataset", keywords="content analysis", keywords="social media", keywords="twitter", keywords="tweet", keywords="sentiment", keywords="attitude", keywords="perception", keywords="perspective", keywords="machine learning", keywords="latent Dirichlet allocation", keywords="vaccine", keywords="vaccination", keywords="public health", keywords="infectious", abstract="Background: The COVID-19 pandemic reshaped social dynamics, fostering reliance on social media for information, connection, and collective sense-making. Understanding how citizens navigate a global health crisis in varying cultural and economic contexts is crucial for effective crisis communication. Objective: This study examines the evolution of citizen collective sense-making during the COVID-19 pandemic by analyzing social media discourse across Italy, the United Kingdom, and Egypt, representing diverse economic and cultural contexts. Methods: A total of 755,215 social media posts from X (formerly Twitter) were collected across 3 time periods: the virus' emergence (February 15 to March 31, 2020), strict lockdown (April 1 to May 30, 2020), and the vaccine rollout (December 1, 2020 to January 15, 2021). In total, 284,512 posts from Italy, 261,978 posts from the United Kingdom, and 209,725 posts from Egypt were analyzed using the latent Dirichlet allocation algorithm to identify key thematic topics and track shifts in discourse across time and regions. Results: The analysis revealed significant regional and temporal differences in collective sense-making during the pandemic. In Italy and the United Kingdom, public discourse prominently addressed pragmatic health care measures and government interventions, reflecting higher institutional trust. By contrast, discussions in Egypt were more focused on religious and political themes, highlighting skepticism toward governmental capacity and reliance on alternative frameworks for understanding the crisis. Over time, all 3 countries displayed a shift in discourse toward vaccine-related topics during the later phase of the pandemic, highlighting its global significance. Misinformation emerged as a recurrent theme across regions, demonstrating the need for proactive measures to ensure accurate information dissemination. These findings emphasize the role of cultural, economic, and institutional factors in shaping public responses during health crises. Conclusions: Crisis communication is influenced by cultural, economic, and institutional contexts, as evidenced by regional variations in citizen engagement. Transparent and culturally adaptive communication strategies are essential to combat misinformation and build public trust. This study highlights the importance of tailoring crisis responses to local contexts to improve compliance and collective resilience. ", doi="10.2196/58656", url="https://www.jmir.org/2025/1/e58656" } @Article{info:doi/10.2196/63583, author="Phaswana Mafuya, Nancy Refilwe and Phalane, Edith and Rao, Amrita and Willis, Kalai and Rucinski, Katherine and Voet, Alida K. and Abdulrahman, Amal and Siyamayambo, Claris and Sebati, Betty and Seloka, Mohlago and Jaiteh, Musa and Olifant, Lucia Lerato and Journeay, Katharine and Sisel, Haley and Li, Xiaoming and Olatosi, Bankole and Hikmet, Neset and Duhoon, Prashant and Wolmarans, Francois and Shiferaw, A. Yegnanew and Motsieloa, Lifutso and Rampilo, Mashudu and Baral, Stefan", title="Harnessing Big Heterogeneous Data to Evaluate the Potential Impact of HIV Responses Among Key Populations in Sub-Saharan Africa: Protocol for the Boloka Data Repository Initiative", journal="JMIR Res Protoc", year="2025", month="Jan", day="22", volume="14", pages="e63583", keywords="HIV, key populations", keywords="Sub-Saharan Africa", keywords="big heterogeneous data", keywords="Boloka data repository", abstract="Background: In South Africa, there is no centralized HIV surveillance system where key populations (KPs) data, including gay men and other men who have sex with men, female sex workers, transgender persons, people who use drugs, and incarcerated persons, are stored in South Africa despite being on higher risk of HIV acquisition and transmission than the general population. Data on KPs are being collected on a smaller scale by numerous stakeholders and managed in silos. There exists an opportunity to harness a variety of data, such as empirical, contextual, observational, and programmatic data, for evaluating the potential impact of HIV responses among KPs in South Africa. Objective: This study aimed to leverage and harness big heterogeneous data on HIV among KPs and harmonize and analyze it to inform a targeted HIV response for greater impact in Sub-Saharan Africa. Methods: The Boloka data repository initiative has 5 stages. There will be engagement of a wide range of stakeholders to facilitate the acquisition of data (stage 1). Through these engagements, different data types will be collated (stage 2). The data will be filtered and screened to enable high-quality analyses (stage 3). The collated data will be stored in the Boloka data repository (stage 4). The Boloka data repository will be made accessible to stakeholders and authorized users (stage 5). Results: The protocol was funded by the South African Medical Research Council following external peer reviews (December 2022). The study received initial ethics approval (May 2022), renewal (June 2023), and amendment (July 2024) from the University of Johannesburg (UJ) Research Ethics Committee. The research team has been recruited, onboarded, and received non--web-based internet ethics training (January 2023). A list of current and potential data partners has been compiled (January 2023 to date). Data sharing or user agreements have been signed with several data partners (August 2023 to date). Survey and routine data have been and are being secured (January 5, 2023). In (September 2024) we received Ghana Men Study data. The data transfer agreement between the Pan African Centre for Epidemics Research and the Perinatal HIV Research Unit was finalized (October 2024), and we are anticipating receiving data by (December 2024). In total, 7 abstracts are underway, with 1 abstract completed the analysis and expected to submit the full article to the peer-reviewed journal in early January 2024. As of March 2025, we expect to submit the remaining 6 full articles. Conclusions: A truly ``complete'' data infrastructure that systematically and rigorously integrates diverse data for KPs will not only improve our understanding of local epidemics but will also improve HIV interventions and policies. Furthermore, it will inform future research directions and become an incredible institutional mechanism for epidemiological and public health training in South Africa and Sub-Saharan Africa. International Registered Report Identifier (IRRID): DERR1-10.2196/63583 ", doi="10.2196/63583", url="https://www.researchprotocols.org/2025/1/e63583" } @Article{info:doi/10.2196/58944, author="Cantarutti, Anna and Boracchini, Riccardo and Bell{\`u}, Roberto and Ronco, Raffaella and Rea, Federico and Locatelli, Anna and Zanini, Rinaldo and Corrao, Giovanni", title="Assessing the Impact of Distance Traveled and Birth Volumes of Hospital Maternity Units on Newborn Outcomes: Population-Based Cohort Study", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="21", volume="11", pages="e58944", keywords="maternity level", keywords="road travel distance", keywords="delivery", keywords="regionalization", keywords="neonatal outcome", keywords="childbirth", keywords="newborn", keywords="cohort", keywords="birth", keywords="population-based", keywords="maternal", keywords="maternal outcomes", keywords="neonatal", keywords="European", keywords="health system", keywords="health care system", keywords="perinatal care", keywords="antenatal", keywords="mortality", keywords="neonatal mortality", keywords="perinatal", abstract="Background: The centralization of childbirth and newborn care in large maternity units has become increasingly prevalent in Europe. While this trend offers potential benefits such as specialized care and improved outcomes, it can also lead to longer travel and waiting times, especially for women in rural areas. Objective: This study aimed to evaluate the association between hospital maternity unit (HMU) volumes, road travel distance (RTD) to the hospital, and other neonatal outcomes. Methods: We conducted a population-based cohort study including all live births in hospitals without intensive care units between 2016 and 2019 in the Lombardy region, Italy. Given the hierarchical structure of our data (births nested within hospitals), we employed log-binomial regression models with random intercepts to estimate relative risks and 95\% CIs for evaluating the association between HMU volumes (?1500 births/year) and RTD (<5 km) with the risk of being transferred and/or death after birth (primary outcome). Secondary outcomes included a low Apgar score at 5 minutes and low adherence to antenatal care (ANC). We controlled for several potential confounders including adherence to the ANC pathway for the primary and low Apgar outcomes. To explore the influence of HMU volumes on the primary outcome, we identified the fractional polynomial model that best described this relationship. Results: Of 65,083 live births, 71\% (n=45,955) occurred in low-volume hospitals (<1000 births/year), 21\% (n=13,560) involved long-distance travel (>15 km), 1\% (n=735) were transferred and/or died after birth, 0.5\% (n=305) had a low Apgar score at 5 minutes, and 64\% (n=41,317) completely adhered to ANC. The risk of transfer and/or death increased as HMU volume decreased, ranging from 1\% for hospitals with 1000?1500 births/year to a 3.6-fold high risk for hospitals with <500 births/year (compared to high-volume hospitals). Travel distance did not affect the primary outcome. Neither HMU volume nor RTD were associated with low Apgar scores. Conversely, the risk of complete adherence to ANC decreased with lower HMU volumes but increased with shorter RTD. Additionally, high-volume hospitals demonstrated a decreasing trend in the frequency of the primary outcome, with transfer and/or death rates ranging from 2\% to 0.5\% and flattening to 0.5\% in hospitals, with activity volume ?1000 mean births/year. Conclusions: Our findings showed an excess risk of neonatal transfer and/or death for live births in HMUs with low activity volumes without an intensive care unit. In contrast, RTD primarily affected adherence to ANC. Moreover, data suggest that 1000 births/year could be an optimal cutoff for maternity hospitals to ensure an appropriate standard of care at delivery. ", doi="10.2196/58944", url="https://publichealth.jmir.org/2025/1/e58944" } @Article{info:doi/10.2196/63314, author="Zhang, Liuren and Chu, Linchen and Sundaram, E. Maria and Zhou, Yi and Sun, Xiu and Wei, Zheng and Fu, Chuanxi", title="Identifying Preferred Features of Influenza Vaccination Programs Among Chinese Clinicians Practicing Traditional Chinese Medicine and Western Medicine: Discrete Choice Experiment", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="20", volume="11", pages="e63314", keywords="influenza vaccination program", keywords="traditional Chinese medicine", keywords="clinicians", keywords="vaccine", keywords="health care worker", keywords="hospital-acquired", keywords="effectiveness", keywords="antiviral", keywords="cross-sectional study", abstract="Background: Achieving high vaccine coverage among clinicians is crucial to curb the spread of influenza. Traditional Chinese medicine (TCM), rooted in cultural symbols and concepts without direct parallels in modern Western medicine, may influence perspectives on vaccination. Therefore, understanding the preferences of TCM clinicians towards influenza vaccines is of great importance. Objective: To understand preferences for features of influenza vaccination programs and identify the optimal influenza vaccination program among clinicians practicing TCM and Western medicine. Methods: We conducted a discrete choice experiment with a national sample of 3085 Chinese clinicians from various hospital levels (n=1013 practicing TCM) from January to May 2022. Simulations from choice models using the experimental data generated the coefficients of preference and predicted the uptake rate of different influenza vaccination programs. Clinicians were grouped by vaccine preference classification through a latent class analysis. Results: All included attributes significantly influenced clinicians' preferences for choosing an influenza vaccination program. An approximate hypothetical 60\% increase of vaccine uptake could be obtained when the attitude of the workplace changed from ``no notice'' to ``encouraging of vaccination''; there was an approximate hypothetical 35\% increase of vaccine uptake when vaccination campaign strategies changed from ``individual appointment'' to ``vaccination in a workplace setting.'' In the entire sample, about 30\% (946/3085) of clinicians preferred free vaccinations, while 26.5\% (819/3085) comprehensively considered all attributes, except vaccination campaign strategies, when making a decision about choosing an influenza vaccination program. Clinicians who practiced TCM, worked in tertiary hospital, or had at least a postgraduate degree exhibited a lower preference for free vaccinations. Clinicians who practiced Western medicine, worked in primary hospital, or had at most a bachelor's degree had a higher preference for vaccinations in workplace settings. Conclusions: Offering a range of influenza vaccination programs targeting the preferred attributes of different clinician groups could potentially encourage more clinicians, including those practicing TCM, to participate in influenza vaccination programs. ", doi="10.2196/63314", url="https://publichealth.jmir.org/2025/1/e63314" } @Article{info:doi/10.2196/64893, author="Scholes, Shaun and Mindell, S. Jennifer and Toomse-Smith, Mari and Cois, Annibale and Adjaye-Gbewonyo, Kafui", title="Estimating Trends in Cardiovascular Disease Risk for the EXPOSE (Explaining Population Trends in Cardiovascular Risk: A Comparative Analysis of Health Transitions in South Africa and England) Study: Repeated Cross-Sectional Study", journal="JMIR Cardio", year="2025", month="Jan", day="20", volume="9", pages="e64893", keywords="data harmonization", keywords="cardiovascular disease", keywords="CVD", keywords="CVD risk scores", keywords="trends", keywords="cross-country comparisons", keywords="public health", keywords="England", keywords="South Africa", abstract="Background: Cardiovascular diseases (CVDs) are the leading cause of death globally. Demographic, behavioral, socioeconomic, health care, and psychosocial variables considered risk factors for CVD are routinely measured in population health surveys, providing opportunities to examine health transitions. Studying the drivers of health transitions in countries where multiple burdens of disease persist (eg, South Africa), compared with countries regarded as models of ``epidemiologic transition'' (eg, England), can provide knowledge on where best to intervene and direct resources to reduce the disease burden. Objective: The EXPOSE (Explaining Population Trends in Cardiovascular Risk: A Comparative Analysis of Health Transitions in South Africa and England) study analyzes microlevel data collected from multiple nationally representative population health surveys conducted in these 2 countries between 1998 and 2017. Creating a harmonized dataset by pooling repeated cross-sectional surveys to model trends in CVD risk is challenging due to changes in aspects such as survey content, question wording, inclusion of boost samples, weighting, measuring equipment, and guidelines for data protection. This study aimed to create a harmonized dataset based on the annual Health Surveys for England to estimate trends in mean predicted 10-year CVD risk (primary outcome) and its individual risk components (secondary outcome). Methods: We compiled a harmonized dataset to estimate trends between 1998 and 2017 in the English adult population, including the primary and secondary outcomes, and potential drivers of those trends. Laboratory- and non--laboratory-based World Health Organization (WHO) and Globorisk algorithms were used to calculate the predicted 10-year total (fatal and nonfatal) CVD risk. Sex-specific estimates of the mean 10-year CVD risk and its components by survey year were calculated, accounting for the complex survey design. Results: Laboratory- and non--laboratory-based 10-year CVD risk scores were calculated for 33,628 and 61,629 participants aged 40 to 74 years, respectively. The absolute predicted 10-year risk of CVD declined significantly on average over the last 2 decades in both sexes (for linear trend; all P<.001). In men, the mean of the laboratory-based WHO risk score was 10.1\% (SE 0.2\%) and 8.4\% (SE 0.2\%) in 1998 and 2017, respectively; corresponding figures in women were 5.6\% (SE 0.1\%) and 4.5\% (SE 0.1\%). In men, the mean of the non--laboratory-based WHO risk score was 9.6\% (SE 0.1\%) and 8.9\% (SE 0.2\%) in 1998 and 2017, respectively; corresponding figures in women were 5.8\% (SE 0.1\%) and 4.8\% (SE 0.1\%). Predicted CVD risk using the Globorisk algorithms was lower on average in absolute terms, but the pattern of change was very similar. Trends in the individual risk components showed a complex pattern. Conclusions: Harmonized data from repeated cross-sectional health surveys can be used to quantify the drivers of recent changes in CVD risk at the population level. ", doi="10.2196/64893", url="https://cardio.jmir.org/2025/1/e64893" } @Article{info:doi/10.2196/58271, author="Savaria, Virginie and Queenton, Johanne and Carrier, Annie", title="Decentralized Management of Home Care Services for Seniors: Protocol for a Participatory Action Research", journal="JMIR Res Protoc", year="2025", month="Jan", day="17", volume="14", pages="e58271", keywords="health system", keywords="decentralization", keywords="management", keywords="home care services", keywords="seniors", keywords="collaboration", abstract="Background: The centralization of decision-making power in the public health care system has a negative impact on the practice of professionals and the quality of home care services (HCS) for seniors. To improve HCS, decentralized management could be a particularly promising approach. To be effective, strategies designed to incorporate this management approach require attention to 3 elements: autonomy of local stakeholders, individual and organizational capacities, and accountability for actions and decisions. Not many studies have focused on strategies for integrating decentralized and collaborative management at the local level in HCS. Objective: The overall aim of this study is to coconstruct HCS management strategies and explore decentralized practices in the day-to-day work of low-level managers and professionals. The specific objectives, in collaboration with local HCS stakeholders, are to (1) identify concrete and achievable strategies for decentralized management, and (2) describe factors (facilitators and obstacles) that could potentially influence their integration. Methods: This participatory action research involves a cyclical process. Before initiating the cycles, a preliminary stage consists of forming a steering committee composed of managers (n=3), professionals (n=3), seniors (n=3), informal caregivers (n=3), and the research team (n=3). This committee will facilitate multistakeholder consultation to coconstruct local management strategies based on a real-life problem identified by the committee. The steering committee will also guide the research process. The first cycle will consist of establishing an initial plan of decentralized management strategies. During the observation phase, meetings of 4 homogeneous focus groups, including managers, professionals, seniors, and informal caregivers, will be held. During the reflection phase, a thematic analysis will be carried out, and data will be interpreted and validated by the steering committee. Then, in the action phase, results will be presented to managers and professionals so that they can coconstruct a plan of decentralized management strategies to prioritize. The second cycle will explore the factors involved. The observation, reflection, and action phases will be repeated. Ultimately, the results of the 2 cycles will be integrated in a model coconstructed by the steering committee. Results: Data collection is in progress; the partnership officially began on February 1, 2024, and the plan is to continue data collection through 2025. The steering committee will validate the data to ensure that they are accurate and that the results reflect the reality of local stakeholders. Conclusions: By identifying decentralized and collaborative management strategies at the local level as well as factors to facilitate their integration in HCS, this approach can be used for other decentralized management projects in different areas of the health care system. This study will give decision makers insight into strategies aimed at improving the management of their institution, which will enhance seniors' well-being and the quality of their health care services. International Registered Report Identifier (IRRID): DERR1-10.2196/58271 ", doi="10.2196/58271", url="https://www.researchprotocols.org/2025/1/e58271" } @Article{info:doi/10.2196/60398, author="Macapagal, Kathryn and Zapata, Pablo Juan and Ma, Junye and Gordon, D. Jacob and Owens, Christopher and Valadez-Tapia, Silvia and Cummings, Peter and Walter, Nathan and Pickett, Jim", title="Sexual and Gender Minority Adolescents' Preferences for HIV Pre-Exposure Prophylaxis Social Marketing Campaigns: Qualitative Preimplementation Study", journal="JMIR Form Res", year="2025", month="Jan", day="17", volume="9", pages="e60398", keywords="social marketing campaigns", keywords="sexual and gender minority", keywords="adolescent", keywords="HIV", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="human-centered design", keywords="implementation science", keywords="dissemination", abstract="Background: Sexual and gender minority (SGM) adolescents in the United States are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical HIV prevention method, but its awareness and uptake among SGM adolescents are low. There are no adolescent-centered PrEP social marketing campaigns in the United States that have the potential to increase awareness and interest in PrEP. Objective: To address this gap, this qualitative study aims to examine SGM adolescents' needs and preferences regarding adolescent-centered PrEP social marketing campaigns. Methods: SGM adolescents from Chicago and its surrounding areas participated in web-based asynchronous focus groups from February to May 2021. Questions elicited their preferences for content, design, and delivery of SGM adolescent--centered PrEP campaigns. We used rapid qualitative data analysis and organized the findings around key components of social marketing, known as the 4 Ps: product, price, place, and promotion. Results: Participants (N=56) were aged 14 to 19 years (mean 18.16, SD 1.22 y), and 64\% (36/56) of them identified as a racial or ethnic minority. Among the 56 participants, 70\% (n=39) were aware of PrEP; however, 95\% (n=53) did not know that PrEP could be prescribed to those aged under 18 years. Adolescents expressed a need for PrEP campaign messaging that provides simple, accurate, and easily accessible information (eg, what is PrEP, for whom PrEP is indicated, and where and how to access PrEP). For product and price, SGM adolescents wanted a campaign to address barriers to, costs of, and how to access PrEP and desired to know about other adolescents' PrEP experiences to improve campaign relatability. For place and promotion, participants preferred digital campaigns on social media to reduce the possibility of embarrassment and stigma and increase the accessibility of health content. Conclusions: These findings lay the groundwork for designing adolescent-centered educational PrEP campaigns that prioritize both user preferences in PrEP marketing design and strategies to overcome common barriers to PrEP awareness. ", doi="10.2196/60398", url="https://formative.jmir.org/2025/1/e60398" } @Article{info:doi/10.2196/66179, author="Cintora-Sanz, Mar{\'i}a Ana and Horrillo-Garc{\'i}a, Cristina and Quesada-Cubo, V{\'i}ctor and P{\'e}rez-Alonso, Mar{\'i}a Ana and Guti{\'e}rrez-Misis, Alicia", title="Prevalence and Economic Impact of Acute Respiratory Failure in the Prehospital Emergency Medical Service of the Madrid Community: Retrospective Cohort Study", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="16", volume="11", pages="e66179", keywords="acute respiratory failure", keywords="COVID-19", keywords="chronic obstructive respiratory insufficiency", keywords="congestive heart failure", keywords="bronchospasm", keywords="emergency medical services costs", keywords="ambulances", keywords="SARS-CoV-2", keywords="coronavirus", keywords="respiratory", keywords="pulmonary", keywords="pandemic", keywords="economic impact", keywords="observational", keywords="Madrid", keywords="community", keywords="medical records", keywords="health records", keywords="medical advanced life support", keywords="ALS", keywords="acute pulmonary edema", keywords="chronic obstructive pulmonary disease", keywords="COPD", keywords="prevalence", abstract="Background: Chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and acute pulmonary edema (APE) are serious illnesses that often require acute care from prehospital emergency medical services (EMSs). These respiratory diseases that cause acute respiratory failure (ARF) are one of the main reasons for hospitalization and death, generating high health care costs. The prevalence of the main respiratory diseases treated in a prehospital environment in the prepandemic period and during the COVID-19 pandemic in Spain is unknown. The Madrid Community EMS is a public service that serves all types of populations and represents an epidemiological reference for supporting a population of 6.4 million inhabitants. The high volume of patients treated by Madrid's medical advanced life supports (ALSs) allows us to analyze this little-studied problem. Objectives: Our goal was to lay the groundwork for comprehensive data collection and surveillance of respiratory failure, with an emphasis on the most prevalent diseases that cause it, an aspect that has been largely overlooked in previous initiatives. By achieving these objectives, we hope to inform efforts to address respiratory failure and establish a standardized methodology and framework that can facilitate expansion to a continuous community-wide registry in Madrid, driving advances in emergency care and care practices in these pathologies. The aim of this retrospective observational study was to determine the pathologies that have mainly caused respiratory failure in patients and required medicalized ALS and to evaluate the cost of care for these pathologies collected through this pilot registry. Methods: A multicenter descriptive study was carried out in the Madrid Community EMS. The anonymized medical records of patients treated with medical ALS, who received any of the following medical diagnoses, were extracted: ARF not related to chronic respiratory disease, ARF in chronic respiratory failure, exacerbations of COPD, APE, CHF, and bronchospasm (not from asthma or COPD). The prevalence of each pathology, its evolution from 2014 to 2020, and the economic impact of the Medical ALSs were calculated. Results: The study included 96,221 patients. The most common pathology was exacerbation of COPD, with a prevalence of 0.07\% in 2014; it decreased to 0.03\% in 2020. CHF followed at 0.06\% in 2014 and 0.03\% in 2020. APE had a prevalence of 0.01\% in 2014, decreasing to 0.005\% in 2020 with the pandemic. The greatest economic impact was on exacerbation of COPD in 2015, with an annual cost of {\texteuro}2,726,893 (which equals to US \$2,864,628). Conclusions: COPD exacerbations had the higher prevalence in the Madrid region among the respiratory diseases studied. With the COVID-19 pandemic, the prevalence and costs of almost all these diseases decreased, except for ARF not related to chronic disease. The cost of these pathologies over 5 years was {\texteuro}58,791,031 (US \$61,832,879). ", doi="10.2196/66179", url="https://publichealth.jmir.org/2025/1/e66179" } @Article{info:doi/10.2196/57399, author="Atkins, Kaitlyn and Carpino, Thomas and Rao, Amrita and Sanchez, Travis and Edwards, Winslow O. and Hannah, Marissa and Sullivan, S. Patrick and Ogale, P. Yasmin and Abara, E. Winston and Delaney, P. Kevin and Baral, D. Stefan", title="Suspected Mpox Symptoms and Testing in Men Who Have Sex With Men in the United States: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="16", volume="11", pages="e57399", keywords="mpox", keywords="emerging infectious diseases", keywords="men who have sex with men", keywords="sexual health", keywords="testing", keywords="monkeypox", keywords="epidemic", keywords="MSM", keywords="United States", keywords="rural", keywords="cross-sectional study", keywords="gay", keywords="bisexual", keywords="symptomology", keywords="sociodemographic", keywords="online sample", keywords="self-efficacy", keywords="rash", keywords="fever", keywords="HIV", keywords="HIV prevention", keywords="GBMSM", keywords="Black and Hispanic", keywords="LGBTQ", keywords="Latino", keywords="public health", keywords="surveillance", keywords="sores", abstract="Background: The 2022 mpox outbreak in the United States disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Uptake of mpox testing may be related to symptomology, sociodemographic characteristics, and behavioral characteristics. Objective: This study aimed to describe suspected mpox symptoms and testing uptake among a sample of GBMSM recruited via the internet in the United States in August 2022. Methods: We conducted a rapid internet-based mpox survey from August 5 to 15, 2022, among cisgender men 15 years and older who had previously participated in the 2021 American Men's Internet Survey. We estimated the prevalence of suspected mpox symptoms (fever or rash or sores with unknown cause in the last 3 mo) and uptake of mpox testing. We calculated adjusted prevalence ratios (aPRs) and 95\% CIs for associations between participant characteristics and suspected mpox symptoms and summarized characteristics of GBMSM reporting mpox testing. Among symptomatic GBMSM who did not receive mpox testing, we described testing self-efficacy, barriers, and facilitators. Results: Of 824 GBMSM, 126 (15.3\%) reported at least 1 mpox symptom in the last 3 months; 58/126 (46\%) with rash or sores, 57 (45.2\%) with fever, and 11 (8.7\%) with both. Increased prevalence of suspected mpox symptoms was associated with condomless anal sex (CAS; aPR 1.53, 95\% CI 1.06?2.20). Mpox testing was reported by 9/824 GBMSM (1\%), including 5 with symptoms. Most GBMSM reporting mpox testing were non-Hispanic White men (7/9 vs 1 Black and 1 Hispanic or Latino man), and all 9 lived in urban areas. Most reported having an sexually transmitted infections test (8/9), 2 or more partners (8/9), CAS (7/9), and group sex (6/9) in the last 3 months. Of those tested, 3 reported living with HIV and all were on treatment, whereas the remaining 6 men without HIV reported current pre-exposure prophylaxis (PrEP) use. Of symptomatic GBMSM who did not report mpox testing, 47/105 (44.8\%) had low mpox testing self-efficacy. Among those with low self-efficacy, the most common barriers to testing were not knowing where to get tested (40/47, 85.1\%) and difficulty getting appointments (23/47, 48.9\%). Among those with high testing self-efficacy (58/105, 55.2\%), the most common facilitators to testing were knowing where to test (52/58, 89.7\%), convenient site hours (40/58, 69\%), and low-cost testing (38/58, 65.5\%). Conclusions: While all GBMSM who reported testing for mpox were linked to HIV treatment or PrEP, those with symptoms but no mpox testing reported fewer such links. This suggests targeted outreach is needed to reduce structural barriers to mpox services among GBMSM in rural areas, Black and Hispanic or Latino GBMSM, and GBMSM living with HIV. Sustaining and scaling community-tailored messaging to promote testing and vaccination represent critical interventions for mpox control among GBMSM in the United States. ", doi="10.2196/57399", url="https://publichealth.jmir.org/2025/1/e57399" } @Article{info:doi/10.2196/59882, author="Hashtarkhani, Soheil and Zhou, Yiwang and Kumsa, Asefa Fekede and White-Means, Shelley and Schwartz, L. David and Shaban-Nejad, Arash", title="Analyzing Geospatial and Socioeconomic Disparities in Breast Cancer Screening Among Populations in the United States: Machine Learning Approach", journal="JMIR Cancer", year="2025", month="Jan", day="16", volume="11", pages="e59882", keywords="mammography", keywords="breast neoplasms", keywords="social determinants of health", keywords="geographic information systems", keywords="machine learning", abstract="Background: Breast cancer screening plays a pivotal role in early detection and subsequent effective management of the disease, impacting patient outcomes and survival rates. Objective: This study aims to assess breast cancer screening rates nationwide in the United States and investigate the impact of social determinants of health on these screening rates. Methods: Data on mammography screening at the census tract level for 2018 and 2020 were collected from the Behavioral Risk Factor Surveillance System. We developed a large-scale dataset of social determinants of health, comprising 13 variables for 72,337 census tracts. Spatial analysis employing Getis-Ord Gi statistics was used to identify clusters of high and low breast cancer screening rates. To evaluate the influence of these social determinants, we implemented a random forest model, with the aim of comparing its performance to linear regression and support vector machine models. The models were evaluated using R2 and root mean squared error metrics. Shapley Additive Explanations values were subsequently used to assess the significance of variables and direction of their influence. Results: Geospatial analysis revealed elevated screening rates in the eastern and northern United States, while central and midwestern regions exhibited lower rates. The random forest model demonstrated superior performance, with an R2=64.53 and root mean squared error of 2.06, compared to linear regression and support vector machine models. Shapley Additive Explanations values indicated that the percentage of the Black population, the number of mammography facilities within a 10-mile radius, and the percentage of the population with at least a bachelor's degree were the most influential variables, all positively associated with mammography screening rates. Conclusions: These findings underscore the significance of social determinants and the accessibility of mammography services in explaining the variability of breast cancer screening rates in the United States, emphasizing the need for targeted policy interventions in areas with relatively lower screening rates. ", doi="10.2196/59882", url="https://cancer.jmir.org/2025/1/e59882" } @Article{info:doi/10.2196/52385, author="Mumtaz, Shahzad and McMinn, Megan and Cole, Christian and Gao, Chuang and Hall, Christopher and Guignard-Duff, Magalie and Huang, Huayi and McAllister, A. David and Morales, R. Daniel and Jefferson, Emily and Guthrie, Bruce", title="A Digital Tool for Clinical Evidence--Driven Guideline Development by Studying Properties of Trial Eligible and Ineligible Populations: Development and Usability Study", journal="J Med Internet Res", year="2025", month="Jan", day="16", volume="27", pages="e52385", keywords="multimorbidity", keywords="clinical practice guideline", keywords="gout", keywords="Trusted Research Environment", keywords="National Institute for Health and Care Excellence", keywords="Scottish Intercollegiate Guidelines Network", keywords="clinical practice", keywords="development", keywords="efficacy", keywords="validity", keywords="epidemiological data", keywords="epidemiology", keywords="epidemiological", keywords="digital tool", keywords="tool", keywords="age", keywords="gender", keywords="ethnicity", keywords="mortality", keywords="feedback", keywords="availability", abstract="Background: Clinical guideline development preferentially relies on evidence from randomized controlled trials (RCTs). RCTs are gold-standard methods to evaluate the efficacy of treatments with the highest internal validity but limited external validity, in the sense that their findings may not always be applicable to or generalizable to clinical populations or population characteristics. The external validity of RCTs for the clinical population is constrained by the lack of tailored epidemiological data analysis designed for this purpose due to data governance, consistency of disease or condition definitions, and reduplicated effort in analysis code. Objective: This study aims to develop a digital tool that characterizes the overall population and differences between clinical trial eligible and ineligible populations from the clinical populations of a disease or condition regarding demography (eg, age, gender, ethnicity), comorbidity, coprescription, hospitalization, and mortality. Currently, the process is complex, onerous, and time-consuming, whereas a real-time tool may be used to rapidly inform a guideline developer's judgment about the applicability of evidence. Methods: The National Institute for Health and Care Excellence---particularly the gout guideline development group---and the Scottish Intercollegiate Guidelines Network guideline developers were consulted to gather their requirements and evidential data needs when developing guidelines. An R Shiny (R Foundation for Statistical Computing) tool was designed and developed using electronic primary health care data linked with hospitalization and mortality data built upon an optimized data architecture. Disclosure control mechanisms were built into the tool to ensure data confidentiality. The tool was deployed within a Trusted Research Environment, allowing only trusted preapproved researchers to conduct analysis. Results: The tool supports 128 chronic health conditions as index conditions and 161 conditions as comorbidities (33 in addition to the 128 index conditions). It enables 2 types of analyses via the graphic interface: overall population and stratified by user-defined eligibility criteria. The analyses produce an overview of statistical tables (eg, age, gender) of the index condition population and, within the overview groupings, produce details on, for example, electronic frailty index, comorbidities, and coprescriptions. The disclosure control mechanism is integral to the tool, limiting tabular counts to meet local governance needs. An exemplary result for gout as an index condition is presented to demonstrate the tool's functionality. Guideline developers from the National Institute for Health and Care Excellence and the Scottish Intercollegiate Guidelines Network provided positive feedback on the tool. Conclusions: The tool is a proof-of-concept, and the user feedback has demonstrated that this is a step toward computer-interpretable guideline development. Using the digital tool can potentially improve evidence-driven guideline development through the availability of real-world data in real time. ", doi="10.2196/52385", url="https://www.jmir.org/2025/1/e52385" } @Article{info:doi/10.2196/64316, author="Kabwama, Ndugwa Steven and Wanyenze, K. Rhoda and Lindgren, Helena and Razaz, Neda and Ssenkusu, M. John and Alfv{\'e}n, Tobias", title="Interventions to Maintain HIV/AIDS, Tuberculosis, and Malaria Service Delivery During Public Health Emergencies in Low- and Middle-Income Countries: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2025", month="Jan", day="15", volume="14", pages="e64316", keywords="service availability", keywords="emergencies", keywords="tuberculosis", keywords="malaria", keywords="systematic reviews", keywords="health services", keywords="HIV", keywords="AIDS", keywords="public health emergency", keywords="low- and middle-income countries", keywords="qualitative reviews", keywords="qualitative", keywords="policies", keywords="communities", keywords="health facilities", keywords="emergency", keywords="implement", keywords="implementation", abstract="Background: Although existing disease preparedness and response frameworks provide guidance about strengthening emergency response capacity, little attention is paid to health service continuity during emergency responses. During the 2014 Ebola outbreak, there were 11,325 reported deaths due to the Ebola virus and yet disruption in access to care caused more than 10,000 additional deaths due to measles, HIV/AIDS, tuberculosis, and malaria. Low- and middle-income countries account for the largest disease burden due to HIV, tuberculosis, and malaria and yet previous responses to health emergencies showed that HIV, tuberculosis, and malaria service delivery can be significantly disrupted. To date, there has not been a systematic synthesis of interventions implemented to maintain the delivery of these services during emergencies. Objective: This study aimed to synthesize the interventions implemented to maintain HIV/AIDS, tuberculosis, and malaria services during public health emergencies in low- and middle-income countries. Methods: The systematic review was registered in the international register for prospective systematic reviews. It will include activities undertaken to improve human health either through preventing the occurrence of HIV, tuberculosis, or malaria, reducing the severity among patients, or promoting the restoration of functioning lost as a result of experiencing HIV, tuberculosis, or malaria during health emergencies. These will include policy-level (eg, development of guidelines), health facility--level (eg, service rescheduling), and community-level interventions (eg, community drug distribution). Service delivery will be in terms of improving access, availability, use, and coverage. We will report on any interventions to maintain services along the care cascade for HIV, tuberculosis, or malaria. Peer-reviewed study databases including MEDLINE, Web of Science, Embase, Cochrane, and Global Index Medicus will be searched. Reference lists from global reports on HIV/AIDS, tuberculosis, or malaria will also be searched. We will use the GRADE-CERQual (Grading of Recommendations Assessment, Development, and Evaluation---Confidence in Evidence from Reviews of Qualitative Research) approach to report on the quality of evidence in each paper. The information from the studies will be synthesized at the disease or condition level (HIV/AIDS, tuberculosis, and malaria), implementation level (policy, health facility, and community), and outcomes (improving access, availability, use, or coverage). We will use the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to report findings and discuss implications for strengthening preparedness and response, as well as strengthening health systems in low- and middle-income countries. Results: The initial search for published literature was conducted between January 2023 and March 2023 and yielded 8119 studies. At the time of publication, synthesis and interpretation of results were being concluded. Final results will be published in 2025. Conclusions: The findings will inform the development of national and global guidance to minimize disruption of services for patients with HIV/AIDS, tuberculosis, and malaria during public health emergencies. Trial Registration: PROSPERO CRD42023408967; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=408967 International Registered Report Identifier (IRRID): PRR1-10.2196/64316 ", doi="10.2196/64316", url="https://www.researchprotocols.org/2025/1/e64316" } @Article{info:doi/10.2196/60084, author="Gebreyohannes, Alemayehu Eyob and Thornton, Christopher and Thiessen, Myra and de Vries, T. Sieta and Q Andrade, Andre and Kalisch Ellett, Lisa and Frank, Oliver and Cheah, Yeong Phaik and Choo, Raymond Kim-Kwang and Laba, Lea Tracey and Roughead, E. Elizabeth and Hwang, Indae and Moses, Geraldine and Lim, Renly", title="Co-Designing a Consumer-Focused Digital Reporting Health Platform to Improve Adverse Medicine Event Reporting: Protocol for a Multimethod Research Project (the ReMedi Project)", journal="JMIR Res Protoc", year="2025", month="Jan", day="15", volume="14", pages="e60084", keywords="adverse drug events", keywords="drug-related side effects and adverse reactions", keywords="adverse drug reaction reporting systems", keywords="pharmacovigilance", keywords="digital health", keywords="medication safety", keywords="co-design", keywords="qualitative research, user-centered design", abstract="Background: Adverse medicine events (AMEs) are unintended effects that occur following administration of medicines. Up to 70\% of AMEs are not reported to, and hence remain undetected by, health care professionals and only 6\% of AMEs are reported to regulators. Increased reporting by consumers, health care professionals, and pharmaceutical companies to medicine regulatory authorities is needed to increase the safety of medicines. Objective: We describe a project that aims to co-design a digital reporting platform to improve detection and management of AMEs by consumers and health care professionals and improve reporting to regulators. Methods: The project will be conducted in 3 phases and uses a co-design methodology that prioritizes equity in designing with stakeholders. Our project is guided by the Consolidated Framework for Implementation Research. In phase 1, we will engage with 3 stakeholder groups---consumers, health care professionals, and regulators---to define digital platform development standards. We will conduct a series of individual interviews, focus group discussions, and co-design workshops with the stakeholder groups. In phase 2, we will work with a software developer and user interaction design experts to prototype, test, and develop the digital reporting platform based on findings from phase 1. In phase 3, we will implement and trial the digital reporting platform in South Australia through general practices and pharmacies. Consumers who have recently started using medicines new to them will be recruited to use the digital reporting platform to report any apparent, suspected, or possible AMEs since starting the new medicine. Process and outcome evaluations will be conducted to assess the implementation process and to determine whether the new platform has increased AME detection and reporting. Results: This project, initiated in 2023, will run until 2026. Phase 1 will result in persona profiles and user journey maps that define the standards for the user-friendly platform and interactive data visualization tool or dashboard that will be developed and further improved in phase 2. Finally, phase 3 will provide insights of the implemented platform regarding its impact on AME detection, management, and reporting. Findings will be published progressively as we complete the different phases of the project. Conclusions: This project adopts a co-design methodology to develop a new digital reporting platform for AME detection and reporting, considering the perspectives and lived experience of stakeholders and addressing their requirements throughout the entire process. The overarching goal of the project is to leverage the potential of both consumers and technology to address the existing challenges of underdetection and underreporting of AMEs to health care professionals and regulators. The project potentially will improve individual patient safety and generate new data for regulatory purposes related to medicine safety and effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/60084 ", doi="10.2196/60084", url="https://www.researchprotocols.org/2025/1/e60084" } @Article{info:doi/10.2196/57457, author="Iera, Jessica and Isonne, Claudia and Seghieri, Chiara and Tavoschi, Lara and Ceparano, Mariateresa and Sciurti, Antonio and D'Alisera, Alessia and Sane Schepisi, Monica and Migliara, Giuseppe and Marzuillo, Carolina and Villari, Paolo and D'Ancona, Fortunato and Baccolini, Valentina", title="Availability and Key Characteristics of National Early Warning Systems for Emerging Profiles of Antimicrobial Resistance in High-Income Countries: Systematic Review", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="15", volume="11", pages="e57457", keywords="early warning system", keywords="surveillance", keywords="emerging AMR", keywords="high-income countries", keywords="antimicrobial resistance", abstract="Background: The World Health Organization (WHO) recently advocated an urgent need for implementing national surveillance systems for the timely detection and reporting of emerging antimicrobial resistance (AMR). However, public information on the existing national early warning systems (EWSs) is often incomplete, and a comprehensive overview on this topic is currently lacking. Objective: This review aimed to map the availability of EWSs for emerging AMR in high-income countries and describe their main characteristics. Methods: A systematic review was performed on bibliographic databases, and a targeted search was conducted on national websites. Any article, report, or web page describing national EWSs in high-income countries was eligible for inclusion. EWSs were identified considering the emerging AMR-reporting WHO framework. Results: We identified 7 national EWSs from 72 high-income countries: 2 in the East Asia and Pacific Region (Australia and Japan), 3 in Europe and Central Asia (France, Sweden, and the United Kingdom), and 2 in North America (the United States and Canada). The systems were established quite recently; in most cases, they covered both community and hospital settings, but their main characteristics varied widely across countries in terms of the organization and microorganisms under surveillance, with also different definitions of emerging AMR and alert functioning. A formal system assessment was available only in Australia. Conclusions: A broader implementation and investment of national surveillance systems for the early detection of emerging AMR are still needed to establish EWSs in countries and regions lacking such capabilities. More standardized data collection and reporting are also advisable to improve cooperation on a global scale. Further research is required to provide an in-depth analysis of EWSs, as this study is limited to publicly available data in high-income countries. ", doi="10.2196/57457", url="https://publichealth.jmir.org/2025/1/e57457" } @Article{info:doi/10.2196/58862, author="Ocagli, Honoria and Zambito, Marco and Da Re, Filippo and Groppi, Vanessa and Zampini, Marco and Terrini, Alessia and Rigoli, Franco and Amoruso, Irene and Baldovin, Tatjana and Baldo, Vincenzo and Russo, Francesca and Gregori, Dario", title="Wastewater Monitoring During the COVID-19 Pandemic in the Veneto Region, Italy: Longitudinal Observational Study", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="14", volume="11", pages="e58862", keywords="wastewater-based epidemiology", keywords="SARS-CoV-2", keywords="COVID-19", keywords="CUSUM", keywords="WBE", keywords="cumulative sum chart", abstract="Background: As the COVID-19 pandemic has affected populations around the world, there has been substantial interest in wastewater-based epidemiology (WBE) as a tool to monitor the spread of SARS-CoV-2. This study investigates the use of WBE to anticipate COVID-19 trends by analyzing the correlation between viral RNA concentrations in wastewater and reported COVID-19 cases in the Veneto region of Italy. Objective: We aimed to evaluate the effectiveness of the cumulative sum (CUSUM) control chart method in detecting changes in SARS-CoV-2 concentrations in wastewater and its potential as an early warning system for COVID-19 outbreaks. Additionally, we aimed to validate these findings over different time periods to ensure robustness. Methods: This study analyzed the temporal correlation between SARS-CoV-2 RNA concentrations in wastewater and COVID-19 clinical outcomes, including confirmed cases, hospitalizations, and intensive care unit (ICU) admissions, from October 2021 to August 2022 in the Veneto region, Italy. Wastewater samples were collected weekly from 10 wastewater treatment plants and analyzed using a reverse transcription--quantitative polymerase chain reaction. The CUSUM method was used to detect significant shifts in the data, with an initial analysis conducted from October 2021 to February 2022, followed by validation in a second period from February 2022 to August 2022. Results: The study found that peaks in SARS-CoV-2 RNA concentrations in wastewater consistently preceded peaks in reported COVID-19 cases by 5.2 days. Hospitalizations followed with a delay of 4.25 days, while ICU admissions exhibited a lead time of approximately 6 days. Notably, certain health care districts exhibited stronger correlations, with notable values in wastewater anticipating ICU admissions by an average of 13.5 and 9.5 days in 2 specific districts. The CUSUM charts effectively identified early changes in viral load, indicating potential outbreaks before clinical cases increased. Validation during the second period confirmed the consistency of these findings, reinforcing the robustness of the CUSUM method in this context. Conclusions: WBE, combined with the CUSUM method, offers valuable insight into the level of COVID-19 outbreaks in a community, including asymptomatic cases, thus acting as a precious early warning tool for infectious disease outbreaks with pandemic potential. ", doi="10.2196/58862", url="https://publichealth.jmir.org/2025/1/e58862" } @Article{info:doi/10.2196/59352, author="Taira, Kazuya and Shiomi, Misa and Nakabe, Takayo and Imanaka, Yuichi", title="The Association Between COVID-19 Vaccination Uptake and Information-Seeking Behaviors Using the Internet: Nationwide Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Jan", day="14", volume="27", pages="e59352", keywords="COVID-19 vaccines", keywords="internet use", keywords="information seeking behavior", keywords="Japan", keywords="vaccine", keywords="COVID-19", keywords="behavior", keywords="panel study", keywords="longitudinal", keywords="survey", keywords="regression analysis", keywords="chi-square test", keywords="adult", keywords="epidemiology", keywords="health informatics", abstract="Background: The COVID-19 pandemic, declared in March 2020, profoundly affected global health, societal, and economic frameworks. Vaccination became a crucial tactic in combating the virus. Simultaneously, the pandemic likely underscored the internet's role as a vital resource for seeking health information. The proliferation of misinformation on social media was observed, potentially influencing vaccination decisions and timing. Objective: This study aimed to explore the relationship between COVID-19 vaccination rates, including the timing of vaccination, and reliance on internet-based information sources in Japan. Methods: Using a cross-sectional study design using a subset of panel data, this nationwide survey was conducted in 7 waves. A total of 10,000 participants were randomly selected through an internet survey firm, narrowing down to 8724 after applying inclusion and exclusion criteria. The primary outcome was the COVID-19 vaccination date, divided into vaccinated versus unvaccinated and early versus late vaccination groups. The main exposure variable was the use of internet-based information sources. Control variables included gender, family structure, education level, employment status, household income, eligibility for priority COVID-19 vaccination due to pre-existing medical conditions, and a health literacy scale score. Two regression analyses using generalized estimating equations accounted for prefecture-specific correlations, focusing on vaccination status and timing. In addition, chi-square tests assessed the relationship between each information source and vaccination rates. Results: Representing a cross-section of the Japanese population, the regression analysis found a significant association between internet information seeking and higher vaccination rates (adjusted odds ratio [aOR] 1.42 for those younger than 65 years; aOR 1.66 for those aged 65 years and older). However, no significant link was found regarding vaccination timing. Chi-square tests showed positive associations with vaccination for television, government web pages, and web news, whereas blogs and some social networking sites were negatively correlated. Conclusions: Internet-based information seeking is positively linked to COVID-19 vaccination rates in Japan, underscoring the significant influence of online information on public health decisions. Nonetheless, certain online information sources, including blogs and some social networks, negatively affected vaccination rates, warranting caution in their use and recognition. The study highlights the critical role of credible online sources in public health communication and the challenge of combating misinformation on less regulated platforms. This research sheds light on how the digital information landscape influences health behaviors, stressing the importance of accurate and trustworthy health information amidst global health emergencies. ", doi="10.2196/59352", url="https://www.jmir.org/2025/1/e59352", url="http://www.ncbi.nlm.nih.gov/pubmed/39808493" } @Article{info:doi/10.2196/66139, author="Ma, Qian and Jiang, Tingting and Chen, Wanjun and Jiang, Shaoqiang and Zheng, Jinlei and Wang, Hui and He, Lin", title="Awareness of Sexual Partner's HIV Status Among Men Who Have Sex With Men in China: Cross-Sec. tional Survey Study", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="13", volume="11", pages="e66139", keywords="human immunodeficiency virus", keywords="HIV", keywords="serostatus disclosure", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="men who have sex with men", keywords="MSM", keywords="web-based survey", keywords="HIV awareness", abstract="Background: Men who have sex with men (MSM) constitute a significant proportion of individuals living with human immunodeficiency virus. Over the past few years, China has implemented various strategies aimed at increasing the rate of HIV testing and reducing HIV transmission among MSM. Among these, the disclosure of HIV serostatus is an effective prevention strategy. Objective: This study aimed to assess HIV serostatus disclosure and identify factors associated with awareness of sexual partners' HIV status among MSM to provide a scientific basis for promoting HIV testing and reducing HIV transmission. Methods: A cross-sectional study based on a large-scale web-based survey was conducted among MSM in Zhejiang province, China, between July and December 2023. MSM who were HIV-negative or had an unknown HIV status were recruited from the Sunshine Test, a web-based platform that uses location-based services to provide HIV prevention services. Participants were required to complete a questionnaire on demographic characteristics, sexual behavior, rush popper use, awareness of sexual partners' HIV status, and knowledge of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP). A multinomial regression model was used to identify the factors associated with awareness of sexual partners' HIV status. Results: A total of 7629 MSM participated in the study, with 45.2\% (n=3451) being aware, 35.4\% (n=2701) being partially aware, and 19.4\% (n=1477) being unaware of their sexual partner's HIV status. The multinomial logistic regression analysis revealed the following results. Compared to those who were unaware of their sexual partner's HIV status, participants who were students (adjusted odds ratio [aOR] 1.43, 95\% CI 1.09?1.86), had a monthly income of more than US \$1400 (aOR 1.36, 95\% CI 1.03?1.80), had insertive anal sex (aOR 1.35, 95\% CI 1.12?1.63), had only male sexual partners (aOR 1.53, 95\% CI 1.28?1.82), had 1 sexual partner in the past 3 months (aOR 2.36, 95\% CI 2.01?2.77), had used condoms for the past 3 months (aOR 1.72, 95\% CI 1.33?2.22), had frequently used rush poppers in the past 3 months (aOR 2.27, 95\% CI 1.81?2.86), were aware of HIV PrEP (aOR 2.04, 95\% CI 1.68?2.48), were aware of HIV PEP (aOR 1.69, 95\% CI 1.39?2.06), used mail reagent self-testing (aOR 1.19, 95\% CI 1.04?1.36), and had previously undergone HIV testing (aOR 1.40, 95\% CI 1.16?1.69) were associated with increased odds of being aware of their sexual partner's HIV status. Conclusions: Overall, 45.2\% of MSM who were HIV-negative or had an unknown status were aware of their sexual partners' HIV status in China. We suggest strengthening targeted interventions through web-based platforms and gay apps to promote the disclosure of HIV serostatus and reduce HIV transmission among MSM. ", doi="10.2196/66139", url="https://publichealth.jmir.org/2025/1/e66139" } @Article{info:doi/10.2196/57619, author="Williams, P. Michael and Manjourides, Justin and Smith, H. Louisa and Rainer, B. Crissi and Hightow-Weidman, B. Lisa and Haley, F. Danielle", title="Studying the Digital Intervention Engagement--Mediated Relationship Between Intrapersonal Measures and Pre-Exposure Prophylaxis Adherence in Sexual and Gender Minority Youth: Secondary Analysis of a Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Jan", day="13", volume="27", pages="e57619", keywords="engagement", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="digital health intervention", keywords="adherence", keywords="men who have sex with men", keywords="sexual orientation", keywords="gender minority", keywords="youth", keywords="adolescent", keywords="teenager", keywords="HIV", keywords="randomized controlled trial", keywords="mental health", keywords="sociodemographic", keywords="logistic regression", keywords="health information", keywords="health behavior", keywords="sexual health", abstract="Background: Improving adherence to pre-exposure prophylaxis (PrEP) via digital health interventions (DHIs) for young sexual and gender minority men who have sex with men (YSGMMSM) is promising for reducing the HIV burden. Measuring and achieving effective engagement (sufficient to solicit PrEP adherence) in YSGMMSM is challenging. Objective: This study is a secondary analysis of the primary efficacy randomized controlled trial (RCT) of Prepared, Protected, Empowered (P3), a digital PrEP adherence intervention that used causal mediation to quantify whether and to what extent intrapersonal behavioral, mental health, and sociodemographic measures were related to effective engagement for PrEP adherence in YSGMMSM. Methods: In May 2019, 264 YSGMMSM were recruited for the primary RCT via social media, community sites, and clinics from 9 study sites across the United States. For this secondary analysis, 140 participants were eligible (retained at follow-up, received DHI condition in primary RCT, and completed trial data). Participants earned US currency for daily use of P3 and lost US currency for nonuse. Dollars accrued at the 3-month follow-up were used to measure engagement. PrEP nonadherence was defined as blood serum concentrations of tenofovir-diphosphate and emtricitabine-triphosphate that correlated with ?4 doses weekly at the 3-month follow-up. Logistic regression was used to estimate the total effect of baseline intrapersonal measures on PrEP nonadherence, represented as odds ratios (ORs) with a null value of 1. The total OR for each intrapersonal measure was decomposed into direct and indirect effects. Results: For every US \$1 earned above the mean (US \$96, SD US \$35.1), participants had 2\% (OR 0.98, 95\% CI 0.97-0.99) lower odds of PrEP nonadherence. Frequently using phone apps to track health information was associated with a 71\% (OR 0.29, 95\% CI 0.06-0.96) lower odds of PrEP nonadherence. This was overwhelmingly a direct effect, not mediated by engagement, with a percentage mediated (PM) of 1\%. Non-Hispanic White participants had 83\% lower odds of PrEP nonadherence (OR 0.17, 95\% CI 0.05-0.48) and had a direct effect (PM=4\%). Participants with depressive symptoms and anxiety symptoms had 3.4 (OR 3.42, 95\% CI 0.95-12) and 3.5 (OR 3.51, 95\% CI 1.06-11.55) times higher odds of PrEP nonadherence, respectively. Anxious symptoms largely operated through P3 engagement (PM=51\%). Conclusions: P3 engagement (dollars accrued) was strongly related to lower odds of PrEP nonadherence. Intrapersonal measures operating through P3 engagement (indirect effect, eg, anxious symptoms) suggest possible pathways to improve PrEP adherence DHI efficacy in YSGMMSM via effective engagement. Conversely, the direct effects observed in this study may reflect existing structural disparity (eg, race and ethnicity) or behavioral dispositions toward technology (eg, tracking health via phone apps). Evaluating effective engagement in DHIs with causal mediation approaches provides a clarifying and mechanistic view of how DHIs impact health behavior. Trial Registration: ClinicalTrials.gov; NCT03320512; https://clinicaltrials.gov/study/NCT03320512 ", doi="10.2196/57619", url="https://www.jmir.org/2025/1/e57619", url="http://www.ncbi.nlm.nih.gov/pubmed/39804696" } @Article{info:doi/10.2196/59937, author="Kaur, Harleen and Tripathi, Stuti and Chalga, Singh Manjeet and Benara, K. Sudhir and Dhiman, Amit and Gupta, Shefali and Nair, Saritha and Menon, Geetha and Gulati, K. B. and Sharma, Sandeep and Sharma, Saurabh", title="Unified Mobile App for Streamlining Verbal Autopsy and Cause of Death Assignment in India: Design and Development Study", journal="JMIR Form Res", year="2025", month="Jan", day="10", volume="9", pages="e59937", keywords="verbal autopsy", keywords="cause of death", keywords="mortality", keywords="mHealth", keywords="public health", keywords="India", keywords="mobile health", abstract="Background: Verbal autopsy (VA) has been a crucial tool in ascertaining population-level cause of death (COD) estimates, specifically in countries where medical certification of COD is relatively limited. The World Health Organization has released an updated instrument (Verbal Autopsy Instrument 2022) that supports electronic data collection methods along with analytical software for assigning COD. This questionnaire encompasses the primary signs and symptoms associated with prevalent diseases across all age groups. Traditional methods have primarily involved paper-based questionnaires and physician-coded approaches for COD assignment, which is time-consuming and resource-intensive. Although computer-coded algorithms have advanced the COD assignment process, data collection in densely populated countries like India remains a logistical challenge. Objective: This study aimed to develop an Android-based mobile app specifically tailored for streamlining VA data collection by leveraging the existing Indian public health workforce. The app has been designed to integrate real-time data collection by frontline health workers and seamless data transmission and digital reporting of COD by physicians. This process aimed to enhance the efficiency and accuracy of COD assignment through VA. Methods: The app was developed using Android Studio, the primary integrated development environment for developing Android apps using Java. The front-end interface was developed using XML, while SQLite and MySQL were employed to streamline complete data storage on the local and server databases, respectively. The communication between the app and the server was facilitated through a PHP application programming interface to synchronize data from the local to the server database. The complete prototype was specifically built to reduce manual intervention and automate VA data collection. Results: The app was developed to align with the current Indian public health system for district-level COD estimation. By leveraging this mobile app, the average duration required for VA data collection to ascertainment of COD, which typically ranges from 6 to 8 months, is expected to decrease by approximately 80\%, reducing it to about 1?2 months. Based on annual caseload projections, the smallest administrative public health unit, health and wellness centers, is anticipated to handle 35?40 VA cases annually, while medical officers at primary health centers are projected to manage 150?200 physician-certified VAs each year. The app's data collection and transmission efficiency were further improved based on feedback from user and subject area experts. Conclusions: The development of a unified mobile app could streamline the VA process, enabling the generation of accurate national and subnational COD estimates. This mobile app can be further piloted and scaled to different regions to integrate the automated VA model into the existing public health system for generating comprehensive mortality statistics in India. ", doi="10.2196/59937", url="https://formative.jmir.org/2025/1/e59937" } @Article{info:doi/10.2196/58509, author="Kurita, Junko and Hori, Motomi and Yamaguchi, Sumiyo and Ogiwara, Aiko and Saito, Yurina and Sugiyama, Minako and Sunadori, Asami and Hayashi, Tomoko and Hara, Akane and Kawana, Yukari and Itoi, Youichi and Sugawara, Tamie and Sugishita, Yoshiyuki and Irie, Fujiko and Sakurai, Naomi", title="Effectiveness of the Facility for Elderly Surveillance System (FESSy) in Two Public Health Center Jurisdictions in Japan: Prospective Observational Study", journal="JMIR Med Inform", year="2025", month="Jan", day="10", volume="13", pages="e58509", keywords="early detection", keywords="facility for older people", keywords="outbreak", keywords="public health center", keywords="syndromic surveillance", keywords="Japan", keywords="older adults", abstract="Background: Residents of facilities for older people are vulnerable to COVID-19 outbreaks. Nevertheless, timely recognition of outbreaks at facilities for older people at public health centers has been impossible in Japan since May 8, 2023, when the Japanese government discontinued aggressive countermeasures against COVID-19 because of the waning severity of the dominant Omicron strain. The Facility for Elderly Surveillance System (FESSy) has been developed to improve information collection. Objective: This study examined FESSy experiences and effectiveness in two public health center jurisdictions in Japan. Methods: This study assessed the use by public health centers of the detection mode of an automated AI detection system (ie, FESSy AI), as well as manual detection by the public health centers' staff (ie, FESSy staff) and direct reporting by facilities to the public health centers. We considered the following aspects: (1) diagnoses or symptoms, (2) numbers of patients as of their detection date, and (3) ultimate numbers of patients involved in incidents. Subsequently, effectiveness was assessed and compared based on detection modes. The study lasted from June 1, 2023, through January 2024. Results: In both areas, this study examined 31 facilities at which 87 incidents were detected. FESSy (AI or staff) detected significantly fewer patients than non-FESSy methods, that is, direct reporting to the public health center of the detection date and ultimate number of patients. Conclusions: FESSy was superior to direct reporting from facilities for the number of patients as of the detection date and for the ultimate outbreak size. ", doi="10.2196/58509", url="https://medinform.jmir.org/2025/1/e58509" } @Article{info:doi/10.2196/58630, author="Malburg, M. Carly and Gutreuter, Steve and Ruise{\~n}or-Escudero, Horacio and Abdul-Quader, Abu and Hladik, Wolfgang", title="Population Size Estimation of Men Who Have Sex With Men in Low- and Middle-Income Countries: Google Trends Analysis", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="9", volume="11", pages="e58630", keywords="population size estimation", keywords="men who have sex with men", keywords="MSM", keywords="PSE", keywords="google trends", keywords="HIV", keywords="AIDS", keywords="programming and policy", keywords="internet", keywords="porn", keywords="gay porn", keywords="male adult", keywords="geriatric", keywords="linear regression", keywords="homosexuality", keywords="sensitivity analysis", keywords="World Health Organization", keywords="WHO", keywords="epidemiology", abstract="Background: Population size estimation (PSE) for key populations is needed to inform HIV programming and policy. Objective: This study aimed to examine the utility of applying a recently proposed method using Google Trend (GT) internet search data to generate PSE (Google Trends Population Size Estimate [GTPSE]) for men who have sex with men (MSM) in 54 countries in Africa, Asia, the Americas, and Europe. Methods: We examined GT relative search volumes (representing the relative internet search frequency of specific search terms) for ``porn'' and, as a comparator term, ``gay porn'' for the year 2020. We assumed ``porn'' represents ``men'' (denominator) while ``gay porn'' represents a subset of ``MSM'' (numerator) in each county, resulting in a proportional size estimate for MSM. We multiplied the proportional GTPSE values with the countries' male adult population (15?49 years) to obtain absolute size estimates. Separately, we produced subnational MSM PSE limited to countries' (commercial) capitals. Using linear regression analysis, we examined the effect of countries' levels of urbanization, internet penetration, criminalization of homosexuality, and stigma on national GTPSE results. We conducted a sensitivity analysis in a subset of countries (n=14) examining the effect of alternative English search terms, different language search terms (Spanish, French, and Swahili), and alternative search years (2019 and 2021). Results: One country was excluded from our analysis as no GT data could be obtained. Of the remaining 53 countries, all national GTPSE values exceeded the World Health Organization's recommended minimum PSE threshold of 1\% (range 1.2\%?7.5\%). For 44 out of 49 (89.8\%) of the countries, GTPSE results were higher than Joint United Nations Programme on HIV/AIDS (UNAIDS) Key Population Atlas values but largely consistent with the regional UNAIDS Global AIDS Monitoring results. Substantial heterogeneity across same-region countries was evident in GTPSE although smaller than those based on Key Population Atlas data. Subnational GTPSE values were obtained in 51 out of 53 (96\%) countries; all subnational GTPSE values exceeded 1\% but often did not match or exceed the corresponding countries' national estimates. None of the covariates examined had a substantial effect on the GTPSE values (R2 values 0.01?0.28). Alternative (English) search terms in 12 out of 14 (85\%) countries produced GTPSE>1\%. Using non-English language terms often produced markedly lower same-country GTPSE values compared with English with 10 out of 14 (71\%) countries showing national GTPSE exceeding 1\%. GTPSE used search data from 2019 and 2021, yielding results similar to those of the reference year 2020. Due to a lack of absolute search volume data, credibility intervals could not be computed. The validity of key assumptions, especially who (males and females) searches for porn and gay porn, could not be assessed. Conclusions: GTPSE for MSM provides a simple, fast, essentially cost-free method. Limitations that impact the certainty of our estimates include a lack of validation of key assumptions and an inability to assign credibility intervals. GTPSE for MSM may provide an additional data source, especially for estimating national-level PSE. ", doi="10.2196/58630", url="https://publichealth.jmir.org/2025/1/e58630" } @Article{info:doi/10.2196/62824, author="Valla, Guido Luca and Rossi, Michele and Gaia, Alessandra and Guaita, Antonio and Rolandi, Elena", title="The Impact of the COVID-19 Pandemic on Oldest-Old Social Capital and Health and the Role of Digital Inequalities: Longitudinal Cohort Study", journal="J Med Internet Res", year="2025", month="Jan", day="9", volume="27", pages="e62824", keywords="older adults", keywords="information and communication technology", keywords="ICT", keywords="ICT use", keywords="COVID-19", keywords="social capital", keywords="health", keywords="mental health", keywords="digital divide", abstract="Background: During the COVID-19 pandemic, information and communication technology (ICT) became crucial for staying connected with loved ones and accessing health services. In this scenario, disparities in ICT use may have exacerbated other forms of inequality, especially among older adults who were less familiar with technology and more vulnerable to severe COVID-19 health consequences. Objective: This study investigated changes in ICT use, psychological and physical health, and social capital before and after the pandemic among the oldest old population (aged 80 years or older after the pandemic) and explored how internet use influenced these changes. Methods: We leveraged data from the InveCe.Ab study, a population-based longitudinal cohort of people born between 1935 and 1939 and living in Abbiategrasso, a municipality on the outskirts of Milan, Italy. Participants underwent multidimensional assessment at baseline (2010) and after 2, 4, 8, and 12 years. We restricted our analysis to cohort members who participated in the last wave (ie, 2022) and who did not have a diagnosis of dementia (n=391). We used linear mixed models to assess the impact of COVID-19 and time on changes in social capital, physical and psychological health, and ICT use in a discontinuity regression design while controlling for age, sex, education, and income satisfaction. Then, we assessed the influence of internet use and its interaction with COVID-19 on these changes. Results: COVID-19 had a significant impact on social relationships ($\beta$=--4.35, 95\% CI 6.38 to --2.32; P<.001), cultural activities ($\beta$=--.55, 95\% CI --0.75 to --0.35; P<.001), cognitive functioning ($\beta$=--1.00, 95\% CI --1.28 to --0.72; P<.001), depressive symptoms ($\beta$=.42, 95\% CI 0.10-0.74; P=.009), physical health ($\beta$=.07, 95\% CI 0.04-0.10; P<.001), and ICT use ($\beta$=--.11, 95\% CI --0.18 to --0.03; P=.008). Internet use predicts reduced depressive symptoms ($\beta$=--.56, 95\% CI --1.07 to --0.06; P=.03) over time. The interaction between internet use and COVID-19 was significant for cultural activities ($\beta$=--.73, 95\% CI --1.22 to --0.24; P=.003) and cognitive functioning ($\beta$=1.36, 95\% CI 0.67-2.05; P<.001). Conclusions: The pandemic had adverse effects on older adults' health and social capital. Contrary to expectations, even ICT use dropped significantly after the pandemic. Internet users maintained higher psychological health regardless of time and COVID-19 status. However, COVID-19 was associated with a steeper decline in cognitive functioning among internet nonusers. Policy makers may develop initiatives to encourage ICT adoption among older adults or strengthen their digital skills. Trial Registration: ClinicalTrials.gov NCT01345110; https://clinicaltrials.gov/study/NCT01345110 ", doi="10.2196/62824", url="https://www.jmir.org/2025/1/e62824" } @Article{info:doi/10.2196/67272, author="Lee, Heui Yoon and Choi, Hanna and Lee, Soo-Kyoung", title="Development of Personas and Journey Maps for Artificial Intelligence Agents Supporting the Use of Health Big Data: Human-Centered Design Approach", journal="JMIR Form Res", year="2025", month="Jan", day="8", volume="9", pages="e67272", keywords="analysis", keywords="health big data", keywords="human-centered design", keywords="persona", keywords="user journey map", keywords="artificial intelligence", keywords="human-AI", keywords="interviews", keywords="users' experiences", abstract="Background: The rapid proliferation of artificial intelligence (AI) requires new approaches for human-AI interfaces that are different from classic human-computer interfaces. In developing a system that is conducive to the analysis and use of health big data (HBD), reflecting the empirical characteristics of users who have performed HBD analysis is the most crucial aspect to consider. Recently, human-centered design methodology, a field of user-centered design, has been expanded and is used not only to develop types of products but also technologies and services. Objective: This study was conducted to integrate and analyze users' experiences along the HBD analysis journey using the human-centered design methodology and reflect them in the development of AI agents that support future HBD analysis. This research aims to help accelerate the development of novel human-AI interfaces for AI agents that support the analysis and use of HBD, which will be urgently needed in the near future. Methods: Using human-centered design methodology, we collected data through shadowing and in-depth interviews with 16 people with experience in analyzing and using HBD. We identified users' empirical characteristics, emotions, pain points, and needs related to HBD analysis and use and created personas and journey maps. Results: The general characteristics of participants (n=16) were as follows: the majority were in their 40s (n=6, 38\%) and held a PhD degree (n=10, 63\%). Professors (n=7, 44\%) and health care personnel (n=10, 63\%) represented the largest professional groups. Participants' experiences with big data analysis varied, with 25\% (n=4) being beginners and 38\% (n=6) having extensive experience. Common analysis methods included statistical analysis (n=7, 44\%) and data mining (n=6, 38\%). Qualitative findings from shadowing and in-depth interviews revealed key challenges: lack of knowledge on using analytical solutions, crisis management difficulties during errors, and inadequate understanding of health care data and clinical decision-making, especially among non--health care professionals. Three types of personas and journey maps---health care professionals as big data analysis beginners, health care professionals who have experience in big data analytics, and non--health care professionals who are experts in big data analytics---were derived. They showed a need for personalized platforms tailored to the user level, appropriate direction through a navigation function, a crisis management support system, communication and sharing among users, and expert linkage service. Conclusions: The knowledge obtained from this study can be leveraged in designing an AI agent to support future HBD analysis and use. This is expected to further increase the usability of HBD by helping users perform effective use of HBD more easily. ", doi="10.2196/67272", url="https://formative.jmir.org/2025/1/e67272" } @Article{info:doi/10.2196/59230, author="Sasaki, Kenji and Ikeda, Yoichi and Nakano, Takashi", title="Quantifying the Regional Disproportionality of COVID-19 Spread: Modeling Study", journal="JMIR Form Res", year="2025", month="Jan", day="3", volume="9", pages="e59230", keywords="infectious disease", keywords="COVID-19", keywords="epidemiology", keywords="public health", keywords="SARS-CoV-2", keywords="pandemic", keywords="inequality measure", keywords="information theory", keywords="Kullback-Leibler divergence", abstract="Background: The COVID-19 pandemic has caused serious health, economic, and social consequences worldwide. Understanding how infectious diseases spread can help mitigate these impacts. The Theil index, a measure of inequality rooted in information theory, is useful for identifying geographic disproportionality in COVID-19 incidence across regions. Objective: This study focused on capturing the degrees of regional disproportionality in incidence rates of infectious diseases over time. Using the Theil index, we aim to assess regional disproportionality in the spread of COVID-19 and detect epicenters where the number of infected individuals was disproportionately concentrated. Methods: To quantify the degree of disproportionality in the incidence rates, we applied the Theil index to the publicly available data of daily confirmed COVID-19 cases in the United States over a 1100-day period. This index measures relative disproportionality by comparing daily regional case distributions with population proportions, thereby identifying regions where infections are disproportionately concentrated. Results: Our analysis revealed a dynamic pattern of regional disproportionality in the confirmed cases by monitoring variations in regional contributions to the Theil index as the pandemic progressed. Over time, the index reflected a transition from localized outbreaks to widespread transmission, with high values corresponding to concentrated cases in some regions. We also found that the peaks in the Theil index often preceded surges in confirmed cases, suggesting its potential utility as an early warning signal. Conclusions: This study demonstrated that the Theil index is one of the effective indices for quantifying regional disproportionality in COVID-19 incidence rates. Although the Theil index alone cannot fully capture all aspects of pandemic dynamics, it serves as a valuable tool when used alongside other indicators such as infection and hospitalization rates. This approach allows policy makers to monitor regional disproportionality efficiently, offering insights for early intervention and targeted resource allocation. ", doi="10.2196/59230", url="https://formative.jmir.org/2025/1/e59230" } @Article{info:doi/10.2196/68792, author="Oyama, Rie and Okuhara, Tsuyoshi and Furukawa, Emi and Okada, Hiroko and Kiuchi, Takahiro", title="Quality Assessment of Medical Institutions' Websites Regarding Prescription Drug Misuse of Glucagon-Like Peptide-1 Receptor Agonists by Off-Label Use for Weight Loss: Website Evaluation Study", journal="JMIR Form Res", year="2025", month="Jan", day="1", volume="9", pages="e68792", keywords="prescription drug misuse", keywords="GLP-1 receptor agonists", keywords="off-label use", keywords="weight loss", keywords="information quality", keywords="DISCERN", keywords="web-based information", keywords="information provision", keywords="misinformation", keywords="advertising guidelines", keywords="exaggerated advertisements", abstract="Background: Misuse of glucagon-like peptide-1 receptor agonists (GLP-1RAs) has emerged globally as individuals increasingly use these drugs for weight loss because of unrealistic and attractive body images advertised and shared on the internet. Objective: This study assesses the quality of information and compliance with Japan's medical advertising guidelines on the websites of medical institutions that prescribe GLP-1RAs off-label for weight loss. Methods: Websites were identified by searching Google and Yahoo! by using keywords related to GLP-1RAs and weight loss in August 2024. The quality of information on these websites was assessed using the DISCERN instrument. To comply with Japan's medical advertising guidelines, we evaluated whether the 5 mandatory items for advertisements of self-paid medical treatments involving the off-label use of drugs were stated and whether there were any exaggerated claims. The content of the exaggerated advertisements was categorized into themes. Results: Of the 87 websites included, only 1 website stated all 5 mandatory items. Websites listing ``ineligible for the relief system for sufferers from adverse drug reactions'' had the lowest percentage at 9\% (8/87), while 83\% (72/87) of the websites listed exaggerated advertisements. Approximately 69\% (60/87) of the websites suggested that no exercise or dietary therapy was required, 24\% (21/87) suggested that using GLP-1RAs is a natural and healthy method, and 31\% (27/87) of the websites provided the author's personal opinions on the risks of using GLP-1RAs. The mean total DISCERN score for all 87 websites was 32.6 (SD 5.5), indicating low quality. Only 1 website achieved a good rating, and 9 websites were rated as fair. The majority of the websites were rated as poor (72 websites) or very poor (5 websites). Conclusions: We found that the quality of information provided by the websites of medical institutions prescribing GLP-1RAs off-label for weight loss was very low and that many websites violated Japan's medical advertising guidelines. The prevalence of exaggerated advertisements, which may lead consumers to believe that they can lose weight without dietary or exercise therapy, suggests the risk of GLP-1RA misuse among consumers. Public institutions and health care providers should monitor and regulate advertisements that violate guidelines and provide accurate information regarding GLP-1RAs, obesity, and weight loss. ", doi="10.2196/68792", url="https://formative.jmir.org/2025/1/e68792" } @Article{info:doi/10.2196/58389, author="Denny, Alanna and Ndemera, Isaach and Chirwa, Kingston and Wu, Shu Joseph Tsung and Chirambo, Baxter Griphin and Yosefe, Simeon and Chilima, Ben and Kagoli, Matthew and Lee, Hsin-yi and Yu, Joseph Kwong Leung and O'Donoghue, John", title="Evaluation of the Development, Implementation, Maintenance, and Impact of 3 Digital Surveillance Tools Deployed in Malawi During the COVID-19 Pandemic: Protocol for a Modified Delphi Expert Consensus Study", journal="JMIR Res Protoc", year="2024", month="Dec", day="31", volume="13", pages="e58389", keywords="delphi study", keywords="COVID-19", keywords="Malawi", keywords="surveillance", keywords="digital health", keywords="delphi", keywords="mobile health", keywords="mHealth", keywords="development", keywords="implementation", keywords="maintenance", keywords="impact", keywords="consensus", keywords="protocol", keywords="survey", keywords="expert", keywords="purposive sampling", keywords="epidemiology", keywords="descriptive statistics", abstract="Background: The COVID-19 pandemic has highlighted the importance of strengthening national monitoring systems to safeguard a globally connected society, especially those in low- and middle-income countries. Africa's rapid adoption of digital technological interventions created a new frontier of digital advancement during crises or pandemics. The use of digital tools for disease surveillance can assist with rapid outbreak identification and response, handling duties such as diagnosis, testing, contact tracing, and risk communication. Malawi was one of the first countries in the region to launch a government-led coordinated effort to harmonize and streamline the necessary COVID-19 digital health implementation through an integrated system architecture. Objective: The aim of this study is to seek expert consensus using the Delphi methodology to examine Malawi's COVID-19 digital surveillance response strategy and to assess the digital tools using the World Health Organization mHealth (mobile health) Assessment and Planning for Scale (MAPS) toolkit. Methods: This protocol follows the Guidance on Conducting and REporting DElphi Studies. Participants must have first-hand experience on the design, implementation or maintenance with COVID-19 digital surveillance systems. There will be no restrictions on the level of expertise or years of experience. The panel will consist of approximately 40 participants. We will use a modified Delphi process whereby rounds 1 and 2 will be hosted online by Qualtrics and round 3 will encompass a face-to-face workshop held in Malawi. Consensus will be defined as ?70\% of participants strongly disagree, disagree, or somewhat disagree, or strongly agree, agree, or somewhat agree. During round 3, the face-to-face workshop, participants will be asked to complete, the MAPS toolkit assessment on the digital tool on which they are experts. The MAPS toolkit will enable the panel members to assess the digital tools from a sustainable perspective from six distinct, yet complementary axes: (1) groundwork, (2) partnerships, (3) financial health, (4) technology and architecture, (5) operations, and (6) monitoring and evaluation. Results: The ability of a country to collate, diagnose, monitor, and analyze data forms the cornerstone of an efficient surveillance system, allowing countries to plan and implement appropriate control actions. Malawi was one of the first countries in the African region to launch a government-led coordinated effort to harmonize and streamline the necessary COVID-19 digital health implementation through an integrated system architecture. Conclusions: We anticipate findings from this Delphi study will provide insights into how and why Malawi was successful in deploying digital surveillance systems. In addition, findings should produce recommendations and guidance for the rapid development, implementation, maintenance, and impact of digital surveillance tools during a health crisis. International Registered Report Identifier (IRRID): DERR1-10.2196/58389 ", doi="10.2196/58389", url="https://www.researchprotocols.org/2024/1/e58389" } @Article{info:doi/10.2196/54506, author="Montoya, Alana and Mao, Lingchao and Drewnowski, Adam and Chen, Joshua and Shi, Ella and Liang, Aileen and Weiner, J. Bryan and Su, Yanfang", title="Influencers in Policy Fields on Social Media: Global Longitudinal Study of Dietary Sodium Reduction Posts, 2006-2022", journal="J Med Internet Res", year="2024", month="Dec", day="30", volume="26", pages="e54506", keywords="policy field", keywords="sodium intake", keywords="sodium consumption", keywords="cardiovascular disease", keywords="social media", keywords="health education", keywords="health promotion", keywords="dissemination", keywords="influence", keywords="Twitter", keywords="X", keywords="activity", keywords="priority", keywords="originality", keywords="popularity", abstract="Background: Excessive sodium intake is a major concern for global public health. Despite multiple dietary guidelines, population sodium intakes are above recommended levels. Lack of health literacy could be one contributing issue and contemporary health literacy is largely shaped by social media. Objective: This study aims to quantify the posting behaviors and influence patterns on dietary sodium--related content by influencers in the policy field on X (formerly Twitter) across time. Methods: We first identified X users with a scope of work related to dietary sodium and retrieved their posts (formerly Tweets) from 2006 to 2022. Users were categorized into the policy groups of outer-setting organization, inner-setting organization, or individual, based on their role in the conceptual policy field. Network analysis was used to analyze interactions among users and identify the top influencers in each policy group. A 4D influence framework was applied to measure the overall influence, activity, priority, originality, and popularity scores. These measures were used to reveal the user-level, group-level, and temporal patterns of sodium-related influence. Results: We identified 78 users with content related to dietary sodium, with 1,099,605 posts in total and 14,732 dietary sodium posts. There was an increasing volume of sodium posts from 2010 to 2015; however, the trend has been decreasing since 2016, especially among outer-setting organizations. The top influencers from the three policy groups were the World Health Organization (WHO), the American Heart Association, and Tom Frieden. Simon Capewell and the WHO ranked the highest in activity; the World Action on Salt, Sugar, and Health and Action on Salt had the highest priority for dietary sodium content; General Mills and Tom Frieden had the highest originality; and WHO, Harvard University School of Medicine, and Tom Frieden received the highest popularity. Outer-setting organizations tend to interact with more users in the network compared to inner-setting organizations and individuals, while inner-setting organizations tend to receive more engagements from other users in the network than the other two groups. Monthly patterns showed a significant peak in the number of sodium posts in March compared with other months. Conclusions: Despite the increased use of social media, recent trends of sodium intake education on social media are decreasing and the priority of sodium among other topics is low. To improve policy implementation effectiveness and meet recommended dietary targets, there is an increasing need for health leaders to consistently and collectively advocate for sodium intake reduction on social media. ", doi="10.2196/54506", url="https://www.jmir.org/2024/1/e54506" } @Article{info:doi/10.2196/65124, author="Srithanaviboonchai, Kriengkrai and Yingyong, Thitipong and Tasaneeyapan, Theerawit and Suparak, Supaporn and Jantaramanee, Supiya and Roudreo, Benjawan and Tanpradech, Suvimon and Chuayen, Jarun and Kanphukiew, Apiratee and Naiwatanakul, Thananda and Aungkulanon, Suchunya and Martin, Michael and Yang, Chunfu and Parekh, Bharat and Northbrook, Chen Sanny", title="Establishment, Implementation, Initial Outcomes, and Lessons Learned from Recent HIV Infection Surveillance Using a Rapid Test for Recent Infection Among Persons Newly Diagnosed With HIV in Thailand: Implementation Study", journal="JMIR Public Health Surveill", year="2024", month="Dec", day="26", volume="10", pages="e65124", keywords="rapid test", keywords="surveillance", keywords="HIV", keywords="AIDS", keywords="diagnosis", keywords="Thailand", keywords="men who have sex with men", keywords="RITA", keywords="human immunodeficiency virus", keywords="acquired immune deficiency syndrome", keywords="transgender", keywords="recent infection testing algorithm", abstract="Background: A recent infection testing algorithm (RITA) incorporating case surveillance (CS) with the rapid test for recent HIV infection (RTRI) was integrated into HIV testing services in Thailand as a small-scale pilot project in October 2020. Objective: We aimed to describe the lessons learned and initial outcomes obtained after the establishment of the nationwide recent HIV infection surveillance project from April through August 2022. Methods: We conducted desk reviews, developed a surveillance protocol and manual, selected sites, trained staff, implemented surveillance, and analyzed outcomes. Remnant blood specimens of consenting newly diagnosed individuals were tested using the Asant{\'e} HIV-1 Rapid Recency Assay. The duration of HIV infection was classified as RTRI-recent or RTRI-long-term. Individuals testing RTRI-recent with CD4 counts <200 cells/mm3 or those having opportunistic infections were classified as RITA-CS-long-term. Individuals testing RTRI-recent with CD4 counts >200 cells/mm3, no opportunistic infections, and not on antiretroviral treatment were classified as RITA-CS-recent. Results: Two hundred and one hospitals in 14 high-burden HIV provinces participated in the surveillance. Of these, 69 reported ?1 HIV diagnosis during the surveillance period. Of 1053 newly diagnosed cases, 64 (6.1\%) were classified as RITA-CS-recent. On multivariate analysis, self-reporting as transgender women (adjusted odds ratio [AOR] 7.41, 95\% CI 1.59?34.53) and men who have sex with men (AOR 2.59, 95\% CI 1.02?6.56) compared to heterosexual men, and students compared to office workers or employers (AOR 3.76, 95\% CI 1.25?11.35) were associated with RITA-CS-recent infection. The proper selection of surveillance sites, utilizing existing surveillance tools and systems, and conducting frequent follow-up and supervision visits were the most commonly cited lessons learned to inform the next surveillance phase. Conclusions: Recent HIV infection surveillance can provide an understanding of current epidemiologic trends to inform HIV prevention interventions to interrupt ongoing or recent HIV transmission. The key success factors of the HIV recent infection surveillance in Thailand include a thorough review of the existing HIV testing service delivery system, a streamlined workflow, strong laboratory and health services, and regular communication between sites and the Provincial Health Offices. ", doi="10.2196/65124", url="https://publichealth.jmir.org/2024/1/e65124" } @Article{info:doi/10.2196/55300, author="Peerawong, Thanarpan and Phenwan, Tharin and Makita, Meiko and Supanichwatana, Sojirat and Puttarak, Panupong and Siammai, Naowanit and Sunthorn, Prakaidao", title="Evaluating Online Cannabis Health Information for Thai Breast Cancer Survivors Using the Quality Evaluation Scoring Tool (QUEST): Mixed Method Study", journal="JMIR Cancer", year="2024", month="Dec", day="24", volume="10", pages="e55300", keywords="cannabis", keywords="medical cannabis", keywords="Thailand", keywords="critical discourse analysis", keywords="mixed method study", keywords="breast cancer", keywords="digital literacy", keywords="legislation", keywords="health literacy", abstract="Background: Following medical cannabis legalization in Thailand in 2019, more people are seeking medical cannabis--related information, including women living with breast cancer. The extent to which they access cannabis-related information from internet sources and social media platforms and the quality of such content are relatively unknown and need further evaluation. Objective: This study aims to analyze the factors determining cannabis-related content quality for breast cancer care from internet sources and on social media platforms and examine the characteristics of such content accessed and consumed by Thai breast cancer survivors. Methods: A mixed methods study was conducted between January 2021 and May 2022, involving a breast cancer survivor support group. The group identified medical cannabis--related content from frequently accessed internet sources and social media platforms. The contents were categorized based on content creators, platforms, content category, and upload dates. Four researchers used the Quality Evaluation Scoring Tool (QUEST) to assess content quality, with scores ranging from 0 to 28. Contents were expert-rated as either high or poor. The QUEST interobserver reliability was analyzed. Receiver-operating characteristic curve analysis with the Youden index was used to determine the QUEST score cut-off point. Statistical significance was set at P<.05. Fairclough Critical Discourse Analysis was undertaken to examine the underlying discourses around poor-quality content. Results: Sixty-two Thai-language cannabis-related items were evaluated. The content sources were categorized as follows: news channels (21/62, 34\%), government sources (16/62, 26\%), health care providers (12/62, 19\%), and alternative medicine providers (12/62, 19\%). Most of the contents (30/62, 48\%) were uploaded to YouTube, whereas 31\% (19/62) appeared on websites and Facebook. Forty of 62 content items (64\%) were news-related and generic cannabis advertisements while 8 of 62 (13\%) content items had no identifiable date. The interobserver QUEST score correlation was 0.86 (P<.001). The mean QUEST score was 12.1 (SD 7.6). Contents were considered ``high'' when the expert rating was >3. With a QUEST score of 15 as the threshold, the sensitivity and specificity for differentiating between high and poor content quality were 81\% and 98\%, respectively. Content creation was the only significant factor between high- and poor-quality content. Poor-quality contents were primarily created by alternative medicine providers and news channels. Two discourses were identified: advocacy for cannabis use normalization and cannabis romanticization as a panacea. These discourses overly normalize and romanticize the use of cannabis, focusing on indications and instructions for cannabis use, and medical cannabis promotion, while neglecting discussions on cannabis contraindications and potential side effects. Conclusions: The varying quality of medical cannabis--related information on internet sources and social media platforms accessed and shared by Thai breast cancer survivors is an issue of concern. Given that content creators are the sole predictive factors of high content quality, future studies should examine a wider range of cannabis-related sources accessible to both the public and patients to gain a more comprehensive understanding of the issue. ", doi="10.2196/55300", url="https://cancer.jmir.org/2024/1/e55300" } @Article{info:doi/10.2196/55376, author="Swets, C. Maaike and Kerr, R. Steven and MacKenna, Brian and Fisher, Louis and van Wijnen, Merel and Brandwagt, Diederik and Schenk, W. Paul and Fraaij, Pieter and Visser, G. Leonardus and Bacon, Sebastian and Mehrkar, Amir and Nichol, Alistair and Twomey, Patrick and Matthews, C. Philippa and and Semple, G. Malcolm and Groeneveld, H. Geert and Goldacre, Ben and Jones, Iain and Baillie, Kenneth J.", title="Using Laboratory Test Results for Surveillance During a New Outbreak of Acute Hepatitis in 3-Week- to 5-Year-Old Children in the United Kingdom, the Netherlands, Ireland, and Cura{\c{c}}ao: Observational Cohort Study", journal="JMIR Public Health Surveill", year="2024", month="Dec", day="23", volume="10", pages="e55376", keywords="pediatric hepatitis", keywords="disease surveillance", keywords="outbreak detection", keywords="pandemic preparedness", keywords="acute hepatitis", keywords="children", keywords="data analytics", keywords="hospital", keywords="laboratory", keywords="all age groups", keywords="pre-pandemic", keywords="United Kingdom", keywords="Netherlands", keywords="Ireland Curacao", keywords="single center", keywords="federated analytics", keywords="pandemic surveillance", keywords="outbreaks", keywords="public health", abstract="Background: In March 2022, a concerning rise in cases of unexplained pediatric hepatitis was reported in multiple countries. Cases were defined as acute hepatitis with serum transaminases >500 U/L (aspartate transaminase [AST] or alanine transaminase [ALT]) in children aged 16 years or younger. We explored a simple federated data analytics method to search for evidence of unreported cases using routinely held data. We conducted a pragmatic survey to analyze changes in the proportion of hospitalized children with elevated AST or ALT over time. In addition, we studied the feasibility of using routinely collected clinical laboratory results to detect or follow-up the outbreak of an infectious disease. Objective: We explored a simple federated data analytics method to search for evidence of unreported cases using routinely held data. Methods: We provided hospitals with a simple computational tool to enable laboratories to share nondisclosive summary-level data. Summary statistics for AST and ALT measurements were collected from the last 10 years across all age groups. Measurements were considered elevated if ALT or AST was >200 U/L. The rate of elevated AST or ALT test for 3-week- to 5-year-olds was compared between a period of interest in which cases of hepatitis were reported (December 1, 2021, to August 31, 2022) and a prepandemic baseline period (January 1, 2012, to December 31, 2019). We calculated a z score, which measures the extent to which the rate for elevated ALT or AST was higher or lower in the period of interest compared to a baseline period, for the 3-week- to 5-year-olds. Results: Our approach of sharing a simple software tool for local use enabled rapid, federated data analysis. A total of 34 hospitals in the United Kingdom, the Netherlands, Ireland, and Cura{\c{c}}ao were asked to contribute summary data, and 30 (88\%) submitted their data. For all locations combined, the rate of elevated AST or ALT measurements in the period of interest was not elevated (z score=?0.46; P=.64). Results from individual regions were discordant, with a higher rate of elevated AST or ALT values in the Netherlands (z score=4.48; P<.001), driven by results from a single center in Utrecht. We did not observe any clear indication of changes in primary care activity or test results in the same period. Conclusions: Hospital laboratories collect large amounts of data on a daily basis that can potentially be of use for disease surveillance, but these are currently not optimally used. Federated analytics using nondisclosive, summary-level laboratory data sharing was successful, safe, and efficient. The approach holds potential as a tool for pandemic surveillance in future outbreaks. Our findings do not indicate the presence of a broader outbreak of mild hepatitis cases among young children, although there was an increase in elevated AST or ALT values locally in the Netherlands. ", doi="10.2196/55376", url="https://publichealth.jmir.org/2024/1/e55376" } @Article{info:doi/10.2196/53585, author="Abogazalah, Naif and Yiannoutsos, Constantin and Soto-Rojas, E. Armando and Bindayeld, Naif and Yepes, F. Juan and Martinez Mier, Angeles Esperanza", title="Distal and Proximal Influences on Self-Reported Oral Pain and Self-Rated Oral Health Status in Saudi Arabia: Retrospective Study Using a 2017 Nationwide Database", journal="JMIR Public Health Surveill", year="2024", month="Dec", day="20", volume="10", pages="e53585", keywords="dental health surveys", keywords="nationwide database", keywords="public health dentistry", keywords="path analysis", keywords="oral health influences", keywords="oral pain", keywords="self-rated oral health", keywords="cross-sectional study", keywords="dental health", keywords="dentistry", keywords="oral health", keywords="self-reported", keywords="retrospective study", keywords="Saudi Arabia", keywords="proximal", keywords="distal", keywords="adult", keywords="children", keywords="youth", keywords="adolescent", keywords="teen", keywords="sociodemographic", abstract="Background: Oral health significantly influences overall well-being, health care costs, and quality of life. In Saudi Arabia, the burden of oral diseases, such as dental caries and periodontal disease, has increased over recent decades, driven by various lifestyle changes. Objective: To explore the associations between proximal (direct) and distal (indirect) influences that affect oral pain (OP) and self-rated oral health (SROH) status in the Kingdom of Saudi Arabia (KSA) using an adapted conceptual framework. Methods: This retrospective cross-sectional study used data from a national health survey conducted in KSA in 2017. The sample included adults (N=29,274), adolescents (N=9910), and children (N=11,653). Sociodemographic data, health characteristics, and access to oral health services were considered distal influences, while frequency and type of dental visits, tooth brushing frequency, smoking, and consumption of sweets and soft drinks were considered proximal influences. Path analysis modeling was used to estimate the direct, indirect, and total effects of proximal and distal influences on OP and SROH status. Results: The mean age of adult respondents was 42.2 years; adolescents, 20.4 years; and children, 10.58 years. Despite OP reports from 39\% of children, 48.5\% of adolescents, and 47.1\% of adults, over 87\% across all groups rated their oral health as good, very good, or excellent. A higher frequency of tooth brushing showed a strong inverse relationship with OP and a positive correlation with SROH (P<.001). Frequent dental visits were positively associated with OP and negatively with SROH (P<.001). Sweet consumption increased OP in adolescents ($\beta$=0.033, P=.007) and negatively affected SROH in children ($\beta$=--0.086, P<.001), adolescents ($\beta$=--0.079, P<.001), and adults ($\beta$=--0.068, P<.001). Soft drink consumption, however, was associated with lower OP in adolescents ($\beta$=--0.034, P=.005) and improved SROH in adolescents ($\beta$=0.063, P<.001) and adults ($\beta$=0.068, P<.001). Smoking increased OP in adults ($\beta$=0.030, P<.001). Distal influences like higher education were directly linked to better SROH ($\beta$=0.046, P=.003) and less OP (indirectly through tooth brushing, $\beta$=--0.004, P<.001). For children, high household income correlated with less OP ($\beta$=--0.030, P=.02), but indirectly increased OP through other pathways ($\beta$=0.024, P=.003). Lack of access was associated with negative oral health measures (P<.001). Conclusions: Among the KSA population, OP and SROH were directly influenced by many proximal and distal influences that had direct, indirect, or combined influences on OP and SROH status. ", doi="10.2196/53585", url="https://publichealth.jmir.org/2024/1/e53585", url="http://www.ncbi.nlm.nih.gov/pubmed/39706582" } @Article{info:doi/10.2196/52651, author="Ahmed, Furqan and Ahmad, Ghufran and Eisinger, Katharina and Khan, Asad Muhammad and Brand, Tilman", title="Promoting Comprehensive Sexuality Education in Pakistan Using a Cocreated Social Media Intervention: Development and Pilot Testing Study", journal="JMIR Form Res", year="2024", month="Dec", day="20", volume="8", pages="e52651", keywords="digital health interventions", keywords="sexuality education", keywords="social media", keywords="influencer marketing", keywords="community readiness", abstract="Background: Comprehensive sexuality education (CSE) is a curriculum-based approach to learning and teaching about sexuality that focuses on the cognitive, emotional, physical, and social domains. The United Nations Educational, Scientific, and Cultural Organization (UNESCO) CSE guideline emphasizes gender issues and is firmly rooted in a human rights--based approach to sexuality. A recent cross-sectional community readiness assessment in Islamabad, Pakistan, found that the community is at the denial or resistant stage when it comes to implementing school-based sexuality education. The reluctance was attributed to a lack of understanding and widespread misconceptions about CSE. Objective: This study aims to use the cocreation process to develop, pilot, and evaluate an intervention based on community readiness level to respond to community resistance by introducing CSE content, its anticipated benefits, and addressing prevalent misconceptions through awareness and promotion content for digital social media platforms. Methods: For the development of the intervention (audio-video content), focus group discussion sessions with key stakeholders were held. Two videos were created in partnership with social media influencers and subsequently shared on Facebook, YouTube, and Instagram. A comprehensive process and performance evaluation of the videos and intervention development phase was conducted to evaluate audience exposure, reach, engagement, demographics, retention, and in-depth insights. The videos were uploaded to social media platforms in June and July 2021, and the data used to assess their performance was obtained in February 2022. Results: With a total reach (number of people who have contact with the videos) of 432,457 and 735,563 for the first and second videos, respectively, on all social media platforms, we concluded that social media platforms provide an opportunity to communicate, promote, and engage with important stakeholders to raise awareness and obtain support for CSE. According to the findings, the public is responsive to CSE promotion content developed for social media platforms, with a total engagement (the number of people who participate in creating, sharing, and using the content) of 11,578. The findings revealed that male viewers predominated across all social media platforms. Punjab province had the largest audience share on Instagram (51.9\% for the first video, 52.7\% for the second) and Facebook (44.3\% for the first video and 48.4\% for the second). YouTube had the highest audience retention, with viewers watching an average of 151 seconds (45\%) of the first video and 163 seconds (38\%) of the second. With a net sentiment score of 0.83 (minimum=?3, maximum=5), end-user participation was also positive, and audience feedback highlighted the reasons for positive and negative criticism. Conclusions: To promote sexuality education in Pakistan, it is vital to overcome opposition through sensitizing the society, and digital social media platforms offer a unique, though underused, chance to do so through reliable influencer marketing. ", doi="10.2196/52651", url="https://formative.jmir.org/2024/1/e52651" } @Article{info:doi/10.2196/51493, author="Grover, Ashoo and Nair, Saritha and Sharma, Saurabh and Gupta, Shefali and Shrivastava, Suyesh and Singh, Pushpendra and Kanungo, Srikanta and Ovung, Senthanro and Singh, Charan and Khan, Mabood Abdul and Sharma, Sandeep and Palo, Kumar Subrata and Chakma, Tapas and Bajaj, Anjali", title="Strengthening Cause of Death Statistics in Selected Districts of 3 States in India: Protocol for an Uncontrolled, Before-After, Mixed Method Study", journal="JMIR Res Protoc", year="2024", month="Dec", day="20", volume="13", pages="e51493", keywords="cause of death", keywords="Medical Certification of Cause of Death", keywords="capacity building", keywords="Civil Registration and Vital Statistics", keywords="training", abstract="Background: Mortality statistics are vital for health policy development, epidemiological research, and health care service planning. A robust surveillance system is essential for obtaining vital information such as cause of death (CoD) information. Objective: This study aims to develop a comprehensive model to strengthen the CoD information in the selected study sites. The specific objectives are (1) to identify the best practices and challenges in the functioning of the Civil Registration and Vital Statistics (CRVS) system with respect to mortality statistics and CoD information; (2) to develop and implement interventions to strengthen the CoD information; (3) to evaluate the quality improvement of the Medical Certification of Cause of Death (MCCD); and (4) to improve the CoD information at the population level through verbal autopsy for noninstitutional deaths in the selected study sites. Methods: An uncontrolled, before-after, mixed method study will be conducted in 3 blocks located in the districts of 3 states (Madhya Pradesh, Uttar Pradesh, and Odisha) in India. A baseline assessment to identify the best practices and challenges in the functioning of the CRVS system, along with a quality assessment of the MCCD, will be conducted. An intervention informed by existing literature and the baseline assessment will be developed and implemented in the study sites. The major components of intervention will include a Training of Trainers workshop, orientation of stakeholders in the functioning of the CRVS system, training of physicians and medical officers in the MCCD, and training of community health workers in World Health Organization Verbal Autopsy 2022 instrument. Postintervention evaluation will be carried out to assess the impact made by the intervention on the availability and quality improvement of CoD information in the selected study sites. The outcome will be measured in terms of the quality improvement of the MCCD and the availability of CoD information at population level through verbal autopsy in the selected study sites. Results: The project has been funded, and regulatory approval has been obtained from the Institutional Ethics Committee. The data collection process began in May 2023. The duration of the study will be for 24 months. Conclusions: Our study is expected to provide a valuable contribution toward strengthening CoD information, which could be helpful for policy making and further research. The intervention model will be developed in collaboration with the existing functionaries of the health and CRVS systems in the selected study sites that are engaged in reporting and recording CoD information; this will ensure sustainability and provide lessons for upscaling, with the aim to improve the reporting of CoD information in the country. International Registered Report Identifier (IRRID): DERR1-10.2196/51493 ", doi="10.2196/51493", url="https://www.researchprotocols.org/2024/1/e51493" } @Article{info:doi/10.2196/59968, author="Colder Carras, Michelle and Aljuboori, Dahlia and Shi, Jing and Date, Mayank and Karkoub, Fatima and Garc{\'i}a Ortiz, Karla and Abreha, Molla Fasika and Thrul, Johannes", title="Prevention and Health Promotion Interventions for Young People in the Context of Digital Well-Being: Rapid Systematic Review", journal="J Med Internet Res", year="2024", month="Dec", day="18", volume="26", pages="e59968", keywords="digital well-being", keywords="internet addiction", keywords="gaming disorder", keywords="social media", keywords="screen time", keywords="prevention", keywords="children", keywords="adolescents", keywords="mobile phone", keywords="PRISMA", abstract="Background: Increasing digital technology and media use among young people has raised concerns about problematic use and negative consequences. The formal recognition of a technology addiction (eg, gaming disorder) requires an understanding of the landscape of interventions designed to prevent this disorder and related technology addictions. Objective: We conducted a rapid systematic review to investigate the current evidence on approaches to prevent problematic technology use and promote digital well-being, defined as the healthy use of digital media and technology and the absence of problems resulting from excessive use. Methods: We used a pragmatic and rapid approach to systematically review and synthesize recent literature with a focus on contextual factors that can aid in understanding translatability, making trade-offs appropriate for rapid reviews per the Cochrane Collaboration guidelines. We searched multiple databases, including gray literature, for primary studies and systematic reviews of prevention interventions targeting children, adolescents, and youth. We extracted data on study characteristics, quality, and translatability and synthesized evidence through narrative description and vote counting of controlled trials. Data are openly available on our Open Science Framework website. Results: We found 6416 citations, of which 41 (0.64\%) were eligible for inclusion (6 reviews and 35 primary studies of 33 interventions). Most interventions (26/33, 79\%) combined intervention approaches and included an education component. Synthesis through vote counting showed benefits for all forms of digital well-being. Both included meta-analyses reported small positive effects on reductions of screen time. However, study reporting was overall lacking, impairing the ability to draw conclusions. Conclusions: As digital technology use increases, interventions to prevent problematic technology use and promote digital well-being continue to proliferate. Understanding context factors that influence healthy technology use and understanding the limitations of the current evidence are vital for informing future research. This review demonstrates positive findings for the effectiveness of prevention interventions and describes factors that may contribute to translation and implementation. Future research would benefit from following appropriate reporting guidelines, reporting both the benefits and harms of interventions, and including greater detail on factors informing translation. Trial Registration: PROSPERO CRD42023444387; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=444387 ", doi="10.2196/59968", url="https://www.jmir.org/2024/1/e59968", url="http://www.ncbi.nlm.nih.gov/pubmed/39693138" } @Article{info:doi/10.2196/65093, author="Virachith, Siriphone and Phakhounthong, Khanxayaphone and Khounvisith, Vilaysone and Mayxay, Mayfong and Kounnavong, Sengchanh and Sayasone, Somphou and H{\"u}bschen, M. Judith and Black, P. Antony", title="Hepatitis B Virus Exposure, Seroprotection Status, and Susceptibility in Health Care Workers From Lao People's Democratic Republic: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Dec", day="17", volume="10", pages="e65093", keywords="hepatitis B", keywords="hepatitis D", keywords="health care workers", keywords="Laos", keywords="prevalence", abstract="Background: Despite the high prevalence of chronic hepatitis B virus (HBV) infection in adults in Lao People's Democratic Republic (Lao PDR), Lao health care workers (HCWs) have previously been shown to have low levels of protection against infection. Furthermore, the prevalence of hepatitis D virus (HDV), which increases disease severity in individuals infected with HBV, is not known in Lao PDR. Objective: This study aimed to estimate the exposure and seroprotection against HBV, as well as exposure to HDV, in Lao HCWs from 5 provinces. Methods: In 2020, a total of 666 HCWs aged 20 to 65 years from 5 provinces of Lao PDR were recruited, and their sera were tested by enzyme-linked immunosorbent assay to determine their HBV and HDV coinfection status. Results: HBV exposure, as indicated by the presence of anti--hepatitis B core antibodies, was 40.1\% (267/666) overall and significantly higher for HCWs from Oudomxay province (21/31, 67.7\%; adjusted odds ratio 3.69, 95\% CI 1.68?8.12; P=.001). The prevalence of hepatitis B surface antigen was 5.4\% (36/666) overall and increased with age, from 3.6\% (9/248) in those aged ?30 years to 6.8\% (8/118) in those aged ?50 years. Only 28.7\% (191/666) of participants had serological indication of immunization. We could find no evidence for HDV exposure in this study. Conclusions: The study found intermediate hepatitis B surface antigen prevalence among HCWs in Lao PDR, with no evidence of HDV coinfection. Notably, a significant proportion of HCWs remains susceptible to HBV, indicating a substantial gap in seroprotection against the disease. ", doi="10.2196/65093", url="https://publichealth.jmir.org/2024/1/e65093" } @Article{info:doi/10.2196/63146, author="Nie, Jia and Huang, Tian and Sun, Yuhong and Peng, Zutong and Dong, Wenlong and Chen, Jiancheng and Zheng, Di and Guo, Fuyin and Shi, Wenhui and Ling, Yuewei and Zhao, Weijia and Yang, Haijun and Shui, Tiejun and Yan, Xiangyu", title="Influence of the Enterovirus 71 Vaccine and the COVID-19 Pandemic on Hand, Foot, and Mouth Disease in China Based on Counterfactual Models: Observational Study", journal="JMIR Public Health Surveill", year="2024", month="Dec", day="17", volume="10", pages="e63146", keywords="hand, foot, and mouth disease", keywords="vaccination", keywords="enterovirus 71", keywords="COVID-19", keywords="epidemical trend", keywords="HFMD", keywords="EV71", abstract="Background: Hand, foot, and mouth disease (HFMD) is a highly contagious viral illness. Understanding the long-term trends of HFMD incidence and its epidemic characteristics under the circumstances of the enterovirus 71 (EV71) vaccination program and the outbreak of COVID-19 is crucial for effective disease surveillance and control. Objective: We aim to give an overview of the trends of HFMD over the past decades and evaluate the impact of the EV71 vaccination program and the COVID-19 pandemic on the epidemic trends of HFMD. Methods: Using official surveillance data from the Yunnan Province, China, we described long-term incidence trends and severity rates of HFMD as well as the variation of enterovirus proportions among cases. We conducted the autoregressive integrated moving average (ARIMA) of time series analyses to predict monthly incidences based on given subsets. The difference between the actual incidences and their counterfactual predictions was compared using absolute percentage errors (APEs) for periods after the EV71 vaccination program and the COVID-19 pandemic, respectively. Results: The annual incidence of HFMD fluctuated between 25.62 cases per 100,000 people in 2008 and 221.52 cases per 100,000 people in 2018. The incidence for men ranged from 30 to 250 cases per 100,000 people from 2008 to 2021, which was constantly higher than that for women. The annual incidence for children aged 1 to 2 years old ranged from 54.54 to 630.06 cases per 100,000 people, which was persistently higher than that for other age groups. For monthly incidences, semiannual peaks were observed for each year. All actual monthly incidences of 2014 to 2015 fell within the predicted 95\% CI by the ARIMA(1,0,1)(1,1,0)[12] model. The average APE was 19\% for a 2-year prediction. After the EV71 vaccination program, the actual monthly incidence of HFMD was consistently lower than the counterfactual predictions by ARIMA(1,0,1)(1,1,0)[12], with negative APEs ranging from ?11\% to ?229\% from January 2017 to April 2018. In the meantime, the proportion of EV71 among the enteroviruses causing HFMD decreased significantly, and the proportion was highly correlated (r=0.73, P=.004) with the severity rate. After the onset of the COVID-19 pandemic in 2020, the actual monthly incidence of HFMD consistently maintained a lower magnitude compared to the counterfactual predictions---ARIMA(1,0,1)(0,1,0)[12]---from February to September 2020, with considerable negative APEs (ranging from ?31\% to ?2248\%). Conclusions: EV71 vaccination alleviated severe HFMD cases and altered epidemiological trends. The HFMD may also benefit from nonpharmaceutical interventions during outbreaks such as the COVID-19 pandemic. Further development of a multivalent virus vaccine is crucial for effectively controlling HFMD outbreaks. Policymakers should implement nonpharmaceutical interventions and emphasize personal hygiene for routine prevention when appropriate. ", doi="10.2196/63146", url="https://publichealth.jmir.org/2024/1/e63146" } @Article{info:doi/10.2196/64362, author="Dahu, M. Butros and Khan, Solaiman and Toubal, Eddine Imad and Alshehri, Mariam and Martinez-Villar, I. Carlos and Ogundele, B. Olabode and Sheets, R. Lincoln and Scott, J. Grant", title="Geospatial Modeling of Deep Neural Visual Features for Predicting Obesity Prevalence in Missouri: Quantitative Study", journal="JMIR AI", year="2024", month="Dec", day="17", volume="3", pages="e64362", keywords="geospatial modeling", keywords="deep convolutional neural network", keywords="DCNN", keywords="Residual Network-50", keywords="ResNet-50", keywords="satellite imagery", keywords="Moran I", keywords="local indicators of spatial association", keywords="LISA", keywords="spatial lag model", keywords="obesity rate", keywords="artificial intelligence", keywords="AI", abstract="Background: The global obesity epidemic demands innovative approaches to understand its complex environmental and social determinants. Spatial technologies, such as geographic information systems, remote sensing, and spatial machine learning, offer new insights into this health issue. This study uses deep learning and spatial modeling to predict obesity rates for census tracts in Missouri. Objective: This study aims to develop a scalable method for predicting obesity prevalence using deep convolutional neural networks applied to satellite imagery and geospatial analysis, focusing on 1052 census tracts in Missouri. Methods: Our analysis followed 3 steps. First, Sentinel-2 satellite images were processed using the Residual Network-50 model to extract environmental features from 63,592 image chips (224{\texttimes}224 pixels). Second, these features were merged with obesity rate data from the Centers for Disease Control and Prevention for Missouri census tracts. Third, a spatial lag model was used to predict obesity rates and analyze the association between deep neural visual features and obesity prevalence. Spatial autocorrelation was used to identify clusters of obesity rates. Results: Substantial spatial clustering of obesity rates was found across Missouri, with a Moran I value of 0.68, indicating similar obesity rates among neighboring census tracts. The spatial lag model demonstrated strong predictive performance, with an R2 of 0.93 and a spatial pseudo R2 of 0.92, explaining 93\% of the variation in obesity rates. Local indicators from a spatial association analysis revealed regions with distinct high and low clusters of obesity, which were visualized through choropleth maps. Conclusions: This study highlights the effectiveness of integrating deep convolutional neural networks and spatial modeling to predict obesity prevalence based on environmental features from satellite imagery. The model's high accuracy and ability to capture spatial patterns offer valuable insights for public health interventions. Future work should expand the geographical scope and include socioeconomic data to further refine the model for broader applications in obesity research. ", doi="10.2196/64362", url="https://ai.jmir.org/2024/1/e64362", url="http://www.ncbi.nlm.nih.gov/pubmed/39688897" } @Article{info:doi/10.2196/65095, author="Singh, Rujul and Tetrick, K. Macy and Fisher, L. James and Washington, Peter and Yu, Jane and Paskett, D. Electra and Penedo, J. Frank and Clinton, K. Steven and Benzo, M. Roberto", title="Analysis of Physical Activity Using Wearable Health Technology in US Adults Enrolled in the All of Us Research Program: Multiyear Observational Study", journal="J Med Internet Res", year="2024", month="Dec", day="10", volume="26", pages="e65095", keywords="Physical Activity Guidelines for Americans", keywords="accelerometry", keywords="All of Us Research Program", keywords="wearable activity monitors", keywords="health equity", keywords="multiyear activity tracking", keywords="activity intensity estimation", keywords="US adult population", keywords="sociodemographic determinants of physical activity", keywords="physical activity", keywords="wearables", keywords="United States", keywords="older adults", keywords="observational studies", keywords="longitudinal setting", keywords="sociodemographic determinants", keywords="physical activity data", keywords="Fitbit data", keywords="step-based method", keywords="adherence", abstract="Background: To date, no studies have examined adherence to the 2018 Physical Activity Guidelines for Americans (PAGA) in real-world longitudinal settings using objectively measured activity monitoring data. This study addresses this gap by using commercial activity monitoring (Fitbit) data from the All of Us dataset. Objective: The primary objectives were to describe the prevalence of adherence to the 2018 PAGA and identify associated sociodemographic determinants. Additionally, we compared 3 distinct methods of processing physical activity (PA) data to estimate adherence to the 2008 PAGA. Methods: We used the National Institutes of Health's All of Us dataset, which contains minute-level Fitbit data for 13,947 US adults over a 7-year time span (2015-2022), to estimate adherence to PAGA. A published step-based method was used to estimate metabolic equivalents and assess adherence to the 2018 PAGA (ie, ?150 minutes of moderate- to vigorous-intensity PA per week). We compared the step-based method, the heart rate--based method, and the proprietary Fitbit-developed algorithm to estimate adherence to the 2008 PAGA. Results: The average overall adherence to the 2018 PAGA was 21.6\% (3006/13,947; SE 0.4\%). Factors associated with lower adherence in multivariate logistic regression analysis included female sex (relative to male sex; adjusted odds ratio [AOR] 0.66, 95\% CI 0.60-0.72; P<.001); BMI of 25.0-29.9 kg/m2 (AOR 0.53, 95\% CI 0.46-0.60; P<.001), 30-34.9 kg/m2 (AOR 0.30, 95\% CI 0.25-0.36; P<.001), or ?35 kg/m2 (AOR 0.13, 95\% CI 0.10-0.16; P<.001; relative to a BMI of 18.5-24.9 kg/m2); being aged 30-39 years (AOR 0.66, 95\% CI 0.56-0.77; P<.001), 40-49 years (AOR 0.79, 95\% CI 0.68-0.93; P=.005), or ?70 years (AOR 0.74, 95\% CI 0.62-0.87; P<.001; relative to being 18-29 years); and non-Hispanic Black race or ethnicity (AOR 0.63, 95\% CI 0.50-0.79; P<.001; relative to non-Hispanic White race or ethnicity). The Fitbit algorithm estimated that a larger percentage of the sample (10,307/13,947, 73.9\%; 95\% CI 71.2-76.6) adhered to the 2008 PAGA compared to the heart rate method estimate (4740/13,947, 34\%; 95\% CI 32.8-35.2) and the step-based method (1401/13,947, 10\%; 95\% CI 9.4-10.6). Conclusions: Our results show significant sociodemographic differences in PAGA adherence and notably different estimates of adherence depending on the algorithm used. These findings warrant the need to account for these disparities when implementing PA interventions and the need to establish an accurate and reliable method of using commercial accelerometers to examine PA, particularly as health care systems begin integrating wearable device data into patient health records. ", doi="10.2196/65095", url="https://www.jmir.org/2024/1/e65095" } @Article{info:doi/10.2196/53401, author="Prignitz, Maren and Guldner, Stella and Lehmler, Johann Stephan and Aggensteiner, Pascal-M and Nees, Frauke and ", title="An Ecological Momentary Assessment Approach of Environmental Triggers in the Role of Daily Affect, Rumination, and Movement Patterns in Early Alcohol Use Among Healthy Adolescents: Exploratory Study", journal="JMIR Mhealth Uhealth", year="2024", month="Dec", day="10", volume="12", pages="e53401", keywords="alcohol use", keywords="adolescence", keywords="affect", keywords="rumination", keywords="ecological momentary assessment", keywords="geospatial measures", abstract="Background: Adolescence is a period characterized by an increased susceptibility to developing risky alcohol consumption habits. This susceptibility can be influenced by social and situational factors encountered in daily life, which, in conjunction with emotions and thoughts, contribute to behavioral patterns related to alcohol use even in the early stages of alcohol experimentation, when initial experiences with alcohol are formed, and regular consumption is still evolving. Objective: This study aimed to examine the association between detailed behavioral and movement patterns, along with emotional and cognitive factors, and the early onset of alcohol use in the everyday lives of adolescents. Methods: A total of 65 healthy adolescents (33 male, twenty-nine 14-year-olds, and thirty-six 16-year-olds) underwent mobile-based ecological momentary assessments on alcohol (once a day at 9 AM, assessing alcohol use the day before), positive and negative affect, craving, rumination, and social context (6 prompts/day at 9 AM, 11 AM, 2 PM, 4 PM, 6 PM and 8 PM), type of day (weekdays or weekends, with weekend including Fridays, Saturdays, and Sundays), and using geospatial measures (specifically roaming entropy and number and type of trigger points for alcohol use met) over 14 days. After adjusting for a compliance rate of at least 50\%, 52 participants (26 male and twenty-four 14-year-olds) were included in the analyses. Results: Generalized linear multilevel models revealed that higher positive affect (b=0.685, P=.007), higher rumination (b=0.586, P=.02), and a larger movement radius (roaming entropy) (b=8.126, P=.02) were positively associated with alcohol use on the same day. However, social context (b=--0.076, P=.90), negative affect (b=--0.077, P=.80), or potential trigger points (all P>.05) did not show significant associations. Alcohol use varied depending on the type of day, with more alcohol use on weekends (b=1.082, P<.001) and age (t50=--2.910, P=.005), with 16-year-olds (mean 1.61, SD 1.66) reporting more days of alcohol consumption than 14-year-olds (mean 0.548, SD 0.72). Conclusions: Our findings support previously identified factors as significant contributors to very early and low levels of alcohol consumption through fine-grained analysis of daily behaviors. These factors include positive affect, rumination, weekend days, and age. In addition, we emphasize that exploratory environmental movement behavior (roaming entropy) is also significantly associated with adolescent alcohol use, highlighting its importance as an additional factor. ", doi="10.2196/53401", url="https://mhealth.jmir.org/2024/1/e53401" } @Article{info:doi/10.2196/55712, author="Portillo-Van Diest, Ana and Mortier, Philippe and Ballester, Laura and Amigo, Franco and Carrasco, Paula and Falc{\'o}, Raquel and Gili, Margalida and Kiekens, Glenn and H Machancoses, Francisco and Piqueras, A. Jose and Rebagliato, Marisa and Roca, Miquel and Rodr{\'i}guez-Jim{\'e}nez, T{\'i}scar and Alonso, Jordi and Vilagut, Gemma", title="Ecological Momentary Assessment of Mental Health Problems Among University Students: Data Quality Evaluation Study", journal="J Med Internet Res", year="2024", month="Dec", day="10", volume="26", pages="e55712", keywords="experience sampling method", keywords="ecological momentary assessment", keywords="mental health", keywords="university students", keywords="participation", keywords="compliance", keywords="reliability", keywords="sensitivity analysis", keywords="mobile phone", abstract="Background: The use of ecological momentary assessment (EMA) designs has been on the rise in mental health epidemiology. However, there is a lack of knowledge of the determinants of participation in and compliance with EMA studies, reliability of measures, and underreporting of methodological details and data quality indicators. Objective: This study aims to evaluate the quality of EMA data in a large sample of university students by estimating participation rate and mean compliance, identifying predictors of individual-level participation and compliance, evaluating between- and within-person reliability of measures of negative and positive affect, and identifying potential careless responding. Methods: A total of 1259 university students were invited to participate in a 15-day EMA study on mental health problems. Logistic and Poisson regressions were used to investigate the associations between sociodemographic factors, lifetime adverse experiences, stressful events in the previous 12 months, and mental disorder screens and EMA participation and compliance. Multilevel reliability and intraclass correlation coefficients were obtained for positive and negative affect measures. Careless responders were identified based on low compliance or individual reliability coefficients. Results: Of those invited, 62.1\% (782/1259) participated in the EMA study, with a mean compliance of 76.9\% (SD 27.7\%). Participation was higher among female individuals (odds ratio [OR] 1.41, 95\% CI 1.06-1.87) and lower among those aged ?30 years (OR 0.20, 95\% CI 0.08-0.43 vs those aged 18-21 years) and those who had experienced the death of a friend or family member in the previous 12 months (OR 0.73, 95\% CI 0.57-0.94) or had a suicide attempt in the previous 12 months (OR 0.26, 95\% CI 0.10-0.64). Compliance was particularly low among those exposed to sexual abuse before the age of 18 years (exponential of $\beta$=0.87) or to sexual assault or rape in the previous year (exponential of $\beta$=0.80) and among those with 12-month positive alcohol use disorder screens (exponential of $\beta$=0.89). Between-person reliability of negative and positive affect was strong (RkRn>0.97), whereas within-person reliability was fair to moderate (Rcn>0.43). Of all answered assessments, 0.86\% (291/33,626) were flagged as careless responses because the response time per item was <1 second or the participants gave the same response to all items. Of the participants, 17.5\% (137/782) could be considered careless responders due to low compliance (<25/56, 45\%) or very low to null individual reliability (raw Cronbach $\alpha$<0.11) for either negative or positive affect. Conclusions: Data quality assessments should be carried out in EMA studies in a standardized manner to provide robust conclusions to advance the field. Future EMA research should implement strategies to mitigate nonresponse bias as well as conduct sensitivity analyses to assess possible exclusion of careless responders. ", doi="10.2196/55712", url="https://www.jmir.org/2024/1/e55712", url="http://www.ncbi.nlm.nih.gov/pubmed/39657180" } @Article{info:doi/10.2196/58581, author="Mora Pinzon, Maria and Hills, Ornella and Levy, George and James, T. Taryn and Benitez, Ashley and Lawrence, Sacheen and Ellis, Tiffany and Washington, Venus and Solorzano, Lizbeth and Tellez-Giron, Patricia and Cano Ospina, Fernando and Metoxen, F. Melissa and Gleason, E. Carey", title="Implementation of a Social Media Strategy for Public Health Promotion in Black, American Indian or Alaska Native, and Hispanic or Latino Communities During the COVID-19 Pandemic: Cross-Sectional Study", journal="J Med Internet Res", year="2024", month="Dec", day="10", volume="26", pages="e58581", keywords="health communications", keywords="social media", keywords="Hispanic", keywords="Latino", keywords="Black", keywords="American Indian", keywords="Alaska Native", keywords="minority health", keywords="health disparities", keywords="COVID-19", abstract="Background: Individuals identifying as Black, American Indian or Alaska Native, or Hispanic or Latino lack access to culturally appropriate accurate information and are the target of disinformation campaigns, which create doubt in science and health care providers and might play a role in sustaining health disparities related to the COVID-19 pandemic. Objective: This study aims to create and disseminate culturally and medically appropriate social media messages for Black, Latino, and American Indian or Alaska Native communities in Wisconsin and evaluate their reach and effectiveness in addressing the information needs of these communities. Methods: Our team identified relevant COVID-19 topics based on feedback from their respective community, developed lay format materials, and translated materials into culturally appropriate social media messages that community advocates delivered across their respective communities. Social media metrics (reach, engagement, and impressions) were collected using Sprout Social and Facebook Analytics. We hosted 9 focus groups with community members to learn about their social media use. These data were analyzed using an inductive approach, using NVivo software (release 1.7) to code content. Results: Between August 2021 and January 2023, we created 980 unique social media posts that reached 88,790 individuals and gathered >6700 engagements. Average reach per post was similar across the 3 communities, despite differences in the number of posts and followers on each page: 119.46 (Latino individuals), 111.74 (Black individuals), and 113.11 (Oneida Nation members). The type of posts that had higher engagement rate per reached person (ERR) varied across communities and platforms, with the highest being live videos for the Latino community on Facebook (ERR 9.4\%), videos for the Black community on Facebook (ERR 19.53\%), and social media messages for the Oneida Nation community (ERR 59.01\%). Conclusions: Our project presents a unique and effective model for health messages and highlights the need for tailoring social media messages and approaches for minoritized audiences (eg, age, gender, race, and ethnicity). Further research studies are needed to explore how specific types of information affect the dissemination of information and the implications for health communications. ", doi="10.2196/58581", url="https://www.jmir.org/2024/1/e58581" } @Article{info:doi/10.2196/59544, author="Klimiuk, Bartosz Krzysztof and Kot, Amelia and Majcherek, Ewa and Kubiak, B. Katarzyna and Balwicki, ?ukasz", title="Themes in Abortion Forum Discussions in a Restrictive Access Context: Qualitative and Quantitative Analyses", journal="J Med Internet Res", year="2024", month="Dec", day="9", volume="26", pages="e59544", keywords="abortion", keywords="content analysis", keywords="reproductive health", keywords="online forum", keywords="Poland", keywords="women", keywords="support", abstract="Background: Abortion is one of the most common medical procedures worldwide. Despite this, access to abortion on demand remains restricted in many countries, including Poland. As a result, many women resort to undergoing the procedure without medical supervision, putting themselves at risk of serious health consequences such as drug poisoning, excessive bleeding, and hypovolemia. Unfortunately, some abortions also lead to severe infections. Objective: This study aims to qualitatively identify key themes in abortion forums to analyze the issues faced by individuals. The forums were then quantitatively analyzed to determine which problems were most prevalent. Methods: The most popular abortion forums were identified. A preliminary thematic analysis was conducted for the qualitative phase, followed by a manual quantitative analysis. Two independent researchers reviewed forum posts, categorizing them into specific themes. Results: An analysis of 13,397 responses from 370 threads across 4 forums revealed ``Abortion Process Progression'' as the most discussed theme, highlighting a strong demand for information, emotional support, and medical guidance. The highest percentage of threads (162/886, 18.3\%) focused on the need for mental support and the desire to have someone in contact during the abortion process. Concerns about the effectiveness of the termination also emerged as a significant topic, accounting for 83 of the 886 (9.4\%) discussions. ``Emotional and Psychological Aspects'' and ``Medical and Pharmacological Aspects'' were also significant, highlighting the need for holistic care. Anxiety and fear related to the process were frequently discussed, accounting for 60 of the 886 (6.8\%) responses. The issue of isolation and lack of support was also a common topic, appearing in 30 of the 886 (3.4\%) threads. Notably, ``Social and Ethical Perception'' accounted for only 13 of the 886 (1.5\%) responses and appeared in just 13 threads. Conclusions: This study highlights the critical need for information and support for women navigating abortion, particularly in regions where access is restricted. It emphasizes the importance of addressing the multifaceted challenges women face and calls for policy changes and strengthened support networks to improve the health and rights of women, as well as all those seeking gynecological care in abortion contexts. Further research is encouraged to refine and expand support strategies. ", doi="10.2196/59544", url="https://www.jmir.org/2024/1/e59544" } @Article{info:doi/10.2196/53218, author="Wu, A. Scott and Soetikno, G. Alan and Ozer, A. Egon and Welch, B. Sarah and Liu, Yingxuan and Havey, J. Robert and Murphy, L. Robert and Hawkins, Claudia and Mason, Maryann and Post, A. Lori and Achenbach, J. Chad and Lundberg, L. Alexander", title="Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Canada: Longitudinal Trend Analysis", journal="JMIR Public Health Surveill", year="2024", month="Dec", day="5", volume="10", pages="e53218", keywords="SARS-CoV-2", keywords="COVID-19", keywords="Canada", keywords="pandemic", keywords="surveillance", keywords="transmission", keywords="acceleration", keywords="deceleration", keywords="dynamic panel", keywords="generalized method of moments", keywords="GMM", keywords="Arellano-Bond", keywords="7-day lag", keywords="k", keywords="metrics", keywords="epidemiology", keywords="dynamic", keywords="genomic", keywords="historical context", keywords="outbreak threshold", abstract="Background: This study provides an update on the status of the COVID-19 pandemic in Canada, building upon our initial analysis conducted in 2020 by incorporating an additional 2 years of data. Objective: This study aims to (1) summarize the status of the pandemic in Canada when the World Health Organization (WHO) declared the end of the public health emergency for the COVID-19 pandemic on May 5, 2023; (2) use dynamic and genomic surveillance methods to describe the history of the pandemic in Canada and situate the window of the WHO declaration within the broader history; and (3) provide historical context for the course of the pandemic in Canada. Methods: This longitudinal study analyzed trends in traditional surveillance data and dynamic panel estimates for COVID-19 transmissions and deaths in Canada from June 2020 to May 2023. We also used sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern. For these sequences, we used Nextclade nomenclature to collect clade designations and Pangolin nomenclature for lineage designations of SARS-CoV-2. We used 1-sided t tests of dynamic panel regression coefficients to measure the persistence of COVID-19 transmissions around the WHO declaration. Finally, we conducted a 1-sided t test for whether provincial and territorial weekly speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. Results: Canada's speed remained below the outbreak threshold for 8 months by the time of the WHO declaration ending the COVID-19 emergency of international concern. Acceleration and jerk were also low and stable. While the 1-day persistence coefficient remained statistically significant and positive (1.074; P<.001), the 7-day coefficient was negative and small in magnitude (--0.080; P=.02). Furthermore, shift parameters for either of the 2 most recent weeks around May 5, 2023, were negligible (0.003 and 0.018, respectively, with P values of .75 and .31), meaning the clustering effect of new COVID-19 cases had remained stable in the 2 weeks around the WHO declaration. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling 1-sided t test of speed equal to 10 became entirely insignificant from mid-October 2022 onward. Conclusions: While COVID-19 continues to circulate in Canada, the rate of transmission remained well below the threshold of an outbreak for 8 months ahead of the WHO declaration. Both standard and enhanced surveillance metrics confirm that the pandemic had largely ended in Canada by the time of the WHO declaration. These results can inform future public health interventions and strategies in Canada, as well as contribute to the global understanding of the trajectory of the COVID-19 pandemic. ", doi="10.2196/53218", url="https://publichealth.jmir.org/2024/1/e53218", url="http://www.ncbi.nlm.nih.gov/pubmed/39471286" } @Article{info:doi/10.2196/65541, author="Qiu, Yuanbo and Huang, Huang and Gai, Junjie and De Leo, Gianluca", title="The Effects of the COVID-19 Pandemic on Age-Based Disparities in Digital Health Technology Use: Secondary Analysis of the 2017-2022 Health Information National Trends Survey", journal="J Med Internet Res", year="2024", month="Dec", day="4", volume="26", pages="e65541", keywords="age-based disparities", keywords="health equity", keywords="digital health technology use", keywords="digital divide", keywords="health policy", keywords="COVID-19", keywords="mobile phone", abstract="Background: The COVID-19 pandemic accelerated the adoption of digital health technology, but it could also impact age-based disparities as existing studies have pointed out. Compared with the pre-pandemic period, whether the rapid digitalization of the health care system during the pandemic widened the age-based disparities over a long period remains unclear. Objective: This study aimed to analyze the long-term effects of the COVID-19 pandemic on the multifaceted landscape of digital health technology used across diverse age groups among US citizens. Methods: We conducted the retrospective observational study using the 2017-2022 Health Information National Trends Survey to identify the influence of the COVID-19 pandemic on a wide range of digital health technology use outcomes across various age groups. The sample included 15,505 respondents, which were categorized into 3 age groups: adults (18-44 years), middle-aged adults (45-64 years), and older adults (more than 65 years). We also designated the time point of March 11, 2020, to divide the pre- and post-pandemic periods. Based on these categorizations, multivariate linear probability models were used to assess pre-post changes in digital health technology use, controlling for demographic, socioeconomic, and health-related variables among different age groups. Results: Essentially, older adults were found to be significantly less likely to use digital health technology compared with adults, with a 26.28\% lower likelihood of using the internet for health information (P<.001) and a 32.63\% lower likelihood of using health apps (P<.001). The usage of digital health technology for all age groups had significantly increased after the onset of the pandemic, and the age-based disparities became smaller in terms of using the internet to look for health information. However, the disparities have widened for older adults in using the internet to look up test results (11.21\%, P<.001) and make appointments (10.03\%, P=.006) and using wearable devices to track health (8.31\%, P=.01). Conclusions: Our study reveals a significant increase in the use of digital health technology among all age groups during the pandemic. However, while the disparities in accessing online information have narrowed, age-based disparities, particularly for older adults, have widened in most areas such as looking up test results and making appointments with doctors. Therefore, older adults are more likely left behind by the rapidly digitalized US health care system during the pandemic. Policy makers and health care providers should focus on addressing these disparities to ensure equitable access to digital health resources for US baby boomers. ", doi="10.2196/65541", url="https://www.jmir.org/2024/1/e65541" } @Article{info:doi/10.2196/59717, author="Linstad, Helen Line and Bj{\o}rn{\aa}, Hilde and Moen, Anne and Tunby Kristiansen, Truls and Hansen, Helen Anne", title="Investigating the Norwegian eHealth Governance Model: Document Study", journal="J Med Internet Res", year="2024", month="Dec", day="4", volume="26", pages="e59717", keywords="eHealth policy", keywords="fragmented decision authority", keywords="top-down governance", keywords="bottom-up network", keywords="participation", keywords="electronic health record", abstract="Background: Governments and policy makers struggle to achieve a balance between hierarchical steering and horizontal governance in systems characterized by fragmented decision authority and multiple interests. To realize its One Citizen--One Journal eHealth policy vision, the Norwegian government established a special eHealth board of stakeholders to create an inclusive governance model that aligned stakeholders' interests with the?government's ambitions through coordination and consensus. Little empirical knowledge exists on how countries realize inclusive governance models. Objective: This study aims to investigate how the Norwegian inclusive eHealth governance model was developed as a tool to align the government's policy ambitions with stakeholders' concerns from January 2012 to December 2022. Methods: This document study used a thematic analysis based on a constructivist research approach. We included 16 policy documents and 175 consultation response documents issued between January 2012 and December 2022 related to the Norwegian One Citizen--One Journal policy implementation process. The themes were constructed deductively from a review of governance models and public governance theory and were applied as our analytical lens to each document. The findings were interpreted, analyzed, and synthesized. Results: The national policy implementation process progressed through 3 phases, with changes in stakeholder inclusion and perceived influence on the decision-making process characterizing transitions from phase to phase. Tension developed between 2 contrasting views regarding top-down government authority and stakeholders' autonomy. The view of the regional health trusts, municipalities, health care professional organizations, and industry actors contrasted with that of the patient organizations. Governmental insensitivity to participation, lack of transparency, and decreasing trust by stakeholder groups challenged the legitimacy of the inclusive governance model. Conclusions: We illustrated that Norway's One Citizen--One Journal policy trajectory was characterized by a process that unfolded across 3 distinct phases. The process was characterized by 2 contrasting stakeholder perspectives. Finally, it was shaped by diminishing trust in the inclusive governance model. The National eHealth Governance Board faced challenges in establishing legitimacy as a top-down inclusive governance model, primarily attributed to its addressing of participation, transparency, and trust dilemmas. Such dilemmas represent significant obstacles to inclusive governance models and require ongoing governmental vigilance and responsiveness from governmental entities. ", doi="10.2196/59717", url="https://www.jmir.org/2024/1/e59717" } @Article{info:doi/10.2196/63035, author="Xie, Zidian and Liu, Xinyi and Lou, Xubin and Li, Dongmei", title="Public Perceptions of Very Low Nicotine Content on Twitter: Observational Study", journal="JMIR Form Res", year="2024", month="Dec", day="4", volume="8", pages="e63035", keywords="very low nicotine", keywords="Twitter", keywords="public perception", keywords="observational study", keywords="content analysis", abstract="Background: Nicotine is a highly addictive agent in tobacco products. On June 21, 2022, the US Food and Drug Administration (FDA) announced a plan to propose a rule to establish a maximum nicotine level in cigarettes and other combusted tobacco products. Objective: This study aimed to understand public perception and discussion of very low nicotine content (VLNC) on Twitter (rebranded as X in July 2023). Methods: From December 12, 2021, to January 1, 2023, we collected Twitter data using relevant keywords such as ``vln,'' ``low nicotine,'' and ``reduced nicotine.'' After a series of preprocessing steps (such as removing duplicates, retweets, and commercial tweets), we identified 3270 unique noncommercial tweets related to VLNC. We used an inductive method to assess the public perception and discussion of VLNC on Twitter. To establish a codebook, we randomly selected 300 tweets for hand-coding, including the attitudes (positive, neutral, and negative) toward VLNC (including its proposed rule) and major topics (13 topics). The Cohen $\kappa$ statistic between the 2 human coders reached over 70\%, indicating a substantial interrater agreement. The rest of the tweets were single-coded according to the codebook. Results: We observed a significant peak in the discussion of VLNC on Twitter within 4 days of the FDA's announcement of the proposed rule on June 21, 2022. The proportion of tweets with a negative attitude toward VLNC was significantly lower than those with a positive attitude, 24.5\% (801/3270) versus 37.09\% (1213/3270) with P<.001 from the 2-proportion z test. Among tweets with a positive attitude, the topic ``Reduce cigarette consumption or help smoking cessation'' was dominant (1097/1213, 90.44\%). Among tweets with a negative attitude, the topic ``VLNC leads to more smoking'' was the most popular topic (227/801, 28.34\%), followed by ``Similar toxicity of VLNC as a regular cigarette'' (223/801, 27.84\%), and ``VLNC is not a good method for quitting smoking'' (211/801, 26.34\%). Conclusions: There is a more positive attitude toward VLNC than a negative attitude on Twitter, resulting from different opinions about VLNC. Discussions around VLNC mainly focused on whether VLNC could help people quit smoking. ", doi="10.2196/63035", url="https://formative.jmir.org/2024/1/e63035" } @Article{info:doi/10.2196/63410, author="Karupaiah, Tilakavati and Rahman, Mahfuzur Shah Md and Zhang, Juan and Kumar, Naveen and Jamiyan, Batjargal and Pokharel, Kumar Raj and Borazon, Quintana Elaine and Thoradeniya, Tharanga and Tho, Thi Nguyen Thi and Mackay, Sally and Kelly, Bridget and Swinburn, Boyd and Chinna, Karuthan and Dashzeveg, Enkhmyagmar and Ong, Rick Gild and Narayanan, Sankara Sreelakshmi and Sameeha, Jamil Mohd and Uddin, Ahsan Mohammad and Tang, Yuxiang and Sharma, Kumar Naresh and Pokharel, Rishav and Rome, Christine Anna and Wickramasinghe, Pujitha V. and Huy, Thanh Phan", title="Extent and Nature of Television Food and Nonalcoholic Beverage Marketing in 9 Asian Countries: Cross-Sectional Study Using a Harmonized Approach", journal="JMIR Pediatr Parent", year="2024", month="Dec", day="4", volume="7", pages="e63410", keywords="children", keywords="Asian food marketing", keywords="television", keywords="unhealthy food", keywords="WHO nutrient profile model", keywords="World Health Organization", keywords="pediatrics", keywords="commercial", keywords="Asia", keywords="unhealthy", keywords="nutrition", keywords="diet", keywords="market", keywords="advertisement", keywords="food", keywords="beverage", keywords="consumption", abstract="Background: Rising childhood obesity rates in Asia are adding risk for the future adult burden of obesity and noncommunicable diseases. Weak policies across most Asian countries enable unrestricted marketing of obesogenic foods and beverages to children. Television is the common medium for food marketing to reach this audience. Objective: This study aimed to assess the extent and nature of television food and nonalcoholic beverage marketing in 9 Asian countries (Bangladesh, China, India, Malaysia, Mongolia, Nepal, the Philippines, Sri Lanka, and Vietnam) with capacity building support from the International Network for Food and Obesity/Non-Communicable Disease Research, Monitoring and Action Support, who enabled harmonization of data collection method and content analyses. Methods: Advertised foods were categorized as permitted or not permitted based on the nutrient profile models established by the World Health Organization regional offices for South-East Asia (SEARO) and the World Health Organization regional offices for Western Pacific (WPRO). Overall rates of food advertisements (advertisements per hour per channel) and persuasive strategy use were analyzed along with comparisons between children's peak viewing time (PVT) and non-PVT. Results: Cross-country comparisons, irrespective of country income level, indicated that not permitted food advertising dominated children's popular television channels, especially during PVT with rates as per WPRO or SEARO criteria ranging from 2.40/2.29 (Malaysia) to 9.70/9.41 advertisements per hour per channel (the Philippines). Persuasive strategy rates were also comparatively higher during PVT. Sugar-sweetened beverages, sugar-containing solid foods, and high salt- and fat-containing snacks and fast foods were frequently advertised. Evaluation of the application of WPRO and SEARO nutrient profile models identified inconsistencies due to regional taste and cuisine variations across Asia. Conclusions: This study clearly showed that unhealthy food marketing through popular children's television channels is widely occurring in Asia and is a clear breach of child rights. Evidence outcomes will benefit advocacy toward stronger policy regulations to control unhealthy food marketing and strengthen strategies to promote a healthier food environment for Asia's children. ", doi="10.2196/63410", url="https://pediatrics.jmir.org/2024/1/e63410", url="http://www.ncbi.nlm.nih.gov/pubmed/39630493" } @Article{info:doi/10.2196/57718, author="Jagomast, Tobias and Finck, Jule and Tangemann-M{\"u}nstedt, Imke and Auth, Katharina and Dr{\"o}mann, Daniel and Franzen, F. Klaas", title="Google Trends Assessment of Keywords Related to Smoking and Smoking Cessation During the COVID-19 Pandemic in 4 European Countries: Retrospective Analysis", journal="Online J Public Health Inform", year="2024", month="Dec", day="3", volume="16", pages="e57718", keywords="internet", keywords="coronavirus", keywords="COVID-19", keywords="SARS-CoV-2", keywords="pandemics", keywords="public health", keywords="smoking cessation", keywords="tobacco products", keywords="Google Trends", keywords="relative search volume", keywords="Europe", keywords="online", keywords="search", keywords="smoking", keywords="addiction", keywords="quit", keywords="cessation", keywords="trend", keywords="cluster", keywords="public interest", keywords="lockdown", keywords="vaccination", keywords="spread", keywords="incidence", abstract="Background: Smoking is a modifiable risk factor for SARS-CoV-2 infection. Evidence of smoking behavior during the pandemic is ambiguous. Most investigations report an increase in smoking. In this context, Google Trends data monitor real-time public information--seeking behavior and are therefore useful to characterize smoking-related interest over the trajectory of the pandemic. Objective: This study aimed to use Google Trends data to evaluate the effect of the pandemic on public interest in smoking-related topics with a focus on lockdowns, vaccination campaigns, and incidence. Methods: The weekly relative search volume was retrieved from Google Trends for England, Germany, Italy, and Spain from December 31, 2017, to April 18, 2021. Data were collected for keywords concerning consumption, cessation, and treatment. The relative search volume before and during the pandemic was compared, and general trends were evaluated using the Wilcoxon rank-sum test. Short-term changes and hereby temporal clusters linked to lockdowns or vaccination campaigns were addressed by the flexible spatial scan statistics proposed by Takahashi and colleagues. Subsequently, the numbers of clusters after the onset of the pandemic were compared by chi-square test. Results: Country-wise minor differences were observed while 3 overarching trends prevailed. First, regarding cessation, the statistical comparison revealed a significant decline in interest for 58\% (7/12) of related keywords, and fewer clusters were present during the pandemic. Second, concerning consumption, significantly reduced relative search volume was observed for 58\% (7/12) of keywords, while treatment-related keywords exhibited heterogeneous trends. Third, substantial clusters of increased interest were sparsely linked to lockdowns, vaccination campaigns, or incidence. Conclusions: This study reports a substantial decline in overall relative search volume and clusters for cessation interest. These results underline the importance of intensifying cessation aid during times of crisis. Lockdowns, vaccination, and incidence had less impact on information-seeking behavior. Other public measures that positively affect smoking behavior remain to be determined. ", doi="10.2196/57718", url="https://ojphi.jmir.org/2024/1/e57718", url="http://www.ncbi.nlm.nih.gov/pubmed/39626237" } @Article{info:doi/10.2196/53685, author="Moore, K. Sarah and Boggis, S. Jesse and Gauthier, R. Phoebe and Lambert-Harris, A. Chantal and Hichborn, G. Emily and Bell, D. Kathleen and Saunders, C. Elizabeth and Montgomery, LaTrice and Murphy, I. Eilis and Turner, M. Avery and Agosti, Nico and McLeman, M. Bethany and Marsch, A. Lisa", title="Technology-Based Interventions for Substance Use Treatment Among People Who Identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native: Scoping Review", journal="J Med Internet Res", year="2024", month="Dec", day="3", volume="26", pages="e53685", keywords="technology-based interventions", keywords="substance use", keywords="treatment", keywords="health equity", keywords="underrepresented", keywords="scoping review", keywords="mobile phone", abstract="Background: In the United States, racial and ethnic disparities in substance use treatment outcomes are persistent, especially among underrepresented minority (URM) populations. Technology-based interventions (TBIs) for substance use treatment show promise in reducing barriers to evidence-based treatment, yet no studies have described how TBIs may impact racial or ethnic health equity. Objective: This study explored whether TBIs in substance use treatment research promote health equity among people who identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native through their inclusion in research. We explored whether research that includes the aforementioned groups consciously considers race and/or ethnicity beyond including these populations as participants. Methods: We conducted a scoping review of 5 electronic databases to identify TBIs in substance use treatment studies published in English between January 2000 and March 2021. Studies were included if ?50\% of participants identified as African American or Black, Hispanic or Latino, or American Indian or Alaska Native when combined. Included studies were evaluated for conscious consideration of race and ethnicity in at least one manuscript section. Finally, we conducted a critical appraisal of each study's potential to facilitate insights into the impact of a TBI for members of specific URM groups. Results: Of 6897 titles and abstracts screened and 1158 full-text articles assessed for eligibility, nearly half (532/1158, 45.9\%) of the full-text articles were excluded due to the absence of data on race, ethnicity, or not meeting the aforementioned demographic eligibility criteria. Overall, 110 studies met the inclusion criteria. Study designs included 39.1\% (43/110) randomized trials, and 35.5\% (39/110) feasibility studies. In total, 47.3\% (52/110) of studies used computer-based interventions, including electronic screening, brief interventions, and referrals to treatment, whereas 33.6\% (37/110) used interactive voice response, ecological momentary assessment or interventions, or SMS text messaging via mobile phones. Studies focused on the following substances: alcohol or drugs (45/110, 40.9\%), alcohol alone (26/110, 23.6\%), opioids (8/110, 7.3\%), cannabis (6/110, 5.5\%), cocaine (4/110, 3.6\%), and methamphetamines (3/110, 2.7\%). Of the studies that consciously considered race or ethnicity (29/110, 26.4\%), 6.4\% (7/110) explicitly considered race or ethnicity in all manuscript sections. Overall, 28.2\% (31/110) of the studies were critically appraised as having a high confidence in the interpretability of the findings for specific URM groups. Conclusions: While the prevalence of TBIs in substance use treatment has increased recently, studies that include and consciously consider URM groups are rare, especially for American Indian or Alaska Native and Hispanic or Latino groups. This review highlights the limited research on TBIs in substance use treatment that promotes racial and ethnic health equity and provides context, insights, and direction for researchers working to develop and evaluate digital technology substance use interventions while promoting health equity. ", doi="10.2196/53685", url="https://www.jmir.org/2024/1/e53685" } @Article{info:doi/10.2196/63276, author="Abdulai, Ratif and Phalane, Edith and Atuahene, Kyeremeh and Phaswana-Mafuya, Nancy Refilwe", title="Consistent and Correct Use of Condoms With Lubricants and Associated Factors Among Men Who Have Sex With Men from the Ghana Men's Study II: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2024", month="Dec", day="3", volume="13", pages="e63276", keywords="men who have sex with men", keywords="consistent condom use", keywords="HIV", keywords="Ghana Men's Study", keywords="condom", keywords="Ghana", keywords="Africa", keywords="mixed methods", keywords="protocol", keywords="lubricant", keywords="qualitative", keywords="quantitative", abstract="Background: Men who have sex with men (MSM) experience a disproportionate burden of HIV infection globally, including in Ghana. The use of condoms with lubricants correctly and consistently plays a vital role in reducing the number of new HIV infections among MSM. However, there are concerns about the consistent and correct use of condoms and lubricants among MSM in Ghana. In this regard, there is a need to understand context-specific factors associated with consistent and correct condom use with lubricants. Objective: This study aims to determine the current scope of consistent and correct use of condoms with lubricants, associated factors, interventions, and user- and service-related challenges on correct condom and lubricant use among the MSM population in Ghana. Methods: The study will use a mixed methods study approach. First, a retrospective analysis of the Ghana Men's Study II data set involving 4095 MSM will be conducted to determine the scope of consistency and correct use of condoms with lubricants as well as associated factors. The data will be imported into STATA (version 17; StataCorp LLC) to treat missing data and outliers before the analysis. Bivariate and multivariate logistic regression analyses will be conducted to determine the associated factors of consistent condom use with lubricants. All statistical analyses will be done at a 95\% CI, with significant differences at P<.05. Second, in-depth interviews with a purposive sample of about 15-20 stakeholders will also be conducted to understand contextual issues regarding the factors identified, identify existing interventions for correct condom and lubricant use, user and service-related challenges, and how best to address those challenges from the stakeholders' perspectives. For qualitative data, thematic analysis will be conducted using Atlas.ti version 23.1.1. Results: Qualitative and quantitative results will be triangulated together with systematic review results, and key findings will be highlighted and used to guide the development of a predictive model for improving correct and consistent condom use with lubrication among MSM. This protocol paper, part of a doctoral study by the first author (RA), received approval from the Research and Ethics Committee of the University of Johannesburg on May 10, 2024. Data collection commenced on August 20, 2024, and the expected results will be published by October 2025. Conclusions: Results from qualitative interviews and secondary data analysis will be triangulated to develop a predictive model to strengthen the correct and consistent use of condoms with condom-compatible lubricants among MSM and other key population groups in Ghana and other parts of sub-Saharan Africa for future pandemic preparedness, policy making, and targeted budget allocation. International Registered Report Identifier (IRRID): DERR1-10.2196/63276 ", doi="10.2196/63276", url="https://www.researchprotocols.org/2024/1/e63276" } @Article{info:doi/10.2196/53248, author="Edler, Johanna-Sophie and Winter, Michael and Steinmetz, Holger and Cohrdes, Caroline and Baumeister, Harald and Pryss, R{\"u}diger", title="Predicting Depressive Symptoms Using GPS-Based Regional Data in Germany With the CORONA HEALTH App During the COVID-19 Pandemic: Cross-Sectional Study", journal="Interact J Med Res", year="2024", month="Dec", day="3", volume="13", pages="e53248", keywords="depression", keywords="COVID-19", keywords="mobile phone", keywords="geographic information systems", keywords="GPS-based data", keywords="mobile applications", keywords="mental health", abstract="Background: Numerous studies have been conducted to predict depressive symptoms using passive smartphone data, mostly integrating the GPS signal as a measure of mobility. Environmental factors have been identified as correlated with depressive symptoms in specialized studies both before and during the pandemic. Objective: This study combined a data-based approach using passive smartphone data to predict self-reported depressive symptoms with a wide range of GPS-based environmental factors as predictors. Methods: The CORONA HEALTH app was developed for the purpose of data collection, and this app enabled the collection of both survey and passive data via smartphone. After obtaining informed consent, we gathered GPS signals at the time of study participation and evaluated depressive symptoms in 249 Android users with the Patient Health Questionnaire-9. The only GPS-based data collected were the participants' location at the time of the questionnaire, which was used to assign participants to the nearest district for linking regional sociodemographic data. Data collection took place from July 2020 to February 2021, coinciding with the COVID-19 pandemic. Using GPS data, each dataset was linked to a wide variety of data on regional sociodemographic, geographic, and economic characteristics describing the respondent's environment, which were derived from a publicly accessible database from official German statistical offices. Moreover, pandemic-specific predictors such as the current pandemic phase or the number of new regional infections were matched via GPS. For the prediction of individual depressive symptoms, we compared 3 models (ie, ridge, lasso, and elastic net regression) and evaluated the models using 10-fold cross-validation. Results: The final elastic net regression model showed the highest explained variance (R2=0.06) and reduced the dataset from 121 to 9 variables, the 3 main predictors being current COVID-19 infections in the respective district, the number of places in nursing homes, and the proportion of fathers receiving parental benefits. The number of places in nursing homes refers to the availability of care facilities for the elderly, which may indicate regional population characteristics that influence mental health. The proportion of fathers receiving parental benefits reflects family structure and work-life balance, which could impact stress and mental well-being during the pandemic. Conclusions: Passive data describing the environment contributed to the prediction of individual depressive symptoms and revealed regional risk and protective factors that may be of interest without their inclusion in routine assessments being costly. ", doi="10.2196/53248", url="https://www.i-jmr.org/2024/1/e53248", url="http://www.ncbi.nlm.nih.gov/pubmed/39625745" } @Article{info:doi/10.2196/59844, author="Baer, J. Rebecca and Bandoli, Gretchen and Jelliffe-Pawlowski, Laura and Chambers, D. Christina", title="The University of California Study of Outcomes in Mothers and Infants (a Population-Based Research Resource): Retrospective Cohort Study", journal="JMIR Public Health Surveill", year="2024", month="Dec", day="3", volume="10", pages="e59844", keywords="birth certificate", keywords="vital statistics", keywords="hospital discharge", keywords="administrative data", keywords="linkage", keywords="pregnancy outcome", keywords="birth outcome", keywords="infant outcome", keywords="adverse outcome", keywords="preterm birth", keywords="birth defects", keywords="pregnancy", keywords="prenatal", keywords="California", keywords="policy", keywords="disparities", keywords="children", keywords="data collection", abstract="Background: Population-based databases are valuable for perinatal research. The California Department of Health Care Access and Information (HCAI) created a linked birth file covering the years 1991 through 2012. This file includes birth and fetal death certificate records linked to the hospital discharge records of the birthing person and infant. In 2019, the University of California Study of Outcomes in Mothers and Infants received approval to create similar linked birth files for births from 2011 onward, with 2 years of overlapping birth files to allow for linkage comparison. Objective: This paper aims to describe the University of California Study of Outcomes in Mothers and Infants linkage methodology, examine the linkage quality, and discuss the benefits and limitations of the approach. Methods: Live birth and fetal death certificates were linked to hospital discharge records for California infants between 2005 and 2020. The linkage algorithm includes variables such as birth hospital and date of birth, and linked record selection is made based on a ``link score.'' The complete file includes California Vital Statistics and HCAI hospital discharge records for the birthing person (1 y before delivery and 1 y after delivery) and infant (1 y after delivery). Linkage quality was assessed through a comparison of linked files and California Vital Statistics only. Comparisons were made to previous linked birth files created by the HCAI for 2011 and 2012. Results: Of the 8,040,000 live births, 7,427,738 (92.38\%) California Vital Statistics live birth records were linked to HCAI records for birthing people, 7,680,597 (95.53\%) birth records were linked to HCAI records for the infant, and 7,285,346 (90.61\%) California Vital Statistics birth records were linked to HCAI records for both the birthing person and the infant. The linkage rates were 92.44\% (976,526/1,056,358) for Asian and 86.27\% (28,601/33,151) for Hawaiian or Pacific Islander birthing people. Of the 44,212 fetal deaths, 33,355 (75.44\%) had HCAI records linked to the birthing person. When assessing variables in both California Vital Statistics and hospital records, the percentage was greatest when using both sources: the rates of gestational diabetes were 4.52\% (329,128/7,285,345) in the California Vital Statistics records, 8.2\% (597,534/7,285,345) in the HCAI records, and 9.34\% (680,757/7,285,345) when using both data sources. Conclusions: We demonstrate that the linkage strategy used for this data platform is similar in linkage rate and linkage quality to the previous linked birth files created by the HCAI. The linkage provides higher rates of crucial variables, such as diabetes, compared to birth certificate records alone, although selection bias from the linkage must be considered. This platform has been used independently to examine health outcomes, has been linked to environmental datasets and residential data, and has been used to obtain and examine maternal serum and newborn blood spots. ", doi="10.2196/59844", url="https://publichealth.jmir.org/2024/1/e59844", url="http://www.ncbi.nlm.nih.gov/pubmed/39625748" } @Article{info:doi/10.2196/54127, author="Nong, Thu Trang Thi and Nguyen, Hoang Giang and Lepe, Alexander and Tran, Bich Thuy and Nguyen, Phuong Lan Thi and Koot, R. Jaap A.", title="Challenges and Opportunities in Digital Screening for Hypertension and Diabetes Among Community Groups of Older Adults in Vietnam: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Dec", day="2", volume="26", pages="e54127", keywords="NCD screening", keywords="DHIS2 tracker", keywords="District Health Information Software, version 2 tracker", keywords="digital application", keywords="ISHC health volunteers", keywords="non-communicable diseases", keywords="prevention", keywords="Vietnam", keywords="mobile phone", abstract="Background: The project of scaling up noncommunicable disease (NCD) interventions in Southeast Asia aimed to strengthen the prevention and control of hypertension and diabetes, focusing on primary health care and community levels. In Vietnam, health volunteers who were members of the Intergenerational Self-Help Clubs (ISHCs) implemented community-based NCD screening and health promotion activities in communities. The ISHC health volunteers used an app based on District Health Information Software, version 2 (DHIS2) tracker (Society for Health Information Systems Programmes, India) to record details of participants during screening and other health activities. Objective: This study aimed to assess the strengths, barriers, and limitations of the NCD screening app used by the ISHC health volunteers on tablets and to provide recommendations for further scaling up. Methods: A mixed methods observational study with a convergent parallel design was performed. For the quantitative data analysis, 2 rounds of screening data collected from all 59 ISHCs were analyzed on completeness and quality. For the qualitative analysis, 2 rounds of evaluation of the screening app were completed. Focus group discussions with ISHC health volunteers and club management boards and in-depth interviews with members of the Association of the Elderly and Commune Health Station staff were performed. Results: In the quantitative analysis, data completeness of all 6704 screenings (n=3485 individuals) was very high. For anthropomorphic measurements, such as blood pressure, body weight, and abdominal circumference, less than 1\% errors were found. The data on NCD risk factors were not adequately recorded in 1908 (29.5\%) of the screenings. From the qualitative analysis, the NCD screening app was appreciated by ISHC health volunteers and supervisors, as an easier and more efficient way to report to higher levels, secure data, and strengthen relationships with relevant stakeholders, using tablets to connect to the internet and internet-based platforms to access information for self-learning and sharing to promote a healthy lifestyle as the strengths. The barriers and limitations reported by the respondents were a non--age-friendly app, incomplete translation of parts of the app into Vietnamese, some issues with the tablet's display, lack of sharing of responsibilities among the health volunteers, and suboptimal involvement of the health sector; limited digital literacy among ISHC health volunteers. Recommendations are continuous capacity building, improving app issues, improving tablet issues, and involving relevant stakeholders or younger members in technology adoption to support older people. Conclusions: The implementation of the NCD screening app by ISHC volunteers can be an effective way to improve community-led NCD screening and increase the uptake of NCD prevention and management services at the primary health care level. However, our study has shown that some barriers need to be addressed to maximize the efficient use of the app by ISHC health volunteers to record, report, and manage the screening data. ", doi="10.2196/54127", url="https://www.jmir.org/2024/1/e54127" } @Article{info:doi/10.2196/65740, author="Barbosa da Silva J{\'u}nior, Jarbas and Garcia-Saiso, Sebastian and Marti, Myrna and Salas, Daniel and Contreras, Marcela and Velandia-Gonzalez, Martha and Luna, Daniel and Nelson, Jennifer and Fitzgerald, James and Bascolo, Ernesto and Talavera Romero, Lorena Ivy and Chomali, May and Curioso, H. Walter and Plazzotta, Fernando and Otero, Carlos and Lopez Osornio, Alejandro and Lennemann, Tessa and Salinas, Karen and D'Agostino, Marcelo", title="Vaccine Certificates Must Go Digital: An Urgent Call for Better Public Health Outcomes", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="26", volume="10", pages="e65740", keywords="medical informatics", keywords="health systems", keywords="immunizations", keywords="public health", keywords="viewpoint", keywords="health challenges", keywords="digital vaccine certificates", keywords="outbreak management", keywords="outbreak", keywords="accuracy", keywords="healthcare", keywords="surveillance", keywords="health outcomes", keywords="global health", keywords="mobile phone", doi="10.2196/65740", url="https://publichealth.jmir.org/2024/1/e65740" } @Article{info:doi/10.2196/57612, author="Yi, Siyan and Yam, Yan Esabelle Lo and Cheruvettolil, Kochukoshy and Linos, Eleni and Gupta, Anshika and Palaniappan, Latha and Rajeshuni, Nitya and Vaska, Gopal Kiran and Schulman, Kevin and Eggleston, N. Karen", title="Perspectives of Digital Health Innovations in Low- and Middle-Income Health Care Systems From South and Southeast Asia", journal="J Med Internet Res", year="2024", month="Nov", day="25", volume="26", pages="e57612", keywords="digital health innovations", keywords="public health", keywords="South and Southeast Asia", keywords="health care challenges", keywords="low- and middle-income countries", keywords="LMICs", keywords="global health", keywords="health AI", keywords="artificial intelligence", keywords="public health responses", keywords="global health contexts", keywords="digital health", doi="10.2196/57612", url="https://www.jmir.org/2024/1/e57612" } @Article{info:doi/10.2196/63031, author="Maa{\ss}, Laura and Badino, Manuel and Iyamu, Ihoghosa and Holl, Felix", title="Assessing the Digital Advancement of Public Health Systems Using Indicators Published in Gray Literature: Narrative Review", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="20", volume="10", pages="e63031", keywords="digital public health", keywords="health system", keywords="indicator", keywords="interdisciplinary", keywords="information and communications technology", keywords="maturity assessment", keywords="readiness assessment", keywords="narrative review", keywords="gray literature", keywords="digital health", keywords="mobile phone", abstract="Background: Revealing the full potential of digital public health (DiPH) systems requires a wide-ranging tool to assess their maturity and readiness for emerging technologies. Although a variety of indices exist to assess digital health systems, questions arise about the inclusion of indicators of information and communications technology maturity and readiness, digital (health) literacy, and interest in DiPH tools by the society and workforce, as well as the maturity of the legal framework and the readiness of digitalized health systems. Existing tools frequently target one of these domains while overlooking the others. In addition, no review has yet holistically investigated the available national DiPH system maturity and readiness indicators using a multidisciplinary lens. Objective: We used a narrative review to map the landscape of DiPH system maturity and readiness indicators published in the gray literature. Methods: As original indicators were not published in scientific databases, we applied predefined search strings to the DuckDuckGo and Google search engines for 11 countries from all continents that had reached level 4 of 5 in the latest Global Digital Health Monitor evaluation. In addition, we searched the literature published by 19 international organizations for maturity and readiness indicators concerning DiPH. Results: Of the 1484 identified references, 137 were included, and they yielded 15,806 indicators. We deemed 286 indicators from 90 references relevant for DiPH system maturity and readiness assessments. The majority of these indicators (133/286, 46.5\%) had legal relevance (targeting big data and artificial intelligence regulation, cybersecurity, national DiPH strategies, or health data governance), and the smallest number of indicators (37/286, 12.9\%) were related to social domains (focusing on internet use and access, digital literacy and digital health literacy, or the use of DiPH tools, smartphones, and computers). Another 14.3\% (41/286) of indicators analyzed the information and communications technology infrastructure (such as workforce, electricity, internet, and smartphone availability or interoperability standards). The remaining 26.2\% (75/286) of indicators described the degree to which DiPH was applied (including health data architecture, storage, and access; the implementation of DiPH interventions; or the existence of interventions promoting health literacy and digital inclusion). Conclusions: Our work is the first to conduct a multidisciplinary analysis of the gray literature on DiPH maturity and readiness assessments. Although new methods for systematically researching gray literature are needed, our study holds the potential to develop more comprehensive tools for DiPH system assessments. We contributed toward a more holistic understanding of DiPH. Further examination is required to analyze the suitability and applicability of all identified indicators in diverse health care settings. By developing a standardized method to assess DiPH system maturity and readiness, we aim to foster informed decision-making among health care planners and practitioners to improve resource distribution and continue to drive innovation in health care delivery. ", doi="10.2196/63031", url="https://publichealth.jmir.org/2024/1/e63031", url="http://www.ncbi.nlm.nih.gov/pubmed/39566910" } @Article{info:doi/10.2196/51477, author="Ji, Lu and Yao, Yifan and Yu, Dandan and Chen, Wen and Yin, Shanshan and Fu, Yun and Tang, Shangfeng and Yao, Lan", title="Performance of a Full-Coverage Cervical Cancer Screening Program Using on an Artificial Intelligence-- and Cloud-Based Diagnostic System: Observational Study of an Ultralarge Population", journal="J Med Internet Res", year="2024", month="Nov", day="20", volume="26", pages="e51477", keywords="full coverage", keywords="cervical cancer screening", keywords="artificial intelligence", keywords="primary health institutions", keywords="accessibility", keywords="efficiency", abstract="Background: The World Health Organization has set a global strategy to eliminate cervical cancer, emphasizing the need for cervical cancer screening coverage to reach 70\%. In response, China has developed an action plan to accelerate the elimination of cervical cancer, with Hubei province implementing China's first provincial full-coverage screening program using an artificial intelligence (AI) and cloud-based diagnostic system. Objective: This study aimed to evaluate the performance of AI technology in this full-coverage screening program. The evaluation indicators included accessibility, screening efficiency, diagnostic quality, and program cost. Methods: Characteristics of 1,704,461 individuals screened from July 2022 to January 2023 were used to analyze accessibility and AI screening efficiency. A random sample of 220 individuals was used for external diagnostic quality control. The costs of different participating screening institutions were assessed. Results: Cervical cancer screening services were extended to all administrative districts, especially in rural areas. Rural women had the highest participation rate at 67.54\% (1,147,839/1,699,591). Approximately 1.7 million individuals were screened, achieving a cumulative coverage of 13.45\% in about 6 months. Full-coverage programs could be achieved by AI technology in approximately 1 year, which was 87.5 times more efficient than the manual reading of slides. The sample compliance rate was as high as 99.1\%, and compliance rates for positive, negative, and pathology biopsy reviews exceeded 96\%. The cost of this program was CN {\textyen}49 (the average exchange rate in 2022 is as follows: US \$1=CN {\textyen}6.7261) per person, with the primary screening institution and the third-party testing institute receiving CN {\textyen}19 and {\textyen}27, respectively. Conclusions: AI-assisted diagnosis has proven to be accessible, efficient, reliable, and low cost, which could support the implementation of full-coverage screening programs, especially in areas with insufficient health resources. AI technology served as a crucial tool for rapidly and effectively increasing screening coverage, which would accelerate the achievement of the World Health Organization's goals of eliminating cervical cancer. ", doi="10.2196/51477", url="https://www.jmir.org/2024/1/e51477" } @Article{info:doi/10.2196/56166, author="Chen, Runnan and Fu, Xiaorong and Liu, Mochi and Liao, Ke and Bai, Lifei", title="Online Depression Communities as a Complementary Approach to Improving the Attitudes of Patients With Depression Toward Medication Adherence: Cross-Sectional Survey Study", journal="J Med Internet Res", year="2024", month="Nov", day="19", volume="26", pages="e56166", keywords="online depression communities", keywords="attitudes", keywords="institution-generated content", keywords="user-generated content", keywords="perceived social support", keywords="antidepressants", keywords="hopelessness", keywords="cross-sectional study", keywords="China", keywords="health care system", keywords="online health community", keywords="depression", keywords="medication adherence", keywords="social support", keywords="health care practitioner", keywords="peer support", abstract="Background: Lack of adherence to prescribed medication is common among patients with depression in China, posing serious challenges to the health care system. Online health communities have been found to be effective in enhancing patient compliance. However, empirical evidence supporting this effect in the context of depression treatment is absent, and the influence of online health community content on patients' attitudes toward medication adherence is also underexplored. Objective: This study aims to explore whether online depression communities (ODCs) can help ameliorate the problem of poor medication taking among patients with depression. Drawing on the stimulus-organism-response and feelings-as-information theories, we established a research model to examine the influence of useful institution-generated content (IGC) and positive user-generated content (UGC) on attitudes toward medication adherence when combined with the mediating role of perceived social support, perceived value of antidepressants, and the moderating role of hopelessness. Methods: A cross-sectional questionnaire survey method was used in this research. Participants were recruited from various Chinese ODCs, generating data for a main study and 2 robustness checks. Hierarchical multiple regression analyses and bootstrapping analyses were adopted as the primary methods to test the hypotheses. Results: We received 1515 valid responses in total, contributing to 5 different datasets: model IGC (n=353, 23.3\%), model UGC (n=358, 23.63\%), model IGC+UGC (n=270, 17.82\%), model IGC-B (n=266, 17.56\%), and model UGC-B (n=268, 17.69\%). Models IGC and UGC were used for the main study. Model IGC+UGC was used for robustness check A. Models IGC-B and UGC-B were used for robustness check B. Useful IGC and positive UGC were proven to have positive impact on the attitudes of patients with depression toward medication adherence through the mediations of perceived social support and perceived value of antidepressants. The findings corroborated the role of hopelessness in weakening or even negating the positive effects of ODC content on the attitudes of patients with depression toward medication adherence. Conclusions: This study provides the first empirical evidence demonstrating the relationship between ODC content and attitudes toward medication adherence, through which we offer a novel solution to the problem of poor medication adherence among patients with depression in China. Our findings also provide suggestions about how to optimize this new approach---health care practitioners should generate online content that precisely matches the informational needs of patients with depression, and ODC service providers should endeavor to regulate the community atmosphere. Nonetheless, we warn that ODC interventions cannot be used as the only approach to addressing the problem of poor medication taking among patients with severe depressive symptoms. ", doi="10.2196/56166", url="https://www.jmir.org/2024/1/e56166" } @Article{info:doi/10.2196/57476, author="Melo, Lopes Carolina and Mageste, Rangel Larissa and Guaraldo, Lusiele and Paula, Polessa Daniela and Wakimoto, Duarte Mayumi", title="Use of Digital Tools in Arbovirus Surveillance: Scoping Review", journal="J Med Internet Res", year="2024", month="Nov", day="18", volume="26", pages="e57476", keywords="arbovirus infections", keywords="dengue", keywords="zika virus", keywords="chikungunya fever", keywords="public health surveillance", keywords="digital tool", keywords="technology", abstract="Background: The development of technology and information systems has led to important changes in public health surveillance. Objective: This scoping review aimed to assess the available evidence and gather information about the use of digital tools for arbovirus (dengue virus [DENV], zika virus [ZIKV], and chikungunya virus [CHIKV]) surveillance. Methods: The databases used were MEDLINE, SCIELO, LILACS, SCOPUS, Web of Science, and EMBASE. The inclusion criterion was defined as studies that described the use of digital tools in arbovirus surveillance. The exclusion criteria were defined as follows: letters, editorials, reviews, case reports, series of cases, descriptive epidemiological studies, laboratory and vaccine studies, economic evaluation studies, and studies that did not clearly describe the use of digital tools in surveillance. Results were evaluated in the following steps: monitoring of outbreaks or epidemics, tracking of cases, identification of rumors, decision-making by health agencies, communication (cases and bulletins), and dissemination of information to society). Results: Of the 2227 studies retrieved based on screening by title, abstract, and full-text reading, 68 (3\%) studies were included. The most frequent digital tools used in arbovirus surveillance were apps (n=24, 35\%) and Twitter, currently called X (n=22, 32\%). These were mostly used to support the traditional surveillance system, strengthening aspects such as information timeliness, acceptability, flexibility, monitoring of outbreaks or epidemics, detection and tracking of cases, and simplicity. The use of apps to disseminate information to society (P=.02), communicate (cases and bulletins; P=.01), and simplicity (P=.03) and the use of Twitter to identify rumors (P=.008) were statistically relevant in evaluating scores. This scoping review had some limitations related to the choice of DENV, ZIKV, and CHIKV as arboviruses, due to their clinical and epidemiological importance. Conclusions: In the contemporary scenario, it is no longer possible to ignore the use of web data or social media as a complementary strategy to health surveillance. However, it is important that efforts be combined to develop new methods that can ensure the quality of information and the adoption of systematic measures to maintain the integrity and reliability of digital tools' data, considering ethical aspects. ", doi="10.2196/57476", url="https://www.jmir.org/2024/1/e57476" } @Article{info:doi/10.2196/50959, author="Zhou, Zhiheng and Jin, Danian and He, Jinghua and Zhou, Shengqing and Wu, Jiang and Wang, Shuangxi and Zhang, Yang and Feng, Tianyuan", title="Digital Health Platform for Improving the Effect of the Active Health Management of Chronic Diseases in the Community: Mixed Methods Exploratory Study", journal="J Med Internet Res", year="2024", month="Nov", day="18", volume="26", pages="e50959", keywords="information platform", keywords="active health", keywords="chronic disease management", keywords="effectiveness", keywords="community", keywords="digital health", keywords="health literacy", keywords="cardio-cerebrovascular disease", keywords="China", abstract="Background: China is vigorously promoting the health management of chronic diseases and exploring digital active health management. However, as most medical information systems in China have been built separately, there is poor sharing of medical information. It is difficult to achieve interconnectivity among community residents' self-testing information, community health care information, and hospital health information, and digital chronic disease management has not been widely applied in China. Objective: This study aimed to build a digital health platform and improve the effectiveness of full-cycle management for community chronic diseases through digital active health management. Methods: This was a single-arm pre-post intervention study involving the development and use of a digital health platform (2-year intervention; 2020 to 2022). The digital health platform included the ``i Active Health'' applet for residents and the active health information system (cardio-cerebrovascular disease risk management system) for medical teams. The digital active health management of chronic diseases involved creating health streets, providing internet-assisted full-cycle active health services for residents, implementing internet-based community management for hypertension and diabetes, and performing real-time quantitative assessment and hierarchical management of residents' risks of cardio-cerebrovascular disease. After the 2-year intervention, management effectiveness was evaluated. Results: We constructed a digital health platform with interconnected health information and implemented a digital active health management model. After the intervention, the 2-way referral between community health care institutions and hospitals increased. Residents' health literacy rate increased from 30.6\% (3062/10,000) in 2020 to 49.9\% (4992/10,000) in 2022, with improvements in health knowledge, health behavior, and health skills. Moreover, the risk of cardio-cerebrovascular disease decreased after the intervention. The community hypertension and diabetes standardized management rates increased from 59.6\% (2124/3566) and 55.8\% (670/1200) in 2020 to 75.0\% (3212/4285) and 69.4\% (1686/2430) in 2022, respectively. The control rates of blood pressure in patients with hypertension and blood sugar in patients with diabetes increased from 51.7\% (1081/2091) and 42.0\% (373/888) in 2020 to 81.2\% (1698/2091) and 73.0\% (648/888) in 2022, respectively. The intervention improved patients' BMI, waist circumference, blood uric acid levels, and low-density lipoprotein cholesterol levels. The drug compliance rate of patients with hypertension and diabetes increased from 33.6\% (703/2091) and 36.0\% (320/888) in 2020 to 73.3\% (1532/2091) and 75.8\% (673/888) in 2022, respectively. The intervention greatly improved the diet behavior, exercise behavior, and drinking behavior of patients with hypertension and diabetes. Conclusions: Our digital health platform can effectively achieve the?interconnection and exchange of different health information. The digital active health management carried out with the assistance of this platform improved the effectiveness of community chronic disease management. Thus, the platform is worth promoting and applying in practice. ", doi="10.2196/50959", url="https://www.jmir.org/2024/1/e50959" } @Article{info:doi/10.2196/55865, author="Bogale, Binyam and Vesinurm, M{\"a}rt and Lillrank, Paul and Celius, Gulowsen Elisabeth and Halvorsrud, Ragnhild", title="Visual Modeling Languages in Patient Pathways: Scoping Review", journal="Interact J Med Res", year="2024", month="Nov", day="15", volume="13", pages="e55865", keywords="patient pathways", keywords="visual modeling languages", keywords="business process model and notation", keywords="BPMN", keywords="unified modeling language", keywords="UML", keywords="domain-specific modeling languages", keywords="scoping review", abstract="Background: Patient pathways (PPs) are presented as a panacea solution to enhance health system functions. It is a complex concept that needs to be described and communicated well. Modeling plays a crucial role in promoting communication, fostering a shared understanding, and streamlining processes. Only a few existing systematic reviews have focused on modeling methods and standardized modeling languages. There remains a gap in consolidated knowledge regarding the use of diverse visual modeling languages. Objective: This scoping review aimed to compile visual modeling languages used to represent PPs, including the justifications and the context in which a modeling language was adopted, adapted, combined, or developed. Methods: After initial experimentation with the keywords used to describe the concepts of PPs and visual modeling languages, we developed a search strategy that was further refined and customized to the major databases identified as topically relevant. In addition, we consulted gray literature and conducted hand searches of the referenced articles. Two reviewers independently screened the articles in 2 stages using preset inclusion criteria, and a third reviewer voted on the discordance. Data charting was done using an iteratively developed form in the Covidence software. Descriptive and thematic summaries were presented following rounds of discussion to produce the final report. Results: Of 1838 articles retrieved after deduplication, 22 satisfied our inclusion criteria. Clinical pathway is the most used phrase to represent the PP concept, and most papers discussed the concept without providing their operational definition. We categorized the visual modeling languages into five categories: (1) general purpose--modeling language (GPML) adopted without major extension or modification, (2) GPML used with formal extension recommendations, (3) combination of 2 or more modeling languages, (4) a developed domain-specific modeling language (DSML), and (5) ontological modeling languages. The justifications for adopting, adapting, combining, and developing visual modeling languages varied accordingly and ranged from versatility, expressiveness, tool support, and extensibility of a language to domain needs, integration, and simplification. Conclusions: Various visual modeling languages were used in PP modeling, each with varying levels of abstraction and granularity. The categorization we made could aid in a better understanding of the complex combination of PP and modeling languages. Standardized GPMLs were used with or without any modifications. The rationale to propose any modification to GPMLs evolved as more evidence was presented following requirement analyses to support domain constructs. DSMLs are infrequently used due to their resource-intensive development, often initiated at a project level. The justifications provided and the context where DSMLs were created are paramount. Future studies should assess the merits and demerits of using a visual modeling language to facilitate PP communications among stakeholders and use evaluation frameworks to identify, modify, or develop them, depending on the scope and goal of the modeling need. ", doi="10.2196/55865", url="https://www.i-jmr.org/2024/1/e55865" } @Article{info:doi/10.2196/58140, author="Hope, Mackline and Kiggundu, Reuben and Byonanebye, M. Dathan and Mayito, Jonathan and Tabajjwa, Dickson and Lwigale, Fahad and Tumwine, Conrad and Mwanja, Herman and Kambugu, Andrew and Kakooza, Francis", title="Progress of Implementation of World Health Organization Global Antimicrobial Resistance Surveillance System Recommendations on Priority Pathogen-Antibiotic Sensitivity Testing in Africa: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2024", month="Nov", day="15", volume="13", pages="e58140", keywords="antimicrobial resistance", keywords="antibiotic sensitivity testing", keywords="global antimicrobial resistance surveillance system", keywords="GLASS implementation", keywords="AMR Surveillance", keywords="Africa", abstract="Background: Antimicrobial resistance (AMR) is a major global public health concern, particularly in low- and middle-income countries where resources and infrastructure for an adequate response are limited. The World Health Organization (WHO) Global Antimicrobial Resistance Surveillance System (GLASS) was introduced in 2016 to address these challenges, outlining recommendations for priority pathogen-antibiotic combinations. Despite this initiative, implementation in Africa remains understudied. This scoping review aims to assess the current state of implementing WHO GLASS recommendations on antimicrobial sensitivity testing (AST) in Africa. Objective: The primary objective of this study is to determine the current state of implementing the WHO GLASS recommendations on AST for priority pathogen-antimicrobial combinations. The review will further document if the reporting of AST results is according to ``susceptible,'' ``intermediate,'' and ``resistant'' recommendations according to GLASS. Methods: Following the methodological framework by Arksey and O'Malley, studies published between January 2016 and November 2023 will be included. Search strategies will target electronic databases, including MEDLINE, Scopus, CINAHL, and Embase. Eligible studies will document isolates tested for antimicrobial sensitivity, focusing on WHO-priority specimens and pathogens. Data extraction will focus on key study characteristics, study context, population, and adherence to WHO GLASS recommendations on AST. Descriptive statistics involving summarizing the quantitative data extracted through measures of central tendency and variation will be used. Covidence and Microsoft Excel software will be used. This study will systematically identify, collate, and analyze relevant studies and data sources based on clear inclusion criteria to provide a clear picture of the progress achieved in the implementation of the WHO GLASS recommendations. Areas for further improvement will be documented to inform future efforts to strengthen GLASS implementation for enhanced AMR surveillance in Africa. Results: The study results are expected in August 2024. Conclusions: To our knowledge, this scoping review will be the first to comprehensively examine the implementation of WHO GLASS recommendations in Africa, shedding light on the challenges and successes of AMR surveillance in the region. Addressing these issues aims to contribute to global efforts to combat AMR. International Registered Report Identifier (IRRID): PRR1-10.2196/58140 ", doi="10.2196/58140", url="https://www.researchprotocols.org/2024/1/e58140" } @Article{info:doi/10.2196/64969, author="Rosenthal, Sarah and Adler-Milstein, Julia and Patel, Vaishali", title="Public Health Data Exchange Through Health Information Exchange Organizations: National Survey Study", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="15", volume="10", pages="e64969", keywords="public health informatics", keywords="health information exchange", keywords="health information technology", keywords="data exchange", keywords="health information", keywords="national survey", keywords="surveillance", keywords="United States", keywords="PHA", keywords="HIO", keywords="public health agency", keywords="health information exchange organization", abstract="Background: The COVID-19 pandemic revealed major gaps in public health agencies' (PHAs') data and reporting infrastructure, which limited the ability of public health officials to conduct disease surveillance, particularly among racial or ethnic minorities disproportionally affected by the pandemic. Leveraging existing health information exchange organizations (HIOs) is one possible mechanism to close these technical gaps, as HIOs facilitate health information sharing across organizational boundaries. Objective: The aim of the study is to survey all HIOs that are currently operational in the United States to assess HIO connectivity with PHAs and HIOs' capabilities to support public health data exchange. Methods: Drawing on multiple sources, we identified all potential local, regional, and state HIOs that were operational in the United States as of March 1, 2022. We defined operational as HIOs that facilitated exchange between at least 2 independent entities. We fielded a survey among our census list of 135 HIOs in January-July 2023. The survey confirmed HIO status as well as captured organizational demographics and current and potential support for PHAs. We report descriptive statistics on HIO demographics and connectivity with PHAs. We also include results on services and data available to support PHAs, funding sources to support public health reporting, and barriers to public health reporting. Of the 135 potential HIOs that received the survey, 90 met our definition of an HIO, and 77 completed the survey, yielding an 86\% response rate. Results: We found that 66 (86\%) of HIOs in 45 states were electronically connected to at least 1 PHA, yielding 187 HIO-PHA connections across all HIOs. Among HIOs connected to PHAs, the most common type of public health reporting supported by HIOs was immunization registry (n=39, 64\%), electronic laboratory result (n=37, 63\%), and syndromic surveillance (n=34, 61\%). In total, 58\% (n=38) of HIOs connected to PHAs provided data to address COVID-19 information gaps, and an additional 30\% (n=20) could do so. The most common types of data provided to PHAs were hospitalization information (n=54, 93\%), other demographic data (n=53, 91\%), health information (eg, chronic health conditions; n=51, 88\%), and hospital laboratory results (n=51, 88\%). A total of 64\% (n=42) of HIOs provided at least 1 type of data analytic service to PHAs to support COVID-19 pandemic response efforts. Top HIO reported barriers to support PHA activities included limited PHA funding (n=21, 32\%) and PHAs' competing priorities (n=15, 23\%). Conclusions: Our results show that many HIOs are already connected to PHAs and that they are assuming an emerging role to facilitate public health reporting. HIOs are well-positioned to provide value-added support for public health data exchange and address PHAs' information gaps, as ongoing federal efforts to modernize public health data infrastructure and interoperability continue. ", doi="10.2196/64969", url="https://publichealth.jmir.org/2024/1/e64969" } @Article{info:doi/10.2196/59800, author="Johnson, K. Amy and Devlin, A. Samantha and Pyra, Maria and Etshokin, Eriika and Ducheny, Kelly and Friedman, E. Eleanor and Hirschhorn, R. Lisa and Haider, Sadia and Ridgway, P. Jessica", title="Mapping Implementation Strategies to Address Barriers to Pre-Exposure Prophylaxis Use Among Women Through POWER Up (Pre-Exposure Prophylaxis Optimization Among Women to Enhance Retention and Uptake): Content Analysis", journal="JMIR Form Res", year="2024", month="Nov", day="15", volume="8", pages="e59800", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="Consolidated Framework for Implementation Research", keywords="CFIR", keywords="Expert Recommendations for Implementing Change", keywords="ERIC", keywords="implementation science", keywords="HIV prevention", keywords="AIDS", keywords="United States", keywords="Black women", keywords="women's health", abstract="Background: Black cisgender women (hereafter referred to as ``women'') experience one of the highest incidences of HIV among all populations in the United States. Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, but uptake among women is low. Despite tailored strategies for certain populations, including men who have sex with men and transgender women, Black women are frequently overlooked in HIV prevention efforts. Strategies to increase PrEP awareness and use among Black women are needed at multiple levels (ie, community, system or clinic, provider, and individual or patient). Objective: This study aimed to identify barriers and facilitators to PrEP uptake and persistence among Black cisgender women and to map implementation strategies to identified barriers using the CFIR (Consolidated Framework for Implementation Research)-ERIC (Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool. Methods: We conducted a secondary analysis of previous qualitative studies completed by a multidisciplinary team of HIV physicians, implementation scientists, and epidemiologists. Studies involved focus groups and interviews with medical providers and women at a federally qualified health center in Chicago, Illinois. Implementation science frameworks such as the CFIR were used to investigate determinants of PrEP use among Black women. In this secondary analysis, data from 45 total transcripts were analyzed. We identified barriers and facilitators to PrEP uptake and persistence among cisgender women across each CFIR domain. The CFIR-ERIC Implementation Strategy Matching Tool was used to map appropriate implementation strategies to address barriers and increase PrEP uptake among Black women. Results: Barriers to PrEP uptake were identified across the CFIR domains. Barriers included being unaware that PrEP was available (characteristics of individuals), worrying about side effects and impacts on fertility and pregnancy (intervention characteristics), and being unsure about how to pay for PrEP (outer setting). Providers identified lack of training (characteristics of individuals), need for additional clinical support for PrEP protocols (inner setting), and need for practicing discussions about PrEP with women (intervention characteristics). ERIC mapping resulted in 5 distinct implementation strategies to address barriers and improve PrEP uptake: patient education, provider training, PrEP navigation, clinical champions, and electronic medical record optimization. Conclusions: Evidence-based implementation strategies that address individual, provider, and clinic factors are needed to engage women in the PrEP care continuum. Tailoring implementation strategies to address identified barriers increases the probability of successfully improving PrEP uptake. Our results provide an overview of a comprehensive, multilevel implementation strategy (ie, ``POWER Up'') to improve PrEP uptake among women. International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0285858 ", doi="10.2196/59800", url="https://formative.jmir.org/2024/1/e59800" } @Article{info:doi/10.2196/62759, author="Leandro, Andr{\'e} and Maciel-de-Freitas, Rafael", title="Development of an Integrated Surveillance System to Improve Preparedness for Arbovirus Outbreaks in a Dengue Endemic Setting: Descriptive Study", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="14", volume="10", pages="e62759", keywords="surveillance", keywords="Aedes aegypti", keywords="vector control", keywords="transmission risk", keywords="dengue fever", abstract="Background: Dengue fever, transmitted by Aedes aegypti and Aedes albopictus mosquitoes, poses a significant public health challenge in tropical and subtropical regions. Dengue surveillance involves monitoring the incidence, distribution, and trends of infections through systematic data collection, analysis, interpretation, and dissemination. It supports public health decision-making, guiding interventions like vector control, vaccination campaigns, and public education. Objective: Herein, we report the development of a surveillance system already in use to support public health managers against dengue transmission in Foz do Igua{\c{c}}u, a dengue-endemic Brazilian city located in the Triple Border with Argentina and Paraguay. Methods: We present data encompassing the fieldwork organization of more than 100 health agents; epidemiological and entomological data were gathered from November 2022 to April 2024, totalizing 18 months of data collection. Results: By registering health agents, we were able to provide support for those facing issues to fill their daily milestone of inspecting 16 traps per working day. We filtered dengue transmission in the city by patient age, gender, and reporting units, as well as according to dengue virus serotype. The entomological indices presented a strong seasonal pattern, as expected. Several longtime established routines in Foz do Igua{\c{c}}u have been directly impacted by the adoption of Vigil{\^a}ncia Integrada com Tecnologia (VITEC). Conclusions: The implementation of VITEC has enabled more efficient and accurate diagnostics of local transmission risk, leading to a better understanding of operational activity patterns and risks. Lately, local public health managers can easily identify hot spots of dengue transmission and optimize interventions toward those highly sensitive areas. ", doi="10.2196/62759", url="https://publichealth.jmir.org/2024/1/e62759" } @Article{info:doi/10.2196/53340, author="Bito, Seiji and Hayashi, Yachie and Fujita, Takanori and Takahashi, Ikuo and Arai, Hiromi and Yonemura, Shigeto", title="Survey of Citizens' Preferences for Combined Contact Tracing App Features During a Pandemic: Conjoint Analysis", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="14", volume="10", pages="e53340", keywords="digital contact tracing apps", keywords="infectious disease", keywords="conjoint analysis", keywords="user attitudes", keywords="public preferences", keywords="citizen values", keywords="attitude to health", keywords="COVID-19", keywords="contact tracing", keywords="privacy", keywords="questionnaires", abstract="Background: During the COVID-19 pandemic, an increased need for novel solutions such as digital contact tracing apps to mitigate virus spread became apparent. These apps have the potential to enhance public health initiatives through timely contact tracing and infection rate reduction. However, public and academic scrutiny has emerged around the adoption and use of these apps due to privacy concerns. Objective: This study aims to investigate public attitudes and preferences for contact tracing apps, specifically in Japan, using conjoint analysis to examine what specifications the public values most in such apps. By offering a nuanced understanding of the values that citizens prioritize, this study can help balance public health benefits and data privacy standards when designing contact tracing apps and serve as reference data for discussions on legal development and social consensus formation in the future. Methods: A cross-sectional, web-based questionnaire survey was conducted to determine how various factors related to the development and integration of infectious disease apps affect the public's intention to use such apps. Individuals were recruited anonymously by a survey company. All respondents were asked to indicate their preferences for a combination of basic attributes and infectious disease app features for conjoint analysis. The respondents were randomly divided into 2 groups: one responded to a scenario where the government was assumed to be the entity dealing with infectious disease apps (ie, the government cluster), and the other responded to a scenario where a commercial company was assumed to be this entity (ie, the business cluster). Samples of 500 respondents from each randomly selected group were used as target data. Results: For the government cluster, the most important attribute in scenario A was distributor rights (42.557), followed by public benefits (29.458), personal health benefits (22.725), and profit sharing (5.260). For the business cluster, the most important attribute was distributor rights (45.870), followed by public benefits (32.896), personal health benefits (13.994), and profit sharing (7.240). Hence, personal health benefits tend to be more important in encouraging active app use than personal financial benefits. However, the factor that increased motivation for app use the most was the public health benefits of cutting infections by half. Further, concern about the use of personal data collected by the app for any secondary purpose was a negative incentive, which was more significant toward app use compared to the other 3 factors. Conclusions: The findings suggest that potential app users are positively motivated not only by personal health benefits but also by contributing to public health. Thus, a combined approach can be taken to increase app use. ", doi="10.2196/53340", url="https://publichealth.jmir.org/2024/1/e53340" } @Article{info:doi/10.2196/56320, author="KC, Sukriti and Papoutsi, Chrysanthi and Reidy, Claire and Gudgin, Bernard and Powell, John and Majeed, Azeem and Greaves, Felix and Laverty, A. Anthony", title="Differences in Use of a Patient Portal Across Sociodemographic Groups: Observational Study of the NHS App in England", journal="J Med Internet Res", year="2024", month="Nov", day="13", volume="26", pages="e56320", keywords="digital health", keywords="patient portals", keywords="technological health divide", keywords="eHealth", keywords="inequality", keywords="observational", keywords="ecological", keywords="England", keywords="app", keywords="patient portal", keywords="disparities", keywords="deprivation", keywords="demographics", keywords="long-term health care", keywords="negative binomial regression model", keywords="intervention", keywords="patient support", keywords="general practice", keywords="digital technology", keywords="patient", keywords="youth", keywords="", abstract="Background: The adoption of patient portals, such as the National Health Service (NHS) App in England, may improve patient engagement in health care. However, concerns remain regarding differences across sociodemographic groups in the uptake and use of various patient portal features, which have not been fully explored. Understanding the use of various functions across diverse populations is essential to ensure any benefits are equally distributed across the population. Objective: This study aims to explore differences in the use of NHS App features across age, sex, deprivation, ethnicity, long-term health care needs, and general practice (GP) size categories. Methods: We used weekly NHS App use data from the NHS App dashboard for 6386 GPs in England from March 2020 to June 2022. Negative binomial regression models explored variations in weekly rates of NHS App features used (registrations, log-ins, prescriptions ordered, medical record views, and appointments booked). Outcomes were measured as weekly rates per 1000 GP-registered patients, and we conducted separate models for each outcome. Regression models included all covariates mentioned above and produced incident rate ratios, which we present here as relative percentages for ease of interpretation. GP-level covariate data on sociodemographic variables were used as categorical variables in 5 groups for deprivation (Q1=least deprived practices and Q5=most deprived practices) and 4 groups for all other variables (Q1=least deprived practices and Q4=most deprived practices). Results: We found variations in the use of different features overall and across sociodemographic categories. Fully adjusted regression models found lower use of features overall in more deprived practices (eg, Q5 vs Q1: registrations=--34\%, log-ins=--34.9\%, appointments booked=--39.7\%, medical record views=--32.3\%, and prescriptions ordered=--9.9\%; P<.001). Practices with greater proportions of male patients also had lower levels of NHS App use (eg, Q4 vs Q1: registration=--7.1\%, log-in=--10.4\%, and appointments booked=--36.4\%; P<.001). Larger practices had an overall higher use of some NHS App features (eg, Q4 vs Q1: registration=3.2\%, log-ins=11.7\%, appointments booked=73.4\%, medical record views=23.9\%, and prescriptions ordered=20.7\%; P<.001), as well as those with greater proportions of White patients (eg, Q4 vs Q1: registration=1.9\%, log-ins=9.1\%, appointments booked=14.1\%, medical record views=28.7\%, and prescriptions ordered=130.4\%; P<.001). Use patterns varied for practices with greater proportions of patients with long-term health care needs (eg, Q4 vs Q1: registrations=--3.6\%, appointments booked=--20\%, and medical record views=6\%; P?.001). Conclusions: This study highlights that the use of the NHS App features varied across sociodemographic groups. In particular, it is used less by people living in more deprived areas. Tailored interventions and patient support are required to ensure that any benefits from the NHS App are spread equally throughout the population. ", doi="10.2196/56320", url="https://www.jmir.org/2024/1/e56320" } @Article{info:doi/10.2196/54200, author="Chen, Xing-Ling and Li, Jin and Sun, Shu-Ning and Zhao, Qiang-Qiang and Lin, Sheng-Rong and Wang, Ling-Jun and Yang, Zhong-Qi and Ni, Shi-Hao and Lu, Lu", title="Association Between Daily Internet Use and Intrinsic Capacity Among Middle-Aged and Older Adults in China: Large Prospective Cohort Study", journal="J Med Internet Res", year="2024", month="Nov", day="12", volume="26", pages="e54200", keywords="daily internet use", keywords="intrinsic capacity", keywords="IC", keywords="middle-aged and older adult", keywords="healthy aging", keywords="social participation", abstract="Background: Intrinsic capacity (IC), as a comprehensive measure of an individual's functional ability, has gained prominence in the framework for healthy aging introduced by the World Health Organization (WHO). As internet usage continues to integrate into daily life, it is imperative to scrutinize the association between internet use and IC to effectively promote healthy aging among the middle-aged and older population. Objective: This study aimed to investigate whether daily internet use in middle-aged and older adults delays or accelerates the decline in IC. Methods: Participants included in the China Health and Retirement Longitudinal Study (CHARLS) comprised individuals aged ?45 years residing in China. We analyzed 4 years of CHARLS data from the first wave (May 2011-March 2012) to the third wave (July 2015-January 2016). Data from the first and third waves were used for longitudinal studies. Self-reported data encompassed internet use, frequency of use, and demographic baseline characteristics. In addition, the IC evaluation involved physical examination and blood test data. Initially, linear regression was used to assess the relationship between daily internet use and IC, followed by regression splines to explore potential nonlinear associations. Subgroup and sensitivity analyses were used to investigate the heterogeneity of IC in specific conditions and the robustness of our results. Mediation effect analysis was conducted to identify the factors that mediate the relationship between daily internet use and IC, focusing on social participation, physical activity, and health status. Results: Among the 12,826 participants included in the longitudinal analyses, 12,305 (95.9\%) did not use the internet, while 521 (4.1\%) reported daily internet use with a mean age of 52.62 (SD 7.67) years. After adjusting for demographic variables, socioeconomic factors, lifestyle behaviors, and health conditions and examining the impact of daily internet use and frequency on changes in IC, our findings indicated important associations. Specifically, daily internet use is significantly linked to a slower decline in IC over time (marginal effect 1.58, 95\% CI 1.03-2.12; P<.001). Individuals with moderate and regular internet use frequency exhibit higher levels of maintenance in IC (marginal effect 0.74, 95\% CI 0.45-1.03, P<.001). In addition, the relationship between IC changes and internet use frequency demonstrated a nonlinear inverted U-shaped curve (nonlinear P=.003). Subgroup analysis further revealed that improvements in IC vary based on age and gender. Furthermore, mediation analysis denoted that more than 28.78\% (95\% CI 21.24-40.33) of the observed association is mediated by social participation (P<.001). Conclusions: The findings of our research underscore the potential benefits of consistent and moderate internet use in promoting and preserving IC, particularly in cognitive capacity, sensory, vitality, and locomotion. The observed effects may be related to social participation. These insights offer valuable guidance for crafting strategies aimed at fostering healthy aging within the middle-aged and older adult demographics. ", doi="10.2196/54200", url="https://www.jmir.org/2024/1/e54200" } @Article{info:doi/10.2196/64555, author="Yang, Si Myung and Taira, Kazuya", title="Predicting Prefecture-Level Well-Being Indicators in Japan Using Search Volumes in Internet Search Engines: Infodemiology Study", journal="J Med Internet Res", year="2024", month="Nov", day="11", volume="26", pages="e64555", keywords="well-being", keywords="spatial indicator", keywords="infodemiology", keywords="search engine", keywords="public health", keywords="health policy", keywords="policy-making", keywords="Google", keywords="Japan", abstract="Background: In recent years, the adoption of well-being indicators by national governments and international organizations has emerged as an important tool for evaluating state governance and societal progress. Traditionally, well-being has been gauged primarily through economic metrics such as gross domestic product, which fall short of capturing multifaceted well-being, including socioeconomic inequalities, life satisfaction, and health status. Current well-being indicators, including both subjective and objective measures, offer a broader evaluation but face challenges such as high survey costs and difficulties in evaluating at regional levels within countries. The emergence of web log data as an alternative source of well-being indicators offers the potential for more cost-effective, timely, and less biased assessments. Objective: This study aimed to develop a model using internet search data to predict well-being indicators at the regional level in Japan, providing policy makers with a more accessible and cost-effective tool for assessing public well-being and making informed decisions. Methods: This study used the Regional Well-Being Index (RWI) for Japan, which evaluates prefectural well-being across 47 prefectures for the years 2010, 2013, 2016, and 2019, as the outcome variable. The RWI includes a comprehensive approach integrating both subjective and objective indicators across 11 domains, including income, job, and life satisfaction. Predictor variables included z score--normalized relative search volume (RSV) data from Google Trends for words relevant to each domain. Unrelated words were excluded from the analysis to ensure relevance. The Elastic Net methodology was applied to predict RWI using RSVs, with $\alpha$ balancing ridge and lasso effects and $\lambda$ regulating their strengths. The model was optimized by cross-validation, determining the best mix and strength of regularization parameters to minimize prediction error. Root mean square errors (RMSE) and coefficients of determination (R2) were used to assess the model's predictive accuracy and fit. Results: An analysis of Google Trends data yielded 275 words related to the RWI domains, and RSVs were collected for 211 words after filtering out irrelevant terms. The mean search frequencies for these words during 2010, 2013, 2016, and 2019 ranged from ?1.587 to 3.902, with SDs between 3.025 and 0.053. The best Elastic Net model ($\alpha$=0.1, $\lambda$=0.906, RMSE=1.290, and R2=0.904) was built using 2010-2016 training data and 2-13 variables per domain. Applied to 2019 test data, it yielded an RMSE of 2.328 and R2 of 0.665. Conclusions: This study demonstrates the effectiveness of using internet search log data through the Elastic Net machine learning method to predict the RWI in Japanese prefectures with high accuracy, offering a rapid and cost-efficient alternative to traditional survey approaches. This study highlights the potential of this methodology to provide foundational data for evidence-based policy making aimed at enhancing well-being. ", doi="10.2196/64555", url="https://www.jmir.org/2024/1/e64555" } @Article{info:doi/10.2196/49708, author="Phadnis, Rachael and Perera, Udara and Lea, Veronica and Davlin, Stacy and Lee, Juliette and Siesel, Casey and Abeygunathilaka, Dhanushka and Wickramasinghe, C. S.", title="Designing and Validating a Survey for National-Level Data During the COVID-19 Pandemic in Sri Lanka: Cross-Sectional Mobile Phone Surveys", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e49708", keywords="pilot study", keywords="mobile phone survey", keywords="survey methodology", keywords="COVID-19", keywords="data collection", keywords="national survey", keywords="pandemic", keywords="population-based study", keywords="Sri Lanka", keywords="middle-income countries", keywords="low-income countries", keywords="vaccine acceptability", keywords="vaccine", keywords="COVID-19 vaccination", abstract="Background: The COVID-19 pandemic has generated a demand for timely data, resulting in a surge of mobile phone surveys for tracking the impacts of and responses to the pandemic. Mobile phone surveys have become a preferred mode of data collection across low- and middle-income countries. Objective: This study piloted 2 population-based, cross-sectional mobile phone surveys among Sri Lankan residents in 2020 and 2021 during the COVID-19 pandemic. The surveys aimed to gather data on knowledge, attitudes, and practices, vaccine acceptability, availability, and barriers to COVID-19 testing, and use of a medicine distribution service. Methods: The study used Surveda, an open-source survey tool developed by the NCD (noncommunicable disease) Mobile Phone Survey Data 4 Health Initiative, for data collection and management. The surveys were conducted through interactive voice response using automated, prerecorded messages in Sinhala, Tamil, and English. The sample design involved random sampling of mobile phone numbers, stratified by sex, proportional to the general population. Eligibility criteria varied between surveys, targeting adults aged 35 years and older with any noncommunicable disease for the first survey and all adults for the second survey. The data were adjusted to population estimates, and statistical analysis was conducted using SAS (SAS Institute) and R software (R Core Team). Descriptive statistics, Rao-Scott chi-square tests, and z tests were used to analyze the data. Response rates, cooperation rates, and productivity of the sampling approach were calculated. Results: In the first survey, n=5001, the overall response rate was 7.5\%, with a completion rate of 85.6\%. In the second survey, n=1250, the overall response rate was 10.9\%, with a completion rate of 61.9\%. Approximately 3 out of 4 adults reported that they avoided public places (888/1175, 75.6\%), more than two-thirds avoided public transportation (808/1173, 68.9\%), and 9 out of 10 practiced physical distancing (1046/1167, 89.7\%). Approximately 1 out of 10 Sri Lankan persons reported being tested for COVID-19, and the majority of those received a polymerase chain reaction test (112/161, 70\%). Significantly more males than females reported being tested for COVID-19 (98/554, 17.8\% vs 61/578, 10.6\%, respectively; P<.001). Finally, the majority of adult Sri Lankan people reported that they definitely or probably would get the COVID-19 vaccination (781/1190, 65.7\%). Conclusions: The surveys revealed that, overall, the adult Sri Lankan population adhered to COVID-19 mitigation strategies. These findings underscore the use of mobile phone surveys in swiftly and easily providing essential data to inform a country's response during the COVID-19 pandemic, obviating the need for face-to-face data collection. ", doi="10.2196/49708", url="https://formative.jmir.org/2024/1/e49708" } @Article{info:doi/10.2196/55555, author="Tran, Thao Thi Phuong and Vu, Trang Thu and Li, Yachao and Popova, Lucy", title="Tobacco and Alcohol Content in Top Vietnamese YouTube Music Videos: Content Analysis", journal="J Med Internet Res", year="2024", month="Nov", day="8", volume="26", pages="e55555", keywords="risk", keywords="risk factor", keywords="tobacco content", keywords="alcohol content", keywords="tobacco", keywords="alcohol", keywords="tobacco portrayal", keywords="alcohol portrayal", keywords="music video", keywords="Vietnam", keywords="Vietnamese", keywords="YouTube", keywords="social media", keywords="socials", keywords="youth", keywords="adolescent", keywords="teen", keywords="teenager", keywords="young adult", abstract="Background: Seeing portrayals of tobacco and alcohol in music videos (MVs) may reduce perceived risks, increase susceptibility, and lead to the initiation of tobacco and alcohol use among adolescents and young adults. Previous studies have predominantly concentrated on assessing tobacco and alcohol contents in English-language MVs within Western countries. However, many other countries have not only been influenced by the English music market but have also produced music in their native languages, and this content remains underexamined. Objective: This study aims to investigate the prevalence of tobacco- and alcohol-related content in top Vietnamese MVs on YouTube from 2013 to 2021, to describe how tobacco and alcohol are portrayed in these MVs, and to examine associations between these portrayals and MV characteristics. Methods: A total of 410 Vietnamese MVs, including the top 40 or 50 most viewed released each year between 2013 and 2021, were analyzed. General information, such as the song name, its release date and ranking, age restriction, musical genre, and type of MV, was collected. We examined tobacco and alcohol content in the MVs, with specific details such as tobacco types, their brands, as well as the number, age, sex, and roles of individuals smoking or drinking. Results: Among the 410 MVs, 36 (8.8\%) contained tobacco-related content and 136 (33.2\%) featured alcohol-related content. Additionally, 28 (6.8\%) out of 410 MVs included both tobacco and alcohol content. The prevalence of videos with tobacco and alcohol content fluctuated over the years. In MVs with tobacco-related content, a higher proportion of hip-hop or rap songs contained tobacco-related content (n=6, 30\%) compared to other music genres. In MVs with tobacco-related content, cigarettes were the most frequently shown product (n=28, 77.8\%), and smoking scenes were often depicted at parties (n=13, 36.1\%) and during dancing and singing scenes (n=12, 33.3\%). Among the 31 MVs portraying actual tobacco use, tobacco use was typically depicted with 1 person, often a young adult male, while 38.7\% (n=12) showed singer(s) smoking. For MVs with alcohol-related content, there was a high proportion showing alcohol images at parties, bars, or pubs (n=96, 70.6\%). Among 87 MVs containing drinking scenes, 60.9\% (n=53) involved groups of young adults of both sexes, and 64\% (n=56) depicted singers drinking. Additionally, only 2 (5.6\%) MVs included health warnings about tobacco harm, and 2 MVs (1.5\%) included warnings about drinking restricted to individuals 18 years and above. Conclusions: The notable prevalence of tobacco and alcohol content in leading Vietnamese YouTube MVs raises concerns, especially as most of this content is portrayed without any warnings. The study underscores a regulatory gap in addressing such content on the internet, emphasizing the urgent need for stricter regulations and age restrictions on platforms such as YouTube. ", doi="10.2196/55555", url="https://www.jmir.org/2024/1/e55555" } @Article{info:doi/10.2196/58116, author="Mayito, Jonathan and Tumwine, Conrad and Galiwango, Ronald and Nuwamanya, Elly and Nakasendwa, Suzan and Hope, Mackline and Kiggundu, Reuben and Byonanebye, M. Dathan and Dhikusooka, Flavia and Twemanye, Vivian and Kambugu, Andrew and Kakooza, Francis", title="Combating Antimicrobial Resistance Through a Data-Driven Approach to Optimize Antibiotic Use and Improve Patient Outcomes: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2024", month="Nov", day="8", volume="13", pages="e58116", keywords="antimicrobial resistance", keywords="AMR database", keywords="AMR", keywords="machine learning", keywords="antimicrobial use", keywords="artificial intelligence", keywords="antimicrobial", keywords="data-driven", keywords="mixed-method", keywords="patient outcome", keywords="drug-resistant infections", keywords="drug resistant", keywords="surveillance data", keywords="economic", keywords="antibiotic", abstract="Background: It is projected that drug-resistant infections will lead to 10 million deaths annually by 2050 if left unabated. Despite this threat, surveillance data from resource-limited settings are scarce and often lack antimicrobial resistance (AMR)--related clinical outcomes and economic burden. We aim to build an AMR and antimicrobial use (AMU) data warehouse, describe the trends of resistance and antibiotic use, determine the economic burden of AMR in Uganda, and develop a machine learning algorithm to predict AMR-related clinical outcomes. Objective: The overall objective of the study is to use data-driven approaches to optimize antibiotic use and combat antimicrobial-resistant infections in Uganda. We aim to (1) build a dynamic AMR and antimicrobial use and consumption (AMUC) data warehouse to support research in AMR and AMUC to inform AMR-related interventions and public health policy, (2) evaluate the trends in AMR and antibiotic use based on annual antibiotic and point prevalence survey data collected at 9 regional referral hospitals over a 5-year period, (3) develop a machine learning model to predict the clinical outcomes of patients with bacterial infectious syndromes due to drug-resistant pathogens, and (4) estimate the annual economic burden of AMR in Uganda using the cost-of-illness approach. Methods: We will conduct a study involving data curation, machine learning--based modeling, and cost-of-illness analysis using AMR and AMU data abstracted from procurement, human resources, and clinical records of patients with bacterial infectious syndromes at 9 regional referral hospitals in Uganda collected between 2018 and 2026. We will use data curation procedures, FLAIR (Findable, Linkable, Accessible, Interactable and Repeatable) principles, and role-based access control to build a robust and dynamic AMR and AMU data warehouse. We will also apply machine learning algorithms to model AMR-related clinical outcomes, advanced statistical analysis to study AMR and AMU trends, and cost-of-illness analysis to determine the AMR-related economic burden. Results: The study received funding from the Wellcome Trust through the Centers for Antimicrobial Optimisation Network (CAMO-Net) in April 2023. As of October 28, 2024, we completed data warehouse development, which is now under testing; completed data curation of the historical Fleming Fund surveillance data (2020-2023); and collected retrospective AMR records for 599 patients that contained clinical outcomes and cost-of-illness economic burden data across 9 surveillance sites for objectives 3 and 4, respectively. Conclusions: The data warehouse will promote access to rich and interlinked AMR and AMU data sets to answer AMR program and research questions using a wide evidence base. The AMR-related clinical outcomes model and cost data will facilitate improvement in the clinical management of AMR patients and guide resource allocation to support AMR surveillance and interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/58116 ", doi="10.2196/58116", url="https://www.researchprotocols.org/2024/1/e58116" } @Article{info:doi/10.2196/62641, author="Patel, Atushi and Maruthananth, Kevin and Matharu, Neha and Pinto, D. Andrew and Hosseini, Banafshe", title="Early Warning Systems for Acute Respiratory Infections: Scoping Review of Global Evidence", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="7", volume="10", pages="e62641", keywords="early warning systems", keywords="acute respiratory infections", keywords="early detection systems", abstract="Background: Early warning systems (EWSs) are tools that integrate clinical observations to identify patterns indicating increased risks of clinical deterioration, thus facilitating timely and appropriate interventions. EWSs can mitigate the impact of global infectious diseases by enhancing information exchange, monitoring, and early detection. Objective: We aimed to evaluate the effectiveness of EWSs in acute respiratory infections (ARIs) through a scoping review of EWSs developed, described, and implemented for detecting novel, exotic, and re-emerging ARIs. Methods: We searched Ovid MEDLINE ALL, Embase, Cochrane Library (Wiley), and CINAHL (Ebsco). The search was conducted on October 03, 2023. Studies that implemented EWSs for the detection of acute respiratory illnesses were included. Covidence was used for citation management, and a modified Critical Appraisal Skills Programme (CASP) checklist was used for quality assessment. Results: From 5838 initial articles, 29 met the inclusion criteria for this review. Twelve studies evaluated the use of EWSs within community settings, ranging from rural community reporting networks to urban online participatory surveillance platforms. Five studies focused on EWSs that used data from hospitalization and emergency department visits. These systems leveraged clinical and admission data to effectively detect and manage local outbreaks of respiratory infections. Two studies focused on the effectiveness of existing surveillance systems, assessing their adaptability and responsiveness to emerging threats and how they could be improved based on past performance. Four studies highlighted the integration of machine learning models to improve the predictive accuracy of EWSs. Three studies explored the applications of national EWSs in different health care settings and emphasized their potential in predicting clinical deterioration and facilitating early intervention. Lastly, 3 studies addressed the use of surveillance systems in aged-care facilities, highlighting the unique challenges and needs of monitoring and responding to health threats in environments housing vulnerable populations. The CASP tool revealed that most studies were relevant, reliable, and of high value (score 6: 11/29, 38\%; score 5: 9/29, 31\%). The common limitations included result generalizability, selection bias, and small sample size for model validation. Conclusions: This scoping review confirms the critical role of EWSs in enhancing public health responses to respiratory infections. Although the effectiveness of these systems is evident, challenges related to generalizability and varying methodologies suggest a need for continued innovation and standardization in EWS development. ", doi="10.2196/62641", url="https://publichealth.jmir.org/2024/1/e62641" } @Article{info:doi/10.2196/51594, author="Zhou, Xinyi and Hao, Xinyu and Chen, Yuhang and Deng, Hui and Fang, Ling and Zhang, Lingyun and Yan, Xiaotao and Zheng, Pinpin and Wang, Fan", title="Social Media Marketing Strategies for Electronic Cigarettes: Content Analysis of Chinese Weibo Accounts", journal="J Med Internet Res", year="2024", month="Nov", day="7", volume="26", pages="e51594", keywords="e-cigarette", keywords="marketing strategy", keywords="social media", keywords="teenagers", keywords="content analysis", abstract="Background: E-cigarettes have gained popularity among teenagers due to extensive marketing strategies on social media platforms. This widespread promotion is a risk factor, as it fosters more positive attitudes toward e-cigarette use among teenagers and increases the perception that using e-cigarettes is normal. Therefore, the marketing of e-cigarettes on social media is a serious global health concern, and its strategies and impact should be clearly identified. Objective: This study examined how e-cigarette companies popularize their products via Weibo and identified the specific strategies influencing the effectiveness of their marketing. Methods: In phase 1, we conducted a search on Qcc.com and identified 32 e-cigarette brands with active Weibo accounts between October 1 and December 31, 2020, along with 863 Weibo posts. The data were investigated through content analysis. The codebook was developed into four categories: (1) product and features, (2) sales and promotions, (3) social contact and interaction, and (4) restrictions and warnings. To further understand the factors influencing e-cigarette brand marketing, we conducted a multiple linear regression analysis. Results: Marketing tactics by e-cigarette companies on Chinese social media were documented, including emphasizing attractive product features, using trendy characters, implicit promotions, downplaying health concerns, and engaging with Weibo users in various ways. Out of 863 posts, 449 (52\%) mentioned product characteristics. In 313 (36.3\%) posts, visible figures were used to attract attention. Product promotion was absent in 762 (88.3\%) posts, and purchase channels were not mentioned in 790 (98.3\%) posts. Social interaction--related posts received attention (n=548, 63.5\%), particularly those featuring hashtag content (n=538, 62.3\%). Most posts did not include claims for restrictions on teenagers' purchases or use (n=687, 79.6\%) or information on health warnings (n=839, 97.2\%). Multiple linear regression analysis identified marketing strategies that effectively increase the exposure of e-cigarette posts on Weibo. Posts including engagement via posts encouraging reposts, comments, and likes (P<.001) and engagement topics related to e-cigarette brands were positively correlated with the number of reposts (P=.009). Posts highlighting nonmonetary incentives (P=.004), posts with age restriction statements (P<.001), engaging via stories and idea collection (P<.001), and engagement topics related to products (P<.001) and current affairs (P=.002) had a positive effect on the number of comments. Engagement topics related to brands (P<.001) or interactive sweepstakes (P<.001) had a positive effect on the number of likes. Conclusions: E-cigarette posts on Weibo that focus on product features and social interaction attract public attention, especially from teenagers. Stricter regulations and monitoring should be adopted to restrict the social media marketing of e-cigarettes. ", doi="10.2196/51594", url="https://www.jmir.org/2024/1/e51594" } @Article{info:doi/10.2196/52738, author="Gong, Jie and Gu, Dandan and Dong, Suyun and Shen, Wangqin and Yan, Haiou and Xie, Juan", title="Effects of Message Framing on Human Papillomavirus Vaccination: Systematic Review", journal="J Med Internet Res", year="2024", month="Nov", day="7", volume="26", pages="e52738", keywords="message framing", keywords="gain-loss framing", keywords="human?papillomavirus", keywords="vaccination", keywords="attitude", keywords="intention", keywords="behavior", keywords="systematic review", keywords="PRISMA", abstract="Background: With the advancement of cervical cancer elimination strategies, promoting human papillomavirus (HPV) vaccination is essential to achieving this goal. The issue of how to structure and develop message content to promote HPV vaccination is a debatable issue. Objective: The efficacy of gain-loss framing in vaccination contexts is disputed. Our study aimed to elucidate the consequences of message framing on attitudes, intentions, and behavioral tendencies toward HPV vaccination, with the objective of refining message framing strategies and their elements. Methods: This systematic review adhered strictly to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guideline reporting standards to comprehensively retrieve, extract, and integrate data. We searched databases, including PubMed, Embase, Scopus, and Web of Science, for literature published from database construction to August 15, 2023. Literature screening, data extraction, and quality evaluation were performed by 2 researchers. Intervention studies published in English, conducted with populations with children eligible for HPV vaccination, and involving message framing were included. Attitudes, intentions, and behaviors served as outcome evaluation criteria. Results: A total of 19 intervention studies were included. Gain-loss framing had no clear effect on vaccination attitudes nor intentions. Loss framing showed a weak advantage at improving HPV vaccination attitudes or intentions, but the evidence was not strong enough to draw definitive conclusions. The impact of gain-loss framing on HPV vaccination behaviors could not be determined due to the limited number of studies and the qualitative nature of the analysis. Conclusions: Combining gain-loss framing with other message framing approaches may be an effective way to enhance the effect of message framing. More high-quality message framing content and exploring alternative moderator or mediator variables are required to support the conclusion. Trial Registration: CRD42023451612; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?RecordID=451612 ", doi="10.2196/52738", url="https://www.jmir.org/2024/1/e52738" } @Article{info:doi/10.2196/50343, author="Bhagavathula, Srikanth Akshaya and Dobbs, D. Page", title="Online Interest in Elf Bar in the United States: Google Health Trends Analysis", journal="J Med Internet Res", year="2024", month="Nov", day="5", volume="26", pages="e50343", keywords="e-cigarettes", keywords="Elf Bar", keywords="JUUL", keywords="tobacco", keywords="Google Trends", keywords="Google Health Trends", abstract="Background: Despite the popularity of JUUL e-cigarettes, other brands (eg, Elf Bar) may be gaining digital attention. Objective: This study compared Google searches for Elf Bar and JUUL from 2022 to 2023 using Google Health Trends Application Programming Interface data. Methods: Using an infodemiology approach, we examined weekly trends in Google searches (per 10 million) for ``Elf Bar'' and ``JUUL'' at the US national and state levels from January 1, 2022, to December 31, 2023. Joinpoint regression was used to assess statistically significant trends in the search probabilities for ``Elf Bar'' and ``JUUL'' during the study period. Results: Elf Bar had less online interest than JUUL at the beginning of 2022. When the US Food and Drug Administration denied JUUL marketing authority on June 23, 2022, JUUL searches peaked at 2609.3 {\texttimes} 107 and fell to 83.9 {\texttimes} 107 on September 3, 2023. Elf Bar searches surpassed JUUL on July 10, 2022, and steadily increased, reaching 523.2 {\texttimes} 107 on December 4, 2022. Overall, Elf Bar's weekly search probability increased by 1.6\% (95\% CI 1.5\%-1.7\%; P=.05) from January 2022 to December 2023, with the greatest increase between May 29 and June 19, 2022 (87.7\%, 95\% CI 35.9\%-123.9\%; P=.001). Elf Bar searches increased after JUUL's suspension in Pennsylvania (1010\%), Minnesota (872.5\%), Connecticut (803.5\%), New York (738.1\%), and New Jersey (702.9\%). Conclusions: Increasing trends in Google searches for Elf Bar indicate that there was a growing online interest in this brand in the United States in 2022. ", doi="10.2196/50343", url="https://www.jmir.org/2024/1/e50343" } @Article{info:doi/10.2196/55311, author="Davis, Kevin and Curry, Laurel and Bradfield, Brian and Stupplebeen, A. David and Williams, J. Rebecca and Soria, Sandra and Lautsch, Julie", title="The Validity of Impressions as a Media Dose Metric in a Tobacco Public Education Campaign Evaluation: Observational Study", journal="J Med Internet Res", year="2024", month="Nov", day="5", volume="26", pages="e55311", keywords="communication", keywords="public education", keywords="tobacco", keywords="media", keywords="public health", abstract="Background: Evaluation research increasingly needs alternatives to target or gross rating points to comprehensively measure total exposure to modern multichannel public education campaigns that use multiple channels, including TV, radio, digital video, and paid social media, among others. Ratings data typically only capture delivery of broadcast media (TV and radio) and excludes other channels. Studies are needed to validate objective cross-channel metrics such as impressions against self-reported exposure to campaign messages. Objective: This study aimed to examine whether higher a volume of total media campaign impressions is predictive of individual-level self-reported campaign exposure in California. Methods: We analyzed over 3 years of advertisement impressions from the California Tobacco Prevention Program's statewide tobacco education campaigns from August 2019 through December 2022. Impressions data varied across designated market areas (DMAs) and across time. These data were merged to individual respondents from 45 waves of panel survey data of Californians aged 18-55 years (N=151,649). Impressions were merged to respondents based on respondents' DMAs and time of survey completion. We used logistic regression to estimate the odds of respondents' campaign recall as a function of cumulative and past 3-month impressions delivered to each respondent's DMA. Results: Cumulative impressions were positively and significantly associated with recall of each of the Flavors Hook Kids (odds ratio [OR] 1.15, P<.001), Dark Balloons and Apartment (OR 1.20, P<.001), We Are Not Profit (OR 1.36, P<.001), Tell Your Story (E-cigarette, or Vaping, product use Associated Lung Injury; OR 1.06, P<.05), and Thrown Away and Little Big Lies (OR 1.05, P<.01) campaigns. Impressions delivered in the past 3 months were associated with recall of the Flavors Hook Kids (OR 1.13, P<.001), Dark Balloons and Apartment (OR 1.08, P<.001), We Are Not Profit (OR 1.14, P<.001), and Thrown Away and Little Big Lies (OR 1.04, P<.001) campaigns. Past 3-month impressions were not significantly associated with Tell Your Story campaign recall. Overall, magnitudes of these associations were greater for cumulative impressions. We visualize recall based on postestimation predicted values from our multivariate logistic regression models. Conclusions: Variation in cumulative impressions for California Tobacco Prevention Program's long-term multichannel tobacco education campaign is predictive of increased self-reported campaign recall, suggesting that impressions may be a valid proxy for potential campaign exposure. The use of impressions for purposes of evaluating public education campaigns may help address current methodological limitations arising from the fragmented nature of modern multichannel media campaigns. ", doi="10.2196/55311", url="https://www.jmir.org/2024/1/e55311" } @Article{info:doi/10.2196/58711, author="Jordan, Arne and Nothacker, Julia and Paucke, Valentina and Hager, Heinz Klaus and Hueber, Susann and Karimzadeh, Arian and K{\"o}tter, Thomas and L{\"o}ffler, Christin and M{\"u}ller, Sigrid Beate and Tajdar, Daniel and L{\"u}hmann, Dagmar and Scherer, Martin and Sch{\"a}fer, Ingmar", title="Association Between Self-Reported Protective Behavior and Heat-Associated Health Complaints Among Patients With Chronic Diseases in Primary Care: Results of the CLIMATE Pilot Cohort Study", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="4", volume="10", pages="e58711", keywords="climate change", keywords="online survey", keywords="open internet data", keywords="climate", keywords="environment", keywords="rising temperature", keywords="heatexposure", keywords="chronic disease management", keywords="epidemiology", abstract="Background: As a result of climate change, exposure to high temperatures is becoming more common, even in countries with temperate climates. For patients with chronic diseases, heat poses significant health risks. Empowering patients is a crucial element in protecting the population from the adverse effects of heat. In this context, self-reports of protective behavior are often used to gain a mutual understanding of patients' issues. However, the extent to which self-reported behavior is associated with health complaints remains unclear. Objective: This study aims to describe the association between light to moderate heat and health complaints in everyday life, and to analyze whether self-reported protective behavior and related psychosocial factors are linked to these complaints. Methods: We conducted a pilot cohort study using internet climate data merged with an online survey of patients with chronic diseases recruited through general practitioner practices. Patients were eligible if they were 18 years or older and had at least one chronic disease. The heat was modeled using temperature and humidity data. Health complaints were assessed through up to 7 follow-up evaluations on the hottest day of each week during the observation period. Data were analyzed using 3 nested models with mixed effects multivariable linear regression, adjusting for random effects at the climate measuring station and participant levels. Model 1 included heat exposure, sociodemographic data, and chronic diseases. Model 2 added protective behavior and health literacy, while model 3 incorporated self-efficacy and somatosensory amplification (ie, the tendency to catastrophize normal bodily sensations such as insect bites). Results: Of the 291 eligible patients, 61 (21.0\%) participated in the study, providing 294 observations. On average, participants were 61 (SD 14) years old, and 31 (51\%) were men. The most prevalent conditions were cardiovascular diseases (n=23, 38\%) and diabetes mellitus (n=20, 33\%). The most commonly reported symptoms were tiredness/fatigue (232/294 observations, 78.9\%) and shortness of breath (142/294 observations, 48.3\%). Compared with temperatures of 27{\textdegree}C or lower, a heat index between over 27{\textdegree}C and 32{\textdegree}C ($\beta$=1.02, 95\% CI 0.08-1.96, P=.03) and over 32{\textdegree}C ($\beta$=1.35, 95\% CI 0.35-2.35, P=.008) were associated with a higher symptom burden. Lower health literacy ($\beta$=--0.25, 95\% CI --0.49 to --0.01, P=.04) and better self-reported protective behavior ($\beta$=0.65, 95\% CI 0.29-1.00, P<.001) were also linked to increased symptom burden but lost statistical significance in model 3. Instead, lower self-efficacy ($\beta$=--0.39, 95\% CI --0.54 to --0.23, P<.001) and higher somatosensory amplification ($\beta$=0.18, 95\% CI 0.07-0.28, P=.001) were associated with a higher symptom burden. Conclusions: Compared with colder weather, light and moderate heat were associated with more severe health complaints. Symptom burden was lower in participants with higher self-efficacy and less somatosensory amplification. Self-reported protective behavior was not linked to a lower symptom burden. Instead, we found that patients who tended to catastrophize normal bodily sensations reported both better protective behavior and a higher symptom burden simultaneously. Trial Registration: ClinicalTrials.gov NCT05961163; https://clinicaltrials.gov/ct2/show/NCT05961163 ", doi="10.2196/58711", url="https://publichealth.jmir.org/2024/1/e58711" } @Article{info:doi/10.2196/55614, author="Sullivan, Sean Patrick and Mera-Giler, M. Robertino and Bush, Staci and Shvachko, Valentina and Sarkodie, Eleanor and O'Farrell, Daniel and Dubose, Stephanie and Magnuson, David", title="Claims-Based Algorithm to Identify Pre-Exposure Prophylaxis Indications for Tenofovir Disoproxil Fumarate and Emtricitabine Prescriptions (2012-2014): Validation Study", journal="JMIR Form Res", year="2024", month="Nov", day="4", volume="8", pages="e55614", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="classification", keywords="electronic medical record", keywords="EMR", keywords="algorithm", keywords="electronic health record", keywords="EHR", keywords="drug", keywords="pharmacology", keywords="pharmacotherapy", keywords="pharmaceutical", keywords="medication", keywords="monotherapy", keywords="HIV", keywords="prevention", abstract="Background: To monitor the use of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) and related medicines for pre-exposure prophylaxis (PrEP) as HIV prevention using commercial pharmacy data, it is necessary to determine whether TDF/FTC prescriptions are used for PrEP or for some other clinical indication. Objective: This study aimed to validate an algorithm to distinguish the use of TDF/FTC for HIV prevention or infectious disease treatment. Methods: An algorithm was developed to identify whether TDF/FTC prescriptions were for PrEP or for other indications from large-scale administrative databases. The algorithm identifies TDF/FTC prescriptions and then excludes patients with International Classification of Diseases (ICD)--9 diagnostic codes, medications, or procedures that suggest indications other than for PrEP (eg, documentation of HIV infection, chronic hepatitis B, or use of TDF/FTC for postexposure prophylaxis). For evaluation, we collected data by clinician assessment of medical records for patients with TDF/FTC prescriptions and compared the assessed indication identified by the clinician review with the assessed indication identified by the algorithm. The algorithm was then applied and evaluated in a large, urban, community-based sexual health clinic. Results: The PrEP algorithm demonstrated high sensitivity and moderate specificity (99.6\% and 49.6\%) in the electronic medical record database and high sensitivity and specificity (99\% and 87\%) in data from the urban community health clinic. Conclusions: The PrEP algorithm classified the indication for PrEP in most patients treated with TDF/FTC with sufficient accuracy to be useful for surveillance purposes. The methods described can serve as a basis for developing a robust and evolving case definition for antiretroviral prescriptions for HIV prevention purposes. ", doi="10.2196/55614", url="https://formative.jmir.org/2024/1/e55614", url="http://www.ncbi.nlm.nih.gov/pubmed/39141024" } @Article{info:doi/10.2196/56943, author="Helms, Bernd Yannick and van der Meer, Akke and Crutzen, Rik and Ferreira, Ant{\'o}nio Jos{\'e} and Kretzschmar, E. Mirjam E. and Timen, Aura and Hamdiui, Nora and Stein, L. Mart", title="Determinants of Citizens' Intention to Participate in Self-Led Contact Tracing: Cross-Sectional Online Questionnaire Study", journal="JMIR Public Health Surveill", year="2024", month="Oct", day="30", volume="10", pages="e56943", keywords="contact tracing", keywords="telemedicine", keywords="health services research", keywords="intention", keywords="public health surveillance", keywords="machine learning", keywords="cross-sectional study", keywords="online questionnaire", keywords="disease outbreaks", keywords="task shifting", abstract="Background: Contact tracing (CT) is a key intervention to contain outbreaks of communicable diseases. During large-scale outbreaks, public health services may lack the resources required to perform CT effectively. One way of mitigating this issue is to shift some of the tasks in CT normally performed by public health services to cases and their contacts, supported by digital tools. We refer to this as ``self-led CT.'' However, while the effectiveness of the self-led CT inherently depends on the willingness and skills of citizens to participate, the determinants of citizens' intention to participate in self-led CT are not yet fully understood. Objective: We aimed to identify determinants of Dutch citizens' intention to participate in self-led CT and assess their potential for behavioral change, so as to identify ``behavior change targets,'' which may be used in the development and implementation of self-led CT to increase citizens' intention to participate. Methods: In March 2022, we performed an online cross-sectional questionnaire study. The questionnaire was developed based on findings from a previous exploratory semistructured interview study and distributed among a Dutch consumer panel. Using all questionnaire items as potential predictors, we performed a random forest analysis to identify determinants of citizens' intention to participate in self-led CT. We then performed an Agglomerative Hierarchical Cluster Analysis to identify groups of related determinants that may be considered overarching behavior change targets. Finally, we used Confidence Interval-Based Estimation of Relevance and calculated the Potential for Change Indices to compare the potential for behavioral change of the selected individual determinants and determinant clusters. Results: The questionnaire was completed by 3019 respondents. Our sample is representative of the Dutch population in terms of age, gender, educational level, and area of residence. Out of 3019 respondents, 2295 (76\%) had a positive intention to participate in self-led CT. We identified 20 determinants of citizens' intention that we grouped into 9 clusters. In general, increasing citizens' trust in the digital tools developed for self-led CT has the highest potential to increase citizens' intention, followed by increasing the belief that using digital tools makes participating in self-led CT easier, reducing privacy-related concerns, and increasing citizens' willingness---and sense of responsibility---to cooperate in CT in general. Conclusions: Overall, Dutch citizens are positive toward participating in self-led CT. Our results provide directions for the development and implementation of self-led CT, which may be particularly useful in preparing for future, large-scale outbreaks. ", doi="10.2196/56943", url="https://publichealth.jmir.org/2024/1/e56943" } @Article{info:doi/10.2196/54246, author="Paiva, Bruno and Gon{\c{c}}alves, Andr{\'e} Marcos and da Rocha, Dutra Leonardo Chaves and Marcolino, Soriano Milena and Lana, Barbosa Fernanda Cristina and Souza-Silva, Rego Maira Viana and Almeida, M. Jussara and Pereira, Delfino Polianna and de Andrade, Valiense Claudio Mois{\'e}s and Gomes, Reis Ang{\'e}lica Gomides dos and Ferreira, Pires Maria Ang{\'e}lica and Bartolazzi, Frederico and Sacioto, Furtado Manuela and Boscato, Paula Ana and Guimar{\~a}es-J{\'u}nior, Henriques Milton and dos Reis, Pereira Priscilla and Costa, Roberto Fel{\'i}cio and Jorge, Oliveira Alzira de and Coelho, Reis Laryssa and Carneiro, Marcelo and Sales, Souza Tha{\'i}s Lorenna and Ara{\'u}jo, Ferreira Silvia and Silveira, Vit{\'o}rio Daniel and Ruschel, Brasil Karen and Santos, Veloso Fernanda Caldeira and Cenci, Almeida Evelin Paola de and Menezes, Monteiro Luanna Silva and Anschau, Fernando and Bicalho, Camargos Maria Aparecida and Manenti, Fernandes Euler Roberto and Finger, Goulart Renan and Ponce, Daniela and de Aguiar, Carrilho Filipe and Marques, Margoto Luiza and de Castro, C{\'e}sar Lu{\'i}s and Vietta, Gr{\"u}newald Giovanna and Godoy, de Mariana Frizzo and Vila{\c{c}}a, Nascimento Mariana do and Morais, Costa Vivian", title="A New Natural Language Processing--Inspired Methodology (Detection, Initial Characterization, and Semantic Characterization) to Investigate Temporal Shifts (Drifts) in Health Care Data: Quantitative Study", journal="JMIR Med Inform", year="2024", month="Oct", day="28", volume="12", pages="e54246", keywords="health care", keywords="machine learning", keywords="data drifts", keywords="temporal drifts", abstract="Background: Proper analysis and interpretation of health care data can significantly improve patient outcomes by enhancing services and revealing the impacts of new technologies and treatments. Understanding the substantial impact of temporal shifts in these data is crucial. For example, COVID-19 vaccination initially lowered the mean age of at-risk patients and later changed the characteristics of those who died. This highlights the importance of understanding these shifts for assessing factors that affect patient outcomes. Objective: This study aims to propose detection, initial characterization, and semantic characterization (DIS), a new methodology for analyzing?changes in health outcomes and variables over time while discovering contextual changes for outcomes in large volumes of data. Methods: The DIS methodology involves 3 steps: detection, initial characterization, and semantic characterization. Detection uses metrics such as Jensen-Shannon divergence to identify significant data drifts. Initial characterization offers a global analysis of changes in data distribution and predictive feature significance over time. Semantic characterization uses natural language processing--inspired techniques to understand the local context of these changes, helping identify factors driving changes in patient outcomes. By integrating the outcomes from these 3 steps, our results can identify specific factors (eg, interventions and modifications in health care practices) that drive changes in patient outcomes. DIS was applied to the Brazilian COVID-19 Registry and the Medical Information Mart for Intensive Care, version IV (MIMIC-IV) data sets. Results: Our approach allowed us to (1) identify drifts effectively, especially using metrics such as the Jensen-Shannon divergence, and (2) uncover reasons for the decline in overall mortality in both the COVID-19 and MIMIC-IV data sets, as well as changes in the cooccurrence between different diseases and this particular outcome. Factors such as vaccination during the COVID-19 pandemic and reduced iatrogenic events and cancer-related deaths in MIMIC-IV were highlighted. The methodology also pinpointed shifts in patient demographics and disease patterns, providing insights into the evolving health care landscape during the study period. Conclusions: We developed a novel methodology combining machine learning?and natural language processing techniques to detect, characterize, and understand temporal shifts in health care data. This understanding can enhance predictive algorithms, improve patient outcomes, and optimize health care resource allocation, ultimately?improving the effectiveness of machine learning predictive algorithms applied to health care data. Our methodology can be applied to a variety of scenarios beyond those discussed in this paper. ", doi="10.2196/54246", url="https://medinform.jmir.org/2024/1/e54246" } @Article{info:doi/10.2196/62657, author="Brooks, J. Donald and Kim, Inae Carolyn and Mboussou, Fortune Franck and Danovaro-Holliday, Carolina M.", title="Developing National Information Systems to Monitor COVID-19 Vaccination: A Global Observational Study", journal="JMIR Public Health Surveill", year="2024", month="Oct", day="25", volume="10", pages="e62657", keywords="COVID-19", keywords="COVID-19 vaccine", keywords="immunization information system", keywords="vaccination monitoring", keywords="vaccine", keywords="monitoring and evaluation", abstract="Background: Strong information systems are essential for safe and effective immunization programs. The COVID-19 vaccine rollout presented all immunization information systems (IIS) with challenging demands---requiring in-depth vaccine implementation data at all health system levels in real time. The system development approaches taken by countries were heterogeneous, with some countries opting to adapt existing systems and others implementing new ones. Objective: Using data reported by Member States to the World Health Organization (WHO), we aim to develop a global understanding of (1) the types of IIS used to monitor COVID-19 vaccination implemented in 2021 and (2) the approaches taken by countries to develop these systems. Methods: We conducted a descriptive analysis of data reported through a supplemental questionnaire of the WHO/United Nations Children's Emergency Fund (UNICEF) Joint Reporting Form on Immunization, collecting data for 2021 on (1) the use of and developmental approaches taken for 7 IIS functions (appointments, aggregate reporting, individual-level reporting, reminders, home-based records, safety surveillance, and stock management), and (2) modifications needed for digital health frameworks to permit COVID-19 vaccination monitoring. Results: In total, 188 of 194 WHO Member States responded to the supplemental questionnaire, with 155 reporting on the IIS-related questions. Among those reporting, for each of the 7 IIS functions explored, greater than 85\% of responding countries reported that the system was in place for COVID-19 vaccines. Among responding countries, ``aggregate reporting system'' was the system most frequently reported as being in place (n=116, 98.3\%), while ``reminder system'' was the least (n=77, 89\%). Among the countries reporting using a system, whether an existing system was adapted for COVID-19 vaccines or a new one was developed varied by system. Additionally, two-thirds (n=127, 67.6\%) of countries reported establishing at least one new system, ranging from 72\% (n=42) in high-income countries (HICs) to 62\% (n=16) in low-income countries. Concurrently, 55.3\% (n=104) of countries reported adapting at least one system already in place for COVID-19 vaccines, with 62\% (n=36) of HICs reporting this compared to about 53\% for other income groups. Of those reporting developing new systems, for each of the systems explored, more than 85\% of countries reported that they intended to keep new systems specific to COVID-19 vaccines. Further, 147 of the 188 (78.2\%) Member States responding to the supplemental questionnaire responded to the digital health frameworks question. Lastly, 31\% (n=46) of responding countries reported needing to adapt them for COVID-19 vaccination systems. HICs had a higher percentage. Conclusions: Nearly all countries have adapted existing or developed new IIS to monitor COVID-19 vaccination. The approaches varied, notably by income group. Reflection is needed on how to sustain the investments made in IIS during the pandemic. Continued support for IIS is critical, given their essential role in program monitoring and performance. ", doi="10.2196/62657", url="https://publichealth.jmir.org/2024/1/e62657" } @Article{info:doi/10.2196/53938, author="Kim, Minji and Vassey, Julia and Li, Dongmei and Galimov, Artur and Han, Eileen and Kirkpatrick, G. Matthew and Stanton, A. Cassandra and Ozga, E. Jenny and Lee, Sarah and Unger, B. Jennifer", title="Discussion of Heated Tobacco Products on Twitter Following IQOS's Modified-Risk Tobacco Product Authorization and US Import Ban: Content Analysis", journal="J Med Internet Res", year="2024", month="Oct", day="24", volume="26", pages="e53938", keywords="heated tobacco products", keywords="IQOS", keywords="social media", keywords="Twitter", keywords="tobacco control", keywords="modified-risk tobacco product authorization", keywords="MRTP authorization", keywords="tobacco regulatory science", keywords="import ban", keywords="observational study", keywords="public opinion", keywords="content analysis", abstract="Background: Understanding public opinions about emerging tobacco products is important to inform future interventions and regulatory decisions. Heated tobacco products (HTPs) are an emerging tobacco product category promoted by the tobacco industry as a ``better alternative'' to combustible cigarettes. Philip Morris International's IQOS is leading the global HTP market and recently has been subject to important policy events, including the US Food and Drug Administration's (FDA) modified-risk tobacco product (MRTP) authorization (July 2020) and the US import ban (November 2021). Although limited in their legal implications outside the United States, these policy events have been quoted in global news outlets and Philip Morris International's promotional communications, showing how they may potentially impact global tobacco regulation. Given the impending return of IQOS to the US market, understanding how the policy events were received through social media discourse will provide valuable insights to inform global tobacco control policy. Objective: This study aims to examine HTP-related social media discourse around important policy events. Methods: We analyzed HTP-related posts on Twitter during the time period that included IQOS's MRTP authorization in the United States and the US import ban, examining personal testimonial, news/information, and direct marketing/retail tweets separately. We also examined how the tweets discussed health and policy. A total of 10,454 public English tweets (posted from June 2020 to December 2021) were collected using HTP-related keywords. We randomly sampled 2796 (26.7\%) tweets and conducted a content analysis. We used pairwise co-occurrence analyses to evaluate connections across themes. Results: Tweet volumes peaked around IQOS-related policy events. Among all tweets, personal testimonials were the most common (1613/2796, 57.7\%), followed by news/information (862/2796, 30.8\%) and direct marketing/retail (321/2796, 11\%). Among personal testimonials, more tweets were positive (495/1613, 30.7\%) than negative (372/1613, 23.1\%), often comparing the health risks of HTPs with cigarettes (402/1613, 24.9\%) or vaping products (252/1613, 15.6\%). Approximately 10\% (31/321) of the direct marketing/retail tweets promoted international delivery, suggesting cross-border promotion. More than a quarter of tweets (809/2796, 28.9\%) discussed US and global policy, including misinterpretation about IQOS being a ``safer'' tobacco product after the US FDA's MRTP authorization. Neutral testimonials mentioning the IQOS brand (634/1613, 39.3\%) and discussing policy (378/1613, 23.4\%) showed the largest pairwise co-occurrence. Conclusions: Results suggest the need for careful communication about the meaning of MRTP authorizations and relative risks of tobacco products. Many tweets expressed HTP-favorable opinions referring to reduced health risks, even though the US FDA has denied marketing of the HTP with reduced risk claims. The popularity of social media as an information source with global reach poses unique challenges in health communication and health policies. While many countries restrict tobacco marketing via the web, our results suggest that retailers may circumvent such regulations by operating overseas. ", doi="10.2196/53938", url="https://www.jmir.org/2024/1/e53938", url="http://www.ncbi.nlm.nih.gov/pubmed/39446431" } @Article{info:doi/10.2196/50184, author="Vecino-Ortiz, I. Andres and Guzman-Tordecilla, Nicolas Deivis and Maniar, Vidhi and Agudelo-Londo{\~n}o, Sandra and Franco-Suarez, Oscar and Aya Pastrana, Nathaly and Rodr{\'i}guez-Patarroyo, Mariana and Mej{\'i}a-Rocha, Marino and Cardona, Jaime and Chavez Chamorro, Mariangela and Gibson, Dustin", title="Mobile Phone Syndromic Surveillance for Respiratory Conditions in an Emergency (COVID-19) Context in Colombia: Representative Survey Design", journal="J Med Internet Res", year="2024", month="Oct", day="17", volume="26", pages="e50184", keywords="mobile phone surveys", keywords="syndromic surveillance", keywords="COVID-19", keywords="public health surveillance", keywords="IVR", keywords="interactive voice response", keywords="survey", keywords="surveys", keywords="voice response", keywords="syndromic", keywords="surveillance", keywords="respiratory", keywords="pandemic", keywords="SARS-CoV-2", keywords="feasibility", keywords="data collection", keywords="public health", keywords="emergency", keywords="outbreak", keywords="mobile phone", abstract="Background: Syndromic surveillance for respiratory infections such as COVID-19 is a crucial part of the public health surveillance toolkit as it allows decision makers to detect and prepare for new waves of the disease in advance. However, it is labor-intensive, costly, and increases exposure to survey personnel. This study assesses the feasibility of conducting a mobile phone--based respiratory syndromic surveillance program in a middle-income country during a public health emergency, providing data to support the inclusion of this method in the standard infection control protocols at the population level. Objective: This study aims to assess the feasibility of a national active syndromic surveillance system for COVID-19 disease in Colombia. Methods: In total, 2 pilots of syndromic mobile phone surveys (MPSs) were deployed using interactive voice response technology in Colombia (367 complete surveys in March 2022 and 451 complete surveys in April and May 2022). Respondents aged 18 years and older were sampled using random digit dialing, and after obtaining consent, they were sent a 10-minute survey with modules on sociodemographic status, respiratory symptoms, past exposure to COVID-19 infection and vaccination status, preferences about COVID-19 vaccination, and information source for COVID-19. Pilot 1 used a nationally representative sample while pilot 2 used quota sampling to yield representative results at the regional level. In this work, we assessed the performance characteristics of the survey pilots and compared the demographic information collected with a nationally representative household survey. Results: For both pilots, contact rates were between 1\% and 2\%, while participation rates were above 80\%. The results revealed that younger, female, and higher educated participants were more likely to participate in the syndromic survey. Survey rates as well as demographics, COVID-19 vaccination status, and prevalence of respiratory symptoms are reported for both pilots. We found that respondents of the MPSs are more likely to be younger and female. Conclusions: In a COVID-19 pandemic setting, using an interactive voice response MPS to conduct syndromic surveillance may be a transformational, low-risk, and feasible method to detect outbreaks. This evaluation expects to provide a path forward to the inclusion of MPSs as a traditional surveillance method. ", doi="10.2196/50184", url="https://www.jmir.org/2024/1/e50184", url="http://www.ncbi.nlm.nih.gov/pubmed/39418077" } @Article{info:doi/10.2196/57242, author="Salisbury, David and Lazarus, V. Jeffrey and Waite, Nancy and Lehmann, Clara and Sri Bhashyam, Sumitra and de la Cruz, Marie and Hahn, Beth and Rousculp, D. Matthew and Bonanni, Paolo", title="COVID-19 Vaccine Preferences in General Populations in Canada, Germany, the United Kingdom, and the United States: Discrete Choice Experiment", journal="JMIR Public Health Surveill", year="2024", month="Oct", day="16", volume="10", pages="e57242", keywords="COVID-19", keywords="discrete choice experiment", keywords="vaccine hesitancy", keywords="vaccine side effects", keywords="SARS-CoV-2", keywords="COVID vaccination", keywords="immunization", keywords="preference elicitation", keywords="informed decision-making", keywords="antivaccine", abstract="Background: Despite strong evidence supporting COVID-19 vaccine efficacy and safety, a proportion of the population remains hesitant to receive immunization. Discrete choice experiments (DCEs) can help assess preferences and decision-making drivers. Objective: We aim to (1) elicit preferences for COVID-19 vaccines in Canada, Germany, the United Kingdom, and the United States; (2) understand which vaccine attributes people there value; and (3) gain insight into the choices that different population subgroups make regarding COVID-19 vaccines. Methods: Participants in the 2019nCoV-408 study were aged ?18 years; self-reported antivaccinationists were excluded. A DCE with a series of 2 hypothetical vaccine options was embedded into a survey to determine participant treatment preferences (primary objective). Survey questions covered vaccine preference, previous COVID-19 experiences, and demographics, which were summarized using descriptive statistics to understand the study participants' backgrounds. In the DCE, participants were provided choice pairs: 1 set with and 1 without an ``opt-out'' option. Each participant viewed 11 unique vaccine profiles. Vaccine attributes consisted of type (messenger RNA or protein), level of protection against any or severe COVID-19, risk of side effects (common and serious), and potential coadministration of COVID-19 and influenza vaccines. Attribute level selections were included for protection and safety (degree of effectiveness and side effect risk, respectively). Participants were stratified by vaccination status (unvaccinated, or partially or fully vaccinated) and disease risk group (high-risk or non--high-risk). A conditional logit model was used to analyze DCE data to estimate preferences of vaccine attributes, with the percentage relative importance calculated to allow for its ranking. Each model was run twice to account for sets with and without the opt-out options. Results: The mean age of participants (N=2000) was 48 (SD 18.8) years, and 51.25\% (1025/2000) were male. The DCE revealed that the most important COVID-19 vaccine attributes were protection against severe COVID-19 or any severity of COVID-19 and common side effects. Protection against severe COVID-19 was the most important attribute for fully vaccinated participants, which significantly differed from the unvaccinated or partially vaccinated subgroup (relative importance 34.8\% vs 30.6\%; P=.049). Avoiding serious vaccine side effects was a significantly higher priority for the unvaccinated or partially versus fully vaccinated subgroup (relative importance 10.7\% vs 8.2\%; P=.044). Attributes with significant differences in the relative importance between the high-risk versus non--high-risk subgroups were protection against severe COVID-19 (38.2\% vs 31.5\%; P<.000), avoiding common vaccine side effects (12\% vs 20.5\%; P<.000), and avoiding serious vaccine side effects (9.7\% vs 7.5\%; P=.002). Conclusions: This DCE identified COVID-19 vaccine attributes, such as protection against severe COVID-19, that may influence preference and drive choice and can inform vaccine strategies. The high ranking of common and serious vaccine side effects suggests that, when the efficacy of 2 vaccines is comparable, safety is a key decision-making factor. ", doi="10.2196/57242", url="https://publichealth.jmir.org/2024/1/e57242", url="http://www.ncbi.nlm.nih.gov/pubmed/39412841" } @Article{info:doi/10.2196/49871, author="Martonik, Rachel and Oleson, Caitlin and Marder, Ellyn", title="Spatiotemporal Cluster Detection for COVID-19 Outbreak Surveillance: Descriptive Analysis Study", journal="JMIR Public Health Surveill", year="2024", month="Oct", day="16", volume="10", pages="e49871", keywords="COVID-19", keywords="cluster detection", keywords="disease outbreaks", keywords="surveillance", keywords="SaTScan", keywords="space-time surveillance", keywords="spatiotemporal", keywords="United States", keywords="outbreak", keywords="outbreaks", keywords="pandemic", keywords="real-time surveillance", keywords="detection", keywords="tool", keywords="tools", keywords="effectiveness", keywords="public health", keywords="intervention", keywords="interventions", keywords="community settings", keywords="outbreak detection", abstract="Background: During the peak of the winter 2020-2021 surge, the number of weekly reported COVID-19 outbreaks in Washington State was 231; the majority occurred in high-priority settings such as workplaces, community settings, and schools. The Washington State Department of Health used automated address matching to identify clusters at health care facilities. No other systematic, statewide outbreak detection methods were in place. This was a gap given the high volume of cases, which delayed investigations and decreased data completeness, potentially leading to undetected outbreaks. We initiated statewide cluster detection using SaTScan, implementing a space-time permutation model to identify COVID-19 clusters for investigation. Objective: To improve outbreak detection, the Washington State Department of Health initiated a systematic cluster detection model to identify timely and actionable COVID-19 clusters for local health jurisdiction (LHJ) investigation and resource prioritization. This report details the model's implementation and the assessment of the tool's effectiveness. Methods: In total, 6 LHJs participated in a pilot to test model parameters including analysis type, geographic aggregation, cluster radius, and data lag. Parameters were determined through heuristic criteria to detect clusters early when they are smaller, making interventions more feasible. This study reviews all clusters detected after statewide implementation from July 17 to December 17, 2021. The clusters were analyzed by LHJ population and disease incidence. Clusters were compared with reported outbreaks. Results: A weekly, LHJ-specific retrospective space-time permutation model identified 2874 new clusters during this period. While the weekly analysis included case data from the prior 3 weeks, 58.25\% (n=1674) of all clusters identified were timely---having occurred within 1 week of the analysis and early enough for intervention to prevent further transmission. There were 2874 reported outbreaks during this same period. Of those, 363 (12.63\%) matched to at least one SaTScan cluster. The most frequent settings among reported and matched outbreaks were schools and youth programs (n=825, 28.71\% and n=108, 29.8\%), workplaces (n=617, 21.46\% and n=56, 15\%), and long-term care facilities (n=541, 18.82\% and n=99, 27.3\%). Settings with the highest percentage of clusters that matched outbreaks were community settings (16/72, 22\%) and congregate housing (44/212, 20.8\%). The model identified approximately one-third (119/363, 32.8\%) of matched outbreaks before cases were associated with the outbreak event in our surveillance system. Conclusions: Our goal was to routinely and systematically identify timely and actionable COVID-19 clusters statewide. Regardless of population or incidence, the model identified reasonably sized, timely clusters statewide, meeting the objective. Among some high-priority settings subject to public health interventions throughout the pandemic, such as schools and community settings, the model identified clusters that were matched to reported outbreaks. In workplaces, another high-priority setting, results suggest the model might be able to identify outbreaks sooner than existing outbreak detection methods. ", doi="10.2196/49871", url="https://publichealth.jmir.org/2024/1/e49871", url="http://www.ncbi.nlm.nih.gov/pubmed/39412839" } @Article{info:doi/10.2196/52792, author="Mechael, Patricia and Gilani, Sara and Ahmad, Ahsan and LeFevre, Amnesty and Mohan, Diwakar and Memon, Asra and Shah, Taighoon Mubarak and Siddiqi, Arif Danya and Chandir, Subhash and Soundardjee, Riswana", title="Evaluating the ``Zindagi Mehfooz'' Electronic Immunization Registry and Suite of Digital Health Interventions to Improve the Coverage and Timeliness of Immunization Services in Sindh, Pakistan: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Oct", day="11", volume="26", pages="e52792", keywords="electronic immunization registry", keywords="registry", keywords="Zindagi Mehfooz", keywords="vaccination", keywords="alert", keywords="reminder", keywords="dashboard", keywords="survey", keywords="cost", keywords="economic", keywords="digital health", keywords="immunization", keywords="children", keywords="pediatrics", keywords="equity", keywords="accessibility", keywords="text messages", keywords="SMS", keywords="zero dose", abstract="Background: The Zindagi Mehfooz (safe life; ZM) electronic immunization registry (EIR) is a comprehensive suite of digital health interventions that aims to improve equitable access, timeliness, and coverage of child immunizations through a smartphone-based app for vaccinators, web-based dashboards for supervisors and managers, text message alerts and reminders for caregivers, and a call center. It has been implemented at scale in Sindh Province, Pakistan. Objective: This study aimed to present findings from an evaluation of the ZM-EIR suite of digital health interventions in order to improve data availability and use as a contribution, among other immunization program interventions, to enhanced immunization outcomes for children aged 12-23 months in Sindh Province. Methods: The mixed methods study included (1) analysis of ZM-EIR system data to identify high-, moderate-, and low-adoption and compliance sites; (2) in-depth interviews with caregivers, vaccinators, supervisors, and managers in the Expanded Program for Immunization (EPI); and (3) pre-post outcome evaluation using vaccine coverage from the Multiple Indicator Cluster Surveys (MICS) 2014 and 2018-2019. Key outcomes of interest were improved data availability, use and contribution to immunization outcomes, including receipt of individual antigens (Bacillus Calmette-Gu{\'e}rin [BCG], pentavalent [Penta] 1-3, measles), full immunization (all antigens), and zero-dose children defined as children aged 6-23 months who have not received the first dosage of the diphtheria-pertussis-tetanus 1/Penta vaccine. Results: By registering newborns, providing alerts and reminders, and tracking their immunization completion, the ZM-EIR improved data availability and use in the EPI. The ZM-EIR was well received by EPI administrators, supervisors, vaccinators, and caregivers. The key benefit highlighted by ZM-EIR users was a list of children who missed scheduled vaccines (defaulters). Through greater availability and use of data, the ZM-EIR implementation, as part of a broader package of immunization program--strengthening activities in Sindh Province, may have contributed to an increase in immunization coverage and timeliness for BCG vaccinations and a decrease in zero-dose children in 2018-2019 from 2014. Additional findings from the study included the dual burden of reporting on paper and gender-related considerations of female caregivers not wanting to provide their phone numbers to male vaccinators, creating barriers to greater uptake of the ZM-EIR. Conclusions: The ZM-EIR is a promising technology platform that has increased the availability and use of immunization data, which may have contributed, along with other intensive immunization program interventions, to improvements in immunization outcomes through systematic registration of children, alerts and reminders, and increased use of data for planning and monitoring by the EPI. Trial Registration: ISRCTN Registry ISRCTN23078223; https://doi.org/10.1186/ISRCTN23078223 ", doi="10.2196/52792", url="https://www.jmir.org/2024/1/e52792", url="http://www.ncbi.nlm.nih.gov/pubmed/39162666" } @Article{info:doi/10.2196/44294, author="Oluokun, Oluwatosin Emmanuel and Adedoyin, Fatai Festus and Dogan, Huseyin and Jiang, Nan", title="Digital Interventions for Managing Medication and Health Care Service Delivery in West Africa: Systematic Review", journal="J Med Internet Res", year="2024", month="Oct", day="9", volume="26", pages="e44294", keywords="digital interventions", keywords="medications delivery", keywords="phone-based intervention", keywords="tele and e-based intervention", keywords="West Africa", keywords="management, technology", keywords="intervention", keywords="medication", keywords="tool", keywords="smartphone", abstract="Background: As a result of the recent advancements in technology, the incorporation of digital interventions into the health care system has gained a lot of attention and adoption globally. However, these interventions have not been fully adopted, thereby limiting their impact on health care delivery in West Africa. Objective: This review primarily aims at evaluating the current digital interventions for medication and health care delivery in West Africa. Its secondary aim is to assess the impacts of digital interventions in managing medication and health care service delivery with the intent of providing vital recommendations that would contribute to an excellent adoption of digital intervention tools in the health care space in West Africa. Methods: In line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a comprehensive search through various databases yielded 529 results. After a rigorous screening, 29 articles that provided information on 3 broad digital health intervention tools were found eligible for this review. Results: Out of 29 studies, 16 (55\%) studies examined phone-based interventions, 9 (31\%) studies focused on tele- and e-based interventions, and 4 (14\%) studies evaluated digital interventions. These interventions were used for diverse purposes, some of which are monitoring adverse drug reactions, general health, sexual and reproductive health, and training of health care practitioners. The phone-based intervention appears to be the most known and impactful of all the interventions, followed by tele- and e-based, while digital interventions were scarcely used. Conclusions: Digital interventions have had a considerable level of impact on medication and health care delivery across West Africa. However, the overall impact is limited. Therefore, strategies must be developed to address the challenges limiting the use of digital intervention tools so that these tools can be fully incorporated into the health care space in West Africa. ", doi="10.2196/44294", url="https://www.jmir.org/2024/1/e44294" } @Article{info:doi/10.2196/55208, author="Greenleaf, R. Abigail and Francis, Sarah and Zou, Jungang and Farley, M. Shannon and Lekhela, T{\vs}epang and Asiimwe, Fred and Chen, Qixuan", title="Influenza-Like Illness in Lesotho From July 2020 to July 2021: Population-Based Participatory Surveillance Results", journal="JMIR Public Health Surveill", year="2024", month="Oct", day="8", volume="10", pages="e55208", keywords="surveillance", keywords="participatory surveillance", keywords="influenza-like illness", keywords="COVID-19", keywords="cell phone", keywords="sub-Saharan Africa", keywords="population-based", keywords="Lesotho", keywords="SARS-CoV-2", keywords="technology", keywords="epidemiology", keywords="adult", keywords="data collection", keywords="innovation", keywords="mobile phone", keywords="cellphone", abstract="Background: Participatory surveillance involves at-risk populations reporting their symptoms using technology. In Lesotho, a landlocked country of 2 million people in Southern Africa, laboratory and case-based COVID-19 surveillance systems were complemented by a participatory surveillance system called ``LeCellPHIA'' (Lesotho Cell Phone Population-Based HIV Impact Assessment Survey). Objective: This report describes the person, place, and time characteristics of influenza-like illness (ILI) in Lesotho from July 15, 2020, to July 15, 2021, and reports the risk ratio of ILI by key demographic variables. Methods: LeCellPHIA employed interviewers to call participants weekly to inquire about ILI. The average weekly incidence rate for the year-long period was created using a Quasi-Poisson model, which accounted for overdispersion. To identify factors associated with an increased risk of ILI, we conducted a weekly data analysis by fitting a multilevel Poisson regression model, which accounted for 3 levels of clustering. Results: The overall response rate for the year of data collection was 75\%, which resulted in 122,985 weekly reports from 1776 participants. ILI trends from LeCellPHIA mirrored COVID-19 testing data trends, with an epidemic peak in mid to late January 2021. Overall, any ILI symptoms (eg, fever, dry cough, and shortness of breath) were reported at an average weekly rate of 879 per 100,000 (95\% CI 782?988) persons at risk. Compared to persons in the youngest age group (15?19 years), all older age groups had an elevated risk of ILI, with the highest risk of ILI in the oldest age group (?60 years; risk ratio 2.6, 95\% CI 1.7?3.8). Weekly data were shared in near real time with the National COVID-19 Secretariat and other stakeholders to monitor ILI trends, identify and respond to increases in reports of ILI, and inform policies and practices designed to reduce COVID-19 transmission in Lesotho. Conclusions: LeCellPHIA, an innovative and cost-effective system, could be replicated in countries where cell phone ownership is high but internet use is not yet high enough for a web- or app-based surveilance system. ", doi="10.2196/55208", url="https://publichealth.jmir.org/2024/1/e55208" } @Article{info:doi/10.2196/63176, author="Durkin, M. Amanda and Zou, Runyu and Boucher, M. Justin and Boyles, SP Matthew and van Boxel, Jeske and Bustamante, Mariona and Christopher, A. Emily and Dadvand, Payam and Dusza, M. Hanna and van Duursen, Majorie and Forsberg, M. Markus and Galea, S. Karen and Legler, Juliette and Mandemaker, DB Laurens and Meirer, Florian and Muncke, Jane and Nawrot, S. Tim and P?ibylov{\'a}, Petra and Robuck, R. Anna and Saenen, D. Nelly and Scholz-B{\"o}ttcher, M. Barbara and Shao, Kuanliang and Vrijheid, Martine and Walker, I. Douglas and Zimmermann, Lisa and Zoutendijk, M. Laura and Lenters, Virissa and Vermeulen, Roel", title="Investigating Exposure and Hazards of Micro- and Nanoplastics During Pregnancy and Early Life (AURORA Project): Protocol for an Interdisciplinary Study", journal="JMIR Res Protoc", year="2024", month="Oct", day="8", volume="13", pages="e63176", keywords="epidemiology", keywords="pregnancy", keywords="toxicology", keywords="microplastics", keywords="placenta", keywords="risk assessment", abstract="Background: Micro- and nanoplastics (MNPs) are emerging pollutants of concern with ubiquitous presence in global ecosystems. MNPs pose potential implications for human health; however, the health impacts of MNP exposures are not yet understood. Recent evidence suggests that MNPs can cross the placental barrier, underlying the urgent need to understand their impact on reproductive health and development. Objective: The Actionable eUropean ROadmap for early-life health Risk Assessment of micro- and nanoplastics (AURORA) project will investigate MNP exposures and their biological and health effects during pregnancy and early life, which are critical periods due to heightened vulnerability to environmental stressors. The AURORA project will enhance exposure assessment capabilities for measuring MNPs, MNP-associated chemicals, and plastic additives in human tissues, including placenta and blood. Methods: In this interdisciplinary project, we will advance methods for in-depth characterization and scalable chemical analytical strategies, enabling high-resolution and large-scale toxicological, exposure assessment, and epidemiological studies. The AURORA project performs observational studies to investigate determinants and health impacts of MNPs by including 800 mother-child pairs from 2 existing birth cohorts and 110 women of reproductive age from a newly established cohort. This will be complemented by toxicological studies using a tiered-testing approach and epidemiological investigations to evaluate associations between maternal and prenatal MNP exposures and health perturbations, such as placental function, immune-inflammatory responses, oxidative stress, accelerated aging, endocrine disruption, and child growth and development. The ultimate goal of the AURORA project is to create an MNP risk assessment framework and identify the remaining knowledge gaps and priorities needed to comprehensively assess the impact of MNPs on early-life health. Results: In the first 3 years of this 5-year project (2021-2026), progress was made toward all objectives. This includes completion of recruitment and data collection for new and existing cohorts, development of analytical methodological protocols, and initiation of the toxicological tiered assessments. As of September 2024, data analysis is ongoing and results are expected to be published starting in 2025. Conclusions: As plastic pollution increases globally, it is imperative to understand the impact of MNPs on human health, particularly during vulnerable developmental stages such as early life. The contributions of the AURORA project will inform future risk assessment. International Registered Report Identifier (IRRID): DERR1-10.2196/63176 ", doi="10.2196/63176", url="https://www.researchprotocols.org/2024/1/e63176" } @Article{info:doi/10.2196/47879, author="Farooq, Kamran and Lim, Melody and Dennison-Hall, Lawrence and Janson, Finn and Olszewska, Hazel Aspen and Ahmad Zabidi, Mamduh Muhammad and Haratym-Rojek, Anna and Narowski, Karol and Clinch, Barry and Prunotto, Marco and Chawla, Devika and Hunter, Victoria and Ukachukwu, Vincent", title="Evaluation of Machine Learning to Detect Influenza Using Wearable Sensor Data and Patient-Reported Symptoms: Cohort Study", journal="J Med Internet Res", year="2024", month="Oct", day="4", volume="26", pages="e47879", keywords="influenza", keywords="influenza-like illness", keywords="wearable sensor", keywords="person-generated health care data", keywords="machine learning", abstract="Background: Machine learning offers quantitative pattern recognition analysis of wearable device data and has the potential to detect illness onset and monitor influenza-like illness (ILI) in patients who are infected. Objective: This study aims to evaluate the ability of machine-learning algorithms to distinguish between participants who are influenza positive and influenza negative in a cohort of symptomatic patients with ILI using wearable sensor (activity) data and self-reported symptom data during the latent and early symptomatic periods of ILI. Methods: This prospective observational cohort study used the extreme gradient boosting (XGBoost) classifier to determine whether a participant was influenza positive or negative based on 3 models using symptom-only data, activity-only data, and combined symptom and activity data. Data were collected from the Home Testing of Respiratory Illness (HTRI) study and FluStudy2020, both conducted between December 2019 and October 2020. The model was developed using the FluStudy2020 data and tested on the HTRI data. Analyses included participants in these studies with an at-home influenza diagnostic test result. Fitbit (Google LLC) devices were used to measure participants' steps, heart rate, and sleep parameters. Participants detailed their ILI symptoms, health care--seeking behaviors, and quality of life. Model performance was assessed by area under the curve (AUC), balanced accuracy, recall (sensitivity), specificity, precision (positive predictive value), negative predictive value, and weighted harmonic mean of precision and recall (F2) score. Results: An influenza diagnostic test result was available for 953 and 925 participants in HTRI and FluStudy2020, respectively, of whom 848 (89\%) and 840 (90.8\%) had activity data. For the training and validation sets, the highest performing model was trained on the combined symptom and activity data (training AUC=0.77; validation AUC=0.74) versus symptom-only (training AUC=0.73; validation AUC=0.72) and activity-only (training AUC=0.68; validation AUC=0.65) data. For the FluStudy2020 test set, the performance of the model trained on combined symptom and activity data was closely aligned with that of the symptom-only model (combined symptom and activity test AUC=0.74; symptom-only test AUC=0.74). These results were validated using independent HTRI data (combined symptom and activity evaluation AUC=0.75; symptom-only evaluation AUC=0.74). The top features guiding influenza detection were cough; mean resting heart rate during main sleep; fever; total minutes in bed for the combined model; and fever, cough, and sore throat for the symptom-only model. Conclusions: Machine-learning algorithms had moderate accuracy in detecting influenza, suggesting that previous findings from research-grade sensors tested in highly controlled experimental settings may not easily translate to scalable commercial-grade sensors. In the future, more advanced wearable sensors may improve their performance in the early detection and discrimination of viral respiratory infections. ", doi="10.2196/47879", url="https://www.jmir.org/2024/1/e47879", url="http://www.ncbi.nlm.nih.gov/pubmed/39365646" } @Article{info:doi/10.2196/62863, author="Zhang, Kehong and Shen, Ganglei and Yuan, Yue and Shi, Chao", title="Association Between Climatic Factors and Varicella Incidence in Wuxi, East China, 2010-2019: Surveillance Study", journal="JMIR Public Health Surveill", year="2024", month="Oct", day="2", volume="10", pages="e62863", keywords="varicella", keywords="meteorological factors", keywords="Generalized Additive Model", keywords="Segmented Linear Regression Model", keywords="China", keywords="meteorology", keywords="regression", keywords="statistics", keywords="surveillance", abstract="Background: Varicella is a common infectious disease and a growing public health concern in China, with increasing outbreaks in Wuxi. Analyzing the correlation between climate factors and varicella incidence in Wuxi is crucial for guiding public health prevention efforts. Objective: This study examines the impact of meteorological variables on varicella incidence in Wuxi, eastern China, from 2010 to 2019, offering insights for public health interventions. Methods: We collected daily meteorological data and varicella case records from January 1, 2010, to December 31, 2019, in Wuxi, China. Generalized cross-validation identified optimal lag days by selecting those with the lowest score. The relationship between meteorological factors and varicella incidence was analyzed using Poisson generalized additive models and segmented linear regression. Subgroup analyses were conducted by gender and age. Results: The study encompassed 64,086 varicella cases. Varicella incidence in Wuxi city displayed a bimodal annual pattern, with peak occurrences from November to January of the following year and lower peaks from May to June. Several meteorological factors influencing varicella risk were identified. A decrease of 1{\textdegree}C when temperatures were ?20{\textdegree}C corresponded to a 1.99\% increase in varicella risk (95\% CI 1.57-2.42, P<.001). Additionally, a decrease of 1{\textdegree}C below 22.38{\textdegree}C in ground temperature was associated with a 1.36\% increase in varicella risk (95\% CI 0.96-1.75, P<.001). Each 1 mm increase in precipitation above 4.88 mm was associated with a 1.62\% increase in varicella incidence (95\% CI 0.93-2.30, P<.001). A 1\% rise in relative humidity above 57.18\% increased varicella risk by 2.05\% (95\% CI 1.26-2.84, P<.001). An increase in air pressure of 1 hPa below 1011.277 hPa was associated with a 1.75\% rise in varicella risk (95\% CI 0.75-2.77, P<.001). As wind speed and evaporation increased, varicella risk decreased linearly with a 16-day lag. Varicella risk was higher with sunshine durations exceeding 1.825 hours, with a 14-day lag, increasing by 1.30\% for each additional hour of sunshine (95\% CI 0.62-2.00, P=.006). Subgroup analyses revealed that teenagers and children under 17 years of age faced higher varicella risks associated with temperature, average ground temperature, precipitation, relative humidity, and air pressure. Adults aged 18-64 years experienced increased risk with longer sunshine durations. Additionally, males showed higher varicella risks related to ground temperature and air pressure compared with females. However, no significant gender differences were observed regarding varicella risks associated with temperature (male: P<.001; female P<.001), precipitation (male: P=.001; female: P=.06), and sunshine duration (male: P=.53; female: P=.04). Conclusions: Our preliminary findings highlight the interplay between varicella outbreaks in Wuxi city and meteorological factors. These insights provide valuable support for developing policies aimed at reducing varicella risks through informed public health measures. ", doi="10.2196/62863", url="https://publichealth.jmir.org/2024/1/e62863", url="http://www.ncbi.nlm.nih.gov/pubmed/39228304" } @Article{info:doi/10.2196/58919, author="Lin, Shuo-Yu and Tulabandu, Kiran Sahithi and Koch, Randy J. and Hayes, Rashelle and Barnes, Andrew and Purohit, Hemant and Chen, Songqing and Han, Bo and Xue, Hong", title="Public Response to Federal Electronic Cigarette Regulations Analyzed Using Social Media Data Through Natural Language Processing: Topic Modeling Study", journal="J Med Internet Res", year="2024", month="Oct", day="1", volume="26", pages="e58919", keywords="social media analysis", keywords="data mining", keywords="natural language processing", keywords="topic modeling", keywords="sentiment analysis", keywords="e-cigarette regulation", keywords="vaping", keywords="Twitter analysis", keywords="public health related policy", keywords="marketing denial orders", abstract="Background: e-Cigarette (electronic cigarette) use has been a public health issue in the United States. On June 23, 2022, the US Food and Drug Administration (FDA) issued marketing denial orders (MDOs) to Juul Labs Inc for all their products currently marketed in the United States. However, one day later, on June 24, 2022, a federal appeals court granted a temporary reprieve to Juul Labs that allowed it to keep its e-cigarettes on the market. As the conversation around Juul continues to evolve, it is crucial to gain insights into the sentiments and opinions expressed by individuals on social media. Objective: This study aims to conduct a comprehensive analysis of tweets before and after the ban on Juul, aiming to shed light on public perceptions and sentiments surrounding this contentious topic and to better understand the life cycle of public health--related policy on social media. Methods: Natural language processing (NLP) techniques were used, including state-of-the-art BERTopic topic modeling and sentiment analysis. A total of 6023 tweets and 22,288 replies or retweets were collected from Twitter (rebranded as X in 2023) between June 2022 and October 2022. The encoded topics were used in time-trend analysis to depict the boom-and-bust cycle. Content analyses of retweets were also performed to better understand public perceptions and sentiments about this contentious topic. Results: The attention surrounding the FDA's ban on Juul lasted no longer than a week on Twitter. Not only the news (ie, tweets with a YouTube link that directs to the news site) related to the announcement itself, but the surrounding discussions (eg, potential consequences of this ban or block and concerns toward kids or youth health) diminished shortly after June 23, 2022, the date when the ban was officially announced. Although a short rebound was observed on July 4, 2022, which was contributed by the suspension on the following day, discussions dried out in 2 days. Out of the top 50 most retweeted tweets, we observed that, except for neutral (23/45, 51\%) sentiment that broadcasted the announcement, posters responded more negatively (19/45, 42\%) to the FDA's ban. Conclusions: We observed a short life cycle for this news announcement, with a preponderance of negative sentiment toward the FDA's ban on Juul. Policy makers could use tactics such as issuing ongoing updates and reminders about the ban, highlighting its impact on public health, and actively engaging with influential social media users who can help maintain the conversation. ", doi="10.2196/58919", url="https://www.jmir.org/2024/1/e58919", url="http://www.ncbi.nlm.nih.gov/pubmed/39352739" } @Article{info:doi/10.2196/48294, author="Fesshaye, Berhaun and Pandya, Shivani and Kan, Lena and Kalbarczyk, Anna and Alland, Kelsey and Rahman, Mustafizur S. M. and Bulbul, Islam Md Mofijul and Mustaphi, Piyali and Siddique, Bakr Muhammad Abu and Tanim, Alam Md Imtiaz and Chowdhury, Mridul and Rumman, Tajkia and Labrique, B. Alain", title="Quality, Usability, and Trust Challenges to Effective Data Use in the Deployment and Use of the Bangladesh Nutrition Information System Dashboard: Qualitative Study", journal="J Med Internet Res", year="2024", month="Sep", day="30", volume="26", pages="e48294", keywords="digital health", keywords="nutrition", keywords="data for decision-making", keywords="health information systems", keywords="information system", keywords="information systems", keywords="LMIC", keywords="low- and middle-income countries", keywords="nutritional", keywords="dashboard", keywords="experience", keywords="experiences", keywords="interview", keywords="interviews", keywords="service", keywords="services", keywords="delivery", keywords="health care management", abstract="Background: Evidence-based decision-making is essential to improve public health benefits and resources, especially in low- and middle-income countries (LMICs), but the mechanisms of its implementation remain less straightforward. The availability of high-quality, reliable, and sufficient data in LMICs can be challenging due to issues such as a lack of human resource capacity and weak digital infrastructure, among others. Health information systems (HISs) have been critical for aggregating and integrating health-related data from different sources to support evidence-based decision-making. Nutrition information systems (NISs), which are nutrition-focused HISs, collect and report on nutrition-related indicators to improve issues related to malnutrition and food security---and can assist in improving populations' nutritional statuses and the integration of nutrition programming into routine health services. Data visualization tools (DVTs) such as dashboards have been recommended to support evidence-based decision-making, leveraging data from HISs or NISs. The use of such DVTs to support decision-making has largely been unexplored within LMIC contexts. In Bangladesh, the Mukto dashboard was developed to display and visualize nutrition-related performance indicators at the national and subnational levels. However, despite this effort, the current use of nutrition data to guide priorities and decisions remains relatively nascent and underused. Objective: The goal of this study is to better understand how Bangladesh's NIS, including the Mukto dashboard, has been used and areas for improvement to facilitate its use for evidence-based decision-making toward ameliorating nutrition-related service delivery and the health status of communities in Bangladesh. Methods: Primary data collection was conducted through qualitative semistructured interviews with key policy-level stakeholders (n=24). Key informants were identified through purposive sampling and were asked questions about the experiences and challenges with the NIS and related nutrition dashboards. Results: Main themes such as trust, data usability, personal power, and data use for decision-making emerged from the data. Trust in both data collection and quality was lacking among many stakeholders. Poor data usability stemmed from unstandardized indicators, irregular data collection, and differences between rural and urban data. Insufficient personal power and staff training coupled with infrastructural challenges can negatively affect data at the input stage. While stakeholders understood and expressed the importance of evidence-based decision-making, ultimately, they noted that the data were not being used to their maximum potential. Conclusions: Leveraging DVTs can improve the use of data for evidence-based decision-making, but decision makers must trust that the data are believable, credible, timely, and responsive. The results support the significance of a tailored data ecosystem, which has not reached its full potential in Bangladesh. Recommendations to reach this potential include ensuring a clear intended user base and accountable stakeholders are present. Systems should also have the capacity to ensure data credibility and support ongoing personal power requirements. ", doi="10.2196/48294", url="https://www.jmir.org/2024/1/e48294", url="http://www.ncbi.nlm.nih.gov/pubmed/39348172" } @Article{info:doi/10.2196/48794, author="Iacoella, Francesco and Tirivayi, Nyasha", title="Mobile Phones and HIV Testing: Multicountry Instrumental Variable Analysis From Sub-Saharan Africa", journal="J Med Internet Res", year="2024", month="Sep", day="27", volume="26", pages="e48794", keywords="information and knowledge", keywords="communication", keywords="health and economic development", keywords="public health", keywords="technological change", keywords="choices and consequences", keywords="mobile phone", keywords="connectivity", keywords="access", keywords="HIV", keywords="testing", keywords="Sub-Saharan Africa", keywords="women's health", abstract="Background: Sub-Saharan Africa has been a technological hothouse when it comes to mobile phone technology adoption. However, evidence on the role played by mobile technology on infectious disease prevention has been mostly limited to experimental studies. Objective: This observational study investigates the role of mobile phone connectivity on HIV testing in sub-Saharan Africa. Methods: We make use of the novel and comprehensive OpenCelliD cell tower database and Demographic and Health Survey geocoded information for over 400,000 women in 29 sub-Saharan African countries. We examine, through ordinary least square and instrumental variable regressions, whether women's community distance from the closest cell tower influences knowledge about HIV testing facilities and the likelihood of ever being tested for HIV. Results: After finding a negative and significant impact of distance to the nearest cell tower on knowledge of HIV testing facility (--0.7 percentage points per unit increase in distance) and HIV testing (--0.5 percentage points per unit increase), we investigate the mechanisms through which such effects might occur. Our analysis shows that distance to a cell tower reduces HIV-related knowledge (--0.4 percentage points per unit increase) as well as reproductive health knowledge (--0.4 percentage points per unit increase). Similar results are observed when the analysis is performed at community level. Conclusions: Results suggest that the effect of mobile phone connectivity is channeled through increased knowledge of HIV, sexually transmittable infections, and modern contraceptive methods. Further analysis shows that cell phone ownership has an even larger impact on HIV testing and knowledge. This paper adds to the recent literature on the impact of mobile-based HIV prevention schemes by showing through large-scale analysis that better mobile network access is a powerful tool to spread reproductive health knowledge and increase HIV awareness. ", doi="10.2196/48794", url="https://www.jmir.org/2024/1/e48794" } @Article{info:doi/10.2196/58584, author="Jacobson, O. Jerry and Doum, Dyna and Lobo, F. Neil and Sovannaroth, Siv and Tatarsky, Allison and McIver, J. David", title="Estimating the Size of Populations at High Risk of Malaria in 2 Operational Districts in Cambodia: Household-Based Survey", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="27", volume="10", pages="e58584", keywords="population size estimate", keywords="malaria", keywords="forest exposure", keywords="Greater Mekong Subregion", keywords="infectious", keywords="epidemiology", keywords="epidemiological", keywords="size", keywords="population", keywords="communicable", keywords="risks", keywords="surveys", keywords="questionnaires", abstract="Background: Cambodia is targeting the elimination of malaria by 2025. The last remaining pockets of malaria in Cambodia are concentrated among populations exposed to forested areas, but the size of these populations is not well understood. To plan for the procurement and distribution of vector-control tools, chemoprophylaxis, and other commodities for malaria prevention and surveillance, robust estimates of the population at greatest risk are required. Objective: This study aims to estimate the number of forest-exposed individuals residing in Cambodia's highest-burden operational districts (ODs) in 2 provinces with active malaria transmission. Methods: In April 2023, a multistage, in-person survey was conducted among residents in the 2 ODs in Cambodia with the highest malaria burden: Sen Monorom in Mondulkiri province and Phnom Srouch in Kampong Speu province. In each OD, 10 villages were randomly selected, and 35 households were randomly selected from each village. To estimate the number of individuals at high risk of malaria---defined as residing within 1 km of a forest or traveling at least once per week to the forest---respondents were asked about the distance from their household to the nearest forested area, and their travel patterns to forested areas. To account for mobility (ie, to avoid double-counting), respondents also provided information on overnight stays at other households in the selected villages in the past month. In the 4 selected villages in Sen Monorom OD where Project BITE forest packs (an intervention in the larger research program) had been distributed prior to the survey, respondents were also asked questions to determine if they had received such a pack, to develop smaller scale ``multiplier method'' estimates of at-risk individuals in each of those villages. Results: In Sen Monorom, 138 households and 872 individuals were enrolled in the survey, and in Phnom Srouch, 163 households and 844 individuals were enrolled. The estimated percentage of female householders was 49.7\% (852/1716) across both ODs; the median age was 22 (IQR 12-37) years in Sen Monorom and 24.5 (IQR 16.0-40.5) years in Phnom Srouch (total age range 3-86). Based on mobility-adjusted survey estimates alone, 32\% (280/706; 95\% CI 19.9-47.2) of residents in Sen Monorom (an estimated 12,133-20,135 individuals) and 36\% (68/198; 95\% CI 24.5-45.5) of residents in Phnom Srouch (an estimated 1717-2203 individuals), met risk criteria for forest exposure. Between 125 and 186 individuals were estimated to be at risk in each of the 4 villages where the multiplier method could be applied. Conclusions: This study provides estimates of the number of individuals potentially at high risk for malaria infection due to forest exposure in 2 ODs in Cambodia. These estimates can support planning for malaria control and elimination efforts. The straightforward methods of household surveys and multipliers should be feasible for many national malaria control programs. ", doi="10.2196/58584", url="https://publichealth.jmir.org/2024/1/e58584", url="http://www.ncbi.nlm.nih.gov/pubmed/39331420" } @Article{info:doi/10.2196/53368, author="Rahmon, Imme and Bosmans, Mark and Baliatsas, Christos and Hooiveld, Mariette and Marra, Elske and D{\"u}ckers, Michel", title="COVID-19 Health Impact: A Use Case for Syndromic Surveillance System Monitoring Based on Primary Care Patient Registries in the Netherlands", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="26", volume="10", pages="e53368", keywords="SARS-CoV-2", keywords="epidemic surveillance", keywords="public health", keywords="general practice", keywords="disaster health research", abstract="Background: The COVID-19 pandemic challenged societies worldwide. The implementation of mitigation measures to limit the number of SARS-CoV-2 infections resulted in unintended health effects. Objective: The objective of this study is to demonstrate the use of an existing syndromic surveillance system in primary care during a first series of quarterly cross-sectional monitoring cycles, targeting health problems presented in primary care among Dutch youth since August 2021. Methods: Aggregated data from the surveillance system of Nivel Primary Care Database were analyzed quarterly to monitor 20 health problems often reported in the aftermath of disasters and environmental incidents. Results were stratified by age (ie, 0?4, 5?14, and 15?24 years), sex, and region (province). Weekly prevalence rates were calculated as the number of persons consulting their general practitioner in a particular week, using the number of enlisted persons as the denominator. Findings were compared to quarterly survey panel data, collected in the context of the Integrated Health Monitor COVID-19, and the Dutch stringency index values, indicative of the intensity of COVID-19 mitigation measures. Results: Over time, weekly rates pointed to an increased number of consultations for depressive feelings and suicide (attempts) among youth, during and after periods with intensified domestic restrictions. Conclusions: The results illustrate how, from a disaster health research perspective based on the COVID-19 pandemic, health consequences of pandemics could be successfully followed over time using an existing infrastructure for syndromic surveillance and monitoring. Particular areas of health concern can be defined beforehand, and may be modified or expanded during the monitoring activities to track relevant developments. Although an association between patterns and changes in the strictness of mitigation measures might seem probable, claims about causality should be made with caution. ", doi="10.2196/53368", url="https://publichealth.jmir.org/2024/1/e53368" } @Article{info:doi/10.2196/53711, author="Lim, Sachiko and Johannesson, Paul", title="An Ontology to Bridge the Clinical Management of Patients and Public Health Responses for Strengthening Infectious Disease Surveillance: Design Science Study", journal="JMIR Form Res", year="2024", month="Sep", day="26", volume="8", pages="e53711", keywords="infectious disease", keywords="ontology", keywords="IoT", keywords="infectious disease surveillance", keywords="patient monitoring", keywords="infectious disease management", keywords="risk analysis", keywords="early warning", keywords="data integration", keywords="semantic interoperability", keywords="public health", abstract="Background: Novel surveillance approaches using digital technologies, including the Internet of Things (IoT), have evolved, enhancing traditional infectious disease surveillance systems by enabling real-time detection of outbreaks and reaching a wider population. However, disparate, heterogenous infectious disease surveillance systems often operate in silos due to a lack of interoperability. As a life-changing clinical use case, the COVID-19 pandemic has manifested that a lack of interoperability can severely inhibit public health responses to emerging infectious diseases. Interoperability is thus critical for building a robust ecosystem of infectious disease surveillance and enhancing preparedness for future outbreaks. The primary enabler for semantic interoperability is ontology. Objective: This study aims to design the IoT-based management of infectious disease ontology (IoT-MIDO) to enhance data sharing and integration of data collected from IoT-driven patient health monitoring, clinical management of individual patients, and disparate heterogeneous infectious disease surveillance. Methods: The ontology modeling approach was chosen for its semantic richness in knowledge representation, flexibility, ease of extensibility, and capability for knowledge inference and reasoning. The IoT-MIDO was developed using the basic formal ontology (BFO) as the top-level ontology. We reused the classes from existing BFO-based ontologies as much as possible to maximize the interoperability with other BFO-based ontologies and databases that rely on them. We formulated the competency questions as requirements for the ontology to achieve the intended goals. Results: We designed an ontology to integrate data from heterogeneous sources, including IoT-driven patient monitoring, clinical management of individual patients, and infectious disease surveillance systems. This integration aims to facilitate the collaboration between clinical care and public health domains. We also demonstrate five use cases using the simplified ontological models to show the potential applications of IoT-MIDO: (1) IoT-driven patient monitoring, risk assessment, early warning, and risk management; (2) clinical management of patients with infectious diseases; (3) epidemic risk analysis for timely response at the public health level; (4) infectious disease surveillance; and (5) transforming patient information into surveillance information. Conclusions: The development of the IoT-MIDO was driven by competency questions. Being able to answer all the formulated competency questions, we successfully demonstrated that our ontology has the potential to facilitate data sharing and integration for orchestrating IoT-driven patient health monitoring in the context of an infectious disease epidemic, clinical patient management, infectious disease surveillance, and epidemic risk analysis. The novelty and uniqueness of the ontology lie in building a bridge to link IoT-based individual patient monitoring and early warning based on patient risk assessment to infectious disease epidemic surveillance at the public health level. The ontology can also serve as a starting point to enable potential decision support systems, providing actionable insights to support public health organizations and practitioners in making informed decisions in a timely manner. ", doi="10.2196/53711", url="https://formative.jmir.org/2024/1/e53711", url="http://www.ncbi.nlm.nih.gov/pubmed/39325530" } @Article{info:doi/10.2196/53899, author="Schneller-Najm, M. Liane and Xie, Zidian and Chen, Jiarui and Lee, Sarah and Xu, Emily and Li, Dongmei", title="Public Perception of the Tobacco 21 Amendment on Twitter in the United States: Observational Study", journal="JMIR Infodemiology", year="2024", month="Sep", day="25", volume="4", pages="e53899", keywords="tobacco policy", keywords="tobacco regulation", keywords="social media", keywords="tobacco use", keywords="tobacco", keywords="health belief", keywords="sentiment analysis", keywords="smoking", keywords="cigarettes", keywords="social media analysis", keywords="vaping", keywords="e-cigarettes", keywords="health behavior", keywords="public opinion", abstract="Background: Following the signing of the Tobacco 21 Amendment (T21) in December 2019 to raise the minimum legal age for the sale of tobacco products from 18 to 21 years in the United States, there is a need to monitor public responses and potential unintended consequences. Social media platforms, such as Twitter (subsequently rebranded as X), can provide rich data on public perceptions. Objective: This study contributes to the literature using Twitter data to assess the knowledge and beliefs of T21. Methods: Twitter data were collected from November 2019 to February 2021 using the Twitter streaming application programming interface with keywords related to vaping or e-cigarettes, such as ``vape,'' ``ecig,'' etc. The temporal trend of the T21 discussion on Twitter was examined using the mean number of daily T21-related tweets. Inductive methods were used to manually code the tweets into different sentiment groups (positive, neutral, and negative) based on the attitude expressed toward the policy by 3 coders with high interrater reliability. Topics discussed were examined within each sentiment group through theme analyses. Results: Among the collected 3197 tweets, 2169 tweets were related to T21, of which 444 tweets (20.5\%) showed a positive attitude, 736 (33.9\%) showed a negative attitude, and 989 (45.6\%) showed a neutral attitude. The temporal trend showed a clear peak in the number of tweets around January 2020, following the enactment of this legislation. For positive tweets, the most frequent topics were ``avoidance of further regulation'' (120/444, 27\%), ``Enforce T21'' (110/444, 24.8\%), and ``health benefits'' (81/444, 18.2\%). For negative tweets, the most frequent topics were ``general disagreement or frustration'' (207/736, 28.1\%) and ``will still use tobacco'' (188/736, 25.5\%). Neutral tweets were primarily ``public service announcements (PSA) or news posts'' (782/989, 79.1\%). Conclusions: Overall, we find that one-third of tweets displayed a negative attitude toward T21 during the study period. Many were frustrated with T21 and reported that underage consumers could still obtain products. Social media data provide a timely opportunity to monitor public perceptions and responses to regulatory actions. Continued monitoring can inform enforcement efforts and potential unintended consequences of T21. ", doi="10.2196/53899", url="https://infodemiology.jmir.org/2024/1/e53899" } @Article{info:doi/10.2196/54503, author="Cabrera Alvargonzalez, J. Jorge and Larra{\~n}aga, Ana and Martinez, Javier and P{\'e}rez Castro, Sonia and Rey Cao, Sonia and Davi{\~n}a Nu{\~n}ez, Carlos and Del Campo P{\'e}rez, V{\'i}ctor and Duran Parrondo, Carmen and Suarez Luque, Silvia and Gonz{\'a}lez Alonso, Elena and Silva Tojo, Jos{\'e} Alfredo and Porteiro, Jacobo and Regueiro, Benito", title="Assessment of the Effective Sensitivity of SARS-CoV-2 Sample Pooling Based on a Large-Scale Screening Experience: Retrospective Analysis", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="24", volume="10", pages="e54503", keywords="pooling", keywords="sensitivity", keywords="SARS-CoV-2", keywords="PCR", keywords="saliva", keywords="screening", keywords="surveillance", keywords="COVID-19", keywords="nonsymptomatic", keywords="transmission control", abstract="Background: The development of new large-scale saliva pooling detection strategies can significantly enhance testing capacity and frequency for asymptomatic individuals, which is crucial for containing SARS-CoV-2. Objective: This study aims to implement and scale-up a SARS-CoV-2 screening method using pooled saliva samples to control the virus in critical areas and assess its effectiveness in detecting asymptomatic infections. Methods: Between August 2020 and February 2022, our laboratory received a total of 928,357 samples. Participants collected at least 1 mL of saliva using a self-sampling kit and registered their samples via a smartphone app. All samples were directly processed using AutoMate 2550 for preanalytical steps and then transferred to Microlab STAR, managed with the HAMILTON Pooling software for pooling. The standard pool preset size was 20 samples but was adjusted to 5 when the prevalence exceeded 2\% in any group. Real-time polymerase chain reaction (RT-PCR) was conducted using the Allplex SARS-CoV-2 Assay until July 2021, followed by the Allplex SARS-CoV-2 FluA/FluB/RSV assay for the remainder of the study period. Results: Of the 928,357 samples received, 887,926 (95.64\%) were fully processed into 56,126 pools. Of these pools, 4863 tested positive, detecting 5720 asymptomatic infections. This allowed for a comprehensive analysis of pooling's impact on RT-PCR sensitivity and false-negative rate (FNR), including data on positive samples per pool (PPP). We defined Ctref as the minimum cycle threshold (Ct) of each data set from a sample or pool and compared these Ctref results from pooled samples with those of the individual tests ($\Delta$CtP). We then examined their deviation from the expected offset due to dilution [$\Delta$$\Delta$CtP = $\Delta$CtP -- log2]. In this work, the $\Delta$CtP and $\Delta$$\Delta$CtP were 2.23 versus 3.33 and --0.89 versus 0.23, respectively, comparing global results with results for pools with 1 positive sample per pool. Therefore, depending on the number of genes used in the test and the size of the pool, we can evaluate the FNR and effective sensitivity (1 -- FNR) of the test configuration. In our scenario, with a maximum of 20 samples per pool and 3 target genes, statistical observations indicated an effective sensitivity exceeding 99\%. From an economic perspective, the focus is on pooling efficiency, measured by the effective number of persons that can be tested with 1 test, referred to as persons per test (PPT). In this study, the global PPT was 8.66, reflecting savings of over 20 million euros (US \$22 million) based on our reagent prices. Conclusions: Our results demonstrate that, as expected, pooling reduces the sensitivity of RT-PCR. However, with the appropriate pool size and the use of multiple target genes, effective sensitivity can remain above 99\%. Saliva pooling may be a valuable tool for screening and surveillance in asymptomatic individuals and can aid in controlling SARS-CoV-2 transmission. Further studies are needed to assess the effectiveness of these strategies for SARS-CoV-2 and their application to other microorganisms or biomarkers detected by PCR. ", doi="10.2196/54503", url="https://publichealth.jmir.org/2024/1/e54503", url="http://www.ncbi.nlm.nih.gov/pubmed/39316785" } @Article{info:doi/10.2196/52345, author="Daneshvar, Hadi and Carver, Hannah and Strachan, Graeme and Greenhalgh, Jessica and Matheson, Catriona", title="From Digital Inclusion to Digital Transformation in the Prevention of Drug-Related Deaths in Scotland: Qualitative Study", journal="J Med Internet Res", year="2024", month="Sep", day="24", volume="26", pages="e52345", keywords="digital inclusion", keywords="digital transformation", keywords="digital health", keywords="drug-related death", keywords="digitalization", keywords="drug overdose", keywords="drug overdose death", keywords="harm reduction", keywords="mobile phone", keywords="digital divide", abstract="Background: Globally, drug-related deaths (DRDs) are increasing, posing a significant challenge. Scotland has the highest DRD rate in Europe and one of the highest globally. The Scottish Government launched the Digital Lifelines Scotland (DLS) program to increase the provision of digital technology in harm reduction services and other support services. Digital technology responses to DRDs can include education through digital platforms, improved access to treatment and support via telehealth and mobile apps, analysis of data to identify risk factors, and the use of digital tools for naloxone distribution. However, digital technology should be integrated into a comprehensive approach that increases access to services and addresses underlying causes. Digital transformation could enhance harm reduction service and support, but challenges must be addressed for successful implementation. The DLS program aims to enhance digital inclusion and improve health outcomes for people who use or are affected by drug use to reduce the risk of DRDs. Objective: This study aims to explore the role of digital technology as an enabler and supporter in enhancing existing services and innovating new solutions, rather than being a stand-alone solution. Specifically focusing on individuals who use drugs, the research investigates the potential of digital inclusion and technology provision for preventing DRDs within the context of the DLS program. Methods: Semistructured interviews were conducted with 47 people: 21 (45\%) service users, 14 (30\%) service providers, and 12 (26\%) program staff who were all involved in DLS. Interviews were audio recorded, transcribed, and then coded. Analysis was done in three phases: (1) thematic analysis of interview data to identify the benefits of digital technologies in this sector; (2) identification of the challenges and enablers of using digital technologies using the Technology, People, Organizations, and Macroenvironment conceptual framework; and (3) mapping digital technology provision to services offered to understand the extent of digital transformation of the field. Results: Participants identified increased connectivity, enhanced access to services, and improved well-being as key benefits. Digital devices facilitated social connections, alleviated loneliness, and fostered a sense of community. Devices enabled engagement with services and support workers, providing better access to resources. In addition, digital technology was perceived as a preventive measure to reduce harmful drug use. Lack of technical knowledge, organizational constraints, and usability challenges, including device preferences and security issues, were identified. Conclusions: The study found that digital inclusion through the provision of devices and connections has the potential to enhance support in the harm reduction sector. However, it highlighted the limitations of existing digital inclusion programs in achieving comprehensive digital transformation. To progress, there is a need for sustained engagement, cultural change, and economic considerations to overcome barriers. ", doi="10.2196/52345", url="https://www.jmir.org/2024/1/e52345" } @Article{info:doi/10.2196/48047, author="Yun, Byungyoon and Park, Heejoo and Choi, Jaesung and Oh, Juyeon and Sim, Juho and Kim, Yangwook and Lee, Jongmin and Yoon, Jin-Ha", title="Inequality in Mortality and Cardiovascular Risk Among Young, Low-Income, Self-Employed Workers: Nationwide Retrospective Cohort Study", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="20", volume="10", pages="e48047", keywords="self-employed", keywords="employee", keywords="all-cause mortality", keywords="cardiovascular disease", keywords="mental illness", keywords="socioeconomic status", keywords="nationwide study", keywords="inequality", keywords="effect modification", keywords="health checkups", abstract="Background: Self-employment is a significant component of South Korea's labor force; yet, it remains relatively understudied in the context of occupational safety and health. Owing to different guidelines for health checkup participation among economically active individuals, disparities in health maintenance may occur across varying employment statuses. Objective: This study aims to address such disparities by comparing the risk of all-cause mortality and comorbidities between the self-employed and employee populations in South Korea, using nationwide data. We sought to provide insights relevant to other countries with similar cultural, social, and economic contexts. Methods: This nationwide retrospective study used data from the Korean National Health Insurance Service database. Participants (aged 20?59 y) who maintained the same insurance type (self-employed or employee insurance) for ?3 years (at least 2008?2010) were recruited for this study and monitored until death or December 2021---whichever occurred first. The primary outcome was all-cause mortality. The secondary outcomes were ischemic heart disease, ischemic stroke, cancer, and hospitalization with a mental illness. Age-standardized cumulative incidence rates were estimated through an indirect method involving 5-unit age standardization. A multivariable Cox proportional hazards model was used to estimate the adjusted hazard ratio (HR) and 95\% CI for each sex stratum. Subgroup analyses and an analysis of the effect modification of health checkup participation were also performed. Results: A total of 11,652,716 participants were analyzed (follow-up: median 10.92, IQR 10.92-10.92 y; age: median 42, IQR 35-50 y; male: n=7,975,116, 68.44\%); all-cause mortality occurred in 1.27\% (99,542/7,851,282) of employees and 3.29\% (124,963/3,801,434) of self-employed individuals (P<.001). The 10-year cumulative incidence rates of all-cause mortality differed significantly by employment status (1.1\% for employees and 2.8\% for self-employed individuals; P<.001). The risk of all-cause mortality was significantly higher among the self-employed individuals when compared with that among employees, especially among female individuals, according to the final model (male: adjusted HR 1.44, 95\% CI 1.42?1.45; female: adjusted HR 1.89, 95\% CI 1.84?1.94; P<.001). The risk of the secondary outcomes, except all types of malignancies, was significantly higher among the self-employed individuals (all P values were <.001). According to subgroup analyses, this association was prominent in younger individuals with lower incomes who formed a part of the nonparticipation groups. Furthermore, health checkup participation acted as an effect modifier for the association between employment status and all-cause mortality in both sexes (male: relative excess risk due to interaction [RERI] 0.76, 95\% CI 0.74?0.79; female: RERI 1.13, 95\% CI 1.05?1.21). Conclusions: This study revealed that self-employed individuals face higher risks of all-cause mortality, cardio-cerebrovascular diseases, and mental illnesses when compared to employees. The mortality risk is particularly elevated in younger, lower-income individuals who do not engage in health checkups, with health checkup nonparticipation acting as an effect modifier for this association. ", doi="10.2196/48047", url="https://publichealth.jmir.org/2024/1/e48047" } @Article{info:doi/10.2196/54861, author="Lin, Ting-Yu and Yen, Ming-Fang Amy and Chen, Li-Sheng Sam and Hsu, Chen-Yang and Lai, Chao-Chih and Luh, Dih-Ling and Yeh, Yen-Po and Chen, Hsiu-Hsi Tony", title="Kinetics of Viral Shedding for Outbreak Surveillance of Emerging Infectious Diseases: Modeling Approach to SARS-CoV-2 Alpha and Omicron Infection", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="19", volume="10", pages="e54861", keywords="COVID-19", keywords="PCR testing", keywords="Ct values", keywords="viral load", keywords="kinetics of viral shedding", keywords="emerging infectious disease", keywords="SARS-CoV-2 variants", keywords="infection surveillance", abstract="Background: Previous studies have highlighted the importance of viral shedding using cycle threshold (Ct) values obtained via reverse transcription polymerase chain reaction to understand the epidemic trajectories of SARS-CoV-2 infections. However, it is rare to elucidate the transition kinetics of Ct values from the asymptomatic or presymptomatic phase to the symptomatic phase before recovery using individual repeated Ct values. Objective: This study proposes a novel Ct-enshrined compartment model to provide a series of quantitative measures for delineating the full trajectories of the dynamics of viral load from infection until recovery. Methods: This Ct-enshrined compartment model was constructed by leveraging Ct-classified states within and between presymptomatic and symptomatic compartments before recovery or death among people with infections. A series of recovery indices were developed to assess the net kinetic movement of Ct-up toward and Ct-down off recovery. The model was applied to (1) a small-scale community-acquired Alpha variant outbreak under the ``zero-COVID-19'' policy without vaccines in May 2021 and (2) a large-scale community-acquired Omicron variant outbreak with high booster vaccination rates following the lifting of the ``zero-COVID-19'' policy in April 2022 in Taiwan. The model used Bayesian Markov chain Monte Carlo methods with the Metropolis-Hastings algorithm for parameter estimation. Sensitivity analyses were conducted by varying Ct cutoff values to assess the robustness of the model. Results: The kinetic indicators revealed a marked difference in viral shedding dynamics between the Alpha and Omicron variants. The Alpha variant exhibited slower viral shedding and lower recovery rates, but the Omicron variant demonstrated swifter viral shedding and higher recovery rates. Specifically, the Alpha variant showed gradual Ct-up transitions and moderate recovery rates, yielding a presymptomatic recovery index slightly higher than 1 (1.10), whereas the Omicron variant had remarkable Ct-up transitions and significantly higher asymptomatic recovery rates, resulting in a presymptomatic recovery index much higher than 1 (152.5). Sensitivity analysis confirmed the robustness of the chosen Ct values of 18 and 25 across different recovery phases. Regarding the impact of vaccination, individuals without booster vaccination had a 19\% higher presymptomatic incidence rate compared to those with booster vaccination. Breakthrough infections in boosted individuals initially showed similar Ct-up transition rates but higher rates in later stages compared to nonboosted individuals. Overall, booster vaccination improved recovery rates, particularly during the symptomatic phase, although recovery rates for persistent asymptomatic infection were similar regardless of vaccination status once the Ct level exceeded 25. Conclusions: The study provides new insights into dynamic Ct transitions, with the notable finding that Ct-up transitions toward recovery outpaced Ct-down and symptom-surfacing transitions during the presymptomatic phase. The Ct-up against Ct-down transition varies with variants and vaccination status. The proposed Ct-enshrined compartment model is useful for the surveillance of emerging infectious diseases in the future to prevent community-acquired outbreaks. ", doi="10.2196/54861", url="https://publichealth.jmir.org/2024/1/e54861" } @Article{info:doi/10.2196/46485, author="Fonseca, Martina and MacKenna, Brian and Mehrkar, Amir and and Walters, E. Caroline and Hickman, George and Pearson, Jonathan and Fisher, Louis and Inglesby, Peter and Bacon, Seb and Davy, Simon and Hulme, William and Goldacre, Ben and Koffman, Ofra and Bakhai, Minal", title="The Use of Online Consultation Systems or Remote Consulting in England Characterized Through the Primary Care Health Records of 53 Million People in the OpenSAFELY Platform: Retrospective Cohort Study", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="18", volume="10", pages="e46485", keywords="online consultation system", keywords="remote monitoring", keywords="triage", keywords="primary care research", keywords="health informatics", keywords="general practice", keywords="digital primary care", keywords="electronic health record coding", keywords="OpenSAFELY", keywords="trusted research environment", abstract="Background: The National Health Service (NHS) Long Term Plan, published in 2019, committed to ensuring that every patient in England has the right to digital-first primary care by 2023-2024. The COVID-19 pandemic and infection prevention and control measures accelerated work by the NHS to enable and stimulate the use of online consultation (OC) systems across all practices for improved access to primary care. Objective: We aimed to explore general practice coding activity associated with the use of OC systems in terms of trends, COVID-19 effect, variation, and quality. Methods: With the approval of NHS England, the OpenSAFELY platform was used to query and analyze the in situ electronic health records of suppliers The Phoenix Partnership (TPP) and Egton Medical Information Systems, covering >53 million patients in >6400 practices, mainly in 2019-2020. Systematized Medical Nomenclature for Medicine--Clinical Terminology (SNOMED-CT) codes relevant to OC systems and written OCs were identified including eConsultation. Events were described by volumes and population rates, practice coverage, and trends before and after the COVID-19 pandemic. Variation was characterized among practices, by sociodemographics, and by clinical history of long-term conditions. Results: Overall, 3,550,762 relevant coding events were found in practices using TPP, with the code eConsultation detected in 84.56\% (2157/2551) of practices. Activity related to digital forms of interaction increased rapidly from March 2020, the onset of the pandemic; namely, in the second half of 2020, >9 monthly eConsultation coding events per 1000 registered population were registered compared to <1 a year prior. However, we found large variations among regions and practices: December 2020 saw the median practice have 0.9 coded instances per 1000 population compared to at least 36 for the highest decile of practices. On sociodemographics, the TPP cohort with OC instances, when compared (univariate analysis) to the cohort with general practitioner consultations, was more predominantly female (661,235/1,087,919, 60.78\% vs 9,172,833/17,166,765, 53.43\%), aged 18 to 40 years (349,162/1,080,589, 32.31\% vs 4,295,711/17,000,942, 25.27\%), White (730,389/1,087,919, 67.14\% vs 10,887,858/17,166,765, 63.42\%), and less deprived (167,889/1,068,887, 15.71\% vs 3,376,403/16,867,074, 20.02\%). Looking at the eConsultation code through multivariate analysis, it was more commonly recorded among patients with a history of asthma (adjusted odds ratio [aOR] 1.131, 95\% CI 1.124-1.137), depression (aOR 1.144, 95\% CI 1.138-1.151), or atrial fibrillation (aOR 1.119, 95\% CI 1.099-1.139) when compared to other patients with general practitioner consultations, adjusted for long-term conditions, age, and gender. Conclusions: We successfully queried general practice coding activity relevant to the use of OC systems, showing increased adoption and key areas of variation during the pandemic at both sociodemographic and clinical levels. The work can be expanded to support monitoring of coding quality and underlying activity. This study suggests that large-scale impact evaluation studies can be implemented within the OpenSAFELY platform, namely looking at patient outcomes. ", doi="10.2196/46485", url="https://publichealth.jmir.org/2024/1/e46485", url="http://www.ncbi.nlm.nih.gov/pubmed/39292500" } @Article{info:doi/10.2196/56804, author="Callaghan-Koru, A. Jennifer and Newman Chargois, Paige and Tiwari, Tanvangi and Brown, C. Clare and Greenfield, William and Koru, G{\"u}ne?", title="Public Maternal Health Dashboards in the United States: Descriptive Assessment", journal="J Med Internet Res", year="2024", month="Sep", day="17", volume="26", pages="e56804", keywords="dashboard", keywords="maternal health", keywords="data visualization", keywords="data communication", keywords="perinatal health", abstract="Background: Data dashboards have become more widely used for the public communication of health-related data, including in maternal health. Objective: We aimed to evaluate the content and features of existing publicly available maternal health dashboards in the United States. Methods: Through systematic searches, we identified 80 publicly available, interactive dashboards presenting US maternal health data. We abstracted and descriptively analyzed the technical features and content of identified dashboards across four areas: (1) scope and origins, (2) technical capabilities, (3) data sources and indicators, and (4) disaggregation capabilities. Where present, we abstracted and qualitatively analyzed dashboard text describing the purpose and intended audience. Results: Most reviewed dashboards reported state-level data (58/80, 72\%) and were hosted on a state health department website (48/80, 60\%). Most dashboards reported data from only 1 (33/80, 41\%) or 2 (23/80, 29\%) data sources. Key indicators, such as the maternal mortality rate (10/80, 12\%) and severe maternal morbidity rate (12/80, 15\%), were absent from most dashboards. Included dashboards used a range of data visualizations, and most allowed some disaggregation by time (65/80, 81\%), geography (65/80, 81\%), and race or ethnicity (55/80, 69\%). Among dashboards that identified their audience (30/80, 38\%), legislators or policy makers and public health agencies or organizations were the most common audiences. Conclusions: While maternal health dashboards have proliferated, their designs and features are not standard. This assessment of maternal health dashboards in the United States found substantial variation among dashboards, including inconsistent data sources, health indicators, and disaggregation capabilities. Opportunities to strengthen dashboards include integrating a greater number of data sources, increasing disaggregation capabilities, and considering end-user needs in dashboard design. ", doi="10.2196/56804", url="https://www.jmir.org/2024/1/e56804" } @Article{info:doi/10.2196/58704, author="Elliot, J. Alex and Hughes, E. Helen and Harcourt, E. Sally and Smith, Sue and Loveridge, Paul and Morbey, A. Roger and Bains, Amardeep and Edeghere, Obaghe and Jones, R. Natalia and Todkill, Daniel and Smith, E. Gillian", title="From Fax to Secure File Transfer Protocol: The 25-Year Evolution of Real-Time Syndromic Surveillance in England", journal="J Med Internet Res", year="2024", month="Sep", day="17", volume="26", pages="e58704", keywords="epidemiology", keywords="population surveillance", keywords="sentinel surveillance", keywords="public health surveillance", keywords="bioterrorism", keywords="mass gathering", keywords="pandemics", doi="10.2196/58704", url="https://www.jmir.org/2024/1/e58704" } @Article{info:doi/10.2196/56958, author="Lv, Jiaqi and Jia, Yangfan and Yan, Chunhui and Zhang, Xingliang and Xu, Ke and Xu, Junfang", title="Drug Use Behaviors and the Risk of HIV Infection Among Drug Users in China Between 2014 and 2021: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="10", volume="10", pages="e56958", keywords="drug user", keywords="drug-using behavior", keywords="HIV", keywords="behaviors", keywords="behavior", keywords="risky", keywords="sexual", keywords="drug", keywords="drugs", keywords="substance", keywords="STI", keywords="STD", keywords="sexual transmission", keywords="sexually transmitted", keywords="association", keywords="associations", keywords="correlation", keywords="correlations", keywords="sentinel", keywords="surveillance", keywords="sexually transmitted infection", keywords="sexually transmitted disease", abstract="Background: Drug users are a high-risk group for HIV infection and are prominent HIV carriers. Given the emergence of new drugs, we explored current drug-using behaviors, HIV infections, and the correlation between drug-using behaviors and HIV infection risk among drug users from 2014 to 2021. Objective: We aimed to identify the prevalence of HIV infection risk among drug users and explore drug use behaviors based on the updated data, which could provide evidence for the precision of HIV prevention strategies among drug users. Methods: Data were collected from sentinel surveillance of drug users in rehabilitation centers and communities in Hangzhou (2014?2021), including sociodemographic characteristics, HIV awareness, drug use, risky sexual behaviors, and HIV infection status. Multivariate logistic regression was used to identify the factors influencing HIV infection and risky sexual behaviors among drug users. Results: In total, 5623 drug users (male: n=4734, 84.19\%; age: mean 38.38, SD 9.94 years) were included. New drugs dominated among the participants (n=3674, 65.34\%). The main mode of drug use was noninjection (n=4756, 84.58\%). Overall, for 27.45\% (n=1544) of injected drugs in the last month before the investigation, the average daily injection frequency was 3.10 (SD 8.24). Meanwhile, 3.43\% of participants shared needles. The incidence of sexual behaviors after drug use was 33.13\% (n=1863), with 35.75\% (n=666) of them using a condom in the last time. Overall, 116 participants tested positive for HIV antibodies (infection rate=2.06\%). New drug users exhibited more postuse sexual behaviors than traditional drug users (odds ratio [OR] 7.771, 95\% CI 6.126?9.856; P<.001). HIV-aware drug users were more likely to engage in risky sexual behaviors (OR 1.624, 95\% CI 1.152?2.291; P=.006). New-type drug users were more likely to engage in unprotected sexual behavior (OR 1.457, 95\% CI 1.055?2.011; P=.02). Paradoxically, drug users with greater HIV awareness were more prone to engaging in unprotected sexual behavior (OR 5.820, 95\% CI 4.650?7.284; P<.001). Women engaged less in unprotected sex than men (OR 0.356, 95\% CI 0.190?0.665; P=.001). HIV rates were higher among injecting drug users (OR 2.692, 95\% CI 0.995?7.287; P=.04) and lower among drug users who used condoms during recent sex than those who did not (OR 0.202, 95\% CI 0.076?0.537; P=.001). Higher education levels were associated with higher HIV infection rates. However, there was no significant correlation between HIV cognition level and HIV infection. Conclusions: New drug types and noninjection were the main patterns in last 7 years. Using new types of drugs, rather than traditional drugs, was associated with an increased risk of HIV infection. Injection drug use was a risk factor for HIV infection. HIV awareness among drug users was high, but the incidence of risky sexual behaviors remained high. Therefore, it is important to promote the behavioral transformation of high-risk populations from cognition to attitude, and then to taking protective measures. ", doi="10.2196/56958", url="https://publichealth.jmir.org/2024/1/e56958" } @Article{info:doi/10.2196/52798, author="Ramachandran, Swathi and Chang, Hsiu-Ju and Worthington, Catherine and Kushniruk, Andre and Ib{\'a}{\~n}ez-Carrasco, Francisco and Davies, Hugh and McKee, Geoffrey and Brown, Adalsteinn and Gilbert, Mark and Iyamu, Ihoghosa", title="Digital Competencies and Training Approaches to Enhance the Capacity of Practitioners to Support the Digital Transformation of Public Health: Rapid Review of Current Recommendations", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="9", volume="10", pages="e52798", keywords="digital public health", keywords="digital transformation", keywords="digital transformations", keywords="rapid review", keywords="rapid reviews", keywords="synthesis", keywords="review methods", keywords="review methodology", keywords="competencies", keywords="competency", keywords="training and practice recommendations", keywords="public health workforce", keywords="workforce", keywords="worker", keywords="workers", keywords="practitioner", keywords="practitioners", keywords="public health", keywords="digital health", keywords="training", keywords="continuing education", keywords="skills", keywords="skill", keywords="recommendation", keywords="recommendations", keywords="best practice", keywords="guideline", keywords="guidelines", abstract="Background: The COVID-19 pandemic highlighted gaps in the public health workforce's capacity to deploy digital technologies while upholding ethical, social justice, and health equity principles. Existing public health competency frameworks have not been updated to reflect the prominent role digital technologies play in contemporary public health, and public health training institutions are seeking to integrate digital technologies in their curricula. Objective: As a first step in a multiphase study exploring recommendations for updates to public health competency frameworks within the Canadian public health context, we conducted a rapid review of literature aiming to identify recommendations for digital competencies, training approaches, and inter- or transdisciplinary partnerships that can enhance public health practitioners' capacity to support the digital transformation of public health. Methods: Following the World Health Organization's (2017) guidelines for rapid reviews, a systematic search was conducted on Ovid MEDLINE, Ovid Embase, ERIC (Education Resources Information Center), and Web of Science for peer-reviewed articles. We also searched Google Scholar and various public health agency and public health association websites for gray literature using search terms related to public health, digital health, practice competencies, and training approaches. We included articles with explicit practice competencies and training recommendations related to digital technologies among public health practitioners published between January 2010 and December 2022. We excluded articles describing these concepts in passing or from a solely clinical perspective. Results: Our search returned 2023 titles and abstracts, of which only 12 studies met the inclusion criteria. We found recommendations for new competencies to enable public health practitioners to appropriately use digital technologies that cut across all existing categories of the core competencies for public health framework of the Public Health Agency of Canada. We also identified a new competency category related to data, data systems management, and governance. Training approaches identified include adapted degree-awarding programs like combined public health and informatics or data science degree programs and ongoing professional certifications with integration of practice-based learning in multi- and interdisciplinary training. Disciplines suggested as important to facilitate practice competency and training recommendations included public health, public health informatics, data, information and computer sciences, biostatistics, health communication, and business. Conclusions: Despite the growth of digital technologies in public health, recommendations about practice competencies and training approaches necessary to effectively support the digital transformation of public health remain limited in the literature. Where available, evidence suggests the workforce requires new competencies that cut across and extend existing public health competencies, including new competencies related to the use and protection of new digital data sources, alongside facilitating health communication and promotion functions using digital media. Recommendations also emphasize the need for training approaches that focus on interdisciplinarity through adapted degree-awarding public health training programs and ongoing professional development. ", doi="10.2196/52798", url="https://publichealth.jmir.org/2024/1/e52798" } @Article{info:doi/10.2196/53050, author="Wei, Hanxue and Hswen, Yulin and Merchant, S. Junaid and Drew, B. Laura and Nguyen, C. Quynh and Yue, Xiaohe and Mane, Heran and Nguyen, T. Thu", title="From Tweets to Streets: Observational Study on the Association Between Twitter Sentiment and Anti-Asian Hate Crimes in New York City from 2019 to 2022", journal="J Med Internet Res", year="2024", month="Sep", day="9", volume="26", pages="e53050", keywords="anti-Asian", keywords="hate crime", keywords="Twitter", keywords="racism", keywords="social media, machine learning, sentiment analysis", abstract="Background: Anti-Asian hate crimes escalated during the COVID-19 pandemic; however, limited research has explored the association between social media sentiment and hate crimes toward Asian communities. Objective: This study aims to investigate the relationship between Twitter (rebranded as X) sentiment data and the occurrence of anti-Asian hate crimes in New York City from 2019 to 2022, a period encompassing both before and during COVID-19 pandemic conditions. Methods: We used a hate crime dataset from the New York City Police Department. This dataset included detailed information on the occurrence of anti-Asian hate crimes at the police precinct level from 2019 to 2022. We used Twitter's application programming interface for Academic Research to collect a random 1\% sample of publicly available Twitter data in New York State, including New York City, that included 1 or more of the selected Asian-related keywords and applied support vector machine to classify sentiment. We measured sentiment toward the Asian community using the rates of negative and positive sentiment expressed in tweets at the monthly level (N=48). We used negative binomial models to explore the associations between sentiment levels and the number of anti-Asian hate crimes in the same month. We further adjusted our models for confounders such as the unemployment rate and the emergence of the COVID-19 pandemic. As sensitivity analyses, we used distributed lag models to capture 1- to 2-month lag times. Results: A point increase of 1\% in negative sentiment rate toward the Asian community in the same month was associated with a 24\% increase (incidence rate ratio [IRR] 1.24; 95\% CI 1.07-1.44; P=.005) in the number of anti-Asian hate crimes. The association was slightly attenuated after adjusting for unemployment and COVID-19 emergence (ie, after March 2020; P=.008). The positive sentiment toward Asian tweets with a 0-month lag was associated with a 12\% decrease (IRR 0.88; 95\% CI 0.79-0.97; P=.002) in expected anti-Asian hate crimes in the same month, but the relationship was no longer significant after adjusting for the unemployment rate and the emergence of COVID-19 pandemic (P=.11). Conclusions: A higher negative sentiment level was associated with more hate crimes specifically targeting the Asian community in the same month. The findings highlight the importance of monitoring public sentiment to predict and potentially mitigate hate crimes against Asian individuals. ", doi="10.2196/53050", url="https://www.jmir.org/2024/1/e53050", url="http://www.ncbi.nlm.nih.gov/pubmed/39250221" } @Article{info:doi/10.2196/51525, author="Fareed, Naleef and Olvera, G. Ramona and Wang, Yiting and Hayes, Michael and Larimore, Liz Elizabeth and Balvanz, Peter and Langley, Ronald and Noel, A. Corinna and Rock, Peter and Redmond, Daniel and Neufeld, Jessica and Kosakowski, Sarah and Harris, Daniel and LaRochelle, Marc and Huerta, R. Timothy and Glasgow, LaShawn and Oga, Emmanuel and Villani, Jennifer and Wu, Elwin", title="Lessons Learned From Developing Dashboards to Support Decision-Making for Community Opioid Response by Community Stakeholders: Mixed Methods and Multisite Study", journal="JMIR Hum Factors", year="2024", month="Sep", day="9", volume="11", pages="e51525", keywords="data visualizations", keywords="dashboards", keywords="public health", keywords="overdose epidemic", keywords="human-centered design", abstract="Background: Data dashboards are published tools that present visualizations; they are increasingly used to display data about behavioral health, social determinants of health, and chronic and infectious disease risks to inform or support public health endeavors. Dashboards can be an evidence-based approach used by communities to influence decision-making in health care for specific populations. Despite widespread use, evidence on how to best design and use dashboards in the public health realm is limited. There is also a notable dearth of studies that examine and document the complexity and heterogeneity of dashboards in community settings. Objective: Community stakeholders engaged in the community response to the opioid overdose crisis could benefit from the use of data dashboards for decision-making. As part of the Communities That HEAL (CTH) intervention, community data dashboards were created for stakeholders to support decision-making. We assessed stakeholders' perceptions of the usability and use of the CTH dashboards for decision-making. Methods: We conducted a mixed methods assessment between June and July 2021 on the use of CTH dashboards. We administered the System Usability Scale (SUS) and conducted semistructured group interviews with users in 33 communities across 4 states of the United States. The SUS comprises 10 five-point Likert-scale questions measuring usability, each scored from 0 to 4. The interview guides were informed by the technology adoption model (TAM) and focused on perceived usefulness, perceived ease of use, intention to use, and contextual factors. Results: Overall, 62 users of the CTH dashboards completed the SUS and interviews. SUS scores (grand mean 73, SD 4.6) indicated that CTH dashboards were within the acceptable range for usability. From the qualitative interview data, we inductively created subthemes within the 4 dimensions of the TAM to contextualize stakeholders' perceptions of the dashboard's usefulness and ease of use, their intention to use, and contextual factors. These data also highlighted gaps in knowledge, design, and use, which could help focus efforts to improve the use and comprehension of dashboards by stakeholders. Conclusions: We present a set of prioritized gaps identified by our national group and list a set of lessons learned for improved data dashboard design and use for community stakeholders. Findings from our novel application of both the SUS and TAM provide insights and highlight important gaps and lessons learned to inform the design of data dashboards for use by decision-making community stakeholders. Trial Registration: ClinicalTrials.gov NCT04111939; https://clinicaltrials.gov/study/NCT04111939 ", doi="10.2196/51525", url="https://humanfactors.jmir.org/2024/1/e51525", url="http://www.ncbi.nlm.nih.gov/pubmed/39250216" } @Article{info:doi/10.2196/54750, author="Sanjak, S. Jaleal and McAuley, M. Erin and Raybern, Justin and Pinkham, Richard and Tarnowski, Jacob and Miko, Nicole and Rasmussen, Bridgette and Manalo, J. Christian and Goodson, Michael and Stamps, Blake and Necciai, Bryan and Sozhamannan, Shanmuga and Maier, J. Ezekiel", title="Wastewater Surveillance Pilot at US Military Installations: Cost Model Analysis", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="6", volume="10", pages="e54750", keywords="wastewater surveillance", keywords="cost analysis", keywords="military health", keywords="public health", keywords="sanitation", keywords="sanitary", keywords="water", keywords="wastewater", keywords="surveillance", keywords="environment", keywords="environmental", keywords="cost", keywords="costs", keywords="economic", keywords="economics", keywords="finance", keywords="financial", keywords="pathogen", keywords="pathogens", keywords="biosurveillance", abstract="Background: The COVID-19 pandemic highlighted the need for pathogen surveillance systems to augment both early warning and outbreak monitoring/control efforts. Community wastewater samples provide a rapid and accurate source of environmental surveillance data to complement direct patient sampling. Due to its global presence and critical missions, the US military is a leader in global pandemic preparedness efforts. Clinical testing for COVID-19 on US Air Force (USAF) bases (AFBs) was effective but costly with respect to direct monetary costs and indirect costs due to lost time. To remain operating at peak capacity, such bases sought a more passive surveillance option and piloted wastewater surveillance (WWS) at 17 AFBs to demonstrate feasibility, safety, utility, and cost-effectiveness from May 2021 to January 2022. Objective: We model the costs of a wastewater program for pathogens of public health concern within the specific context of US military installations using assumptions based on the results of the USAF and Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense pilot program. The objective was to determine the cost of deploying WWS to all AFBs relative to clinical swab testing surveillance regimes. Methods: A WWS cost projection model was built based on subject matter expert input and actual costs incurred during the WWS pilot program at USAF AFBs. Several SARS-CoV-2 circulation scenarios were considered, and the costs of both WWS and clinical swab testing were projected. Analysis was conducted to determine the break-even point and how a reduction in swab testing could unlock funds to enable WWS to occur in parallel. Results: Our model confirmed that WWS is complementary and highly cost-effective when compared to existing alternative forms of biosurveillance. We found that the cost of WWS was between US \$10.5-\$18.5 million less expensive annually in direct costs as compared to clinical swab testing surveillance. When the indirect cost of lost work was incorporated, including lost work associated with required clinical swab testing, we estimated that over two-thirds of clinical swab testing could be maintained with no additional costs upon implementation of WWS. Conclusions: Our results support the adoption of WWS across US military installations as part of a more comprehensive and early warning system that will enable adaptive monitoring during disease outbreaks in a more cost-effective manner than swab testing alone. ", doi="10.2196/54750", url="https://publichealth.jmir.org/2024/1/e54750" } @Article{info:doi/10.2196/59449, author="Liu, Fang-Chen and Chen, Bao-Chung and Huang, Yao-Ching and Huang, Shi-Hao and Chung, Jei Ren and Yu, Pi-Ching and Yu, Chia-Peng", title="Epidemiological Survey of Enterovirus Infections in Taiwan From 2011 to 2020: Retrospective Study", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="5", volume="10", pages="e59449", keywords="epidemiology", keywords="enterovirus", keywords="domestic", keywords="cluster", keywords="sporadic", keywords="retrospective", keywords="Taiwan", abstract="Background: Young children are susceptible to enterovirus (EV) infections, which cause significant morbidity in this age group. Objective: This study investigated the characteristics of virus strains and the epidemiology of EVs circulating among young children in Taiwan from 2011 to 2020. Methods: Children diagnosed with EV infections from 2011 to 2020 were identified from the routine national health insurance data monitoring disease system, real-time outbreak and disease surveillance system, national laboratory surveillance system, and Statistics of Communicable Diseases and Surveillance Report, a data set (secondary data) of the Taiwan Centers for Disease and Control. Four primary outcomes were identified: epidemic features, characteristics of sporadic and cluster cases of EV infections, and main cluster institutions. Results: From 2011 to 2020, between 10 and 7600 person-times visited the hospitals for EV infections on an outpatient basis daily. Based on 2011 to 2020 emergency department EV infection surveillance data, the permillage of EV visits throughout the year ranged from 0.07{\texttenthousand} and 25.45{\texttenthousand}. After typing by immunofluorescence assays, the dominant type was coxsackie A virus (CVA; 8844/12,829, 68.9\%), with most constituting types CVA10 (n=2972), CVA2 (n=1404), CVA6 (n=1308), CVA4 (n=1243), CVA16 (n=875), and CVA5 (n=680); coxsackie B virus CVB (n=819); echovirus (n=508); EV-A71 (n=1694); and EV-D68 (n=10). There were statistically significant differences (P<.001) in case numbers of EV infections among EV strains from 2011 to 2020. Cases in 2012 had 15.088 times the odds of being EV-A71, cases in 2014 had 2.103 times the odds of being CVA, cases in 2015 had 1.569 times the odds of being echovirus, and cases in 2018 had 2.274 times the odds of being CVB as cases in other years. From 2011 to 2020, in an epidemic analysis of EV clusters, 57 EV clusters were reported. Clusters that tested positive included 53 (53/57, 93\%) CVA cases (the major causes were CVA6, n=32, and CVA10, n=8). Populous institutions had the highest proportion (7 of 10) of EV clusters. Conclusion: This study is the first report of sporadic and cluster cases of EV infections from surveillance data (Taiwan Centers for Disease and Control, 2011?2020). This information will be useful for policy makers and clinical experts to direct prevention and control activities to EV infections that cause the most severe illness and greatest burden to the Taiwanese. ", doi="10.2196/59449", url="https://publichealth.jmir.org/2024/1/e59449" } @Article{info:doi/10.2196/52666, author="Zhao, Yusui and Xu, Yue and Yao, Dingming and Wu, Qingqing and Chen, Heni and Hu, Xiujing and Huang, Yu and Zhang, Xuehai", title="Changes in Infectious Disease--Specific Health Literacy in the Post--COVID-19 Pandemic Period: Two-Round Cross-Sectional Survey Study", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="30", volume="10", pages="e52666", keywords="survey", keywords="infectious disease--specific health literacy", keywords="COVID-19", keywords="health education", keywords="factors", keywords="postpandemic", abstract="Background: Infectious disease--specific health literacy (IDSHL) is a crucial factor in the development of infectious diseases. It plays a significant role not only in mitigating the resurgence of infectious diseases but also in effectively averting the emergence of novel infections such as COVID-19. During the 3 years of the COVID-19 pandemic, China primarily adopted nonpharmaceutical interventions, advocating for people to avoid crowded places and wear masks to prevent the spread of COVID-19. Consequently, there has been a dearth of research concerning IDSHL and its corresponding focal points for health education. Objective: This study aimed to (1) evaluate the changes in IDSHL scores between 2019 (before the COVID-19 pandemic) and 2022 (the postepidemic period of COVID-19) and (2) explore the risk factors affecting IDSHL using a multivariate logistic regression analysis. Methods: This study used 2-round cross-sectional surveys, conducted in 2019 and 2022, respectively, in 30 counties in Zhejiang Province, China. Multiple-stage stratified random sampling was used to select households, and a Kish grid was used to identify participants. An identical standardized questionnaire consisting of 12 closed-ended questions was used to measure IDSHL scores before and after the COVID-19 pandemic (2019 and 2022). Standard descriptive statistics, chi-square tests, t tests, and multivariate logistic regression analyses were used to analyze the data. Results: The 2-round cross-sectional surveys conducted in 2019 and 2022 yielded, out of 19,366 and 19,221 total questionnaires, 19,257 (99.44\% response rate) and 18,857 (98.11\% response rate) valid questionnaires, respectively. The correct response rate for the respiratory infectious diseases question ``When coughing or sneezing, which of the following is correct?'' increased from 29.10\% in 2019 to 37.92\% in 2022 ($\chi${\texttwosuperior}1=332.625; P<.001). The correct response rate for the nonrespiratory infectious diseases question ``In which of the following ways can hepatitis B be transmitted to others?'' decreased from 64.28\% to 59.67\% ($\chi${\texttwosuperior}1=86.059; P<.001). In terms of IDSHL scores, a comparison between 2022 and 2019 revealed notable statistical differences in the overall scores (t1=10.829; P<.001) and across the 3 dimensions of knowledge (t1=8.840; P<.001), behavior (t1=16.170; P<.001), and skills (t1=9.115; P<.001). With regard to the questions, all but 4 exhibited statistical differences (P<.001). Multivariate logistic regression analyses indicated that the 2022 year group had a higher likelihood of possessing acquired IDSHL than the 2019 group (odds ratio 1.323, 95\% CI 1.264?1.385; P<.001). Conclusions: When conducting health education, it is imperative to enhance efforts in nonrespiratory infectious disease health education, as well as respiratory infectious diseases such as COVID-19. Health education interventions should prioritize ethnic minority populations with a poor self-health status and low education. ", doi="10.2196/52666", url="https://publichealth.jmir.org/2024/1/e52666" } @Article{info:doi/10.2196/52089, author="Liu, Bowen and Zhang, Tao and Wang, Duoquan and Xia, Shang and Li, Weidong and Zhang, Xiaoxi and Wang, Shuxun and Guo, Xiao-Kui and Zhou, Xiao-Nong and Li, Shizhu", title="Profile and Determinants for Complications of Imported Malaria in 5 Chinese Provinces From 2014 to 2021: Retrospective Analysis", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="30", volume="10", pages="e52089", keywords="imported malaria", keywords="epidemiological characteristics", keywords="complications", keywords="influencing factors", keywords="China", abstract="Background: In 2021, the World Health Organization officially declared the People's Republic of China as malaria-free. However, despite this milestone achievement, the continued occurrence of severe and fatal cases of imported malaria in China, due to globalization and increased international communication, remains a significant public health concern. Objective: The aim of this study was to elucidate the epidemiological characteristics of imported malaria in 5 Chinese provinces from 2014 to 2021 and to identify the factors that influence complications in imported malaria cases. The findings will provide a basis for enhancing prevention and control measures, thereby consolidating China's achievements in malaria elimination. Methods: A case-based retrospective study was performed, using surveillance data collected from the representative provinces of China from 2014 to 2021. Epidemiological characteristics were analyzed using descriptive statistics. Logistic regression was used to identify the factors influencing the occurrence of complications. Results: A total of 5559 malaria cases were included during the study period. The predominant species was Plasmodium falciparum (3940/5559, 70.9\%), followed by Plasmodium ovale (1054/5559, 19\%), Plasmodium vivax (407/5559, 7.3\%), Plasmodium malariae (157/5559, 2.8\%), and 1 case of Plasmodium knowlesi. Most of the cases were male (5343/5559, 96.1\%). The complication rates for P falciparum and P ovale were 11.4\% and 3.3\%, respectively. Multivariate logistic regression analysis of the relevant factors of malaria complications revealed potential protective factors, including a previous infection by Plasmodium (P<.001; odds ratio [OR] 0.512, 95\% CI 0.422?0.621), and risk factors, including increased age (P=.004; OR 1.014, 95\% CI 1.004?1.024), misdiagnosis at the first clinical visit (P<.001; OR 3.553, 95\% CI 2.886?4.375), and the time interval from onset to treatment (P=.001; OR 1.026, 95\% CI 1.011?1.042). Subgroup analyses identified risk factors associated with P falciparum, which include advanced age (P=.004; OR 1.015, 95\% CI 1.005?1.026), initial misdiagnosis during the first clinical visit (P<.001; OR 3.549, 95\% CI 2.827?4.455), the time interval from onset to treatment (P<.001; OR 1.043, 95\% CI 1.022?1.063), and a delay of more than 3 days from the first treatment to diagnosis (P<.001; OR 2.403, 95\% CI 1.823?3.164). Additionally, the risk factors pertaining to P ovale involve misdiagnosis at the initial clinical visit (P=.01; OR 2.901, 95\% CI 1.336?6.298), the time interval from onset to treatment (P=.002; OR 1.095, 95\% CI 1.033?1.160), and the duration from the initial treatment to diagnosis (P=.43; OR 1.032, 95\% CI 0.953?1.118). Previous infections can prevent the progression of both P falciparum and P ovale. Conclusions: This study showed that the increasing proportion of P ovale in recent years should not be ignored. Furthermore, there is a need to improve diagnostic awareness, enhance the capacity of medical institutions, and provide health education for high-risk groups. ", doi="10.2196/52089", url="https://publichealth.jmir.org/2024/1/e52089" } @Article{info:doi/10.2196/52759, author="Baillet, Ma{\"e}lle and Wathelet, Marielle and Lamer, Antoine and Fr{\'e}vent, Camille and Fovet, Thomas and D'Hondt, Fabien and Notredame, Charles-Edouard and Vaiva, Guillaume and G{\'e}nin, Michael", title="Association Between COVID-19 and Self-Harm: Nationwide Retrospective Ecological Spatiotemporal Study in Metropolitan France", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="27", volume="10", pages="e52759", keywords="self-harm", keywords="COVID-19", keywords="spatiotemporal analysis", keywords="ecological regression", keywords="data reuse", abstract="Background: The COVID-19 pandemic has not been associated with increases in suicidal behavior at the national, regional, or county level. However, previous studies were not conducted on a finer scale or adjusted for ecological factors. Objective: Our objective was to assess the fine-scale spatiotemporal association between self-harm and COVID-19 hospitalizations, while considering ecological factors. Methods: Using the French national hospital discharge database, we extracted data on hospitalizations for self-harm of patients older than 10 years (from 2019 to 2021) or for COVID-19 (from 2020 to 2021) in metropolitan France. We first calculated monthly standardized incidence ratios (SIRs) for COVID-19 between March 2020 and December 2021, using a Besag, York, and Molli{\'e} spatiotemporal model. Next, we entered the SIRs into an ecological regression in order to test the association between hospital admissions for self-harm and those for COVID-19. Lastly, we adjusted for ecological variables with time lags of 0 to 6 months. Results: Compared with a smoothed SIR of ?1, smoothed SIRs from 1 to 3, from 3 to 4, and greater than 4 for COVID-19 hospital admissions were associated with a subsequent increase in hospital admissions for self-harm, with a time lag of 2 to 4 months, 4 months, and 6 months, respectively. Conclusions: A high SIR for hospital admissions for COVID-19 was a risk factor for hospital admission for self-harm some months after the epidemic peaks. This finding emphasizes the importance of monitoring and seeking to prevent suicide attempts outside the epidemic peak periods. ", doi="10.2196/52759", url="https://publichealth.jmir.org/2024/1/e52759" } @Article{info:doi/10.2196/57885, author="Rao, K. Varun and Valdez, Danny and Muralidharan, Rasika and Agley, Jon and Eddens, S. Kate and Dendukuri, Aravind and Panth, Vandana and Parker, A. Maria", title="Digital Epidemiology of Prescription Drug References on X (Formerly Twitter): Neural Network Topic Modeling and Sentiment Analysis", journal="J Med Internet Res", year="2024", month="Aug", day="23", volume="26", pages="e57885", keywords="digital epidemiology", keywords="BERTtopic", keywords="Valence Aware Dictionary and Sentiment Reasoner", keywords="VADER", keywords="sentiment analysis", keywords="social media", keywords="prescription drugs", keywords="prescription", keywords="prescriptions", keywords="drug", keywords="drugs", keywords="drug use", keywords="platform X", keywords="Twitter", keywords="tweet", keywords="tweets", keywords="latent Dirichlet allocation", keywords="machine-driven", keywords="natural language processing", keywords="NLP", keywords="brand name", keywords="logistic regression", keywords="machine learning", keywords="health informatics", abstract="Background: Data from the social media platform X (formerly Twitter) can provide insights into the types of language that are used when discussing drug use. In past research using latent Dirichlet allocation (LDA), we found that tweets containing ``street names'' of prescription drugs were difficult to classify due to the similarity to other colloquialisms and lack of clarity over how the terms were used. Conversely, ``brand name'' references were more amenable to machine-driven categorization. Objective: This study sought to use next-generation techniques (beyond LDA) from natural language processing to reprocess X data and automatically cluster groups of tweets into topics to differentiate between street- and brand-name data sets. We also aimed to analyze the differences in emotional valence between the 2 data sets to study the relationship between engagement on social media and sentiment. Methods: We used the Twitter application programming interface to collect tweets that contained the street and brand name of a prescription drug within the tweet. Using BERTopic in combination with Uniform Manifold Approximation and Projection and k-means, we generated topics for the street-name corpus (n=170,618) and brand-name corpus (n=245,145). Valence Aware Dictionary and Sentiment Reasoner (VADER) scores were used to classify whether tweets within the topics had positive, negative, or neutral sentiments. Two different logistic regression classifiers were used to predict the sentiment label within each corpus. The first model used a tweet's engagement metrics and topic ID to predict the label, while the second model used those features in addition to the top 5000 tweets with the largest term-frequency--inverse document frequency score. Results: Using BERTopic, we identified 40 topics for the street-name data set and 5 topics for the brand-name data set, which we generalized into 8 and 5 topics of discussion, respectively. Four of the general themes of discussion in the brand-name corpus referenced drug use, while 2 themes of discussion in the street-name corpus referenced drug use. From the VADER scores, we found that both corpora were inclined toward positive sentiment. Adding the vectorized tweet text increased the accuracy of our models by around 40\% compared with the models that did not incorporate the tweet text in both corpora. Conclusions: BERTopic was able to classify tweets well. As with LDA, the discussion using brand names was more similar between tweets than the discussion using street names. VADER scores could only be logically applied to the brand-name corpus because of the high prevalence of non--drug-related topics in the street-name data. Brand-name tweets either discussed drugs positively or negatively, with few posts having a neutral emotionality. From our machine learning models, engagement alone was not enough to predict the sentiment label; the added context from the tweets was needed to understand the emotionality of a tweet. ", doi="10.2196/57885", url="https://www.jmir.org/2024/1/e57885", url="http://www.ncbi.nlm.nih.gov/pubmed/39178036" } @Article{info:doi/10.2196/43173, author="Alsallakh, Mohammad and Adeloye, Davies and Vasileiou, Eleftheria and Sivakumaran, Shanya and Akbari, Ashley and Lyons, A. Ronan and Robertson, Chris and Rudan, Igor and Davies, A. Gwyneth and Sheikh, Aziz", title="Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="21", volume="10", pages="e43173", keywords="influenza", keywords="hospitalization", keywords="mortality", keywords="COVID-19 pandemic", keywords="nonpharmaceutical interventions", keywords="Wales", keywords="COVID-19", keywords="community health", keywords="hospital admission", keywords="endemic virus", keywords="public health surveillance", abstract="Background: The COVID-19 pandemic and the ensuing implementation of control measures caused widespread societal disruption. These disruptions may also have affected community transmission and seasonal circulation patterns of endemic respiratory viruses. Objective: We aimed to investigate the impact of COVID-19--related disruption on influenza-related emergency hospital admissions and deaths in Wales in the first 2 years of the pandemic. Methods: A descriptive analysis of influenza activity was conducted using anonymized pathology, hospitalization, and mortality data from the Secure Anonymised Information Linkage Databank in Wales. The annual incidence of emergency hospitalizations and deaths with influenza-specific diagnosis codes between January 1, 2015, and December 31, 2021, was estimated. Case definitions of emergency hospitalization and death required laboratory confirmation with a polymerase chain reaction test. Trends of admissions and deaths were analyzed monthly and yearly. We conducted 2 sensitivity analyses by extending case definitions to include acute respiratory illnesses with a positive influenza test and by limiting admissions to those with influenza as the primary diagnosis. We also examined yearly influenza testing trends to understand changes in testing behavior during the pandemic. Results: We studied a population of 3,235,883 Welsh residents in 2020 with a median age of 42.5 (IQR 22.9--61.0) years. Influenza testing in Wales increased notably in the last 2 months of 2020, and particularly in 2021 to 39,720 per 100,000 people, compared to the prepandemic levels (1343 in 2019). The percentage of influenza admissions matched to an influenza polymerase chain reaction test increased from 74.8\% (1890/2526) in 2019 to 85.2\% (98/115) in 2021. However, admissions with a positive test per 100,000 population decreased from 17.0 in 2019 to 2.7 and 0.6 in 2020 and 2021, respectively. Similarly, deaths due to influenza with a positive influenza test per 100,000 population decreased from 0.4 in 2019 to 0.0 in 2020 and 2021. Sensitivity analyses showed similar patterns of decreasing influenza admissions and deaths in the first 2 years of the COVID-19 pandemic. Conclusions: Nonpharmaceutical interventions to control COVID-19 were associated with a substantial reduction in the transmission of the influenza virus, with associated substantial reductions in hospital cases and deaths observed. Beyond the pandemic context, consideration should be given to the role of nonpharmaceutical community-driven interventions to reduce the burden of influenza. ", doi="10.2196/43173", url="https://publichealth.jmir.org/2024/1/e43173" } @Article{info:doi/10.2196/56931, author="Kisa, Sezer and Kisa, Adnan", title="A Comprehensive Analysis of COVID-19 Misinformation, Public Health Impacts, and Communication Strategies: Scoping Review", journal="J Med Internet Res", year="2024", month="Aug", day="21", volume="26", pages="e56931", keywords="communication strategies", keywords="COVID-19", keywords="infodemic", keywords="misinformation", keywords="public health", abstract="Background: The COVID-19 pandemic was marked by an infodemic, characterized by the rapid spread of both accurate and false information, which significantly affected public health. This infodemic led to confusion, mistrust in health authorities, noncompliance with health guidelines, and engagement in risky health behaviors. Understanding the dynamics of misinformation during the pandemic is crucial for developing effective public health communication strategies. Objective: This comprehensive analysis aimed to examine the complexities of COVID-19 misinformation. Specifically, it sought to identify the sources and themes of misinformation, the target audiences most affected, and the effectiveness of various public health communication strategies in mitigating misinformation. Methods: This scoping review used the MEDLINE (PubMed), Embase, and Scopus databases to identify relevant studies. An established, methodical framework for scoping reviews was used to review literature published between December 2019 and September 2023. The inclusion criteria focused on peer-reviewed studies published in English that address COVID-19 misinformation and its sources, themes, and target audiences, as well as the effectiveness of public health communication strategies. Results: The scoping review identified that misinformation significantly impacted mental health, vaccine hesitancy, and health care decision-making. Social media and traditional media were major conduits for spreading misinformation. Key misinformation themes included the origins of the virus, ineffective treatments, and misunderstandings about public health measures. Misinformation sources ranged from social media platforms to traditional media outlets and informal networks. The impact of misinformation was found to vary across different regions and demographic groups, with vulnerable populations being disproportionately affected. Effective strategies to counter misinformation included enhancing health literacy; using digital technology; promoting clear, authoritative communication; and implementing fact-checking mechanisms. In addition, community engagement and targeted health campaigns played a crucial role in addressing misinformation. Conclusions: The review emphasizes the critical need for accurate and consistent messaging to combat misinformation. Cooperative efforts among policy makers, health professionals, and communication experts are essential for developing effective interventions. Addressing the infodemic is vital for building a well-informed, health-literate society capable of handling misinformation in future global health crises. The study provides valuable insights into the dynamics of misinformation and highlights the importance of robust public health communication strategies. These findings can guide future efforts to mitigate the impact of misinformation during health emergencies. ", doi="10.2196/56931", url="https://www.jmir.org/2024/1/e56931" } @Article{info:doi/10.2196/57742, author="Ohsawa, Yukio and Sun, Yi and Sekiguchi, Kaira and Kondo, Sae and Maekawa, Tomohide and Takita, Morihito and Tanimoto, Tetsuya and Kami, Masahiro", title="Risk Index of Regional Infection Expansion of COVID-19: Moving Direction Entropy Study Using Mobility Data and Its Application to Tokyo", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="21", volume="10", pages="e57742", keywords="suppressing the spread of infection", keywords="index for risk assessment", keywords="local regions", keywords="diversity of mobility", keywords="mobility data", keywords="moving direction entropy", keywords="MDE", keywords="social network model", keywords="COVID-19", keywords="influenza", keywords="sexually transmitted diseases", abstract="Background: Policies, such as stay home, bubbling, and stay with your community, recommending that individuals reduce contact with diverse communities, including families and schools, have been introduced to mitigate the spread of the COVID-19 pandemic. However, these policies are violated if individuals from various communities gather, which is a latent risk in a real society where people move among various unreported communities. Objective: We aimed to create a physical index to assess the possibility of contact between individuals from diverse communities, which serves as an indicator of the potential risk of SARS-CoV-2 spread when considered and combined with existing indices. Methods: Moving direction entropy (MDE), which quantifies the diversity of moving directions of individuals in each local region, is proposed as an index to evaluate a region's risk of contact of individuals from diverse communities. MDE was computed for each inland municipality in Tokyo using mobility data collected from smartphones before and during the COVID-19 pandemic. To validate the hypothesis that the impact of intercommunity contact on infection expansion becomes larger for a virus with larger infectivity, we compared the correlations of the expansion of infectious diseases with indices, including MDE and the densities of supermarkets, restaurants, etc. In addition, we analyzed the temporal changes in MDE in municipalities. Results: This study had 4 important findings. First, the MDE values for local regions showed significant invariance between different periods according to the Spearman rank correlation coefficient (>0.9). Second, MDE was found to correlate with the rate of infection cases of COVID-19 among local populations in 53 inland regions (average of 0.76 during the period of expansion). The density of restaurants had a similar correlation with COVID-19. The correlation between MDE and the rate of infection was smaller for influenza than for COVID-19, and tended to be even smaller for sexually transmitted diseases (order of infectivity). These findings support the hypothesis. Third, the spread of COVID-19 was accelerated in regions with high-rank MDE values compared to those with high-rank restaurant densities during and after the period of the governmental declaration of emergency (P<.001). Fourth, the MDE values tended to be high and increased during the pandemic period in regions where influx or daytime movement was present. A possible explanation for the third and fourth findings is that policymakers and living people have been overlooking MDE. Conclusions: We recommend monitoring the regional values of MDE to reduce the risk of infection spread. To aid in this monitoring, we present a method to create a heatmap of MDE values, thereby drawing public attention to behaviors that facilitate contact between communities during a highly infectious disease pandemic. ", doi="10.2196/57742", url="https://publichealth.jmir.org/2024/1/e57742", url="http://www.ncbi.nlm.nih.gov/pubmed/39037745" } @Article{info:doi/10.2196/55183, author="Chang, Min-Chien and Wen, Tzai-Hung", title="The Mediating Role of Human Mobility in Temporal-Lagged Relationships Between Risk Perception and COVID-19 Dynamics in Taiwan: Statistical Modeling for Comparing the Pre-Omicron and Omicron Eras", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="20", volume="10", pages="e55183", keywords="human mobility", keywords="risk perception", keywords="COVID-19", keywords="Omicron", keywords="Taiwan", keywords="pandemic", keywords="disease transmission", keywords="pandemic dynamics", keywords="global threats", keywords="infectious disease", keywords="behavioural health", keywords="public health", keywords="surveillance", abstract="Background: The COVID-19 pandemic has profoundly impacted all aspects of human life for over 3 years. Understanding the evolution of public risk perception during these periods is crucial. Few studies explore the mechanisms for reducing disease transmission due to risk perception. Thus, we hypothesize that changes in human mobility play a mediating role between risk perception and the progression of the pandemic. Objective: The study aims to explore how various forms of human mobility, including essential, nonessential, and job-related behaviors, mediate the temporal relationships between risk perception and pandemic dynamics. Methods: We used distributed-lag linear structural equation models to compare the mediating impact of human mobility across different virus variant periods. These models examined the temporal dynamics and time-lagged effects among risk perception, changes in mobility, and virus transmission in Taiwan, focusing on two distinct periods: (1) April-August 2021 (pre-Omicron era) and (2) February-September 2022 (Omicron era). Results: In the pre-Omicron era, our findings showed that an increase in public risk perception correlated with significant reductions in COVID-19 cases across various types of mobility within specific time frames. Specifically, we observed a decrease of 5.59 (95\% CI ?4.35 to ?6.83) COVID-19 cases per million individuals after 7 weeks in nonessential mobility, while essential mobility demonstrated a reduction of 10.73 (95\% CI ?9.6030 to ?11.8615) cases after 8 weeks. Additionally, job-related mobility resulted in a decrease of 3.96 (95\% CI ?3.5039 to ?4.4254) cases after 11 weeks. However, during the Omicron era, these effects notably diminished. A reduction of 0.85 (95\% CI ?1.0046 to ?0.6953) cases through nonessential mobility after 10 weeks and a decrease of 0.69 (95\% CI ?0.7827 to ?0.6054) cases through essential mobility after 12 weeks were observed. Conclusions: This study confirms that changes in mobility serve as a mediating factor between heightened risk perception and pandemic mitigation in both pre-Omicron and Omicron periods. This suggests that elevating risk perception is notably effective in impeding virus progression, especially when vaccines are unavailable or their coverage remains limited. Our findings provide significant value for health authorities in devising policies to address the global threats posed by emerging infectious diseases. ", doi="10.2196/55183", url="https://publichealth.jmir.org/2024/1/e55183" } @Article{info:doi/10.2196/48825, author="Riggins, P. Daniel and Zhang, Huiyuan and Trick, E. William", title="Using Social Vulnerability Indices to Predict Priority Areas for Prevention of Sudden Unexpected Infant Death in Cook County, IL: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="20", volume="10", pages="e48825", keywords="infant", keywords="socioeconomic disparities in health", keywords="sudden unexpected infant death", keywords="SUID", keywords="sudden infant death", keywords="SID", keywords="geographic information systems", keywords="structural racism", keywords="predict", keywords="social vulnerability", keywords="racial disparity", keywords="socioeconomic", keywords="disparity", keywords="child", keywords="infancy", keywords="pediatric", keywords="sudden infant death syndrome", keywords="SIDS", abstract="Background: The incidence of sudden unexpected infant death (SUID) in the United States has persisted at roughly the same level since the mid-2000s, despite intensive prevention efforts around safe sleep. Disparities in outcomes across racial and socioeconomic lines also persist. These disparities are reflected in the spatial distribution of cases across neighborhoods. Strategies for prevention should be targeted precisely in space and time to further reduce SUID and correct disparities. Objective: We sought to aid neighborhood-level prevention efforts by characterizing communities where SUID occurred in Cook County, IL, from 2015 to 2019 and predicting where it would occur in 2021?2025 using a semiautomated, reproducible workflow based on open-source software and data. Methods: This cross-sectional retrospective study queried geocoded medical examiner data from 2015?2019 to identify SUID cases in Cook County, IL, and aggregated them to ``communities'' as the unit of analysis. We compared demographic factors in communities affected by SUID versus those unaffected using Wilcoxon rank sum statistical testing. We used social vulnerability indicators from 2014 to train a negative binomial prediction model for SUID case counts in each given community for 2015?2019. We applied indicators from 2020 to the trained model to make predictions for 2021?2025. Results: Validation of our query of medical examiner data produced 325 finalized cases with a sensitivity of 95\% (95\% CI 93\%?97\%) and a specificity of 98\% (95\% CI 94\%?100\%). Case counts at the community level ranged from a minimum of 0 to a maximum of 17. A map of SUID case counts showed clusters of communities in the south and west regions of the county. All communities with the highest case counts were located within Chicago city limits. Communities affected by SUID exhibited lower median proportions of non-Hispanic White residents at 17\% versus 60\% (P<.001) and higher median proportions of non-Hispanic Black residents at 32\% versus 3\% (P<.001). Our predictive model showed moderate accuracy when assessed on the training data (Nagelkerke R2=70.2\% and RMSE=17.49). It predicted Austin (17 cases), Englewood (14 cases), Auburn Gresham (12 cases), Chicago Lawn (12 cases), and South Shore (11 cases) would have the largest case counts between 2021 and 2025. Conclusions: Sharp racial and socioeconomic disparities in SUID incidence persisted within Cook County from 2015 to 2019. Our predictive model and maps identify precise regions within the county for local health departments to target for intervention. Other jurisdictions can adapt our coding workflows and data sources to predict which of their own communities will be most affected by SUID. ", doi="10.2196/48825", url="https://publichealth.jmir.org/2024/1/e48825" } @Article{info:doi/10.2196/57595, author="Erridge, Simon and Troup, Lucy and Sodergren, Hans Mikael", title="Illicit Cannabis Use to Self-Treat Chronic Health Conditions in the United Kingdom: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="14", volume="10", pages="e57595", keywords="cannabis", keywords="chronic pain", keywords="anxiety", keywords="multiple sclerosis", keywords="posttraumatic stress disorder", keywords="PTSD", keywords="fibromyalgia", keywords="misuse", keywords="cannabis misuse", keywords="cannabis use", keywords="self-treatment", keywords="chronic health condition", keywords="cross-sectional study", keywords="United Kingdom", keywords="illicit cannabis", keywords="adult", keywords="consumption", keywords="adults", keywords="survey", keywords="cannabis-based", keywords="medicinal products", keywords="cannabis-based medicinal products", abstract="Background: In 2019, it was estimated that approximately 1.4 million adults in the United Kingdom purchased illicit cannabis to self-treat chronic physical and mental health conditions. This analysis was conducted following the rescheduling of cannabis-based medicinal products (CBMPs) in the United Kingdom but before the first specialist clinics had started treating patients. Objective: The aim of this study was to assess the prevalence of illicit cannabis consumption to treat a medically diagnosed condition following the introduction of specialist clinics that could prescribe legal CBMPs in the United Kingdom. Methods: Adults older than 18 years in the United Kingdom were invited to participate in a cross-sectional survey through YouGov between September 22 and 29, 2022. A series of questions were asked about respondents' medical diagnoses, illicit cannabis use, the cost of purchasing illicit cannabis per month, and basic demographics. The responding sample was weighted to generate a sample representative of the adult population of the United Kingdom. Modeling of population size was conducted based on an adult (18 years or older) population of 53,369,083 according to 2021 national census data. Results: There were 10,965 respondents to the questionnaire, to which weighting was applied. A total of 5700 (51.98\%) respondents indicated that they were affected by a chronic health condition. The most reported condition was anxiety (n=1588, 14.48\%). Of those enduring health conditions, 364 (6.38\%) purchased illicit cannabis to self-treat health conditions. Based on survey responses, it was modeled that 1,770,627 (95\% CI 1,073,791?2,467,001) individuals consume illicit cannabis for health conditions across the United Kingdom. In the multivariable logistic regression, the following were associated with an increased likelihood of reporting illicit cannabis use for health reasons---chronic pain, fibromyalgia, posttraumatic stress disorder, multiple sclerosis, other mental health disorders, male sex, younger age, living in London, being unemployed or not working for other reasons, and working part-time (P<.05). Conclusions: This study highlights the scale of illicit cannabis use for health reasons in the United Kingdom and the potential barriers to accessing legally prescribed CBMPs. This is an important step in developing harm reduction policies to transition these individuals, where appropriate, to CBMPs. Such policies are particularly important considering the potential risks from harmful contaminants of illicit cannabis and self-treating a medical condition without clinical oversight. Moreover, it emphasizes the need for further funding of randomized controlled trials and the use of novel methodologies to determine the efficacy of CBMPs and their use in common chronic conditions. ", doi="10.2196/57595", url="https://publichealth.jmir.org/2024/1/e57595" } @Article{info:doi/10.2196/55822, author="Wang, Haitao and Geng, Mengjie and Schikowski, Tamara and Areal, Tracey Ashtyn and Hu, Kejia and Li, Wen and Coelho, Stagliorio Micheline de Sousa Zanotti and Saldiva, Nascimento Paulo Hil{\'a}rio and Sun, Wei and Zhou, Chengchao and Lu, Liang and Zhao, Qi and Ma, Wei", title="Increased Risk of Influenza Infection During Cold Spells in China: National Time Series Study", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="13", volume="10", pages="e55822", keywords="influenza", keywords="cold spell", keywords="definition", keywords="vulnerable population", keywords="modification effect", keywords="China", abstract="Background: Studies have reported the adverse effects of cold events on influenza. However, the role of critical factors, such as characteristics of cold spells, and regional variations remain unresolved. Objective: We aimed to systematically evaluate the association between cold spells and influenza incidence in mainland China. Methods: This time series analysis used surveillance data of daily influenza from 325 sites in China in the 2014?2019 period. A total of 15 definitions of cold spells were adopted based on combinations of temperature thresholds and days of duration. A distributed lag linear model was used to estimate the short-term effects of cold spells on influenza incidence during the cool seasons (November to March), and we further explored the potential impact of cold spell characteristics (ie, intensity, duration, and timing during the season) on the estimated associations. Meta-regressions were used to evaluate the modification effect of city-level socioeconomic indicators. Results: The overall effect of cold spells on influenza incidence increased with the temperature threshold used to define cold spells, whereas the added effects were generally small and not statistically significant. The relative risk of influenza-associated with cold spells was 3.35 (95\% CI 2.89?3.88), and the estimated effects were stronger during the middle period of cool seasons. The health effects of cold spells varied geographically and residents in Jiangnan region were vulnerable groups (relative risk 7.36, 95\% CI 5.44?9.95). The overall effects of cold spells were positively correlated with the urban population density, population size, gross domestic product per capita, and urbanization rate, indicating a sterner response to cold spells in metropolises. Conclusions: Cold spells create a substantial health burden on seasonal influenza in China. Findings on regional and socioeconomic differences in the health effects of cold spells on seasonal influenza may be useful in formulating region-specific public health policies to address the hazardous effects of cold spells. ", doi="10.2196/55822", url="https://publichealth.jmir.org/2024/1/e55822" } @Article{info:doi/10.2196/51325, author="Denis-Robichaud, Jos{\'e} and Rees, E. Erin and Daley, Patrick and Zarowsky, Christina and Diouf, Assane and Nasri, R. Bouchra and de Montigny, Simon and Carabin, H{\'e}l{\`e}ne", title="Linking Opinions Shared on Social Media About COVID-19 Public Health Measures to Adherence: Repeated Cross-Sectional Surveys of Twitter Use in Canada", journal="J Med Internet Res", year="2024", month="Aug", day="13", volume="26", pages="e51325", keywords="adherence to mask wearing", keywords="adherence to vaccination", keywords="social media", keywords="sociodemographic characteristics", keywords="Twitter", keywords="COVID-19", keywords="survey data", abstract="Background: The effectiveness of public health measures (PHMs) depends on population adherence. Social media were suggested as a tool to assess adherence, but representativeness and accuracy issues have been raised. Objective: The objectives of this repeated cross-sectional study were to compare self-reported PHM adherence and sociodemographic characteristics between people who used Twitter (subsequently rebranded X) and people who did not use Twitter. Methods: Repeated Canada-wide web-based surveys were conducted every 14 days from September 2020 to March 2022. Weighted proportions were calculated for descriptive variables. Using Bayesian logistic regression models, we investigated associations between Twitter use, as well as opinions in tweets, and self-reported adherence with mask wearing and vaccination. Results: Data from 40,230 respondents were analyzed. As self-reported, Twitter was used by 20.6\% (95\% CI 20.1\%-21.2\%) of Canadians, of whom 29.9\% (95\% CI 28.6\%-31.3\%) tweeted about COVID-19. The sociodemographic characteristics differed across categories of Twitter use and opinions. Overall, 11\% (95\% CI 10.6\%-11.3\%) of Canadians reported poor adherence to mask-wearing, and 10.8\% (95\% CI 10.4\%-11.2\%) to vaccination. Twitter users who tweeted about COVID-19 reported poorer adherence to mask wearing than nonusers, which was modified by the age of the respondents and their geographical region (odds ratio [OR] 0.79, 95\% Bayesian credibility interval [BCI] 0.18-1.69 to OR 4.83, 95\% BCI 3.13-6.86). The odds of poor adherence to vaccination of Twitter users who tweeted about COVID-19 were greater than those of nonusers (OR 1.76, 95\% BCI 1.48-2.07). English- and French-speaking Twitter users who tweeted critically of PHMs were more likely (OR 4.07, 95\% BCI 3.38-4.80 and OR 7.31, 95\% BCI 4.26-11.03, respectively) to report poor adherence to mask wearing than non--Twitter users, and those who tweeted in support were less likely (OR 0.47, 95\% BCI 0.31-0.64 and OR 0.96, 95\% BCI 0.18-2.33, respectively) to report poor adherence to mask wearing than non--Twitter users. The OR of poor adherence to vaccination for those tweeting critically about PHMs and for those tweeting in support of PHMs were 4.10 (95\% BCI 3.40-4.85) and 0.20 (95\% BCI 0.10-0.32), respectively, compared to non--Twitter users. Conclusions: Opinions shared on Twitter can be useful to public health authorities, as they are associated with adherence to PHMs. However, the sociodemographics of social media users do not represent the general population, calling for caution when using tweets to assess general population-level behaviors. ", doi="10.2196/51325", url="https://www.jmir.org/2024/1/e51325", url="http://www.ncbi.nlm.nih.gov/pubmed/39137009" } @Article{info:doi/10.2196/50244, author="Guo, Tonglei and Shen, Fei and Xin, Henan and Du, Jiang and Cao, Xuefang and Feng, Boxuan and He, Yijun and Shen, Lingyu and Di, Yuanzhi and Chen, Yanxiao and Li, Zihan and Jin, Qi and Li, Hongzhi and Zhang, Chunming and Gao, Lei", title="Association of Fine Particulate Matter and Residential Greenness With Risk of Pulmonary Tuberculosis Retreatment: Population-Based Retrospective Study", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="12", volume="10", pages="e50244", keywords="tuberculosis", keywords="PM2.5", keywords="particulate matter", keywords="air pollution", keywords="greenness", keywords="retrospective study", keywords="pulmonary", keywords="retreatment", abstract="Background: The evidence on the association of fine particulate matter with an aerodynamic diameter of 2.5 $\mu$m or less (PM2.5) with pulmonary tuberculosis (PTB) retreatment is limited. There are no data on whether greenness exposure protects air pollution--related PTB retreatment in patients with prior PTB. Objective: In a population-based retrospective study, we aimed to investigate the influence of PM2.5 and residential greenness on the risk of PTB retreatment. Methods: A total of 26,482 patients with incident PTB, registered in a mandatory web-based reporting system between 2012 and 2019 in Zhengzhou, China, were included in the analysis. The exposure to PM2.5 was assessed based on the China High Air Pollutants dataset, and the level of greenness was estimated using the Normalized Difference Vegetation Index (NDVI) values. The associations of PTB retreatment with exposure to PM2.5 and greenness were evaluated, respectively, considering the local socioeconomic level indicated by the nighttime light index. Results: Among the 26,482 patients (mean age 46.86, SD 19.52 years) with a median follow-up time of 1523 days per patient, 1542 (5.82\%) PTB retreatments were observed between 2012 and 2019. Exposure to PM2.5 was observed to be significantly associated with the increased risk of PTB retreatment in fully adjusted models with a hazard ratio of 1.97 (95\% CI 1.34?2.83) per 10 $\mu$g/m3 increase in PM2.5. Patients living in the regions with relatively high quartiles of NDVI values had a 45\% lower risk of PTB retreatment than those living in the regions with the lowest quartile for the 500 m buffers (hazard ratio 0.55, 95\% CI 0.40?0.77). Such a protective effect of residential greenness was more pronounced among patients living in lower nighttime light areas. The strength of the association between PM2.5 exposure and the risk of PTB retreatment was attenuated by greenness. No significant association was observed between NDVI and the incidence of drug resistance. Conclusions: Long-term exposure to PM2.5 might be a risk factor for PTB retreatment, while an increased level of residential greenness was found to be associated with reduced risks of PTB retreatment. Our results suggest strengthening the control of ambient air pollution and improving residential greenness may contribute to the reduction of PTB retreatment. ", doi="10.2196/50244", url="https://publichealth.jmir.org/2024/1/e50244" } @Article{info:doi/10.2196/54967, author="Gan, Ting and Liu, Yunning and Bambrick, Hilary and Zhou, Maigeng and Hu, Wenbiao", title="Liver Cancer Mortality Disparities at a Fine Scale Among Subpopulations in China: Nationwide Analysis of Spatial and Temporal Trends", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="8", volume="10", pages="e54967", keywords="liver cancer", keywords="mortality", keywords="year of life lost", keywords="spatial distribution", keywords="temporal trend", abstract="Background: China has the highest number of liver cancers worldwide, and liver cancer is at the forefront of all cancers in China. However, current research on liver cancer in China primarily relies on extrapolated data or relatively lagging data, with limited focus on subregions and specific population groups. Objective: The purpose of this study is to identify geographic disparities in liver cancer by exploring the spatial and temporal trends of liver cancer mortality and the years of life lost (YLL) caused by it within distinct geographical regions, climate zones, and population groups in China. Methods: Data from the National Death Surveillance System between 2013 and 2020 were used to calculate the age-standardized mortality rate of liver cancer (LASMR) and YLL from liver cancer in China. The spatial distribution and temporal trends of liver cancer were analyzed in subgroups by sex, age, region, and climate classification. Estimated annual percentage change was used to describe liver cancer trends in various regions, and partial correlation was applied to explore associations between LASMR and latitude. Results: In China, the average LASMR decreased from 28.79 in 2013 to 26.38 per 100,000 in 2020 among men and 11.09 to 9.83 per 100,000 among women. This decline in mortality was consistent across all age groups. Geographically, Guangxi had the highest LASMR for men in China, with a rate of 50.15 per 100,000, while for women, it was Heilongjiang, with a rate of 16.64 per 100,000. Within these regions, the LASMR among men in most parts of Guangxi ranged from 32.32 to 74.98 per 100,000, whereas the LASMR among women in the majority of Heilongjiang ranged from 13.72 to 21.86 per 100,000. The trend of LASMR varied among regions. For both men and women, Guizhou showed an increasing trend in LASMR from 2013 to 2020, with estimated annual percentage changes ranging from 10.05\% to 29.07\% and from 10.09\% to 21.71\%, respectively. Both men and women observed an increase in LASMR with increasing latitude below the 40th parallel. However, overall, LASMR in men was positively correlated with latitude (R=0.225; P<.001), while in women, it showed a negative correlation (R=0.083; P=.04). High LASMR areas among men aligned with subtropical zones, like Cwa and Cfa. The age group 65 years and older, the southern region, and the Cwa climate zone had the highest YLL rates at 4850.50, 495.50, and 440.17 per 100,000, respectively. However, the overall trends in these groups showed a decline over the period. Conclusions: Despite the declining overall trend of liver cancer in China, there are still marked disparities between regions and populations. Future prevention and control should focus on high-risk regions and populations to further reduce the burden of liver cancer in China. ", doi="10.2196/54967", url="https://publichealth.jmir.org/2024/1/e54967" } @Article{info:doi/10.2196/53371, author="Howell, R. Carrie and Zhang, Li and Clay, J. Olivio and Dutton, Gareth and Horton, Trudi and Mugavero, J. Michael and Cherrington, L. Andrea", title="Social Determinants of Health Phenotypes and Cardiometabolic Condition Prevalence Among Patients in a Large Academic Health System: Latent Class Analysis", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="7", volume="10", pages="e53371", keywords="social determinants of health", keywords="electronic medical record", keywords="phenotypes", keywords="diabetes", keywords="obesity", keywords="cardiovascular disease", keywords="obese", keywords="social determinants", keywords="social determinant", keywords="cardiometabolic", keywords="risk factors", keywords="risk factor", keywords="latent class analysis", keywords="cardiometabolic disease", keywords="EMR", keywords="EHR", keywords="electronic health record", abstract="Background: Adverse social determinants of health (SDoH) have been associated with cardiometabolic disease; however, disparities in cardiometabolic outcomes are rarely the result of a single risk factor. Objective: This study aimed to identify and characterize SDoH phenotypes based on patient-reported and neighborhood-level data from the institutional electronic medical record and evaluate the prevalence of diabetes, obesity, and other cardiometabolic diseases by phenotype status. Methods: Patient-reported SDoH were collected (January to December 2020) and neighborhood-level social vulnerability, neighborhood socioeconomic status, and rurality were linked via census tract to geocoded patient addresses. Diabetes status was coded in the electronic medical record using International Classification of Diseases codes; obesity was defined using measured BMI ?30 kg/m2. Latent class analysis was used to identify clusters of SDoH (eg, phenotypes); we then examined differences in the prevalence of cardiometabolic conditions based on phenotype status using prevalence ratios (PRs). Results: Complete data were available for analysis for 2380 patients (mean age 53, SD 16 years; n=1405, 59\% female; n=1198, 50\% non-White). Roughly 8\% (n=179) reported housing insecurity, 30\% (n=710) reported resource needs (food, health care, or utilities), and 49\% (n=1158) lived in a high-vulnerability census tract. We identified 3 patient SDoH phenotypes: (1) high social risk, defined largely by self-reported SDoH (n=217, 9\%); (2) adverse neighborhood SDoH (n=1353, 56\%), defined largely by adverse neighborhood-level measures; and (3) low social risk (n=810, 34\%), defined as low individual- and neighborhood-level risks. Patients with an adverse neighborhood SDoH phenotype had higher prevalence of diagnosed type 2 diabetes (PR 1.19, 95\% CI 1.06?1.33), hypertension (PR 1.14, 95\% CI 1.02?1.27), peripheral vascular disease (PR 1.46, 95\% CI 1.09?1.97), and heart failure (PR 1.46, 95\% CI 1.20?1.79). Conclusions: Patients with the adverse neighborhood SDoH phenotype had higher prevalence of poor cardiometabolic conditions compared to phenotypes determined by individual-level characteristics, suggesting that neighborhood environment plays a role, even if individual measures of socioeconomic status are not suboptimal. ", doi="10.2196/53371", url="https://publichealth.jmir.org/2024/1/e53371" } @Article{info:doi/10.2196/53879, author="Xu, Ting and Ni, Haobo and Cai, Xiaoyan and Dai, Tingting and Wang, Lingxi and Xiao, Lina and Zeng, Qinghui and Yu, Xiaolin and Han, Lu and Guo, Pi", title="Association Between Particulate Matter Exposure and Preterm Birth in Women With Abnormal Preconception Thyrotropin Levels: Large Cohort Study", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="2", volume="10", pages="e53879", keywords="PM2.5", keywords="particulate matter with an aerodynamic diameter of ?2.5 $\mu$m", keywords="thyroid stimulating hormone", keywords="preterm birth", keywords="cohort study", keywords="preconception", abstract="Background: Prior research has linked exposure to particulate matter with an aerodynamic diameter of ?2.5 $\mu$m (PM2.5) with preterm birth (PTB). However, the modulating effect of preconception thyroid stimulating hormone (TSH) levels on the relationship between PM2.5 exposure and PTB has not been investigated. Objective: This study aimed to assess whether preconception TSH levels modulate the impact of PM2.5 exposure on PTB. Methods: This cohort study was conducted in Guangdong, China, as a part of the National Free Pre-Pregnancy Checkups Project. PM2.5 exposure was estimated by using the inverse distance weighting method. To investigate the moderating effects of TSH levels on trimester-specific PM2.5 exposure and PTB, we used the Cox proportional hazards model. Additionally, to identify the susceptible exposure windows for weekly specific PM2.5 exposure and PTB, we built distributed lag models incorporating Cox proportional hazards models. Results: A total of 633,516 women who delivered between January 1, 2014, to December 31, 2019, were included. In total, 34,081 (5.4\%) of them had abnormal preconception TSH levels. During the entire pregnancy, each 10-$\mu$g/m3 increase in PM2.5 was linked to elevated risks of PTB (hazard ratio [HR] 1.559, 95\% CI 1.390?1.748), early PTB (HR 1.559, 95\% CI 1.227?1.980), and late PTB (HR 1.571, 95\% CI 1.379?1.791) among women with abnormal TSH levels. For women with normal preconception TSH levels, PM2.5 exposure during the entire pregnancy was positively associated with the risk of PTB (HR 1.345, 95\% CI 1.307?1.385), early PTB (HR 1.203, 95\% CI 1.126?1.285), and late PTB (HR 1.386, 95\% CI 1.342?1432). The critical susceptible exposure windows were the 3rd-13th and 28th-35th gestational weeks for women with abnormal preconception TSH levels, compared to the 1st-13th and 21st-35th gestational weeks for those with normal preconception TSH levels. Conclusions: PM2.5 exposure was linked with a higher PTB risk, particularly in women with abnormal preconception TSH levels. PM2.5 exposure appears to have a greater effect on pregnant women who are in the early or late stages of pregnancy. ", doi="10.2196/53879", url="https://publichealth.jmir.org/2024/1/e53879" } @Article{info:doi/10.2196/58821, author="Liu, Jiaojiao and Wang, Hui and Zhong, Siyi and Zhang, Xiao and Wu, Qilin and Luo, Haipeng and Luo, Lei and Zhang, Zhoubin", title="Spatiotemporal Changes and Influencing Factors of Hand, Foot, and Mouth Disease in Guangzhou, China, From 2013 to 2022: Retrospective Analysis", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="2", volume="10", pages="e58821", keywords="hand, foot, and mouth disease", keywords="spatial analysis", keywords="space-time scan statistics", keywords="geographically and temporally weighted regression", keywords="infectious disease", abstract="Background: In the past 10 years, the number of hand, foot, and mouth disease (HFMD) cases reported in Guangzhou, China, has averaged about 60,000 per year. It is necessary to conduct an in-depth analysis to understand the epidemiological pattern and related influencing factors of HFMD in this region. Objective: This study aims to describe the epidemiological characteristics and spatiotemporal distribution of HFMD cases in Guangzhou from 2013 to 2022 and explore the relationship between sociodemographic factors and HFMD incidence. Methods: The data of HFMD cases in Guangzhou come from the Infectious Disease Information Management System of the Guangzhou Center for Disease Control and Prevention. Spatial analysis and space-time scan statistics were used to visualize the spatiotemporal distribution of HFMD cases. Multifactor ordinary minimum regression model, geographically weighted regression, and geographically and temporally weighted regression were used to analyze the influencing factors, including population, economy, education, and medical care. Results: From 2013 to 2022, a total of 599,353 HFMD cases were reported in Guangzhou, with an average annual incidence rate of 403.62/100,000. Children aged 5 years and younger accounted for 93.64\% (561,218/599,353) of all cases. HFMD cases showed obvious bimodal distribution characteristics, with the peak period from May to July and the secondary peak period from August to October. HFMDs in Guangzhou exhibited a spatial aggregation trend, with the central urban area showing a pattern of low-low aggregation and the peripheral urban area demonstrating high-high aggregation. High-risk areas showed a dynamic trend of shifting from the west to the east of peripheral urban areas, with coverage first increasing and then decreasing. The geographically and temporally weighted regression model results indicated that population density ($\beta$=?0.016) and average annual income of employees ($\beta$=?0.007) were protective factors for HFMD incidence, while the average number of students in each primary school ($\beta$=1.416) and kindergarten ($\beta$=0.412) was a risk factor. Conclusions: HFMD cases in Guangzhou were mainly infants and young children, and there were obvious differences in time and space. HFMD is highly prevalent in summer and autumn, and peripheral urban areas were identified as high-risk areas. Improving the economic level of peripheral urban areas and reducing the number of students in preschool education institutions are key strategies to controlling HFMD. ", doi="10.2196/58821", url="https://publichealth.jmir.org/2024/1/e58821" } @Article{info:doi/10.2196/46070, author="Tao, Mingyong and Liu, Ying and Ling, Feng and Ren, Jiangping and Zhang, Rong and Shi, Xuguang and Guo, Song and Jiang, Jianmin and Sun, Jimin", title="Factors Associated With the Spatial Distribution of Severe Fever With Thrombocytopenia Syndrome in Zhejiang Province, China: Risk Analysis Based on Maximum Entropy", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="2", volume="10", pages="e46070", keywords="severe fever with thrombocytopenia syndrome", keywords="MaxEnt", keywords="maximum entropy", keywords="tick density", keywords="spatial distribution", keywords="risk factor", keywords="China", abstract="Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was first identified in mainland China in 2009 and has been reported in Zhejiang Province, China, since 2011. However, few studies have focused on the association between ticks, host animals, and SFTS. Objective: In this study, we analyzed the influence of meteorological and environmental factors as well as the influence of ticks and host animals on SFTS. This can serve as a foundational basis for the development of strategic policies aimed at the prevention and control of SFTS. Methods: Data on SFTS incidence, tick density, cattle density, and meteorological and environmental factors were collected and analyzed using a maximum entropy--based model. Results: As of December 2019, 463 laboratory-confirmed SFTS cases were reported in Zhejiang Province. We found that the density of ticks, precipitation in the wettest month, average temperature, elevation, and the normalized difference vegetation index were significantly associated with SFTS spatial distribution. The niche model fitted accurately with good performance in predicting the potential risk areas of SFTS (the average test area under the receiver operating characteristic curve for the replicate runs was 0.803 and the SD was 0.013). The risk of SFTS occurrence increased with an increase in tick density, and the response curve indicated that the risk was greater than 0.5 when tick density exceeded 1.4. The risk of SFTS occurrence decreased with increased precipitation in the wettest month, and the risk was less than 0.5 when precipitation exceeded 224.4 mm. The relationship between elevation and SFTS occurrence showed a reverse V shape, and the risk peaked at approximately 400 m. Conclusions: Tick density, precipitation, and elevation were dominant influencing factors for SFTS, and comprehensive intervention measures should be adjusted according to these factors to reduce SFTS incidence in Zhejiang Province. ", doi="10.2196/46070", url="https://publichealth.jmir.org/2024/1/e46070" } @Article{info:doi/10.2196/56237, author="Amadi, David and Kiwuwa-Muyingo, Sylvia and Bhattacharjee, Tathagata and Taylor, Amelia and Kiragga, Agnes and Ochola, Michael and Kanjala, Chifundo and Gregory, Arofan and Tomlin, Keith and Todd, Jim and Greenfield, Jay", title="Making Metadata Machine-Readable as the First Step to Providing Findable, Accessible, Interoperable, and Reusable Population Health Data: Framework Development and Implementation Study", journal="Online J Public Health Inform", year="2024", month="Aug", day="1", volume="16", pages="e56237", keywords="FAIR data principles", keywords="metadata", keywords="machine-readable metadata", keywords="DDI", keywords="Data Documentation Initiative", keywords="standardization", keywords="JSON-LD", keywords="JavaScript Object Notation for Linked Data", keywords="OMOP CDM", keywords="Observational Medical Outcomes Partnership Common Data Model", keywords="data science", keywords="data models", abstract="Background: Metadata describe and provide context for other data, playing a pivotal role in enabling findability, accessibility, interoperability, and reusability (FAIR) data principles. By providing comprehensive and machine-readable descriptions of digital resources, metadata empower both machines and human users to seamlessly discover, access, integrate, and reuse data or content across diverse platforms and applications. However, the limited accessibility and machine-interpretability of existing metadata for population health data hinder effective data discovery and reuse. Objective: To address these challenges, we propose a comprehensive framework using standardized formats, vocabularies, and protocols to render population health data machine-readable, significantly enhancing their FAIRness and enabling seamless discovery, access, and integration across diverse platforms and research applications. Methods: The framework implements a 3-stage approach. The first stage is Data Documentation Initiative (DDI) integration, which involves leveraging the DDI Codebook metadata and documentation of detailed information for data and associated assets, while ensuring transparency and comprehensiveness. The second stage is Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) standardization. In this stage, the data are harmonized and standardized into the OMOP CDM, facilitating unified analysis across heterogeneous data sets. The third stage involves the integration of Schema.org and JavaScript Object Notation for Linked Data (JSON-LD), in which machine-readable metadata are generated using Schema.org entities and embedded within the data using JSON-LD, boosting discoverability and comprehension for both machines and human users. We demonstrated the implementation of these 3 stages using the Integrated Disease Surveillance and Response (IDSR) data from Malawi and Kenya. Results: The implementation of our framework significantly enhanced the FAIRness of population health data, resulting in improved discoverability through seamless integration with platforms such as Google Dataset Search. The adoption of standardized formats and protocols streamlined data accessibility and integration across various research environments, fostering collaboration and knowledge sharing. Additionally, the use of machine-interpretable metadata empowered researchers to efficiently reuse data for targeted analyses and insights, thereby maximizing the overall value of population health resources. The JSON-LD codes are accessible via a GitHub repository and the HTML code integrated with JSON-LD is available on the Implementation Network for Sharing Population Information from Research Entities website. Conclusions: The adoption of machine-readable metadata standards is essential for ensuring the FAIRness of population health data. By embracing these standards, organizations can enhance diverse resource visibility, accessibility, and utility, leading to a broader impact, particularly in low- and middle-income countries. Machine-readable metadata can accelerate research, improve health care decision-making, and ultimately promote better health outcomes for populations worldwide. ", doi="10.2196/56237", url="https://ojphi.jmir.org/2024/1/e56237", url="http://www.ncbi.nlm.nih.gov/pubmed/39088253" } @Article{info:doi/10.2196/52019, author="Shi, Yulin and Wang, Baohua and Zhao, Jian and Wang, Chunping and Li, Ning and Chen, Min and Wan, Xia", title="Summary Measure of Health-Related Quality of Life and Its Related Factors Based on the Chinese Version of the Core Healthy Days Measures: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="31", volume="10", pages="e52019", keywords="health-related quality of life", keywords="Healthy Days", keywords="summary measure", keywords="health status indicators", keywords="exploratory factor analyses", keywords="confirmatory factor analyses", abstract="Background: The core Healthy Days measures were used to track the population-level health status in the China Chronic Disease and Risk Factor Surveillance; however, they were not easily combined to create a summary of the overall health-related quality of life (HRQOL), limiting this indicator's use. Objective: This study aims to develop a summary score based on the Chinese version of the core Healthy Days measures (HRQOL-5) and apply it to estimate HRQOL and its determinants in a Chinese population. Methods: From November 2018 to May 2019, a multistage stratified cluster survey was conducted to examine population health status and behavioral risk factors among the resident population older than 15 years in Weifang City, Shandong Province, China. Both exploratory factor analyses and confirmatory factor analyses were performed to reveal the underlying latent construct of HRQOL-5 and then to quantify the overall HRQOL by calculating its summary score. Tobit regression models were finally carried out to identify the influencing factors of the summary score. Results: A total of 26,269 participants (male: n=13,571, 51.7\%; mean age 55.9, SD 14.9 years) were included in this study. A total of 71\% (n=18,663) of respondents reported that they had excellent or very good general health. One summary factor was extracted to capture overall HRQOL using exploratory factor analysis. The confirmatory factor analysis further confirmed this one-factor model (Tucker-Lewis index, comparative fit index, and goodness-of-fit index >0.90; root mean square error of approximation 0.02). Multivariate Tobit regression analysis showed that age ($\beta$=--0.06), educational attainments (primary school: $\beta$=0.72; junior middle school: $\beta$=1.46; senior middle school or more: $\beta$=2.58), average income (?{\textyen}30,000 [US \$4200]: $\beta$=0.69), physical activity ($\beta$=0.75), alcohol use ($\beta$=0.46), self-reported disease ($\beta$=?6.36), and self-reported injury ($\beta$=--5.00) were the major influencing factors on the summary score of the HRQOL-5. Conclusions: This study constructs a summary score from the HRQOL-5, providing a comprehensive representation of population-level HRQOL. Differences in summary scores of different subpopulations may help set priorities for health planning in China to improve population HRQOL. ", doi="10.2196/52019", url="https://publichealth.jmir.org/2024/1/e52019" } @Article{info:doi/10.2196/51120, author="Markovic, Andjela and Kovacevic, Vladimir and Brakenhoff, B. Timo and Veen, Duco and Klaver, Paul and Mitratza, Marianna and Downward, S. George and Grobbee, E. Diederick and Cronin, Maureen and Goodale, M. Brianna and ", title="Physiological Response to the COVID-19 Vaccine: Insights From a Prospective, Randomized, Single-Blinded, Crossover Trial", journal="J Med Internet Res", year="2024", month="Jul", day="31", volume="26", pages="e51120", keywords="wearable technology", keywords="biosignals", keywords="digital health", keywords="SARS-CoV-2", keywords="vaccine reactogenicity", keywords="menstrual cycle", keywords="vaccine", keywords="wearables", keywords="sex", keywords="development", keywords="implementation", keywords="medical device", keywords="breathing rate", keywords="heart rate", keywords="biological mechanism", keywords="immune response", keywords="vaccination", abstract="Background: Rapid development and implementation of vaccines constituted a crucial step in containing the COVID-19 pandemic. A comprehensive understanding of physiological responses to these vaccines is important to build trust in medicine. Objective: This study aims to investigate temporal dynamics before and after COVID-19 vaccination in 4 physiological parameters as well as the duration of menstrual cycle phases. Methods: In a prospective trial, 17,825 adults in the Netherlands wore a medical device on their wrist for up to 9 months. The device recorded their physiological signals and synchronized with a complementary smartphone app. By means of multilevel quadratic regression, we examined changes in wearable-recorded breathing rate, wrist skin temperature, heart rate, heart rate variability, and objectively assessed the duration of menstrual cycle phases in menstruating participants to assess the effects of COVID-19 vaccination. Results: The recorded physiological signals demonstrated short-term increases in breathing rate and heart rate after COVID-19 vaccination followed by a prompt rebound to baseline levels likely reflecting biological mechanisms accompanying the immune response to vaccination. No sex differences were evident in the measured physiological responses. In menstruating participants, we found a 0.8\% decrease in the duration of the menstrual phase following vaccination. Conclusions: The observed short-term changes suggest that COVID-19 vaccines are not associated with long-term biophysical issues. Taken together, our work provides valuable insights into continuous fluctuations of physiological responses to vaccination and highlights the importance of digital solutions in health care. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05241-5 ", doi="10.2196/51120", url="https://www.jmir.org/2024/1/e51120" } @Article{info:doi/10.2196/49205, author="Knauss, Samuel and Andriamiadana, Gracia and Leitheiser, Roxane and Rampanjato, Zavaniarivo and B{\"a}rnighausen, Till and Emmrich, Valentin Julius", title="Effect of the COVID-19 Lockdown on Mobile Payments for Maternal Health: Regression Discontinuity Analysis", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="30", volume="10", pages="e49205", keywords="digital health", keywords="behavioral surveillance", keywords="digital health wallet", keywords="mobile money", keywords="COVID-19", keywords="health financing", keywords="public health", keywords="sub-Saharan Africa", abstract="Background: The COVID-19 pandemic resulted in the unprecedented popularity of digital financial services for contactless payments and government cash transfer programs to mitigate the economic effects of the pandemic. The effect of the pandemic on the use of digital financial services for health in low- and middle-income countries, however, is poorly understood. Objective: This study aimed to assess the effect of the first COVID-19 lockdown on the use of a mobile maternal health wallet, with a particular focus on delineating the age-dependent differential effects, and draw conclusions on the effect of lockdown measures on the use of digital health services. Methods: We analyzed 819,840 person-days of health wallet use data from 3416 women who used health care at 25 public sector primary care facilities and 4 hospitals in Antananarivo, Madagascar, between January 1 and August 27, 2020. We collected data on savings, payments, and voucher use at the point of care. To estimate the effects of the first COVID-19 lockdown in Madagascar, we used regression discontinuity analysis around the starting day of the first COVID-19 lockdown on March 23, 2020. We determined the bandwidth using a data-driven method for unbiased bandwidth selection and used modified Poisson regression for binary variables to estimate risk ratios as lockdown effect sizes. Results: We recorded 3719 saving events, 1572 payment events, and 3144 use events of electronic vouchers. The first COVID-19 lockdown in Madagascar reduced mobile money savings by 58.5\% (P<.001), payments by 45.8\% (P<.001), and voucher use by 49.6\% (P<.001). Voucher use recovered to the extrapolated prelockdown counterfactual after 214 days, while savings and payments did not cross the extrapolated prelockdown counterfactual. The recovery duration after the lockdown differed by age group. Women aged >30 years recovered substantially faster, returning to prelockdown rates after 34, 226, and 77 days for savings, payments, and voucher use, respectively. Younger women aged <25 years did not return to baseline values. The results remained robust in sensitivity analyses using {\textpm}20 days of the optimal bandwidth. Conclusions: The COVID-19 lockdown greatly reduced the use of mobile money in the health sector, affecting savings, payments, and voucher use. Savings were the most significantly reduced, implying that the lockdown affected women's expectations of future health care use. Declines in payments and voucher use indicated decreased actual health care use caused by the lockdown. These effects are crucial since many maternal and child health care services cannot be delayed, as the potential benefits will be lost or diminished. To mitigate the adverse impacts of lockdowns on maternal health service use, digital health services could be leveraged to provide access to telemedicine and enhance user communication with clear information on available health care access options and adherence to safety protocols. ", doi="10.2196/49205", url="https://publichealth.jmir.org/2024/1/e49205", url="http://www.ncbi.nlm.nih.gov/pubmed/39078698" } @Article{info:doi/10.2196/48139, author="Al-Aboosi, Mustafa Ahmad and Sheikh Abdullah, Huda Siti Norul and Ismail, Rozmi and Abdul Maulud, Nizam Khairul and Nahar, Lutfun and Zainol Ariffin, Akram Khairul and Lam, Chun Meng and bin Talib, Lazim Muhamad and Wahab, Suzaily and Elias, Mahadzir", title="A Geospatial Drug Abuse Risk Assessment and Monitoring Dashboard Tailored for School Students: Development Study With Requirement Analysis and Acceptance Evaluation", journal="JMIR Hum Factors", year="2024", month="Jul", day="30", volume="11", pages="e48139", keywords="geospatial", keywords="statistics", keywords="map", keywords="youth", keywords="drugs", keywords="dashboard", keywords="evaluation", keywords="drug abuse", keywords="monitoring", keywords="risk assessment", abstract="Background: The enormous consequences of drugs include suicides, traffic accidents, and violence, affecting the individual, family, society, and country. Therefore, it is necessary to constantly identify and monitor the drug abuse rate among school-going youth. A geospatial dashboard is vital for the monitoring of drug abuse and related crime incidence in a decision support system. Objective: This paper mainly focuses on developing MyAsriGeo, a geospatial drug abuse risk assessment and monitoring dashboard tailored for school students. It introduces innovative functionality, seamlessly orchestrating the assessment of drug abuse usage patterns and risks using multivariate student data. Methods: A geospatial drug abuse dashboard for monitoring and analysis was designed and developed in this study based on agile methodology and prototyping. Using focus group and interviews, we first examined and gathered the requirements, feedback, and user approval of the MyAsriGeo dashboard. Experts and stakeholders such as the National Anti-Drugs Agency, police, the Federal Department of Town and Country Planning, school instructors, students, and researchers were among those who responded. A total of 20 specialists were involved in the requirement analysis and acceptance evaluation of the pilot and final version of the dashboard. The evaluation sought to identify various user acceptance aspects, such as ease of use and usefulness, for both the pilot and final versions, and 2 additional factors based on the Post-Study System Usability Questionnaire and Task-Technology Fit models were enlisted to assess the interface quality and dashboard sufficiency for the final version. Results: The MyAsriGeo geospatial dashboard was designed to meet the needs of all user types, as identified through a requirement gathering process. It includes several key functions, such as a geospatial map that shows the locations of high-risk areas for drug abuse, data on drug abuse among students, tools for assessing the risk of drug abuse in different areas, demographic information, and a self-problem test. It also includes the Alcohol, Smoking, and Substance Involvement Screening Test and its risk assessment to help users understand and interpret the results of student risk. The initial prototype and final version of the dashboard were evaluated by 20 experts, which revealed a significant improvement in the ease of use (P=.047) and usefulness (P=.02) factors and showed a high acceptance mean scores for ease of use (4.2), usefulness (4.46), interface quality (4.29), and sufficiency (4.13). Conclusions: The MyAsriGeo geospatial dashboard is useful for monitoring and analyzing drug abuse among school-going youth in Malaysia. It was developed based on the needs of various stakeholders and includes a range of functions. The dashboard was evaluated by a group of experts. Overall, the MyAsriGeo geospatial dashboard is a valuable resource for helping stakeholders understand and respond to the issue of drug abuse among youth. ", doi="10.2196/48139", url="https://humanfactors.jmir.org/2024/1/e48139", url="http://www.ncbi.nlm.nih.gov/pubmed/39078685" } @Article{info:doi/10.2196/49648, author="Sawires, Rana and Clothier, J. Hazel and Burgner, David and Fahey, Collingwood Michael and Buttery, Jim", title="Kawasaki Disease and Respiratory Viruses: Ecological Spatiotemporal Analysis", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="25", volume="10", pages="e49648", keywords="Kawasaki disease", keywords="pediatric", keywords="infection", keywords="RSV", keywords="human metapneumovirus", keywords="respiratory virus", keywords="virology", keywords="community", keywords="viral infection", keywords="respiratory disease", keywords="respiratory diseases", keywords="children", keywords="epidemiology", keywords="respiratory syncytial virus", abstract="Background: Kawasaki disease is an uncommon vasculitis affecting young children. Its etiology is not completely understood, although infections have been frequently postulated as the triggers. Respiratory viruses, specifically, have often been implicated as causative agents for Kawasaki disease presentations. Objective: We aimed to conduct an ecological spatiotemporal analysis to determine whether Kawasaki disease incidence was related to community respiratory virus circulation in a shared region and population, and to describe viral associations before and during the COVID-19 pandemic. Methods: We obtained independent statewide data sets of hospital admissions of Kawasaki disease and respiratory multiplex polymerase chain reaction tests performed at two large hospital networks in Victoria, Australia, from July 2011 to November 2021. We studied spatiotemporal relationships by negative binomial regression analysis of the monthly incidence of Kawasaki disease and the rate of positive respiratory polymerase chain reaction tests in different regions of Victoria. Peak viral seasons (95th percentile incidence) were compared to median viral circulation (50th percentile incidence) to calculate peak season increased rate ratios. Results: While no seasonal trend in Kawasaki disease incidence was identified throughout the study period, we found a 1.52 (99\% CI 1.27?1.82) and a 1.43 (99\% CI 1.17?1.73) increased rate ratio of Kawasaki disease presentations in association with human metapneumovirus and respiratory syncytial virus circulation, respectively, before the COVID-19 pandemic. No respiratory viral associations with Kawasaki disease were observed during the COVID-19 pandemic. Conclusions: Our large ecological analysis demonstrates novel spatiotemporal relationships between human metapneumovirus and respiratory syncytial virus circulation with Kawasaki disease. The disappearance of these associations in the COVID-19 pandemic may reflect the reduced circulation of non--SARS-CoV-2 viruses during this period, supporting the prepandemic associations identified in this study. The roles of human metapneumovirus and respiratory syncytial virus in Kawasaki disease etiology warrant further investigation. ", doi="10.2196/49648", url="https://publichealth.jmir.org/2024/1/e49648" } @Article{info:doi/10.2196/51883, author="Chen, Yang and Zhou, Lidan and Zha, Yuanyi and Wang, Yujin and Wang, Kai and Lu, Lvliang and Guo, Pi and Zhang, Qingying", title="Impact of Ambient Temperature on Mortality Burden and Spatial Heterogeneity in 16 Prefecture-Level Cities of a Low-Latitude Plateau Area in Yunnan Province: Time-Series Study", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="23", volume="10", pages="e51883", keywords="mortality burden", keywords="nonaccidental deaths", keywords="multivariate meta-analysis", keywords="distributed lagged nonlinear mode", keywords="attributable risk", keywords="climate change", keywords="human health", keywords="association", keywords="temperature", keywords="mortality", keywords="nonaccidental death", keywords="spatial heterogeneity", keywords="meteorological data", keywords="temperature esposure", keywords="heterogeneous", keywords="spatial planning", keywords="environmental temperature", keywords="prefecture-level", keywords="resource allocation", abstract="Background: The relation between climate change and human health has become one of the major worldwide public health issues. However, the evidence for low-latitude plateau regions is limited, where the climate is unique and diverse with a complex geography and topography. Objectives: This study aimed to evaluate the effect of ambient temperature on the mortality burden of nonaccidental deaths in Yunnan Province and to further explore its spatial heterogeneity among different regions. Methods: We collected mortality and meteorological data from all 129 counties in Yunnan Province from 2014 to 2020, and 16 prefecture-level cities were analyzed as units. A distributed lagged nonlinear model was used to estimate the effect of temperature exposure on years of life lost (YLL) for nonaccidental deaths in each prefecture-level city. The attributable fraction of YLL due to ambient temperature was calculated. A multivariate meta-analysis was used to obtain an overall aggregated estimate of effects, and spatial heterogeneity among 16 prefecture-level cities was evaluated by adjusting the city-specific geographical characteristics, demographic characteristics, economic factors, and health resources factors. Results: The temperature-YLL association was nonlinear and followed slide-shaped curves in all regions. The cumulative cold and heat effect estimates along lag 0?21 days on YLL for nonaccidental deaths were 403.16 (95\% empirical confidence interval [eCI] 148.14?615.18) and 247.83 (95\% eCI 45.73?418.85), respectively. The attributable fraction for nonaccidental mortality due to daily mean temperature was 7.45\% (95\% eCI 3.73\%?10.38\%). Cold temperature was responsible for most of the mortality burden (4.61\%, 95\% eCI 1.70?7.04), whereas the burden due to heat was 2.84\% (95\% eCI 0.58?4.83). The vulnerable subpopulations include male individuals, people aged <75 years, people with education below junior college level, farmers, nonmarried individuals, and ethnic minorities. In the cause-specific subgroup analysis, the total attributable fraction (\%) for mean temperature was 13.97\% (95\% eCI 6.70?14.02) for heart disease, 11.12\% (95\% eCI 2.52?16.82) for respiratory disease, 10.85\% (95\% eCI 6.70?14.02) for cardiovascular disease, and 10.13\% (95\% eCI 6.03?13.18) for stroke. The attributable risk of cold effect for cardiovascular disease was higher than that for respiratory disease cause of death (9.71\% vs 4.54\%). Furthermore, we found 48.2\% heterogeneity in the effect of mean temperature on YLL after considering the inherent characteristics of the 16 prefecture-level cities, with urbanization rate accounting for the highest proportion of heterogeneity (15.7\%) among urban characteristics. Conclusions: This study suggests that the cold effect dominated the total effect of temperature on mortality burden in Yunnan Province, and its effect was heterogeneous among different regions, which provides a basis for spatial planning and health policy formulation for disease prevention. ", doi="10.2196/51883", url="https://publichealth.jmir.org/2024/1/e51883" } @Article{info:doi/10.2196/59446, author="Kim, Inho Bryan and Achangwa, Chiara and Cho, Seonghui and Ahn, Jisoo and Won, Jisu and Do, Hyunkyung and Lee, Dayeong and Yoon, Bohye and Kim, Joohee and Ryu, Sukhyun", title="The Hand, Foot, and Mouth Disease Sentinel Surveillance System in South Korea: Retrospective Evaluation Study", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="23", volume="10", pages="e59446", keywords="hand-foot-mouth disease", keywords="surveillance", keywords="evaluation", keywords="sentinel", keywords="sensitivity", keywords="surveillance system", keywords="effective", keywords="South Korea", keywords="COVID-19", keywords="public health system", keywords="policy maker", keywords="timeliness", keywords="stability", keywords="completeness", keywords="representativeness", keywords="hand, foot, and mouth disease", abstract="Background: South Korea has implemented a hand, foot, and mouth disease (HFMD) surveillance system since 2009 to monitor incidence trends and identify disease burden. This nationwide surveillance involves a network of approximately 100 pediatric clinics that report all probable and confirmed HFMD cases. Following the COVID-19 pandemic, infectious disease surveillance systems must be evaluated to ensure the effective use of limited public health resources. Objective: This study aimed to evaluate the HFMD sentinel surveillance system in South Korea from 2017 to 2022, focusing on the transition period after the COVID-19 pandemic. Methods: We retrospectively reviewed the HFMD sentinel surveillance system from the Korea Disease Control and Prevention Agency using systematic guidelines for public health surveillance system evaluation developed by the US Centers for Disease Control and Prevention. We assessed the system's overall performance in 5 main factors: timeliness, stability, completeness, sensitivity, and representativeness (ie, the age and geographic distribution of sentinels). We rated these factors as weak, moderate, or good. Results: Our study showed that the completeness, sensitivity, and age representativeness of the HFMD surveillance performance were temporarily reduced to moderate levels from 2020 to 2021 and recovered in 2022, while the timeliness and geographic representativeness were maintained at a good level throughout the study period. The stability of the surveillance was moderate from 2017 to 2021 and weak in 2022. Conclusions: This is the first study to evaluate the HFMD surveillance system after the acute phase of the COVID-19 pandemic. We identified a temporarily reduced level of performance (ie, completeness, sensitivity, and age-specific representativeness) during the acute phase of the pandemic and good performance in 2022. Surveillance system evaluation and maintenance during public health emergencies will provide robust and reliable data to support public health policy development. Regular staff training programs and reducing staff turnover will improve HFMD surveillance system stability. ", doi="10.2196/59446", url="https://publichealth.jmir.org/2024/1/e59446" } @Article{info:doi/10.2196/52366, author="Hong, Hang and Shi, Xiaojun and Liu, Yuhui and Feng, Wei and Fang, Ting and Tang, Chunlan and Xu, Guozhang", title="HIV Incidence and Transactional Sex Among Men Who Have Sex With Men in Ningbo, China: Prospective Cohort Study Using a WeChat-Based Platform", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="23", volume="10", pages="e52366", keywords="HIV/AIDS", keywords="incidence", keywords="men who have sex with men", keywords="MSM", keywords="transactional sex", keywords="WeChat", keywords="HIV", keywords="STI", keywords="STD", keywords="sexual", keywords="behavior", keywords="behavioral", keywords="risk", keywords="risky", keywords="risks", keywords="China", keywords="Chinese", keywords="testing", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="applications", keywords="text message", keywords="text messages", keywords="messaging", keywords="social media", keywords="regression", keywords="sexually transmitted infection", keywords="sexually transmitted disease", abstract="Background: Sexual transmission among men who have sex with men (MSM) has become the major HIV transmission route. However, limited research has been conducted to investigate the association between transactional sex (TS) and HIV incidence in China. Objective: This study aims to investigate HIV incidence and distinguish sociodemographic and sexual behavioral risk factors associated with HIV incidence among MSM who engage in TS (MSM-TS) in China. Methods: We conducted a prospective cohort study using a WeChat-based platform to evaluate HIV incidence among Chinese MSM, including MSM-TS in Ningbo, recruited from July 2019 until June 2022. At each visit, participants completed a questionnaire and scheduled an appointment for HIV counseling and testing on the WeChat-based platform before undergoing offline HIV tests. HIV incidence density was calculated as the number of HIV seroconversions divided by person-years (PYs) of follow-up, and univariate and multivariate Cox proportional hazards regression was conducted to identify factors associated with HIV incidence. Results: A total of 932 participants contributed 630.9 PYs of follow-up, and 25 HIV seroconversions were observed during the study period, resulting in an estimated HIV incidence of 4.0 (95\% CI 2.7-5.8) per 100 PYs. The HIV incidence among MSM-TS was 18.4 (95\% CI 8.7-34.7) per 100 PYs, which was significantly higher than the incidence of 3.2 (95\% CI 2.1-5.0) per 100 PYs among MSM who do not engage in TS. After adjusting for sociodemographic characteristics, factors associated with HIV acquisition were MSM-TS (adjusted hazard ratio [aHR] 3.93, 95\% CI 1.29-11.93), having unprotected sex with men (aHR 10.35, 95\% CI 2.25-47.69), and having multiple male sex partners (aHR 3.43, 95\% CI 1.22-9.64) in the past 6 months. Conclusions: This study found a high incidence of HIV among MSM-TS in Ningbo, China. The risk factors associated with HIV incidence include TS, having unprotected sex with men, and having multiple male sex partners. These findings emphasize the need for developing targeted interventions and providing comprehensive medical care, HIV testing, and preexposure prophylaxis for MSM, particularly those who engage in TS. ", doi="10.2196/52366", url="https://publichealth.jmir.org/2024/1/e52366" } @Article{info:doi/10.2196/52762, author="Dotson, Timothy and Price, Brad and Witrick, Brian and Davis, Sherri and Kemper, Emily and Whanger, Stacey and Hodder, Sally and Hendricks, Brian", title="Factors Associated With Surveillance Testing in Individuals With COVID-19 Symptoms During the Last Leg of the Pandemic: Multivariable Regression Analysis", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="18", volume="10", pages="e52762", keywords="COVID-19", keywords="testing", keywords="symptomatic", keywords="RADx", keywords="rural", keywords="health disparities", keywords="regression analysis", keywords="surveillance", keywords="SARS-CoV-2", keywords="United States", keywords="asymptomatic", keywords="survey", keywords="demographic", keywords="clinical", keywords="behavioral", keywords="logistic regression", keywords="bivariate map", keywords="child", keywords="children", keywords="youth", keywords="adolescent", keywords="adolescents", keywords="teen", keywords="teens", keywords="teenager", keywords="teenagers", keywords="public health", keywords="machine learning", keywords="mHealth", keywords="mobile health", keywords="digital health", keywords="cross-sectional study", keywords="physical health", keywords="mental health", keywords="Rapid Acceleration of Diagnostics", abstract="Background: Rural underserved areas facing health disparities have unequal access to health resources. By the third and fourth waves of SARS-CoV-2 infections in the United States, COVID-19 testing had reduced, with more reliance on home testing, and those seeking testing were mostly symptomatic. Objective: This study identifies factors associated with COVID-19 testing among individuals who were symptomatic versus asymptomatic seen at a Rapid Acceleration of Diagnostics for Underserved Populations phase 2 (RADx-UP2) testing site in West Virginia. Methods: Demographic, clinical, and behavioral factors were collected via survey from tested individuals. Logistic regression was used to identify factors associated with the presence of individuals who were symptomatic seen at testing sites. Global tests for spatial autocorrelation were conducted to examine clustering in the proportion of symptomatic to total individuals tested by zip code. Bivariate maps were created to display geographic distributions between higher proportions of tested individuals who were symptomatic and social determinants of health. Results: Among predictors, the presence of a physical (adjusted odds ratio [aOR] 1.85, 95\% CI 1.3-2.65) or mental (aOR 1.53, 95\% CI 0.96-2.48) comorbid condition, challenges related to a place to stay/live (aOR 307.13, 95\% CI 1.46-10,6372), no community socioeconomic distress (aOR 0.99, 95\% CI 0.98-1.00), no challenges in getting needed medicine (aOR 0.01, 95\% CI 0.00-0.82) or transportation (aOR 0.23, 95\% CI 0.05-0.64), an interaction between community socioeconomic distress and not getting needed medicine (aOR 1.06, 95\% CI 1.00-1.13), and having no community socioeconomic distress while not facing challenges related to a place to stay/live (aOR 0.93, 95\% CI 0.87-0.99) were statistically associated with an individual being symptomatic at the first test visit. Conclusions: This study addresses critical limitations to the current COVID-19 testing literature, which almost exclusively uses population-level disease screening data to inform public health responses. ", doi="10.2196/52762", url="https://publichealth.jmir.org/2024/1/e52762" } @Article{info:doi/10.2196/53716, author="Esmaeilpour, Zeinab and Natarajan, Aravind and Su, Hao-Wei and Faranesh, Anthony and Friel, Ciaran and Zanos, P. Theodoros and D'Angelo, Stefani and Heneghan, Conor", title="Detection of Common Respiratory Infections, Including COVID-19, Using Consumer Wearable Devices in Health Care Workers: Prospective Model Validation Study", journal="JMIR Form Res", year="2024", month="Jul", day="17", volume="8", pages="e53716", keywords="COVID detection", keywords="wearable", keywords="respiratory virus detection", keywords="algorithm", keywords="respiratory infection", keywords="respiratory virus", keywords="COVID-19", keywords="wearable device", keywords="well-being", keywords="health", keywords="physiology", keywords="health care worker", keywords="prediction", keywords="infection", keywords="physical stress", keywords="emotional stress", abstract="Background: The early detection of respiratory infections could improve responses against outbreaks. Wearable devices can provide insights into health and well-being using longitudinal physiological signals. Objective: The purpose of this study was to prospectively evaluate the performance of a consumer wearable physiology-based respiratory infection detection algorithm in health care workers. Methods: In this study, we evaluated the performance of a previously developed system to predict the presence of COVID-19 or other upper respiratory infections. The system generates real-time alerts using physiological signals recorded from a smartwatch. Resting heart rate, respiratory rate, and heart rate variability measured during the sleeping period were used for prediction. After baseline recordings, when participants received a notification from the system, they were required to undergo testing at a Northwell Health System site. Participants were asked to self-report any positive tests during the study. The accuracy of model prediction was evaluated using respiratory infection results (laboratory results or self-reports), and postnotification surveys were used to evaluate potential confounding factors. Results: A total of 577 participants from Northwell Health in New York were enrolled in the study between January 6, 2022, and July 20, 2022. Of these, 470 successfully completed the study, 89 did not provide sufficient physiological data to receive any prediction from the model, and 18 dropped out. Out of the 470 participants who completed the study and wore the smartwatch as required for the 16-week study duration, the algorithm generated 665 positive alerts, of which 153 (23.0\%) were not acted upon to undergo testing for respiratory viruses. Across the 512 instances of positive alerts that involved a respiratory viral panel test, 63 had confirmed respiratory infection results (ie, COVID-19 or other respiratory infections detected using a polymerase chain reaction or home test) and the remaining 449 had negative upper respiratory infection test results. Across all cases, the estimated false-positive rate based on predictions per day was 2\%, and the positive-predictive value ranged from 4\% to 10\% in this specific population, with an observed incidence rate of 198 cases per week per 100,000. Detailed examination of questionnaires filled out after receiving a positive alert revealed that physical or emotional stress events, such as intense exercise, poor sleep, stress, and excessive alcohol consumption, could cause a false-positive result. Conclusions: The real-time alerting system provides advance warning on respiratory viral infections as well as other physical or emotional stress events that could lead to physiological signal changes. This study showed the potential of wearables with embedded alerting systems to provide information on wellness measures. ", doi="10.2196/53716", url="https://formative.jmir.org/2024/1/e53716" } @Article{info:doi/10.2196/54611, author="Mustafa, Hazim Ali and Khaleel, Abdulghafoor Hanan and Lami, Faris", title="Human Brucellosis in Iraq: Spatiotemporal Data Analysis From 2007-2018", journal="JMIRx Med", year="2024", month="Jul", day="3", volume="5", pages="e54611", keywords="human brucellosis", keywords="livestock", keywords="clustering", keywords="spatial", keywords="temporal", keywords="Iraq", abstract="Background: Brucellosis is both endemic and enzootic in Iraq, resulting in long-term morbidity for humans as well as economic loss. No previous study of the spatial and temporal patterns of brucellosis in Iraq was done to identify potential clustering of cases. Objective: This study aims to detect the spatial and temporal distribution of human brucellosis in Iraq and identify any changes that occurred from 2007 to 2018. Methods: A descriptive, cross-sectional study was conducted using secondary data from the Surveillance Section at the Communicable Diseases Control Center, Public Health Directorate, Ministry of Health in Iraq. The trends of cases by sex and age group from 2007 to 2018 were displayed. The seasonal distribution of the cases from 2007 to 2012 was graphed. We calculated the incidence of human brucellosis per district per year and used local Getis-Ord Gi* statistics to detect the spatial distribution of the data. The data were analyzed using Microsoft Excel and GeoDa software. Results: A total of 51,508 human brucellosis cases were reported during the 12-year study period, with some missing data for age groups. Human brucellosis persisted annually in Iraq across the study period with no specific temporal clustering of cases. In contrast, spatial clustering was predominant in northern Iraq. Conclusions: There were significant differences in the geographic distribution of brucellosis. The number of cases is the highest in the north and northeast regions of the country, which has borders with nearby countries. In addition, people in these areas depend more on locally made dairy products, which can be inadequately pasteurized. Despite the lack of significant temporal clustering of cases, the highest number of cases were reported during summer and spring. Considering these patterns when allocating resources to combat this disease, determining public health priorities, and planning prevention and control strategies is important. ", doi="10.2196/54611", url="https://xmed.jmir.org/2024/1/e54611" } @Article{info:doi/10.2196/56755, author="Aronson, David Ian and Ardouin-Guerrier, Mary-Andr{\'e}e and Baus, Esteban Juan and Bennett, S. Alex", title="Barriers to, and Facilitators of, Checking Drugs for Adulterants in the Era of Fentanyl and Xylazine: Qualitative Study", journal="JMIR Form Res", year="2024", month="Jul", day="3", volume="8", pages="e56755", keywords="overdose", keywords="overdoses", keywords="fentanyl", keywords="xylazine", keywords="benzodiazepines", keywords="adulterants", keywords="drug", keywords="drugs", keywords="substance", keywords="substances", keywords="illicit drug", keywords="illicit drugs", keywords="drug test", keywords="drug testing", keywords="drug checking", keywords="qualitative", keywords="interview", keywords="interviews", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="digital interventions", keywords="technological intervention", keywords="technological interventions", keywords="technology-based intervention", keywords="technology-based interventions", abstract="Background: Overdose deaths continue to reach new records in New York City and nationwide, largely driven by adulterants such as fentanyl and xylazine in the illicit drug supply. Unknowingly consuming adulterated substances dramatically increases risks of overdose and other health problems, especially when individuals consume multiple adulterants and are exposed to a combination of drugs they did not intend to take. Although test strips and more sophisticated devices enable people to check drugs for adulterants including fentanyl and xylazine prior to consumption and are often available free of charge, many people who use drugs decline to use them. Objective: We sought to better understand why people in the New York City area do or do not check drugs before use. We plan to use study findings to inform the development of technology-based interventions to encourage consistent drug checking. Methods: In summer 2023, team members who have experience working with people who use drugs conducted 22 semistructured qualitative interviews with a convenience sample of people who reported illicit drug use within the past 90 days. An interview guide examined participants' knowledge of and experience with adulterants including fentanyl, xylazine, and benzodiazepines; using drug testing strips; and whether they had ever received harm reduction services. All interviews were audio recorded, transcribed, and analyzed for emerging themes. Results: Most participants lacked knowledge of adulterants, and only a few reported regularly checking drugs. Reasons for not checking included lacking convenient access to test supplies, or a place to check samples out of the public's view, as well as time considerations. Some participants also reported a strong belief that they were not at risk from fentanyl, xylazine, or other adulterants because they exclusively used cocaine or crack, or that they were confident the people they bought drugs from would not sell them adulterated substances. Those who did report testing their drugs described positive interactions with harm reduction agency staff. Conclusions: New forms of outreach are needed not only to increase people's knowledge of adulterated substances and awareness of the increasing risks they pose but also to encourage people who use drugs to regularly check their substances prior to use. This includes new intervention messages that highlight the importance of drug checking in the context of a rapidly changing and volatile drug supply. This messaging can potentially help normalize drug checking as an easily enacted behavior that benefits public health. To increase effectiveness, messages can be developed with, and outreach can be conducted by, trusted community members including people who use drugs and, potentially, people who sell drugs. Pairing this messaging with access to no-cost drug-checking supplies and equipment may help address the ongoing spiral of increased overdose deaths nationwide. ", doi="10.2196/56755", url="https://formative.jmir.org/2024/1/e56755" } @Article{info:doi/10.2196/58058, author="Goldstein, D. Neal and Jones, Justin and Kahal, Deborah and Burstyn, Igor", title="Inferring Population HIV Viral Load From a Single HIV Clinic's Electronic Health Record: Simulation Study With a Real-World Example", journal="Online J Public Health Inform", year="2024", month="Jul", day="3", volume="16", pages="e58058", keywords="HIV", keywords="human immunodeficiency virus", keywords="viral load", keywords="population viral load", keywords="electronic health record", keywords="EHR", keywords="electronic health records", keywords="EHRs", keywords="electric medical record", keywords="EMR", keywords="electric medical records", keywords="EMRs", keywords="patient record", keywords="health record", keywords="health records", keywords="personal health record", keywords="PHR", keywords="selection weights", keywords="sampling", keywords="sampling bias", keywords="Bayes", abstract="Background: Population viral load (VL), the most comprehensive measure of the HIV transmission potential, cannot be directly measured due to lack of complete sampling of all people with HIV. Objective: A given HIV clinic's electronic health record (EHR), a biased sample of this population, may be used to attempt to impute this measure. Methods: We simulated a population of 10,000 individuals with VL calibrated to surveillance data with a geometric mean of 4449 copies/mL. We sampled 3 hypothetical EHRs from (A) the source population, (B) those diagnosed, and (C) those retained in care. Our analysis imputed population VL from each EHR using sampling weights followed by Bayesian adjustment. These methods were then tested using EHR data from an HIV clinic in Delaware. Results: Following weighting, the estimates moved in the direction of the population value with correspondingly wider 95\% intervals as follows: clinic A: 4364 (95\% interval 1963-11,132) copies/mL; clinic B: 4420 (95\% interval 1913-10,199) copies/mL; and clinic C: 242 (95\% interval 113-563) copies/mL. Bayesian-adjusted weighting further improved the estimate. Conclusions: These findings suggest that methodological adjustments are ineffective for estimating population VL from a single clinic's EHR without the resource-intensive elucidation of an informative prior. ", doi="10.2196/58058", url="https://ojphi.jmir.org/2024/1/e58058" } @Article{info:doi/10.2196/59121, author="Shi, Yun and Wu, Bei and Islam, Nadia and Sevick, Ann Mary and Shallcross, J. Amanda and Levy, Natalie and Tamura, Kosuke and Bao, Han and Lieu, Ricki and Xu, Xinyi and Jiang, Yulin and Hu, Lu", title="Characterizing Mental Health Status and Service Utilization in Chinese Americans With Type 2 Diabetes in New York City: Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Jul", day="2", volume="8", pages="e59121", keywords="mental health", keywords="diabetes distress", keywords="depression", keywords="anxiety", keywords="service utilization", keywords="psychological distress", keywords="type 2 diabetes", keywords="diabetes", keywords="United States", keywords="mental health burden", keywords="Chinese American", keywords="cross-sectional", keywords="telephone survey", keywords="stress", keywords="depressive symptoms", keywords="mental health care", keywords="mental health screening", abstract="Background: Emerging evidence indicates that individuals with type 2 diabetes (T2D) are more prone to mental health issues than the general population; however, there is a significant lack of data concerning the mental health burden in Chinese Americans with T2D. Objective: The aim of this study was to explore the comorbid mental health status, health-seeking behaviors, and mental service utilization among Chinese Americans with T2D. Methods: A cross-sectional telephone survey was performed among 74 Chinese Americans with T2D in New York City. We used standardized questionnaires to assess mental health status and to gather data on mental health--seeking behaviors and service utilization. Descriptive statistics were applied for data analysis. Results: A total of 74 Chinese Americans with T2D completed the survey. Most participants (mean age 56, SD 10 years) identified as female (42/74, 57\%), were born outside the United States (73/74, 99\%), and had limited English proficiency (71/74, 96\%). Despite nearly half of the participants (34/74, 46\%) reporting at least one mental health concern (elevated stress, depressive symptoms, and/or anxiety), only 3\% (2/74) were currently using mental health services. Common reasons for not seeking care included no perceived need, lack of information about Chinese-speaking providers, cost, and time constraints. The cultural and language competence of the provider was ranked as the top factor related to seeking mental health care. Conclusions: Chinese Americans with T2D experience relatively high comorbid mental health concerns yet have low service utilization. Clinicians may consider team-based care to incorporate mental health screening and identify strategies to provide culturally and linguistically concordant mental health services to engage Chinese Americans with T2D. ", doi="10.2196/59121", url="https://formative.jmir.org/2024/1/e59121" } @Article{info:doi/10.2196/52103, author="Lee, HyunHae and Kim, Ji-Su and Shin, Hyerine", title="Predicting the Transition to Metabolically Unhealthy Obesity Among Young Adults With Metabolically Healthy Obesity in South Korea: Nationwide Population-Based Study", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="28", volume="10", pages="e52103", keywords="metabolically healthy obesity", keywords="metabolic syndrome", keywords="metabolically unhealthy obesity", keywords="nomogram", keywords="obesity", keywords="young adult", keywords="male", keywords="noncommunicable disease", keywords="South Korea", keywords="population-based study", keywords="intervention", abstract="Background: Globally, over 39\% of individuals are obese. Metabolic syndrome, usually accompanied by obesity, is regarded as a major contributor to noncommunicable diseases. Given this relationship, the concepts of metabolically healthy and unhealthy obesity, considering metabolic status, have been evolving. Attention is being directed to metabolically healthy people with obesity who have relatively low transition rates to noncommunicable diseases. As obesity rates continue to rise and unhealthy behaviors prevail among young adults, there is a growing need for obesity management that considers these metabolic statuses. A nomogram can be used as an effective tool to predict the risk of transitioning to metabolically unhealthy obesity from a metabolically healthy status. Objective: The study aimed to identify demographic factors, health behaviors, and 5 metabolic statuses related to the transition from metabolically healthy obesity to unhealthy obesity among people aged between 20 and 44 years and to develop a screening tool to predict this transition. Methods: This secondary analysis study used national health data from the National Health Insurance System in South Korea. We analyzed the customized data using SAS (SAS Institute Inc) and conducted logistic regression to identify factors related to the transition from metabolically healthy to unhealthy obesity. A nomogram was developed to predict the transition using the identified factors. Results: Among 3,351,989 people, there was a significant association between the transition from metabolically healthy to unhealthy obesity and general characteristics, health behaviors, and metabolic components. Male participants showed a 1.30 higher odds ratio for transitioning to metabolically unhealthy obesity than female participants, and people in the lowest economic status were also at risk for the transition (odds ratio 1.08, 95\% CI 1.05-1.1). Smoking status, consuming >30 g of alcohol, and insufficient regular exercise were negatively associated with the transition. Each relevant variable was assigned a point value. When the nomogram total points reached 295, the shift from metabolically healthy to unhealthy obesity had a prediction rate of >50\%. Conclusions: This study identified key factors for young adults transitioning from healthy to unhealthy obesity, creating a predictive nomogram. This nomogram, including triglycerides, waist circumference, high-density lipoprotein-cholesterol, blood pressure, and fasting glucose, allows easy assessment of obesity risk even for the general population. This tool simplifies predictions amid rising obesity rates and interventions. ", doi="10.2196/52103", url="https://publichealth.jmir.org/2024/1/e52103" } @Article{info:doi/10.2196/55013, author="Liu, Chuchu and Holme, Petter and Lehmann, Sune and Yang, Wenchuan and Lu, Xin", title="Nonrepresentativeness of Human Mobility Data and its Impact on Modeling Dynamics of the COVID-19 Pandemic: Systematic Evaluation", journal="JMIR Form Res", year="2024", month="Jun", day="28", volume="8", pages="e55013", keywords="human mobility", keywords="data representativeness", keywords="population composition", keywords="COVID-19", keywords="epidemiological modeling", abstract="Background: In recent years, a range of novel smartphone-derived data streams about human mobility have become available on a near--real-time basis. These data have been used, for example, to perform traffic forecasting and epidemic modeling. During the COVID-19 pandemic in particular, human travel behavior has been considered a key component of epidemiological modeling to provide more reliable estimates about the volumes of the pandemic's importation and transmission routes, or to identify hot spots. However, nearly universally in the literature, the representativeness of these data, how they relate to the underlying real-world human mobility, has been overlooked. This disconnect between data and reality is especially relevant in the case of socially disadvantaged minorities. Objective: The objective of this study is to illustrate the nonrepresentativeness of data on human mobility and the impact of this nonrepresentativeness on modeling dynamics of the epidemic. This study systematically evaluates how real-world travel flows differ from census-based estimations, especially in the case of socially disadvantaged minorities, such as older adults and women, and further measures biases introduced by this difference in epidemiological studies. Methods: To understand the demographic composition of population movements, a nationwide mobility data set from 318 million mobile phone users in China from January 1 to February 29, 2020, was curated. Specifically, we quantified the disparity in the population composition between actual migrations and resident composition according to census data, and shows how this nonrepresentativeness impacts epidemiological modeling by constructing an age-structured SEIR (Susceptible-Exposed-Infected- Recovered) model of COVID-19 transmission. Results: We found a significant difference in the demographic composition between those who travel and the overall population. In the population flows, 59\% (n=20,067,526) of travelers are young and 36\% (n=12,210,565) of them are middle-aged (P<.001), which is completely different from the overall adult population composition of China (where 36\% of individuals are young and 40\% of them are middle-aged). This difference would introduce a striking bias in epidemiological studies: the estimation of maximum daily infections differs nearly 3 times, and the peak time has a large gap of 46 days. Conclusions: The difference between actual migrations and resident composition strongly impacts outcomes of epidemiological forecasts, which typically assume that flows represent underlying demographics. Our findings imply that it is necessary to measure and quantify the inherent biases related to nonrepresentativeness for accurate epidemiological surveillance and forecasting. ", doi="10.2196/55013", url="https://formative.jmir.org/2024/1/e55013" } @Article{info:doi/10.2196/52773, author="Wang, JianLi and Kharrat, Zadeh Fatemeh Gholi and Gari{\'e}py, Genevi{\`e}ve and Gagn{\'e}, Christian and Pelletier, Jean-Fran{\c{c}}ois and Massamba, Kubuta Victoria and L{\'e}vesque, Pascale and Mohammed, Mada and Lesage, Alain", title="Predicting the Population Risk of Suicide Using Routinely Collected Health Administrative Data in Quebec, Canada: Model-Based Synthetic Estimation Study", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="28", volume="10", pages="e52773", keywords="population risk prediction", keywords="case-control", keywords="development", keywords="validation", keywords="health administrative data", keywords="suicide", keywords="depression", keywords="anxiety", keywords="Quebec", keywords="Canada", keywords="mental health", keywords="suicide prevention", keywords="prevention", keywords="adolescent", keywords="adolescents", keywords="teen", keywords="teens", keywords="teenager", keywords="teenagers", keywords="male", keywords="female", abstract="Background: Suicide is a significant public health issue. Many risk prediction tools have been developed to estimate an individual's risk of suicide. Risk prediction models can go beyond individual risk assessment; one important application of risk prediction models is population health planning. Suicide is a result of the interaction among the risk and protective factors at the individual, health care system, and community levels. Thus, policy and decision makers can play an important role in suicide prevention. However, few prediction models for the population risk of suicide have been developed. Objective: This study aims to develop and validate prediction models for the population risk of suicide using health administrative data, considering individual-, health system--, and community-level predictors. Methods: We used a case-control study design to develop sex-specific risk prediction models for suicide, using the health administrative data in Quebec, Canada. The training data included all suicide cases (n=8899) that occurred from January 1, 2002, to December 31, 2010. The control group was a 1\% random sample of living individuals in each year between January 1, 2002, and December 31, 2010 (n=645,590). Logistic regression was used to develop the prediction models based on individual-, health care system--, and community-level predictors. The developed model was converted into synthetic estimation models, which concerted the individual-level predictors into community-level predictors. The synthetic estimation models were directly applied to the validation data from January 1, 2011, to December 31, 2019. We assessed the performance of the synthetic estimation models with four indicators: the agreement between predicted and observed proportions of suicide, mean average error, root mean square error, and the proportion of correctly identified high-risk regions. Results: The sex-specific models based on individual data had good discrimination (male model: C=0.79; female model: C=0.85) and calibration (Brier score for male model 0.01; Brier score for female model 0.005). With the regression-based synthetic models applied in the validation data, the absolute differences between the synthetic risk estimates and observed suicide risk ranged from 0\% to 0.001\%. The root mean square errors were under 0.2. The synthetic estimation model for males correctly predicted 4 of 5 high-risk regions in 8 years, and the model for females correctly predicted 4 of 5 high-risk regions in 5 years. Conclusions: Using linked health administrative databases, this study demonstrated the feasibility and the validity of developing prediction models for the population risk of suicide, incorporating individual-, health system--, and community-level variables. Synthetic estimation models built on routinely collected health administrative data can accurately predict the population risk of suicide. This effort can be enhanced by timely access to other critical information at the population level. ", doi="10.2196/52773", url="https://publichealth.jmir.org/2024/1/e52773" } @Article{info:doi/10.2196/54551, author="Wass, Minh Lily and O'Keeffe Hoare, Derek and Smits, Elena Georgia and Osman, Marwan and Zhang, Ning and Klepack, William and Parrilla, Lara and Busche, M. Jefferson and Clarkberg, E. Marin and Basu, Sumanta and Cazer, L. Casey", title="Syndromic Surveillance Tracks COVID-19 Cases in University and County Settings: Retrospective Observational Study", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="27", volume="10", pages="e54551", keywords="COVID-19", keywords="epidemiology", keywords="epidemiological", keywords="SARS-CoV-2", keywords="syndromic surveillance", keywords="surveillance system", keywords="syndromic", keywords="surveillance", keywords="coronavirus", keywords="pandemic", keywords="epidemic", keywords="respiratory", keywords="infectious", keywords="predict", keywords="predictive", keywords="prediction", keywords="predictions", abstract="Background: Syndromic surveillance represents a potentially inexpensive supplement to test-based COVID-19 surveillance. By strengthening surveillance of COVID-19--like illness (CLI), targeted and rapid interventions can be facilitated that prevent COVID-19 outbreaks without primary reliance on testing. Objective: This study aims to assess the temporal relationship between confirmed SARS-CoV-2 infections and self-reported and health care provider--reported CLI in university and county settings, respectively. Methods: We collected aggregated COVID-19 testing and symptom reporting surveillance data from Cornell University (2020?2021) and Tompkins County Health Department (2020?2022). We used negative binomial and linear regression models to correlate confirmed COVID-19 case counts and positive test rates with CLI rate time series, lagged COVID-19 cases or rates, and day of the week as independent variables. Optimal lag periods were identified using Granger causality and likelihood ratio tests. Results: In modeling undergraduate student cases, the CLI rate (P=.003) and rate of exposure to CLI (P<.001) were significantly correlated with the COVID-19 test positivity rate with no lag in the linear models. At the county level, the health care provider--reported CLI rate was significantly correlated with SARS-CoV-2 test positivity with a 3-day lag in both the linear (P<.001) and negative binomial model (P=.005). Conclusions: The real-time correlation between syndromic surveillance and COVID-19 cases on a university campus suggests symptom reporting is a viable alternative or supplement to COVID-19 surveillance testing. At the county level, syndromic surveillance is also a leading indicator of COVID-19 cases, enabling quick action to reduce transmission. Further research should investigate COVID-19 risk using syndromic surveillance in other settings, such as low-resource settings like low- and middle-income countries. ", doi="10.2196/54551", url="https://publichealth.jmir.org/2024/1/e54551" } @Article{info:doi/10.2196/54250, author="Babona Nshuti, Aimee Marie and Touray, Kebba and Muluh, Johnson Ticha and Ubong, Akpan Godwin and Ngofa, Opara Reuben and Mohammed, Isa Bello and Roselyne, Ishimwe and Oviaesu, David and Bakata, Oliver Evans Mawa and Lau, Fiona and Kipterer, John and Green, W. Hugh Henry and Seaman, Vincent and Ahmed, A. Jamal and Ndoutabe, Modjirom", title="Development of a Consolidated Health Facility Masterlist Using Data From Polio Electronic Surveillance in the World Health Organization African Region", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="21", volume="10", pages="e54250", keywords="African region", keywords="electronic surveillance", keywords="geographic information systems", keywords="Global Polio Eradication Initiative", keywords="integrated supportive supervision", keywords="polio", doi="10.2196/54250", url="https://publichealth.jmir.org/2024/1/e54250", url="http://www.ncbi.nlm.nih.gov/pubmed/38904997" } @Article{info:doi/10.2196/53551, author="Lundberg, L. Alexander and Wu, A. Scott and Soetikno, G. Alan and Hawkins, Claudia and Murphy, L. Robert and Havey, J. Robert and Ozer, A. Egon and Moss, B. Charles and Welch, B. Sarah and Mason, Maryann and Liu, Yingxuan and Post, A. Lori", title="Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Europe: Longitudinal Trend Analysis", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="21", volume="10", pages="e53551", keywords="Europe", keywords="COVID-19", keywords="history of the pandemic", keywords="method of the moments", keywords="Arellano-Bond estimators", keywords="Albania", keywords="Andorra", keywords="Austria", keywords="Belarus", keywords="Belgium", keywords="Bosnia and Herzegovina", keywords="Bulgaria", keywords="Croatia", keywords="the Czech Republic", keywords="Denmark", keywords="Estonia", keywords="Finland", keywords="France", keywords="Germany", keywords="Greece", keywords="Greenland", keywords="Hungary", keywords="Iceland", keywords="Ireland", keywords="the Isle of Man", keywords="Italy", keywords="Latvia", keywords="Liechtenstein", keywords="Lithuania", keywords="Luxembourg", keywords="Moldova", keywords="Monaco", keywords="Montenegro", keywords="the Netherlands", keywords="Norway", keywords="Poland", keywords="Portugal", keywords="Romania", keywords="San Marino", keywords="Serbia", keywords="Slovakia", keywords="Slovenia", keywords="Spain", keywords="Sweden", keywords="Switzerland", keywords="Ukraine", keywords="the United Kingdom", keywords="the Vatican City", abstract="Background: In this study, we built upon our initial research published in 2020 by incorporating an additional 2 years of data for Europe. We assessed whether COVID-19 had shifted from the pandemic to endemic phase in the region when the World Health Organization (WHO) declared the end of the public health emergency of international concern on May 5, 2023. Objective: We first aimed to measure whether there was an expansion or contraction in the pandemic in Europe at the time of the WHO declaration. Second, we used dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we provided the historical context for the course of the pandemic in Europe in terms of policy and disease burden at the country and region levels. Methods: In addition to the updates of traditional surveillance data and dynamic panel estimates from the original study, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-tailed t test for whether regional weekly speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. Results: Speed for the region had remained below the outbreak threshold for 4 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. While the 1-day and 7-day persistence coefficients remained statistically significant, the coefficients were moderate in magnitude (0.404 and 0.547, respectively; P<.001 for both). The shift parameters for the 2 weeks around the WHO declaration were small and insignificant, suggesting little change in the clustering effect of cases on future cases at the time. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of speed equal to 10 became insignificant for the first time in April 2023. Conclusions: While COVID-19 continues to circulate in Europe, the rate of transmission remained below the threshold of an outbreak for 4 months ahead of the WHO declaration. The region had previously been in a nearly continuous state of outbreak. The more recent trend suggested that COVID-19 was endemic in the region and no longer reached the threshold of the pandemic definition. However, several countries remained in a state of outbreak, and the conclusion that COVID-19 was no longer a pandemic in Europe at the time is unclear. ", doi="10.2196/53551", url="https://publichealth.jmir.org/2024/1/e53551", url="http://www.ncbi.nlm.nih.gov/pubmed/38568186" } @Article{info:doi/10.2196/57164, author="Huang, Liang-Chin and Eiden, L. Amanda and He, Long and Annan, Augustine and Wang, Siwei and Wang, Jingqi and Manion, J. Frank and Wang, Xiaoyan and Du, Jingcheng and Yao, Lixia", title="Natural Language Processing--Powered Real-Time Monitoring Solution for Vaccine Sentiments and Hesitancy on Social Media: System Development and Validation", journal="JMIR Med Inform", year="2024", month="Jun", day="21", volume="12", pages="e57164", keywords="vaccine sentiment", keywords="vaccine hesitancy", keywords="natural language processing", keywords="NLP", keywords="social media", keywords="social media platforms", keywords="real-time tracking", keywords="vaccine", keywords="vaccines", keywords="sentiment", keywords="sentiments", keywords="vaccination", keywords="vaccinations", keywords="hesitancy", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", keywords="machine learning", keywords="uptake", keywords="willing", keywords="willingness", keywords="classification", abstract="Background: Vaccines serve as a crucial public health tool, although vaccine hesitancy continues to pose a significant threat to full vaccine uptake and, consequently, community health. Understanding and tracking vaccine hesitancy is essential for effective public health interventions; however, traditional survey methods present various limitations. Objective: This study aimed to create a real-time, natural language processing (NLP)--based tool to assess vaccine sentiment and hesitancy across 3 prominent social media platforms. Methods: We mined and curated discussions in English from Twitter (subsequently rebranded as X), Reddit, and YouTube social media platforms posted between January 1, 2011, and October 31, 2021, concerning human papillomavirus; measles, mumps, and rubella; and unspecified vaccines. We tested multiple NLP algorithms to classify vaccine sentiment into positive, neutral, or negative and to classify vaccine hesitancy using the World Health Organization's (WHO) 3Cs (confidence, complacency, and convenience) hesitancy model, conceptualizing an online dashboard to illustrate and contextualize trends. Results: We compiled over 86 million discussions. Our top-performing NLP models displayed accuracies ranging from 0.51 to 0.78 for sentiment classification and from 0.69 to 0.91 for hesitancy classification. Explorative analysis on our platform highlighted variations in online activity about vaccine sentiment and hesitancy, suggesting unique patterns for different vaccines. Conclusions: Our innovative system performs real-time analysis of sentiment and hesitancy on 3 vaccine topics across major social networks, providing crucial trend insights to assist campaigns aimed at enhancing vaccine uptake and public health. ", doi="10.2196/57164", url="https://medinform.jmir.org/2024/1/e57164", url="http://www.ncbi.nlm.nih.gov/pubmed/38904984" } @Article{info:doi/10.2196/57807, author="Ma, Shuli and Ge, Jie and Qin, Lei and Chen, Xiaoting and Du, Linlin and Qi, Yanbo and Bai, Li and Han, Yunfeng and Xie, Zhiping and Chen, Jiaxin and Jia, Yuehui", title="Spatiotemporal Epidemiological Trends of Mpox in Mainland China: Spatiotemporal Ecological Comparison Study", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="19", volume="10", pages="e57807", keywords="mpox", keywords="spatiotemporal analysis", keywords="emergencies", keywords="prevention and control", keywords="public health", abstract="Background: The World Health Organization declared mpox an international public health emergency. Since January 1, 2022, China has been ranked among the top 10 countries most affected by the mpox outbreak globally. However, there is a lack of spatial epidemiological studies on mpox, which are crucial for accurately mapping the spatial distribution and clustering of the disease. Objective: This study aims to provide geographically accurate visual evidence to determine priority areas for mpox prevention and control. Methods: Locally confirmed mpox cases were collected between June and November 2023 from 31 provinces of mainland China excluding Taiwan, Macao, and Hong Kong. Spatiotemporal epidemiological analyses, including spatial autocorrelation and regression analyses, were conducted to identify the spatiotemporal characteristics and clustering patterns of mpox attack rate and its spatial relationship with sociodemographic and socioeconomic factors. Results: From June to November 2023, a total of 1610 locally confirmed mpox cases were reported in 30 provinces in mainland China, resulting in an attack rate of 11.40 per 10 million people. Global spatial autocorrelation analysis showed that in July (Moran I=0.0938; P=.08), August (Moran I=0.1276; P=.08), and September (Moran I=0.0934; P=.07), the attack rates of mpox exhibited a clustered pattern and positive spatial autocorrelation. The Getis-Ord Gi* statistics identified hot spots of mpox attack rates in Beijing, Tianjin, Shanghai, Jiangsu, and Hainan. Beijing and Tianjin were consistent hot spots from June to October. No cold spots with low mpox attack rates were detected by the Getis-Ord Gi* statistics. Local Moran I statistics identified a high-high (HH) clustering of mpox attack rates in Guangdong, Beijing, and Tianjin. Guangdong province consistently exhibited HH clustering from June to November, while Beijing and Tianjin were identified as HH clusters from July to September. Low-low clusters were mainly located in Inner Mongolia, Xinjiang, Xizang, Qinghai, and Gansu. Ordinary least squares regression models showed that the cumulative mpox attack rates were significantly and positively associated with the proportion of the urban population (t0.05/2,1=2.4041 P=.02), per capita gross domestic product (t0.05/2,1=2.6955; P=.01), per capita disposable income (t0.05/2,1=2.8303; P=.008), per capita consumption expenditure (PCCE; t0.05/2,1=2.7452; P=.01), and PCCE for health care (t0.05/2,1=2.5924; P=.01). The geographically weighted regression models indicated a positive association and spatial heterogeneity between cumulative mpox attack rates and the proportion of the urban population, per capita gross domestic product, per capita disposable income, and PCCE, with high R2 values in north and northeast China. Conclusions: Hot spots and HH clustering of mpox attack rates identified by local spatial autocorrelation analysis should be considered key areas for precision prevention and control of mpox. Specifically, Guangdong, Beijing, and Tianjin provinces should be prioritized for mpox prevention and control. These findings provide geographically precise and visualized evidence to assist in identifying key areas for targeted prevention and control. ", doi="10.2196/57807", url="https://publichealth.jmir.org/2024/1/e57807", url="http://www.ncbi.nlm.nih.gov/pubmed/38896444" } @Article{info:doi/10.2196/48815, author="Miao, Huazhang and He, Hui and Nie, Chuan and Ren, Jianbing and Luo, Xianqiong", title="Spatiotemporal Characteristics and Risk Factors for All and Severity-Specific Preterm Births in Southern China, 2014-2021: Large Population-Based Study", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="18", volume="10", pages="e48815", keywords="preterm birth", keywords="spatiotemporal", keywords="incidence", keywords="risk", keywords="neonatal", keywords="infant", keywords="pregnancy health", keywords="pregnancy complication", keywords="pregnancy", keywords="birth defect", keywords="birth defects", keywords="obstetric labor", keywords="premature", abstract="Background: The worldwide incidence of preterm births is increasing, and the risks of adverse outcomes for preterm infants significantly increase with shorter gestation, resulting in a substantial socioeconomic burden. Limited epidemiological studies have been conducted in China regarding the incidence and spatiotemporal trends of preterm births. Seasonal variations in risk indicate the presence of possible modifiable factors. Gender influences the risk of preterm birth. Objective: This study aims to assess the incidence rates of preterm birth, very preterm birth, and extremely preterm birth; elucidate their spatiotemporal distribution; and investigate the risk factors associated with preterm birth. Methods: We obtained data from the Guangdong Provincial Maternal and Child Health Information System, spanning from January 1, 2014, to December 31, 2021, pertaining to neonates with gestational ages ranging from 24 weeks to 42 weeks. The primary outcome measures assessed variations in the rates of different preterm birth subtypes over the course of the study, such as by year, region, and season. Furthermore, we examined the relationship between preterm birth incidence and per capita gross domestic product (GDP), simultaneously analyzing the contributing risk factors. Results: The analysis incorporated data from 13,256,743 live births. We identified 754,268 preterm infants and 12,502,475 full-term infants. The incidences of preterm birth, very preterm birth, and extremely preterm birth were 5.69 per 100 births, 4.46 per 1000 births, and 4.83 per 10,000 births, respectively. The overall incidence of preterm birth increased from 5.12\% in 2014 to 6.38\% in 2021. The incidence of extremely preterm birth increased from 4.10 per 10,000 births in 2014 to 8.09 per 10,000 births in 2021. There was a positive correlation between the incidence of preterm infants and GDP per capita. In more developed economic regions, the incidence of preterm births was higher. Furthermore, adjusted odds ratios revealed that advanced maternal age, multiple pregnancies, and male infants were associated with an increased risk of preterm birth, whereas childbirth in the autumn season was associated with a protective effect against preterm birth. Conclusions: The incidence of preterm birth in southern China exhibited an upward trend, closely linked to enhancements in the care capabilities for high-risk pregnant women and critically ill newborns. With the recent relaxation of China's 3-child policy, coupled with a temporary surge in advanced maternal age and multiple pregnancies, the risk of preterm birth has risen. Consequently, there is a pressing need to augment public health investments aimed at mitigating the risk factors associated with preterm birth, thereby alleviating the socioeconomic burden it imposes. ", doi="10.2196/48815", url="https://publichealth.jmir.org/2024/1/e48815", url="http://www.ncbi.nlm.nih.gov/pubmed/38888944" } @Article{info:doi/10.2196/42050, author="Rahi, Manju and Mishra, AK and Chand, Gyan and Baharia, RK and Hazara, RK and Singh, SP and Khan, Siraj and Sreehari, U. and Kamaraju, Divya and Kumar, Gaurav and Gupta, Kumar Sanjeev and Sharma, Amit and Raghavendra, K. and Gunasekaran, K. and Singh, P. Om and Subbarao, K. Sarala", title="Malaria Vector Bionomics: Countrywide Surveillance Study on Implications for Malaria Elimination in India", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="17", volume="10", pages="e42050", keywords="malaria", keywords="bionomics", keywords="sibling species", keywords="insecticide resistance", keywords="elimination", keywords="India", abstract="Background: The biological characteristics of mosquito vectors vary, impacting their response to control measures. Thus, having up-to-date information on vector bionomics is essential to maintain the effectiveness of existing control strategies and tools, particularly as India aims for malaria elimination by 2030. Objective: This study aims to assess the proportions of vector species resting indoors and outdoors, determine their preference for host biting/feeding, identify transmission sites, and evaluate the susceptibility of vectors to insecticides used in public health programs. Methods: Mosquito collections were conducted in 13 districts across 8 Indian states from 2017 to 2020 using various methods to estimate their densities. Following morphological identification in the field, sibling species of Anopheles mosquitoes were identified molecularly using polymerase chain reaction (PCR)--specific alleles. Plasmodium falciparum and Plasmodium vivax infections in the vectors were detected using enzyme-linked immunosorbent assay (ELISA) and PCR assays. In addition, we assessed the insecticide susceptibility status of primary malaria vectors following the World Health Organization (WHO) protocol. Results: Anopheles culicifacies, a primary malaria vector, was collected (with a man-hour density ranging from 3.1 to 15.9) from all states of India except those in the northeastern region. Anopheles fluviatilis, another primary vector, was collected from the states of Madhya Pradesh, Maharashtra, Karnataka, and Odisha. In Haryana and Karnataka, An. culicifacies sibling species A predominated, whereas species C and E were predominant in Madhya Pradesh and Maharashtra. An. culicifacies displayed mainly endophilic behavior across all states, except in Madhya Pradesh, where the proportion of semigravid and gravid mosquitoes was nearly half of that of unfed mosquitoes. The human blood index of An. culicifacies ranged from 0.001 to 0.220 across all study sites. The sporozoite rate of An. culicifacies ranged from 0.06 to 4.24, except in Madhya Pradesh, where none of the vector mosquitoes were found to be infected with the Plasmodium parasite. In the study area, An. culicifacies exhibited resistance to DDT (dichlorodiphenyltrichloroethane; with <39\% mortality). Moreover, it showed resistance to malathion (with mortality rates ranging from 49\% to 78\%) in all districts except Angul in Odisha and Palwal in Haryana. In addition, resistance to deltamethrin was observed in districts of Maharashtra, Gujarat, Haryana, and Karnataka. Conclusions: Our study offers vital insights into the prevalence, resting behavior, and sibling species composition of malaria vectors in India. It is evident from our findings that resistance development in An. culicifacies, the primary vector, to synthetic pyrethroids is on the rise in the country. Furthermore, the results of our study suggest a potential change in the resting behavior of An. culicifacies in Madhya Pradesh, although further studies are required to confirm this shift definitively. These findings are essential for the development of effective vector control strategies in India, aligning with the goal of malaria elimination by 2030. ", doi="10.2196/42050", url="https://publichealth.jmir.org/2024/1/e42050", url="http://www.ncbi.nlm.nih.gov/pubmed/38885497" } @Article{info:doi/10.2196/56064, author="Wang, Qiang and Yang, Liuqing and Xiu, Shixin and Shen, Yuan and Jin, Hui and Lin, Leesa", title="A Prediction Model for Identifying Seasonal Influenza Vaccination Uptake Among Children in Wuxi, China: Prospective Observational Study", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="17", volume="10", pages="e56064", keywords="influenza", keywords="vaccination", keywords="children", keywords="prediction model", keywords="China", keywords="vaccine", keywords="behaviors", keywords="health care professional", keywords="intervention", keywords="sociodemographics", keywords="vaccine hesitancy", keywords="clinic", keywords="Bayesian network", keywords="logistic regression", keywords="accuracy", keywords="Cohen $\kappa$", keywords="prediction", keywords="public health", keywords="immunization", keywords="digital age", abstract="Background: Predicting vaccination behaviors accurately could provide insights for health care professionals to develop targeted interventions. Objective: The aim of this study was to develop predictive models for influenza vaccination behavior among children in China. Methods: We obtained data from a prospective observational study in Wuxi, eastern China. The predicted outcome was individual-level vaccine uptake and covariates included sociodemographics of the child and parent, parental vaccine hesitancy, perceptions of convenience to the clinic, satisfaction with clinic services, and willingness to vaccinate. Bayesian networks, logistic regression, least absolute shrinkage and selection operator (LASSO) regression, support vector machine (SVM), naive Bayes (NB), random forest (RF), and decision tree classifiers were used to construct prediction models. Various performance metrics, including area under the receiver operating characteristic curve (AUC), were used to evaluate the predictive performance of the different models. Receiver operating characteristic curves and calibration plots were used to assess model performance. Results: A total of 2383 participants were included in the study; 83.2\% of these children (n=1982) were <5 years old and 6.6\% (n=158) had previously received an influenza vaccine. More than half (1356/2383, 56.9\%) the parents indicated a willingness to vaccinate their child against influenza. Among the 2383 children, 26.3\% (n=627) received influenza vaccination during the 2020-2021 season. Within the training set, the RF model showed the best performance across all metrics. In the validation set, the logistic regression model and NB model had the highest AUC values; the SVM model had the highest precision; the NB model had the highest recall; and the logistic regression model had the highest accuracy, F1 score, and Cohen $\kappa$ value. The LASSO and logistic regression models were well-calibrated. Conclusions: The developed prediction model can be used to quantify the uptake of seasonal influenza vaccination for children in China. The stepwise logistic regression model may be better suited for prediction purposes. ", doi="10.2196/56064", url="https://publichealth.jmir.org/2024/1/e56064", url="http://www.ncbi.nlm.nih.gov/pubmed/38885032" } @Article{info:doi/10.2196/57209, author="Lai, Peixuan and Cai, Weicong and Qu, Lin and Hong, Chuangyue and Lin, Kaihao and Tan, Weiguo and Zhao, Zhiguang", title="Pulmonary Tuberculosis Notification Rate Within Shenzhen, China, 2010-2019: Spatial-Temporal Analysis", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="14", volume="10", pages="e57209", keywords="tuberculosis", keywords="spatial analysis", keywords="spatial-temporal cluster", keywords="Shenzhen", keywords="China", abstract="Background: Pulmonary tuberculosis (PTB) is a chronic communicable disease of major public health and social concern. Although spatial-temporal analysis has been widely used to describe distribution characteristics and transmission patterns, few studies have revealed the changes in the small-scale clustering of PTB at the street level. Objective: The aim of this study was to analyze the temporal and spatial distribution characteristics and clusters of PTB at the street level in the Shenzhen municipality of China to provide a reference for PTB prevention and control. Methods: Data of reported PTB cases in Shenzhen from January 2010 to December 2019 were extracted from the China Information System for Disease Control and Prevention to describe the epidemiological characteristics. Time-series, spatial-autocorrelation, and spatial-temporal scanning analyses were performed to identify the spatial and temporal patterns and high-risk areas at the street level. Results: A total of 58,122 PTB cases from 2010 to 2019 were notified in Shenzhen. The annual notification rate of PTB decreased significantly from 64.97 per 100,000 population in 2010 to 43.43 per 100,000 population in 2019. PTB cases exhibited seasonal variations with peaks in late spring and summer each year. The PTB notification rate was nonrandomly distributed and spatially clustered with a Moran I value of 0.134 (P=.02). One most-likely cluster and 10 secondary clusters were detected, and the most-likely clustering area was centered at Nanshan Street of Nanshan District covering 6 streets, with the clustering time spanning from January 2010 to November 2012. Conclusions: This study identified seasonal patterns and spatial-temporal clusters of PTB cases at the street level in the Shenzhen municipality of China. Resources should be prioritized to the identified high-risk areas for PTB prevention and control. ", doi="10.2196/57209", url="https://publichealth.jmir.org/2024/1/e57209", url="http://www.ncbi.nlm.nih.gov/pubmed/38875687" } @Article{info:doi/10.2196/56906, author="He, Lin and Jiang, Tingting and Chen, Wanjun and Jiang, Shaoqiang and Zheng, Jinlei and Chen, Weiyong and Wang, Hui and Ma, Qiaoqin and Chai, Chengliang", title="Examining HIV Testing Coverage and Factors Influencing First-Time Testing Among Men Who Have Sex With Men in Zhejiang Province, China: Cross-Sectional Study Based on a Large Internet Survey", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="14", volume="10", pages="e56906", keywords="HIV", keywords="testing", keywords="men who have sex with men", keywords="MSM", keywords="internet", keywords="pre-exposure prophylaxis", keywords="China", keywords="mobile phone", abstract="Background: Men who have sex with men (MSM) constitute a significant population of patients infected with HIV. In recent years, several efforts have been made to promote HIV testing among MSM in China. Objective: This study aimed to assess HIV testing coverage and factors associated with first-time HIV testing among MSM to provide a scientific basis for achieving the goal of diagnosing 95\% of patients infected with HIV by 2030. Methods: This cross-sectional study was conducted between July 2023 and December 2023. MSM were recruited from the ``Sunshine Test,'' an internet platform that uses location-based services to offer free HIV testing services to MSM by visiting the WeChat official account in Zhejiang Province, China. Participants were required to complete a questionnaire on their demographic characteristics, sexual behaviors, substance use, and HIV testing history. A logistic regression model was used to analyze first-time HIV testing and its associated factors. Results: A total of 7629 MSM participated in the study, with 87.1\% (6647) having undergone HIV testing before and 12.9\% (982) undergoing HIV testing for the first time. Multivariate logistic regression analysis revealed that first-time HIV testing was associated with younger age (adjusted odds ratio [aOR] 2.55, 95\% CI 1.91-3.42), lower education (aOR 1.39, 95\% CI 1.03-1.88), student status (aOR 1.35, 95\% CI 1.04-1.75), low income (aOR 1.55, 95\% CI 1.16-2.08), insertive anal sex role (aOR 1.28, 95\% CI 1.05-1.56), bisexuality (aOR 1.69, 95\% CI 1.40-2.03), fewer sex partners (aOR 1.44, 95\% CI 1.13-1.83), use of rush poppers (aOR 2.06, 95\% CI 1.70-2.49), unknown HIV status of sex partners (aOR 1.40, 95\% CI 1.17-1.69), lack of awareness of HIV pre-exposure prophylaxis (aOR 1.39, 95\% CI 1.03-1.88), and offline HIV testing uptake (aOR 2.08, 95\% CI 1.80-2.41). Conclusions: A notable 12.9\% (982/7629) of MSM had never undergone HIV testing before this large internet survey. We recommend enhancing HIV intervention and testing through internet-based platforms and gay apps to promote testing among MSM and achieve the target of diagnosing 95\% of patients infected with HIV by 2030. ", doi="10.2196/56906", url="https://publichealth.jmir.org/2024/1/e56906", url="http://www.ncbi.nlm.nih.gov/pubmed/38875001" } @Article{info:doi/10.2196/53219, author="Soetikno, G. Alan and Lundberg, L. Alexander and Ozer, A. Egon and Wu, A. Scott and Welch, B. Sarah and Mason, Maryann and Liu, Yingxuan and Havey, J. Robert and Murphy, L. Robert and Hawkins, Claudia and Moss, B. Charles and Post, Ann Lori", title="Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in the Middle East and North Africa: Longitudinal Trend Analysis", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="12", volume="10", pages="e53219", keywords="SARS-CoV-2", keywords="COVID-19", keywords="Middle East", keywords="North Africa", keywords="Bahrain", keywords="Iran", keywords="Iraq", keywords="Israel", keywords="Jordan", keywords="Kuwait", keywords="Lebanon", keywords="Oman", keywords="Qatar", keywords="Saudi Arabia", keywords="Syria", keywords="the United Arab Emirates", keywords="Yemen", keywords="Algeria", keywords="Djibouti", keywords="Egypt", keywords="Libya", keywords="Morocco", keywords="Tunisia", keywords="pandemic history", keywords="COVID-19 transmission", keywords="speed", keywords="acceleration", keywords="deceleration", keywords="jerk", keywords="dynamic panel", keywords="generalized method of moments", keywords="Arellano-Bond", keywords="7-day lag", abstract="Background: This study updates the COVID-19 pandemic surveillance in the Middle East and North Africa (MENA) we first conducted in 2020 with 2 additional years of data for the region. Objective: The objective of this study is to determine whether the MENA region meets the criteria for moving from a pandemic to endemic. In doing so, this study considers pandemic trends, dynamic and genomic surveillance methods, and region-specific historical context for the pandemic. These considerations continue through the World Health Organization (WHO) declaration of the end of the public health emergency for the COVID-19 pandemic on May 5, 2023. Methods: In addition to updates to traditional surveillance data and dynamic panel estimates from the original study by Post et al, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t test to determine whether regional weekly speed of COVID-19 spread was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data from September 4, 2020, to May 12, 2023. Results: The speed of COVID-19 spread for the region had remained below the outbreak threshold for 7 continuous months by the time of the WHO declaration. Acceleration and jerk were also low and stable. Although the 1- and 7-day persistence coefficients remained statistically significant and positive, the weekly shift parameters suggested the coefficients had most recently turned negative, meaning the clustering effect of new COVID-19 cases became even smaller in the 2 weeks around the WHO declaration. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of the speed of spread equal to 10 became entirely insignificant from October 2022 onward. Conclusions: The COVID-19 pandemic had far-reaching effects on MENA, impacting health care systems, economies, and social well-being. Although COVID-19 continues to circulate in the MENA region, the rate of transmission remained well below the threshold of an outbreak for over 1 year ahead of the WHO declaration. COVID-19 is endemic in the region and no longer reaches the threshold of the pandemic definition. Both standard and enhanced surveillance metrics confirm that the pandemic had transitioned to endemic by the time of the WHO declaration. ", doi="10.2196/53219", url="https://publichealth.jmir.org/2024/1/e53219", url="http://www.ncbi.nlm.nih.gov/pubmed/38568184" } @Article{info:doi/10.2196/50653, author="Levin-Rector, Alison and Kulldorff, Martin and Peterson, R. Eric and Hostovich, Scott and Greene, K. Sharon", title="Prospective Spatiotemporal Cluster Detection Using SaTScan: Tutorial for Designing and Fine-Tuning a System to Detect Reportable Communicable Disease Outbreaks", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="11", volume="10", pages="e50653", keywords="communicable diseases", keywords="disease outbreaks", keywords="disease surveillance", keywords="epidemiology", keywords="infectious disease", keywords="outbreak detection", keywords="public health practice", keywords="SaTScan", keywords="spatiotemporal", keywords="urban health", doi="10.2196/50653", url="https://publichealth.jmir.org/2024/1/e50653", url="http://www.ncbi.nlm.nih.gov/pubmed/38861711" } @Article{info:doi/10.2196/57239, author="Salvi, Amey and Gillenwater, A. Logan and Cockrum, P. Brandon and Wiehe, E. Sarah and Christian, Kaitlyn and Cayton, John and Bailey, Timothy and Schwartz, Katherine and Dir, L. Allyson and Ray, Bradley and Aalsma, C. Matthew and Reda, Khairi", title="Development of a Real-Time Dashboard for Overdose Touchpoints: User-Centered Design Approach", journal="JMIR Hum Factors", year="2024", month="Jun", day="11", volume="11", pages="e57239", keywords="overdose prevention", keywords="dashboards", keywords="fatality review", keywords="data integration", keywords="visualizations", keywords="visualization", keywords="dashboard", keywords="fatality", keywords="death", keywords="overdose", keywords="overdoses", keywords="overdosing", keywords="prevention", keywords="develop", keywords="development", keywords="design", keywords="interview", keywords="interviews", keywords="focus group", keywords="focus groups", keywords="touchpoints", keywords="touchpoint", keywords="substance abuse", keywords="drug abuse", abstract="Background: Overdose Fatality Review (OFR) is an important public health tool for shaping overdose prevention strategies in communities. However, OFR teams review only a few cases at a time, which typically represent a small fraction of the total fatalities in their jurisdiction. Such limited review could result in a partial understanding of local overdose patterns, leading to policy recommendations that do not fully address the broader community needs. Objective: This study explored the potential to enhance conventional OFRs with a data dashboard, incorporating visualizations of touchpoints---events that precede overdoses---to highlight prevention opportunities. Methods: We conducted 2 focus groups and a survey of OFR experts to characterize their information needs and design a real-time dashboard that tracks and measures decedents' past interactions with services in Indiana. Experts (N=27) were engaged, yielding insights on essential data features to incorporate and providing feedback to guide the development of visualizations. Results: The findings highlighted the importance of showing decedents' interactions with health services (emergency medical services) and the justice system (incarcerations). Emphasis was also placed on maintaining decedent anonymity, particularly in small communities, and the need for training OFR members in data interpretation. The developed dashboard summarizes key touchpoint metrics, including prevalence, interaction frequency, and time intervals between touchpoints and overdoses, with data viewable at the county and state levels. In an initial evaluation, the dashboard was well received for its comprehensive data coverage and its potential for enhancing OFR recommendations and case selection. Conclusions: The Indiana touchpoints dashboard is the first to display real-time visualizations that link administrative and overdose mortality data across the state. This resource equips local health officials and OFRs with timely, quantitative, and spatiotemporal insights into overdose risk factors in their communities, facilitating data-driven interventions and policy changes. However, fully integrating the dashboard into OFR practices will likely require training teams in data interpretation and decision-making. ", doi="10.2196/57239", url="https://humanfactors.jmir.org/2024/1/e57239", url="http://www.ncbi.nlm.nih.gov/pubmed/38861717" } @Article{info:doi/10.2196/56643, author="Bennett, W. Brady and DuBose, Stephanie and Huang, A. Ya-Lin and Johnson, H. Christopher and Hoover, W. Karen and Wiener, Jeffrey and Purcell, W. David and Sullivan, S. Patrick", title="Population Percentage and Population Size of Men Who Have Sex With Men in the United States, 2017-2021: Meta-Analysis of 5 Population-Based Surveys", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="11", volume="10", pages="e56643", keywords="sexual behavior", keywords="sexual identity", keywords="sexual attraction", keywords="men who have sex with men", keywords="population estimates", keywords="MSM", keywords="men who have sex with other men", keywords="national surveys", keywords="census", keywords="United States", abstract="Background: Male-to-male sexual transmission continues to account for the greatest proportion of new HIV diagnoses in the United States. However, calculating population-specific surveillance metrics for HIV and other sexually transmitted infections requires regularly updated estimates of the number and proportion of men who have sex with men (MSM) in the United States, which are not collected by census surveys. Objective: The purpose of this analysis was to estimate the number and percentage of MSM in the United States from population-based surveys. Methods: We used data from 5 population-based surveys to calculate weighted estimates of the proportion of MSM in the United States and pooled these estimates using meta-analytic procedures. We estimated the proportion of MSM using sexual behavior--based questions (encompassing anal or oral sex) for 3 recall periods---past 12 months, past 5 years, and lifetime. In addition, we estimated the proportion of MSM using self-reported identity and attraction survey responses. The total number of MSM and non-MSM in the United States were calculated from estimates of the percentage of MSM who reported sex with another man in the past 12 months. Results: The percentage of MSM varied by recall period: 3.3\% (95\% CI 1.7\%-4.9\%) indicated sex with another male in the past 12 months, 4.7\% (95\% CI 0.0\%-33.8\%) in the past 5 years, and 6.2\% (95\% CI 2.9\%-9.5\%) in their lifetime. There were comparable percentages of men who identified as gay or bisexual (3.4\%, 95\% CI 2.2\%-4.6\%) or who indicated that they are attracted to other men (4.9\%, 95\% CI 3.1\%-6.7\%) based on pooled estimates. Our estimate of the total number of MSM in the United States is 4,230,000 (95\% CI 2,179,000-6,281,000) based on the history of recent sexual behavior (sex with another man in the past 12 months). Conclusions: We calculated the pooled percentage and number of MSM in the United States from a meta-analysis of population-based surveys collected from 2017 to 2021. These estimates update and expand upon those derived from the Centers for Disease Control and Prevention in 2012 by including estimates of the percentage of MSM based on sexual identity and sexual attraction. The percentage and number of MSM in the United States is an important indicator for calculating population-specific disease rates and eligibility for preventive interventions such as pre-exposure prophylaxis. ", doi="10.2196/56643", url="https://publichealth.jmir.org/2024/1/e56643", url="http://www.ncbi.nlm.nih.gov/pubmed/38861303" } @Article{info:doi/10.2196/50049, author="Stellmach, Caroline and Hopff, Marie Sina and Jaenisch, Thomas and Nunes de Miranda, Marina Susana and Rinaldi, Eugenia and ", title="Creation of Standardized Common Data Elements for Diagnostic Tests in Infectious Disease Studies: Semantic and Syntactic Mapping", journal="J Med Internet Res", year="2024", month="Jun", day="10", volume="26", pages="e50049", keywords="core data element", keywords="CDE", keywords="case report form", keywords="CRF", keywords="interoperability", keywords="semantic standards", keywords="infectious disease", keywords="diagnostic test", keywords="covid19", keywords="COVID-19", keywords="mpox", keywords="ZIKV", keywords="patient data", keywords="data model", keywords="syntactic interoperability", keywords="clinical data", keywords="FHIR", keywords="SNOMED CT", keywords="LOINC", keywords="virus infection", keywords="common element", abstract="Background: It is necessary to harmonize and standardize data variables used in case report forms (CRFs) of clinical studies to facilitate the merging and sharing of the collected patient data across several clinical studies. This is particularly true for clinical studies that focus on infectious diseases. Public health may be highly dependent on the findings of such studies. Hence, there is an elevated urgency to generate meaningful, reliable insights, ideally based on a high sample number and quality data. The implementation of core data elements and the incorporation of interoperability standards can facilitate the creation of harmonized clinical data sets. Objective: This study's objective was to compare, harmonize, and standardize variables focused on diagnostic tests used as part of CRFs in 6 international clinical studies of infectious diseases in order to, ultimately, then make available the panstudy common data elements (CDEs) for ongoing and future studies to foster interoperability and comparability of collected data across trials. Methods: We reviewed and compared the metadata that comprised the CRFs used for data collection in and across all 6 infectious disease studies under consideration in order to identify CDEs. We examined the availability of international semantic standard codes within the Systemized Nomenclature of Medicine - Clinical Terms, the National Cancer Institute Thesaurus, and the Logical Observation Identifiers Names and Codes system for the unambiguous representation of diagnostic testing information that makes up the CDEs. We then proposed 2 data models that incorporate semantic and syntactic standards for the identified CDEs. Results: Of 216 variables that were considered in the scope of the analysis, we identified 11 CDEs to describe diagnostic tests (in particular, serology and sequencing) for infectious diseases: viral lineage/clade; test date, type, performer, and manufacturer; target gene; quantitative and qualitative results; and specimen identifier, type, and collection date. Conclusions: The identification of CDEs for infectious diseases is the first step in facilitating the exchange and possible merging of a subset of data across clinical studies (and with that, large research projects) for possible shared analysis to increase the power of findings. The path to harmonization and standardization of clinical study data in the interest of interoperability can be paved in 2 ways. First, a map to standard terminologies ensures that each data element's (variable's) definition is unambiguous and that it has a single, unique interpretation across studies. Second, the exchange of these data is assisted by ``wrapping'' them in a standard exchange format, such as Fast Health care Interoperability Resources or the Clinical Data Interchange Standards Consortium's Clinical Data Acquisition Standards Harmonization Model. ", doi="10.2196/50049", url="https://www.jmir.org/2024/1/e50049", url="http://www.ncbi.nlm.nih.gov/pubmed/38857066" } @Article{info:doi/10.2196/55194, author="Huang, Xuefeng and Kong, Qian-Yi and Wan, Xiaowen and Huang, Yating and Wang, Rongrong and Wang, Xiaoxue and Li, Yingying and Wu, Yuqing and Guan, Chongyuan and Wang, Junyang and Zhang, Yuanyuan", title="From the Public Health Perspective: a Scalable Model for Improving Epidemiological Testing Efficacy in Low- and Middle-Income Areas", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="10", volume="10", pages="e55194", keywords="low- and middle-income country", keywords="LMIC", keywords="pandemic", keywords="epidemiological surveillance", keywords="universal public health", keywords="nonpharmacological interventions", keywords="public health", keywords="callable model", keywords="efficacy", keywords="COVID-19", keywords="public safety threats", keywords="effectiveness", keywords="China", keywords="detection", keywords="epidemic", doi="10.2196/55194", url="https://publichealth.jmir.org/2024/1/e55194", url="http://www.ncbi.nlm.nih.gov/pubmed/38857063" } @Article{info:doi/10.2196/54485, author="Li, ming Yi and Jia, Yuheng and Bai, Lin and Yang, Bosen and Chen, Mao and Peng, Yong", title="U-Shaped Relationship Between Fibrinogen Level and 10-year Mortality in Patients With Acute Coronary Syndrome: Prospective Cohort Study", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="7", volume="10", pages="e54485", keywords="fibrinogen", keywords="acute coronary syndrome", keywords="10-year mortality", keywords="risk factor", keywords="coronary artery disease", keywords="myocardial", keywords="heart disease", keywords="inflammatory factor", keywords="retrospective study", keywords="Kaplan-Meier analysis", keywords="mortality", keywords="all-cause mortality", keywords="cubic-spline curve", keywords="regression model", doi="10.2196/54485", url="https://publichealth.jmir.org/2024/1/e54485", url="http://www.ncbi.nlm.nih.gov/pubmed/38848124" } @Article{info:doi/10.2196/56229, author="Xie, Ziyi and Chen, Bowen and Duan, Zhizhuang", title="Spatiotemporal Analysis of HIV/AIDS Incidence in China From 2009 to 2019 and Its Association With Socioeconomic Factors: Geospatial Study", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="7", volume="10", pages="e56229", keywords="HIV/AIDS", keywords="spatiotemporal distribution", keywords="cluster analysis", keywords="socioeconomic factors", keywords="China", abstract="Background: The Joint United Nations Program on HIV/AIDS (UNAIDS) has set the ``95-95-95'' targets to ensure that 95\% of all people living with HIV will know their HIV status, 95\% of all people living with HIV will receive sustained antiretroviral therapy (ART), and 95\% of all people receiving ART will achieve viral suppression (<1000 copies/mL). However, few countries have currently achieved these targets, posing challenges to the realization of the UNAIDS goal to eliminate the global HIV/AIDS epidemic by 2030. The Chinese government has implemented corresponding policies for HIV/AIDS prevention and control; however, it still faces the challenge of a large number of HIV/AIDS cases. Existing research predominantly focuses on the study of a particular region or population in China, and there is relatively limited research on the macro-level analysis of the spatiotemporal distribution of HIV/AIDS across China and its association with socioeconomic factors. Objective: This study seeks to identify the impact of these factors on the spatiotemporal distribution of HIV/AIDS incidence in China, aiming to provide scientific recommendations for future policy development. Methods: This study employed ArcGIS 10.2 (Esri) for spatial analysis, encompassing measures such as the imbalance index, geographical concentration index, spatial autocorrelation analysis (Moran I), and hot spot analysis (Getis-Ord Gi*). These methods were used to unveil the spatiotemporal distribution characteristics of HIV/AIDS incidence in 31 provinces of China from 2009 to 2019. Geographical Detector was used for ecological detection, risk area detection, factor detection, and interaction detection. The analysis focused on 9 selected socioeconomic indicators to further investigate the influence of socioeconomic factors on HIV/AIDS incidence in China. Results: The spatiotemporal distribution analysis of HIV/AIDS incidence in China from 2009 to 2019 revealed distinct patterns. The spatial distribution type of HIV/AIDS incidence in China was random in 2009-2010. However, from 2011 to 2019, the distribution pattern evolved toward a clustered arrangement, with the degree of clustering increasing each year. Notably, from 2012 onwards, there was a significant and rapid growth in the aggregation of cold and hot spot clusters of HIV/AIDS incidence in China, stabilizing only by the year 2016. An analysis of the impact of socioeconomic factors on HIV/AIDS incidence in China highlighted the ``urbanization rate'' and ``urban basic medical insurance fund expenditure'' as the primary factors influencing the spatial distribution of HIV/AIDS incidence. Additionally, among social factors, indicators related to medical resources exerted a crucial influence on HIV/AIDS incidence. Conclusions: From 2009 to 2019, HIV/AIDS incidence in China was influenced by various socioeconomic factors. In the future, it is imperative to optimize the combination of different socioeconomic indicators based on regional incidence patterns. This optimization will facilitate the formulation of corresponding policies to address the challenges posed by the HIV/AIDS epidemic. ", doi="10.2196/56229", url="https://publichealth.jmir.org/2024/1/e56229", url="http://www.ncbi.nlm.nih.gov/pubmed/38848123" } @Article{info:doi/10.2196/51323, author="Hopcroft, EM Lisa and Curtis, J. Helen and Croker, Richard and Pretis, Felix and Inglesby, Peter and Evans, David and Bacon, Sebastian and Goldacre, Ben and Walker, J. Alex and MacKenna, Brian", title="Data-Driven Identification of Potentially Successful Intervention Implementations Using 5 Years of Opioid Prescribing Data: Retrospective Database Study", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="5", volume="10", pages="e51323", keywords="electronic health records", keywords="primary care", keywords="general practice", keywords="opioid analgesics", keywords="data science", keywords="implementation science", keywords="data-driven", keywords="identification", keywords="intervention", keywords="implementations", keywords="proof of concept", keywords="opioid", keywords="unbiased", keywords="prescribing data", keywords="analysis tool", abstract="Background: We have previously demonstrated that opioid prescribing increased by 127\% between 1998 and 2016. New policies aimed at tackling this increasing trend have been recommended by public health bodies, and there is some evidence that progress is being made. Objective: We sought to extend our previous work and develop a data-driven approach to identify general practices and clinical commissioning groups (CCGs) whose prescribing data suggest that interventions to reduce the prescribing of opioids may have been successfully implemented. Methods: We analyzed 5 years of prescribing data (December 2014 to November 2019) for 3 opioid prescribing measures---total opioid prescribing as oral morphine equivalent per 1000 registered population, the number of high-dose opioids prescribed per 1000 registered population, and the number of high-dose opioids as a percentage of total opioids prescribed. Using a data-driven approach, we applied a modified version of our change detection Python library to identify reductions in these measures over time, which may be consistent with the successful implementation of an intervention to reduce opioid prescribing. This analysis was carried out for general practices and CCGs, and organizations were ranked according to the change in prescribing rate. Results: We identified a reduction in total opioid prescribing in 94 (49.2\%) out of 191 CCGs, with a median reduction of 15.1 (IQR 11.8-18.7; range 9.0-32.8) in total oral morphine equivalence per 1000 patients. We present data for the 3 CCGs and practices demonstrating the biggest reduction in opioid prescribing for each of the 3 opioid prescribing measures. We observed a 40\% proportional drop (8.9\% absolute reduction) in the regular prescribing of high-dose opioids (measured as a percentage of regular opioids) in the highest-ranked CCG (North Tyneside); a 99\% drop in this same measure was found in several practices (44\%-95\% absolute reduction). Decile plots demonstrate that CCGs exhibiting large reductions in opioid prescribing do so via slow and gradual reductions over a long period of time (typically over a period of 2 years); in contrast, practices exhibiting large reductions do so rapidly over a much shorter period of time. Conclusions: By applying 1 of our existing analysis tools to a national data set, we were able to identify rapid and maintained changes in opioid prescribing within practices and CCGs and rank organizations by the magnitude of reduction. Highly ranked organizations are candidates for further qualitative research into intervention design and implementation. ", doi="10.2196/51323", url="https://publichealth.jmir.org/2024/1/e51323", url="http://www.ncbi.nlm.nih.gov/pubmed/38838327" } @Article{info:doi/10.2196/52221, author="Luo, Yizhe and Zhang, Longyao and Xu, Yameng and Kuai, Qiyuan and Li, Wenhao and Wu, Yifan and Liu, Licheng and Ren, Jiarong and Zhang, Lingling and Shi, Qiufang and Liu, Xiaobo and Tan, Weilong", title="Epidemic Characteristics and Meteorological Risk Factors of Hemorrhagic Fever With Renal Syndrome in 151 Cities in China From 2015 to 2021: Retrospective Analysis", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="5", volume="10", pages="e52221", keywords="China", keywords="hemorrhagic fever with renal syndrome", keywords="HFRS", keywords="climate change", keywords="meteorological factors", keywords="distributed lag nonlinear model", abstract="Background: Hemorrhagic fever with renal syndrome (HFRS) continues to pose a significant public health threat to the population in China. Previous epidemiological evidence indicates that HFRS is climate sensitive and influenced by meteorological factors. However, past studies either focused on too-narrow geographical regions or investigated time periods that were too early. There is an urgent need for a comprehensive analysis to interpret the epidemiological patterns of meteorological factors affecting the incidence of HFRS across diverse climate zones. Objective: In this study, we aimed to describe the overall epidemic characteristics of HFRS and explore the linkage between monthly HFRS cases and meteorological factors at different climate levels in China. Methods: The reported HFRS cases and meteorological data were collected from 151 cities in China during the period from 2015 to 2021. We conducted a 3-stage analysis, adopting a distributed lag nonlinear model and a generalized additive model to estimate the interactions and marginal effects of meteorological factors on HFRS. Results: This study included a total of 63,180 cases of HFRS; the epidemic trends showed seasonal fluctuations, with patterns varying across different climate zones. Temperature had the greatest impact on the incidence of HFRS, with the maximum hysteresis effects being at 1 month (--19 {\textordmasculine}C; relative risk [RR] 1.64, 95\% CI 1.24-2.15) in the midtemperate zone, 0 months (28 {\textordmasculine}C; RR 3.15, 95\% CI 2.13-4.65) in the warm-temperate zone, and 0 months (4 {\textordmasculine}C; RR 1.72, 95\% CI 1.31-2.25) in the subtropical zone. Interactions were discovered between the average temperature, relative humidity, and precipitation in different temperature zones. Moreover, the influence of precipitation and relative humidity on the incidence of HFRS had different characteristics under different temperature layers. The hysteresis effect of meteorological factors did not end after an epidemic season, but gradually weakened in the following 1 or 2 seasons. Conclusions: Weather variability, especially low temperature, plays an important role in epidemics of HFRS in China. A long hysteresis effect indicates the necessity of continuous intervention following an HFRS epidemic. This finding can help public health departments guide the prevention and control of HFRS and develop strategies to cope with the impacts of climate change in specific regions. ", doi="10.2196/52221", url="https://publichealth.jmir.org/2024/1/e52221", url="http://www.ncbi.nlm.nih.gov/pubmed/38837197" } @Article{info:doi/10.2196/56899, author="Nickel, Brooke and Heiss, Raffael and Shih, Patti and Gram, Grundtvig Emma and Copp, Tessa and Taba, Melody and Moynihan, Ray and Zadro, Joshua", title="Social Media Promotion of Health Tests With Potential for Overdiagnosis or Overuse: Protocol for a Content Analysis", journal="JMIR Res Protoc", year="2024", month="Jun", day="4", volume="13", pages="e56899", keywords="social media", keywords="influencers", keywords="tests", keywords="overdiagnosis", keywords="overuse", keywords="evidence-based medicine", keywords="promotion", abstract="Background: In recent years, social media have emerged as important spaces for commercial marketing of health tests, which can be used for the screening and diagnosis of otherwise generally healthy people. However, little is known about how health tests are promoted on social media, whether the information provided is accurate and balanced, and if there is transparency around conflicts of interest. Objective: This study aims to understand and quantify how social media is being used to discuss or promote health tests with the potential for overdiagnosis or overuse to generally healthy people. Methods: Content analysis of social media posts on the anti-Mullerian hormone test, whole-body magnetic resonance imaging scan, multicancer early detection, testosterone test, and gut microbe test from influential international social media accounts on Instagram and TikTok. The 5 tests have been identified as having the following criteria: (1) there are evidence-based concerns about overdiagnosis or overuse, (2) there is evidence or concerns that the results of tests do not lead to improved health outcomes for generally healthy people and may cause harm or waste, and (3) the tests are being promoted on social media to generally healthy people. English language text-only posts, images, infographics, articles, recorded videos including reels, and audio-only posts are included. Posts from accounts with <1000 followers as well as stories, live videos, and non-English posts are excluded. Using keywords related to the test, the top posts were searched and screened until there were 100 eligible posts from each platform for each test (total of 1000 posts). Data from the caption, video, and on-screen text are being summarized and extracted into a Microsoft Excel (Microsoft Corporation) spreadsheet and included in the analysis. The analysis will take a combined inductive approach when generating key themes and a deductive approach using a prespecified framework. Quantitative data will be analyzed in Stata SE (version 18.0; Stata Corp). Results: Data on Instagram and TikTok have been searched and screened. Analysis has now commenced. The findings will be disseminated via publications in peer-reviewed international medical journals and will also be presented at national and international conferences in late 2024 and 2025. Conclusions: This study will contribute to the limited evidence base on the nature of the relationship between social media and the problems of overdiagnosis and overuse of health care services. This understanding is essential to develop strategies to mitigate potential harm and plan solutions, with the aim of helping to protect members of the public from being marketed low-value tests, becoming patients unnecessarily, and taking resources away from genuine needs within the health system. International Registered Report Identifier (IRRID): DERR1-10.2196/56899 ", doi="10.2196/56899", url="https://www.researchprotocols.org/2024/1/e56899", url="http://www.ncbi.nlm.nih.gov/pubmed/38833693" } @Article{info:doi/10.2196/47070, author="Lang, Anna-Lena and Hohmuth, Nils and Vi{\vs}kovi{\'c}, Vuka{\vs}in and Konigorski, Stefan and Scholz, Stefan and Balzer, Felix and Remschmidt, Cornelius and Leistner, Rasmus", title="COVID-19 Vaccine Effectiveness and Digital Pandemic Surveillance in Germany (eCOV Study): Web Application--Based Prospective Observational Cohort Study", journal="J Med Internet Res", year="2024", month="Jun", day="4", volume="26", pages="e47070", keywords="COVID-19", keywords="SARS-CoV-2", keywords="COVID-19 vaccines", keywords="BNT162b2", keywords="vaccine effectiveness", keywords="participatory disease surveillance", keywords="web application", keywords="digital public health", keywords="vaccination", keywords="Germany", keywords="effectiveness", keywords="data collection", keywords="disease surveillance", keywords="tool", abstract="Background: The COVID-19 pandemic posed significant challenges to global health systems. Efficient public health responses required a rapid and secure collection of health data to improve the understanding of SARS-CoV-2 and examine the vaccine effectiveness (VE) and drug safety of the novel COVID-19 vaccines. Objective: This study (COVID-19 study on vaccinated and unvaccinated subjects over 16 years; eCOV study) aims to (1) evaluate the real-world effectiveness of COVID-19 vaccines through a digital participatory surveillance tool and (2) assess the potential of self-reported data for monitoring key parameters of the COVID-19 pandemic in Germany. Methods: Using a digital study web application, we collected self-reported data between May 1, 2021, and August 1, 2022, to assess VE, test positivity rates, COVID-19 incidence rates, and adverse events after COVID-19 vaccination. Our primary outcome measure was the VE of SARS-CoV-2 vaccines against laboratory-confirmed SARS-CoV-2 infection. The secondary outcome measures included VE against hospitalization and across different SARS-CoV-2 variants, adverse events after vaccination, and symptoms during infection. Logistic regression models adjusted for confounders were used to estimate VE 4 to 48 weeks after the primary vaccination series and after third-dose vaccination. Unvaccinated participants were compared with age- and gender-matched participants who had received 2 doses of BNT162b2 (Pfizer-BioNTech) and those who had received 3 doses of BNT162b2 and were not infected before the last vaccination. To assess the potential of self-reported digital data, the data were compared with official data from public health authorities. Results: We enrolled 10,077 participants (aged ?16 y) who contributed 44,786 tests and 5530 symptoms. In this young, primarily female, and digital-literate cohort, VE against infections of any severity waned from 91.2\% (95\% CI 70.4\%-97.4\%) at week 4 to 37.2\% (95\% CI 23.5\%-48.5\%) at week 48 after the second dose of BNT162b2. A third dose of BNT162b2 increased VE to 67.6\% (95\% CI 50.3\%-78.8\%) after 4 weeks. The low number of reported hospitalizations limited our ability to calculate VE against hospitalization. Adverse events after vaccination were consistent with previously published research. Seven-day incidences and test positivity rates reflected the course of the pandemic in Germany when compared with official numbers from the national infectious disease surveillance system. Conclusions: Our data indicate that COVID-19 vaccinations are safe and effective, and third-dose vaccinations partially restore protection against SARS-CoV-2 infection. The study showcased the successful use of a digital study web application for COVID-19 surveillance and continuous monitoring of VE in Germany, highlighting its potential to accelerate public health decision-making. Addressing biases in digital data collection is vital to ensure the accuracy and reliability of digital solutions as public health tools. ", doi="10.2196/47070", url="https://www.jmir.org/2024/1/e47070", url="http://www.ncbi.nlm.nih.gov/pubmed/38833299" } @Article{info:doi/10.2196/53454, author="Pike, E. Caitlin and Dohnt, C. Henriette and Tully, J. Phillip and Bartik, Warren and Welton-Mitchell, Courtney and Murray, V. Clara and Rice, Kylie and Cosh, M. Suzanne and Lykins, D. Amy", title="A Community Mental Health Integrated Disaster Preparedness Intervention for Bushfire Recovery in Rural Australian Communities: Protocol for a Multimethods Feasibility and Acceptability Pilot Study", journal="JMIR Res Protoc", year="2024", month="Jun", day="4", volume="13", pages="e53454", keywords="bushfires", keywords="wildfires", keywords="rural mental health", keywords="natural disasters", keywords="mental health", keywords="disaster preparedness", keywords="natural hazards resilience", keywords="community interventions", keywords="mixed-methods", keywords="pilot study", keywords="disaster", keywords="preparedness", keywords="preparation", keywords="natural hazard", keywords="psychological distress", keywords="resilience", keywords="help-seeking", abstract="Background: Natural hazards are increasing in frequency and intensity due to climate change. Many of these natural disasters cannot be prevented; what may be reduced is the extent of the risk and negative impact on people and property. Research indicates that the 2019-2020 bushfires in Australia (also known as the ``Black Summer Bushfires'') resulted in significant psychological distress among Australians both directly and indirectly exposed to the fires. Previous intervention research suggests that communities impacted by natural hazards (eg, earthquakes, hurricanes, and floods) can benefit from interventions that integrate mental health and social support components within disaster preparedness frameworks. Research suggests that disaster-affected communities often prefer the support of community leaders, local services, and preexisting relationships over external supports, highlighting that community-based interventions, where knowledge stays within the local community, are highly beneficial. The Community-Based Disaster Mental Health Intervention (CBDMHI) is an evidence-based approach that aims to increase disaster preparedness, resilience, social cohesion, and social support (disaster-related help-seeking), and decrease mental health symptoms, such as depression and anxiety. Objective: This research aims to gain insight into rural Australian's recovery needs post natural hazards, and to enhance community resilience in advance of future fires. Specifically, this research aims to adapt the CBDMHI for the rural Australian context and for bushfires and second, to assess the acceptability and feasibility of the adapted CBDMHI in a rural Australian community. Methods: Phase 1 consists of qualitative interviews (individual or dyads) with members of the target bushfire-affected rural community. Analysis of these data will include identifying themes related to disaster preparedness, social cohesion, and mental health, which will inform the adaptation. An initial consultation phase is a key component of the adaptation process and, therefore, phase 2 will involve additional discussion with key stakeholders and members of the community to further guide adaptation of the CBDMHI to specific community needs, building on phase 1 inputs. Phase 3 includes identifying and training local community leaders in the adapted intervention. Following this, leaders will co-deliver the intervention. The acceptability and feasibility of the adapted CBDMHI within the community will be evaluated by questionnaires and semistructured interviews. Effectiveness will be evaluated by quantifying psychological distress, resilience, community cohesion, psychological preparedness, and help-seeking intentions. Results: This study has received institutional review board approval and commenced phase 1 recruitment in October 2022. Conclusions: The study will identify if the adapted CBDMHI is viable and acceptable within a village in the Northern Tablelands of New South Wales, Australia. These findings will inform future scale-up in the broader rural Australian context. If this intervention is well received, the CBDMHI may be valuable for future disaster recovery and preparedness efforts in rural Australia. These findings may inform future scale-up in the broader rural Australian context. International Registered Report Identifier (IRRID): DERR1-10.2196/53454 ", doi="10.2196/53454", url="https://www.researchprotocols.org/2024/1/e53454", url="http://www.ncbi.nlm.nih.gov/pubmed/38833279" } @Article{info:doi/10.2196/48378, author="Liu, Pei and Liu, Yijun and Liu, Hao and Xiong, Linping and Mei, Changlin and Yuan, Lei", title="A Random Forest Algorithm for Assessing Risk Factors Associated With Chronic Kidney Disease: Observational Study", journal="Asian Pac Isl Nurs J", year="2024", month="Jun", day="3", volume="8", pages="e48378", keywords="chronic kidney disease", keywords="random forest model", keywords="risk factors", keywords="assessment", abstract="Background: The prevalence and mortality rate of chronic kidney disease (CKD) are increasing year by year, and it has become a global public health issue. The economic burden caused by CKD is increasing at a rate of 1\% per year. CKD is highly prevalent and its treatment cost is high but unfortunately remains unknown. Therefore, early detection and intervention are vital means to mitigate the treatment burden on patients and decrease disease progression. Objective: In this study, we investigated the advantages of using the random forest (RF) algorithm for assessing risk factors associated with CKD. Methods: We included 40,686 people with complete screening records who underwent screening between January 1, 2015, and December 22, 2020, in Jing'an District, Shanghai, China. We grouped the participants into those with and those without CKD by staging based on the glomerular filtration rate staging and grouping based on albuminuria. Using a logistic regression model, we determined the relationship between CKD and risk factors. The RF machine learning algorithm was used to score the predictive variables and rank them based on their importance to construct a prediction model. Results: The logistic regression model revealed that gender, older age, obesity, abnormal index estimated glomerular filtration rate, retirement status, and participation in urban employee medical insurance were significantly associated with the risk of CKD. On RF algorithm--based screening, the top 4 factors influencing CKD were age, albuminuria, working status, and urinary albumin-creatinine ratio. The RF model predicted an area under the receiver operating characteristic curve of 93.15\%. Conclusions: Our findings reveal that the RF algorithm has significant predictive value for assessing risk factors associated with CKD and allows the screening of individuals with risk factors. This has crucial implications for early intervention and prevention of CKD. ", doi="10.2196/48378", url="https://apinj.jmir.org/2024/1/e48378", url="http://www.ncbi.nlm.nih.gov/pubmed/38830204" } @Article{info:doi/10.2196/53860, author="Dong, Wen-Hong and Guo, Jun-Xia and Wang, Lei and Zheng, Shuang-Shuang and Zhu, Bing-Quan and Shao, Jie", title="Trend of Mortality Due to Congenital Anomalies in Children Younger Than 5 Years in Eastern China, 2012-2021: Surveillance Data Analysis", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="3", volume="10", pages="e53860", keywords="under-five years", keywords="congenital anomalies", keywords="mortality", keywords="death cause", keywords="rank", abstract="Background: As one of the leading causes of child mortality, deaths due to congenital anomalies (CAs) have been a prominent obstacle to meet Sustainable Development Goal 3.2. Objective: We conducted this study to understand the death burden and trend of under-5 CA mortality (CAMR) in Zhejiang, one of the provinces with the best medical services and public health foundations in Eastern China. Methods: We used data retrieved from the under-5 mortality surveillance system in Zhejiang from 2012 to 2021. CAMR by sex, residence, and age group for each year was calculated and standardized according to 2020 National Population Census sex- and residence-specific live birth data in China. Poisson regression models were used to estimate the annual average change rate (AACR) of CAMR and to obtain the rate ratio between subgroups after adjusting for sex, residence, and age group when appropriate. Results: From 2012 to 2021, a total of 1753 children died from CAs, and the standardized CAMR declined from 121.2 to 62.6 per 100,000 live births with an AACR of --9\% (95\% CI --10.7\% to --7.2\%; P<.001). The declining trend was also observed in female and male children, urban and rural children, and neonates and older infants, and the AACRs were --9.7\%, --8.5\%, --8.5\%, --9.2\%, --12\%, and --6.3\%, respectively (all P<.001). However, no significant reduction was observed in children aged 1-4 years (P=.22). Generally, the CAMR rate ratios for male versus female children, rural versus urban children, older infants versus neonates, and older children versus neonates were 1.18 (95\% CI 1.08-1.30; P<.001), 1.20 (95\% CI 1.08-1.32; P=.001), 0.66 (95\% CI 0.59-0.73; P<.001), and 0.20 (95\% CI 0.17-0.24; P<.001), respectively. Among all broad CA groups, circulatory system malformations, mainly deaths caused by congenital heart diseases, accounted for 49.4\% (866/1753) of deaths and ranked first across all years, although it declined yearly with an AACR of --9.8\% (P<.001). Deaths due to chromosomal abnormalities tended to grow in recent years, although the AACR was not significant (P=.90). Conclusions: CAMR reduced annually, with cardiovascular malformations ranking first across all years in Zhejiang, China. Future research and practices should focus more on the prevention, early detection, long-term management of CAs and comprehensive support for families with children with CAs to improve their survival chances. ", doi="10.2196/53860", url="https://publichealth.jmir.org/2024/1/e53860", url="http://www.ncbi.nlm.nih.gov/pubmed/38829691" } @Article{info:doi/10.2196/51734, author="Cantarutti, Anna and Rescigno, Paola and Da Borso, Claudia and Gutierrez de Rubalcava Doblas, Joaquin and Bressan, Silvia and Barbieri, Elisa and Giaquinto, Carlo and Canova, Cristina", title="Association Between Early-Life Exposure to Antibiotics and Development of Child Obesity: Population-Based Study in Italy", journal="JMIR Public Health Surveill", year="2024", month="May", day="31", volume="10", pages="e51734", keywords="childhood obesity", keywords="BMI z score", keywords="pediatric population-based", keywords="antibiotics", keywords="real-world data", keywords="association", keywords="exposure", keywords="child obesity", keywords="obesity", keywords="population-based", keywords="gut microbiome", keywords="early life", keywords="pediatric", keywords="prescription", abstract="Background: Childhood obesity is a significant public health problem representing the most severe challenge in the world. Antibiotic exposure in early life has been identified as a potential factor that can disrupt the development of the gut microbiome, which may have implications for obesity. Objective: This study aims to evaluate the risk of developing obesity among children exposed to antibiotics early in life. Methods: An Italian retrospective pediatric population-based cohort study of children born between 2004 and 2018 was adopted using the Pedianet database. Children were required to be born at term, with normal weight, and without genetic diseases or congenital anomalies. We assessed the timing of the first antibiotic prescription from birth to 6, 12, and 24 months of life and the dose-response relationship via the number of antibiotic prescriptions recorded in the first year of life (none, 1, 2, and ?3 prescriptions). Obesity was defined as a BMI z score >3 for children aged ?5 years and >2 for children aged >5 years, using the World Health Organization growth references. The obese incidence rate (IR) {\texttimes} 100 person-years and the relative 95\% CI were computed using infant sex, area of residence, preschool and school age, and area deprivation index, which are the covariates of interest. A mixed-effect Cox proportional hazards model was used to estimate the hazard ratio and 95\% CI for the association between antibiotic exposure in early life and child obesity between 24 months and 14 years of age, considering the family pediatricians as a random factor. Several subgroup and sensitivity analyses were performed to assess the robustness of our results. Results: Among 121,540 children identified, 54,698 were prescribed at least an antibiotic within the first year of life and 26,990 were classified as obese during follow-up with an incidence rate of 4.05 cases (95\% CI 4.01-4.10) {\texttimes} 100 person-year. The risk of obesity remained consistent across different timings of antibiotic prescriptions at 6 months, 1 year, and 2 years (fully adjusted hazard ratio [aHR] 1.07, 95\% CI 1.04-1.10; aHR 1.06, 95\% CI 1.03-1.09; and aHR 1.07, 95\% CI 1.04-1.10, respectively). Increasing the number of antibiotic exposures increases the risk of obesity significantly (P trend<.001). The individual-specific age analysis showed that starting antibiotic therapy very early (between 0 and 5 months) had the greatest impact (aHR 1.12, 95\% CI 1.08-1.17) on childhood obesity with respect to what was observed among those who were first prescribed antibiotics after the fifth month of life. These results were consistent across subgroup and sensitivity analyses. Conclusions: The results from this large population-based study support the association between early exposure to antibiotics and an increased risk of childhood obesity. This association becomes progressively stronger with both increasing numbers of antibiotic prescriptions and younger age at the time of the first prescription. ", doi="10.2196/51734", url="https://publichealth.jmir.org/2024/1/e51734", url="http://www.ncbi.nlm.nih.gov/pubmed/38820573" } @Article{info:doi/10.2196/49383, author="Zhang, Lianshan and Jiang, Shaohai", title="Examining the Role of Information Behavior in Linking Cancer Risk Perception and Cancer Worry to Cancer Fatalism in China: Cross-Sectional Survey Study", journal="J Med Internet Res", year="2024", month="May", day="31", volume="26", pages="e49383", keywords="cancer fatalism", keywords="cancer risk perception", keywords="cancer worry", keywords="health information seeking", keywords="information avoidance", abstract="Background: Reducing cancer fatalism is essential because of its detrimental impact on cancer-related preventive behaviors. However, little is known about factors influencing individuals' cancer fatalism in China. Objective: With a general basis of the extended parallel process model, this study aims to examine how distinct cancer-related mental conditions (risk perception and worry) and different information behaviors (information seeking vs avoidance) become associated with cancer fatalism, with an additional assessment of the moderating effect of information usefulness. Methods: Data were drawn from the Health Information National Trends Survey in China, which was conducted in 2017 (N=2358). Structural equation modeling and bootstrapping methods were performed to test a moderated mediation model and hypothesized relationships. Results: The results showed that cancer risk perception and cancer worry were positively associated with online health information seeking. In addition, cancer worry was positively related to cancer information avoidance. Moreover, online health information seeking was found to reduce cancer fatalism, while cancer information avoidance was positively associated with cancer fatalism. The results also indicated that the perceived usefulness of cancer information moderated this dual-mediation pathway. Conclusions: The national survey data indicate that cancer mental conditions should not be treated as homogeneous entities, given their varying functions and effects. Apart from disseminating useful cancer information to encourage individuals to adaptively cope with cancer threats, we advocate for health communication programs to reduce cancer information avoidance to alleviate fatalistic beliefs about cancer prevention. ", doi="10.2196/49383", url="https://www.jmir.org/2024/1/e49383", url="http://www.ncbi.nlm.nih.gov/pubmed/38819919" } @Article{info:doi/10.2196/55068, author="Ostermann, Jan and Njau, Bernard and van Zwetselaar, Marco and Yamanis, Thespina and McClimans, Leah and Mwangi, Rose and Beti, Melkiory and Hobbie, Amy and Gass, Salom{\'e}-Joelle and Mtuy, Tara and Thielman, Nathan", title="Mobile Phone--Based Confidential Social Network Referrals for HIV Testing (CONSORT): Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="May", day="30", volume="13", pages="e55068", keywords="confidential referrals", keywords="HIV counseling and testing", keywords="mHealth", keywords="mobile health", keywords="social networks", keywords="stigma", keywords="sub-Saharan Africa", keywords="Tanzania", abstract="Background: Critical to efforts to end the HIV epidemic is the identification of persons living with HIV who have yet to be diagnosed and engaged in care. Expanded HIV testing outreach efforts need to be both efficient and ambitious, targeting the social networks of persons living with HIV and those at above-average risk of undiagnosed HIV infection. The ubiquity of mobile phones across many high HIV prevalence settings has created opportunities to leverage mobile health (mHealth) technologies to engage social networks for HIV testing outreach, prevention, and treatment. Objective: The purpose of this study is to evaluate the acceptability and efficacy of a novel mHealth intervention, ``Confidential Social Network Referrals for HIV Testing (CONSORT),'' to nudge at-risk individuals to test for HIV using SMS text messages. Methods: We will conduct the CONSORT study in Moshi, Tanzania, the commercial center and administrative capital of the Kilimanjaro Region in northern Tanzania. After qualitative formative work and pilot testing, we will enroll 400 clients presenting for HIV counseling and testing and 200 persons living with HIV and receiving care at HIV care and treatment centers as ``inviters'' into a randomized controlled trial. Eligible participants will be aged 18 years or older and live, work, or regularly receive care in Moshi. We will randomize inviters into 1 of 2 study arms. All inviters will be asked to complete a survey of their HIV testing and risk behaviors and to think of social network contacts who would benefit from HIV testing. They will then be asked to whom they would prefer to extend an HIV testing invitation in the form of a physical invitation card. Arm 1 participants will also be given the opportunity to extend CONSORT invitations in the form of automated confidential SMS text messages to any of their social network contacts or ``invitees.'' Arm 2 participants will be offered physical invitation cards alone. The primary outcome will be counselor-documented uptake of HIV testing by invitees within 30 days of inviter enrollment. Secondary outcomes will include the acceptability of CONSORT among inviters, the number of new HIV diagnoses, and the HIV risk of invitees who present for testing. Results: Enrollment in the randomized controlled trial is expected to start in September 2024. The findings will be disseminated to stakeholders and published in peer-reviewed journals. Conclusions: If CONSORT is acceptable and effective for increasing the uptake of HIV testing, given the minimal costs of SMS text reminders and the potential for exponential but targeted growth using chain referrals, it may shift current practices for HIV testing programs in the area. Trial Registration: ClincalTrials.gov NCT05967208; https://clinicaltrials.gov/study/NCT05967208 International Registered Report Identifier (IRRID): PRR1-10.2196/55068 ", doi="10.2196/55068", url="https://www.researchprotocols.org/2024/1/e55068", url="http://www.ncbi.nlm.nih.gov/pubmed/38814692" } @Article{info:doi/10.2196/53071, author="Uwera, Thaoussi and Venkateswaran, Mahima and Bhutada, Kiran and Papadopoulou, Eleni and Rukundo, Enock and K Tumusiime, David and Fr{\o}en, Frederik J.", title="Electronic Immunization Registry in Rwanda: Qualitative Study of Health Worker Experiences", journal="JMIR Hum Factors", year="2024", month="May", day="28", volume="11", pages="e53071", keywords="childhood immunization", keywords="electronic immunization registry", keywords="digital health interventions", abstract="Background: Monitoring childhood immunization programs is essential for health systems. Despite the introduction of an electronic immunization registry called e-Tracker in Rwanda, challenges such as lacking population denominators persist, leading to implausible reports of coverage rates of more than 100\%. Objective: This study aimed to assess the extent to which the immunization e-Tracker responds to stakeholders' needs and identify key areas for improvement. Methods: In-depth interviews were conducted with all levels of e-Tracker users including immunization nurses, data managers, and supervisors from health facilities in 5 districts of Rwanda. We used an interview guide based on the constructs of the Human, Organization, and Technology--Fit (HOT-Fit) framework, and we analyzed and summarized our findings using the framework. Results: Immunization nurses reported using the e-Tracker as a secondary data entry tool in addition to paper-based forms, which resulted in considerable dissatisfaction among nurses. While users acknowledged the potential of a digital tool compared to paper-based systems, they also reported the need for improvement of functionalities to support their work, such as digital client appointment lists, lists of defaulters, search and register functions, automated monthly reports, and linkages to birth notifications and the national identity system. Conclusions: Reducing dual documentation for users can improve e-Tracker use and user satisfaction. Our findings can help identify additional digital health interventions to support and strengthen the health information system for the immunization program. ", doi="10.2196/53071", url="https://humanfactors.jmir.org/2024/1/e53071", url="http://www.ncbi.nlm.nih.gov/pubmed/38805254" } @Article{info:doi/10.2196/51191, author="Garc{\'i}a-Garc{\'i}a, David and Fern{\'a}ndez-Mart{\'i}nez, Beatriz and Bartumeus, Frederic and G{\'o}mez-Barroso, Diana", title="Modeling the Regional Distribution of International Travelers in Spain to Estimate Imported Cases of Dengue and Malaria: Statistical Inference and Validation Study", journal="JMIR Public Health Surveill", year="2024", month="May", day="27", volume="10", pages="e51191", keywords="epidemiology", keywords="imported infections", keywords="modeling", keywords="surveillance system", keywords="vector-borne diseases", abstract="Background: Understanding the patterns of disease importation through international travel is paramount for effective public health interventions and global disease surveillance. While global airline network data have been used to assist in outbreak prevention and effective preparedness, accurately estimating how these imported cases disseminate locally in receiving countries remains a challenge. Objective: This study aimed to describe and understand the regional distribution of imported cases of dengue and malaria upon arrival in Spain via air travel. Methods: We have proposed a method to describe the regional distribution of imported cases of dengue and malaria based on the computation of the ``travelers' index'' from readily available socioeconomic data. We combined indicators representing the main drivers for international travel, including tourism, economy, and visits to friends and relatives, to measure the relative appeal of each region in the importing country for travelers. We validated the resulting estimates by comparing them with the reported cases of malaria and dengue in Spain from 2015 to 2019. We also assessed which motivation provided more accurate estimates for imported cases of both diseases. Results: The estimates provided by the best fitted model showed high correlation with notified cases of malaria (0.94) and dengue (0.87), with economic motivation being the most relevant for imported cases of malaria and visits to friends and relatives being the most relevant for imported cases of dengue. Conclusions: Factual descriptions of the local movement of international travelers may substantially enhance the design of cost-effective prevention policies and control strategies, and essentially contribute to decision-support systems. Our approach contributes in this direction by providing a reliable estimate of the number of imported cases of nonendemic diseases, which could be generalized to other applications. Realistic risk assessments will be obtained by combining this regional predictor with the observed local distribution of vectors. ", doi="10.2196/51191", url="https://publichealth.jmir.org/2024/1/e51191", url="http://www.ncbi.nlm.nih.gov/pubmed/38801767" } @Article{info:doi/10.2196/51991, author="Sun, Yehao and Prabhu, Prital and Rahman, Ryan and Li, Dongmei and McIntosh, Scott and Rahman, Irfan", title="e-Cigarette Tobacco Flavors, Public Health, and Toxicity: Narrative Review", journal="Online J Public Health Inform", year="2024", month="May", day="27", volume="16", pages="e51991", keywords="vaping", keywords="e-cigarettes", keywords="tobacco flavors", keywords="toxicity", keywords="regulation", keywords="tobacco", keywords="public health", keywords="smoking", keywords="menthol", keywords="social media", keywords="nicotine", keywords="symptoms", keywords="symptom", keywords="risk", keywords="risks", keywords="toxicology", keywords="health risk", abstract="Background: Recently, the US Food and Drug Administration implemented enforcement priorities against all flavored, cartridge-based e-cigarettes other than menthol and tobacco flavors. This ban undermined the products' appeal to vapers, so e-cigarette manufacturers added flavorants of other attractive flavors into tobacco-flavored e-cigarettes and reestablished appeal. Objective: This review aims to analyze the impact of the addition of other flavorants in tobacco-flavored e-cigarettes on both human and public health issues and to propose further research as well as potential interventions. Methods: Searches for relevant literature published between 2018 and 2023 were performed. Cited articles about the toxicity of e-cigarette chemicals included those published before 2018, and governmental websites and documents were also included for crucial information. Results: Both the sales of e-cigarettes and posts on social media suggested that the manufacturers' strategy was successful. The reestablished appeal causes not only a public health issue but also threats to the health of individual vapers. Research has shown an increase in toxicity associated with the flavorants commonly used in flavored e-cigarettes, which are likely added to tobacco-flavored e-cigarettes based on tobacco-derived and synthetic tobacco-free nicotine, and these other flavors are associated with higher clinical symptoms not often induced solely by natural, traditional tobacco flavors. Conclusions: The additional health risks posed by the flavorants are pronounced even without considering the toxicological interactions of the different tobacco flavorants, and more research should be done to understand the health risks thoroughly and to take proper actions accordingly for the regulation of these emerging products. ", doi="10.2196/51991", url="https://ojphi.jmir.org/2024/1/e51991", url="http://www.ncbi.nlm.nih.gov/pubmed/38801769" } @Article{info:doi/10.2196/47154, author="Comer, Leigha and Donelle, Lorie and Hiebert, Bradley and Smith, J. Maxwell and Kothari, Anita and Stranges, Saverio and Gilliland, Jason and Long, Jed and Burkell, Jacquelyn and Shelley, J. Jacob and Hall, Jodi and Shelley, James and Cooke, Tommy and Ngole Dione, Marionette and Facca, Danica", title="Short- and Long-Term Predicted and Witnessed Consequences of Digital Surveillance During the COVID-19 Pandemic: Scoping Review", journal="JMIR Public Health Surveill", year="2024", month="May", day="24", volume="10", pages="e47154", keywords="digital surveillance", keywords="COVID-19", keywords="public health", keywords="scoping review", keywords="pandemic", keywords="digital technologies", abstract="Background: The COVID-19 pandemic has prompted the deployment of digital technologies for public health surveillance globally. The rapid development and use of these technologies have curtailed opportunities to fully consider their potential impacts (eg, for human rights, civil liberties, privacy, and marginalization of vulnerable groups). Objective: We conducted a scoping review of peer-reviewed and gray literature to identify the types and applications of digital technologies used for surveillance during the COVID-19 pandemic and the predicted and witnessed consequences of digital surveillance. Methods: Our methodology was informed by the 5-stage methodological framework to guide scoping reviews: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the findings. We conducted a search of peer-reviewed and gray literature published between December 1, 2019, and December 31, 2020. We focused on the first year of the pandemic to provide a snapshot of the questions, concerns, findings, and discussions emerging from peer-reviewed and gray literature during this pivotal first year of the pandemic. Our review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines. Results: We reviewed a total of 147 peer-reviewed and 79 gray literature publications. Based on our analysis of these publications, we identified a total of 90 countries and regions where digital technologies were used for public health surveillance during the COVID-19 pandemic. Some of the most frequently used technologies included mobile phone apps, location-tracking technologies, drones, temperature-scanning technologies, and wearable devices. We also found that the literature raised concerns regarding the implications of digital surveillance in relation to data security and privacy, function creep and mission creep, private sector involvement in surveillance, human rights, civil liberties, and impacts on marginalized groups. Finally, we identified recommendations for ethical digital technology design and use, including proportionality, transparency, purpose limitation, protecting privacy and security, and accountability. Conclusions: A wide range of digital technologies was used worldwide to support public health surveillance during the COVID-19 pandemic. The findings of our analysis highlight the importance of considering short- and long-term consequences of digital surveillance not only during the COVID-19 pandemic but also for future public health crises. These findings also demonstrate the ways in which digital surveillance has rendered visible the shifting and blurred boundaries between public health surveillance and other forms of surveillance, particularly given the ubiquitous nature of digital surveillance. International Registered Report Identifier (IRRID): RR2-https://doi.org/10.1136/bmjopen-2021-053962 ", doi="10.2196/47154", url="https://publichealth.jmir.org/2024/1/e47154", url="http://www.ncbi.nlm.nih.gov/pubmed/38788212" } @Article{info:doi/10.2196/41567, author="Jain, Lovely and Pradhan, Sreya and Aggarwal, Arun and Padhi, Kumar Bijaya and Itumalla, Ramaiah and Khatib, Nazli Mahalaqua and Gaidhane, Shilpa and Zahiruddin, Syed Quazi and Santos, Guimar{\~a}es Celso Augusto and AL-Mugheed, Khalid and Alrahbeni, Tahani and Kukreti, Neelima and Satapathy, Prakasini and Rustagi, Sarvesh and Heidler, Petra and Marzo, Rillera Roy", title="Association of Child Growth Failure Indicators With Household Sanitation Practices in India (1998-2021): Spatiotemporal Observational Study", journal="JMIR Public Health Surveill", year="2024", month="May", day="24", volume="10", pages="e41567", keywords="undernutrition", keywords="malnutrition", keywords="stunting", keywords="wasting", keywords="underweight", keywords="sanitation", keywords="WaSH", keywords="LISA", keywords="NFHS", keywords="DHS", keywords="spatial epidemiology", keywords="epidemiology", keywords="children", keywords="child", keywords="India", keywords="intervention", abstract="Background: Undernutrition among children younger than 5 years is a subtle indicator of a country's health and economic status. Despite substantial macroeconomic progress in India, undernutrition remains a significant burden with geographical variations, compounded by poor access to water, sanitation, and hygiene services. Objective: This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India. Methods: We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators. Results: Our study showed a decreasing trend in stunting (44.9\%-38.4\%) and underweight (46.7\%-35.7\%) but an increasing prevalence of wasting (15.7\%-21.0\%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions. Conclusions: Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas. ", doi="10.2196/41567", url="https://publichealth.jmir.org/2024/1/e41567", url="http://www.ncbi.nlm.nih.gov/pubmed/38787607" } @Article{info:doi/10.2196/53067, author="Cornell, Samuel and Peden, E. Amy", title="Visual ``Scrollytelling'': Mapping Aquatic Selfie-Related Incidents in Australia", journal="Interact J Med Res", year="2024", month="May", day="23", volume="13", pages="e53067", keywords="selfie", keywords="map", keywords="social media", keywords="selfies", keywords="scrollama", keywords="JavaScript", keywords="scrollytelling", keywords="Mapbox", keywords="incidence", keywords="incidents", keywords="incident", keywords="fatality", keywords="fatalities", keywords="injury", keywords="injuries", keywords="retrieval", keywords="prevalence", keywords="image", keywords="images", keywords="photo", keywords="photos", keywords="photograph", keywords="photographs", keywords="Australia", keywords="emergency", keywords="visualization", keywords="visualizations", keywords="interactive", keywords="location", keywords="geography", keywords="geographic", keywords="geographical", keywords="spatial", keywords="artificial intelligence", keywords="longitude", keywords="latitude", keywords="visual representation", keywords="visual representations", doi="10.2196/53067", url="https://www.i-jmr.org/2024/1/e53067", url="http://www.ncbi.nlm.nih.gov/pubmed/38781002" } @Article{info:doi/10.2196/54958, author="Harris, Daniel and Delcher, Chris", title="Geospatial Imprecision With Constraints for Precision Public Health: Algorithm Development and Validation", journal="Online J Public Health Inform", year="2024", month="May", day="21", volume="16", pages="e54958", keywords="social determinants of health", keywords="geocoding", keywords="privacy", keywords="poverty", keywords="obfuscation", keywords="security", keywords="confidentiality", keywords="low income", keywords="geography", keywords="geographic", keywords="location", keywords="locations", keywords="spatial", keywords="geospatial", keywords="precision", abstract="Background: Location and environmental social determinants of health are increasingly important factors in both an individual's health and the monitoring of community-level public health issues. Objective: We aimed to measure the extent to which location obfuscation techniques, designed to protect an individual's privacy, can unintentionally shift geographical coordinates into neighborhoods with significantly different socioeconomic demographics, which limits the precision of findings for public health stakeholders. Methods: Point obfuscation techniques intentionally blur geographic coordinates to conceal the original location. The pinwheel obfuscation method is an existing technique in which a point is moved along a pinwheel-like path given a randomly chosen angle and a maximum radius; we evaluate the impact of this technique using 2 data sets by comparing the demographics of the original point and the resulting shifted point by cross-referencing data from the United States Census Bureau. Results: Using poverty measures showed that points from regions of low poverty may be shifted to regions of high poverty; similarly, points in regions with high poverty may be shifted into regions of low poverty. We varied the maximum allowable obfuscation radius; the mean difference in poverty rate before and after obfuscation ranged from 6.5\% to 11.7\%. Additionally, obfuscation inadvertently caused false hot spots for deaths by suicide in Cook County, Illinois. Conclusions: Privacy concerns require patient locations to be imprecise to protect against risk of identification; precision public health requires accuracy. We propose a modified obfuscation technique that is constrained to generate a new point within a specified census-designated region to preserve both privacy and analytical accuracy by avoiding demographic shifts. ", doi="10.2196/54958", url="https://ojphi.jmir.org/2024/1/e54958", url="http://www.ncbi.nlm.nih.gov/pubmed/38772021" } @Article{info:doi/10.2196/56054, author="Xu, Huan Richard and Sun, Ruiqi and Fu, Siu-Ngor", title="Out-of-Hospital Cardiac Arrest Before and During the COVID-19 Pandemic in Hong Kong: Registry-Based Study From 2017 to 2023", journal="JMIR Public Health Surveill", year="2024", month="May", day="21", volume="10", pages="e56054", keywords="out-of-hospital cardiac arrest", keywords="OHCA", keywords="COVID-19", keywords="pandemic", keywords="survival", keywords="Chinese", keywords="Asian", abstract="Background: The COVID-19 pandemic has exerted a significant toll on individual health and the efficacy of health care systems. However, the influence of COVID-19 on the frequency and outcomes of out-of-hospital cardiac arrest (OHCA) within the Chinese population, both before and throughout the entire pandemic period, remains to be clarified. Objective: This study aimed to fill the gaps by investigating the prevalence and outcomes of OHCA in Hong Kong (HK) both before and during the whole pandemic period. Methods: This is a retrospective regional registry study. The researchers matched OHCA data with COVID-19--confirmed case records between December 2017 and May 2023. The data included information on response times, location of OHCA, witness presence, initial rhythm, bystander cardiopulmonary resuscitation (CPR), use of public-access defibrillation, resuscitation in the accident and emergency department, and survival to admission. Descriptive analyses were conducted, and statistical tests such as analysis of variance and $\chi$2 were used to examine differences between variables. The incidence of OHCA and survival rates were calculated, and logistic regression analysis was performed to assess associations. The prevalence of OHCA and COVID-19 during the peak of the pandemic was also described. Results: A total of 43,882 cases of OHCA were reported in HK and included in our analysis. Around 13,946 cases were recorded during the prepandemic period (2017-2019), and the remaining 29,936 cases were reported during the pandemic period (2020-2023). During the pandemic period, the proportion of female patients increased to 44.1\% (13,215/29,936), and the average age increased slightly to 76.5 (SD 18.5) years. The majority of OHCAs (n=18,143, 61.1\% cases) occurred at home. A witness was present in 45.9\% (n=10,723) of the cases, and bystander CPR was initiated in 44.6\% (n=13,318) of the cases. There was a significant increase in OHCA incidence, with a corresponding decrease in survival rates compared to the prepandemic period. The location of OHCA shifted, with a decrease in incidents in public places and a potential increase in incidents at home. We found that CPR (odds ratio 1.48, 95\% CI 1.17-1.86) and public-access defibrillation (odds ratio 1.16, 95\% CI 1.05-1.28) were significantly associated with a high survival to admission rate during the pandemic period. There was a correlation between the development of OHCA and the prevalence of COVID-19 in HK. Conclusions: The COVID-19 pandemic has had a significant impact on OHCA in HK, resulting in increased incidence and decreased survival rates. The findings highlight the importance of addressing the indirect effects of the pandemic, such as increased stress levels and strain on health care systems, on OHCA outcomes. Strategies should be developed to improve OHCA prevention, emergency response systems, and health care services during public health emergencies to mitigate the impact on population health. ", doi="10.2196/56054", url="https://publichealth.jmir.org/2024/1/e56054", url="http://www.ncbi.nlm.nih.gov/pubmed/38771620" } @Article{info:doi/10.2196/50812, author="Karuchit, Samart and Thiengtham, Panupit and Tanpradech, Suvimon and Srinor, Watcharapol and Yingyong, Thitipong and Naiwatanakul, Thananda and Northbrook, Sanny and Hladik, Wolfgang", title="A Web-Based, Respondent-Driven Sampling Survey Among Men Who Have Sex With Men (Kai Noi): Description of Methods and Characteristics", journal="JMIR Form Res", year="2024", month="May", day="20", volume="8", pages="e50812", keywords="online respondent-driven sampling", keywords="web-based respondent-driven sampling", keywords="virtual architecture", keywords="men who have sex with men", keywords="Thailand", keywords="MSM", keywords="Asia", keywords="Asian", keywords="gay", keywords="homosexual", keywords="homosexuality", keywords="sexual minority", keywords="sexual minorities", keywords="biobehavioral", keywords="surveillance", keywords="respondent driven sampling", keywords="survey", keywords="surveys", keywords="web app", keywords="web application", keywords="coding", keywords="PHP", keywords="web based", keywords="automation", keywords="automated", keywords="design", keywords="architecture", keywords="information system", keywords="information systems", keywords="online sampling", keywords="HIV", keywords="sexually transmitted infection", keywords="STI", keywords="sexually transmitted disease", keywords="STD", keywords="sexual transmission", keywords="sexually transmitted", keywords="RDS", keywords="webRDS", abstract="Background: Thailand's HIV epidemic is heavily concentrated among men who have sex with men (MSM), and surveillance efforts are mostly based on case surveillance and local biobehavioral surveys. Objective: We piloted Kai Noi, a web-based respondent-driven sampling (RDS) survey among MSM. Methods: We developed an application coded in PHP that facilitated all procedures and events typically used in an RDS office for use on the web, including e-coupon validation, eligibility screening, consent, interview, peer recruitment, e-coupon issuance, and compensation. All procedures were automated and e-coupon ID numbers were randomly generated. Participants' phone numbers were the principal means to detect and prevent duplicate enrollment. Sampling took place across Thailand; residents of Bangkok were also invited to attend 1 of 10 clinics for an HIV-related blood draw with additional compensation. Results: Sampling took place from February to June 2022; seeds (21 at the start, 14 added later) were identified through banner ads, micromessaging, and in online chat rooms. Sampling reached all 6 regions and almost all provinces. Fraudulent (duplicate) enrollment using ``borrowed'' phone numbers was identified and led to the detection and invalidation of 318 survey records. A further 106 participants did not pass an attention filter question (asking recruits to select a specific categorical response) and were excluded from data analysis, leading to a final data set of 1643 valid participants. Only one record showed signs of straightlining (identical adjacent responses). None of the Bangkok respondents presented for a blood draw. Conclusions: We successfully developed an application to implement web-based RDS among MSM across Thailand. Measures to minimize, detect, and eliminate fraudulent survey enrollment are imperative in web-based surveys offering compensation. Efforts to improve biomarker uptake are needed to fully tap the potential of web-based sampling and data collection. ", doi="10.2196/50812", url="https://formative.jmir.org/2024/1/e50812", url="http://www.ncbi.nlm.nih.gov/pubmed/38767946" } @Article{info:doi/10.2196/46845, author="Phillips, R. Tiffany and Fairley, K. Christopher and Maddaford, Kate and McNulty, Anna and Donovan, Basil and Guy, Rebecca and McIver, Ruthy and Wigan, Rebecca and Varma, Rick and Ong, J. Jason and Callander, Denton and Skelsey, Gabrielle and Pony, Mish and O'Hara, Dylan and Bilardi, E. Jade and Chow, PF Eric", title="Understanding Risk Factors for Oropharyngeal Gonorrhea Among Sex Workers Attending Sexual Health Clinics in 2 Australian Cities: Mixed Methods Study", journal="JMIR Public Health Surveill", year="2024", month="May", day="20", volume="10", pages="e46845", keywords="case-control", keywords="qualitative", keywords="oral sex", keywords="condoms", keywords="transactional sex", abstract="Background: The risk factors for oropharyngeal gonorrhea have not been examined in sex workers despite the increasing prevalence of gonorrhea infection. Objective: This study aims to determine the risk factors for oropharyngeal gonorrhea in female and gender-diverse sex workers (including cisgender and transgender women, nonbinary and gender fluid sex workers, and those with a different identity) and examine kissing, oral sex, and mouthwash practices with clients. Methods: This mixed methods case-control study was conducted from 2018 to 2020 at 2 sexual health clinics in Melbourne, Victoria, and Sydney, New South Wales, Australia. We recruited 83 sex workers diagnosed with oropharyngeal gonorrhea (cases) and 581 sex workers without (controls). Semistructured interviews with 19 sex workers from Melbourne were conducted. Results: In the case-control study, the median age of 664 sex workers was 30 (IQR 25-36) years. Almost 30\% of sex workers (192/664, 28.9\%) reported performing condomless fellatio on clients. Performing condomless fellatio with clients was the only behavior associated with oropharyngeal gonorrhea (adjusted odds ratio 3.6, 95\% CI 1.7-7.6; P=.001). Most participants (521/664, 78.5\%) used mouthwash frequently. In the qualitative study, almost all sex workers reported kissing clients due to demand and generally reported following clients' lead with regard to kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting sexually transmitted infections, unlike cunnilingus without a dental dam. Conclusions: Our study shows that condomless fellatio is a risk factor for oropharyngeal gonorrhea among sex workers despite most sex workers using condoms with their clients for fellatio. Novel interventions, particularly targeting the oropharynx, will be required for oropharyngeal gonorrhea prevention. ", doi="10.2196/46845", url="https://publichealth.jmir.org/2024/1/e46845", url="http://www.ncbi.nlm.nih.gov/pubmed/38767954" } @Article{info:doi/10.2196/44398, author="Post, Ann Lori and Wu, A. Scott and Soetikno, G. Alan and Ozer, A. Egon and Liu, Yingxuan and Welch, B. Sarah and Hawkins, Claudia and Moss, B. Charles and Murphy, L. Robert and Mason, Maryann and Havey, J. Robert and Lundberg, L. Alexander", title="Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Latin America and the Caribbean: Longitudinal Trend Analysis", journal="JMIR Public Health Surveill", year="2024", month="May", day="17", volume="10", pages="e44398", keywords="SARS-CoV-2", keywords="COVID-19", keywords="Latin America", keywords="Caribbean", keywords="pandemic", keywords="surveillance", keywords="COVID-19 transmission", keywords="speed", keywords="acceleration", keywords="deceleration", keywords="jerk", keywords="dynamic panel", keywords="generalized method of moments", keywords="GMM", keywords="Arellano-Bond", keywords="7-day lag", keywords="epidemiological", keywords="genomic", keywords="transmission", abstract="Background: In May 2020, the World Health Organization (WHO) declared Latin America and the Caribbean (LAC) the epicenter of the COVID-19 pandemic, with over 40\% of worldwide COVID-19--related deaths at the time. This high disease burden was a result of the unique circumstances in LAC. Objective: This study aimed to (1) measure whether the pandemic was expanding or contracting in LAC when the WHO declared the end of COVID-19 as a public health emergency of international concern on May 5, 2023; (2) use dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history; and (3) provide, with a focus on prevention policies, a historical context for the course of the pandemic in the region. Methods: In addition to updates of traditional surveillance data and dynamic panel estimates from the original study, we used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern (VOCs). We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Additionally, we conducted a 1-sided t test for whether the regional weekly speed (rate of novel COVID-19 transmission) was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the period from August 2020 to May 2023. Results: The speed of pandemic spread for the region had remained below the outbreak threshold for 6 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. Although the 1- and 7-day persistence coefficients remained statistically significant for the 120-day period ending on the week of May 5, 2023, the coefficients were relatively modest in magnitude (0.457 and 0.491, respectively). Furthermore, the shift parameters for either of the 2 most recent weeks around May 5, 2023, did not indicate any change in this clustering effect of cases on future cases. From December 2021 onward, Omicron was the predominant VOC in sequenced viral samples. The rolling t test of speed=10 became entirely insignificant from January 2023 onward. Conclusions: Although COVID-19 continues to circulate in LAC, surveillance data suggest COVID-19 is endemic in the region and no longer reaches the threshold of the pandemic definition. However, the region experienced a high COVID-19 burden in the early stages of the pandemic, and prevention policies should be an immediate focus in future pandemics. Ahead of vaccination development, these policies can include widespread testing of individuals and an epidemiological task force with a contact-tracing system. ", doi="10.2196/44398", url="https://publichealth.jmir.org/2024/1/e44398", url="http://www.ncbi.nlm.nih.gov/pubmed/38568194" } @Article{info:doi/10.2196/53437, author="Cummins, R. Mollie and Shishupal, Sukrut and Wong, Bob and Wan, Neng and Han, Jiuying and Johnny, D. Jace and Mhatre-Owens, Amy and Gouripeddi, Ramkiran and Ivanova, Julia and Ong, Triton and Soni, Hiral and Barrera, Janelle and Wilczewski, Hattie and Welch, M. Brandon and Bunnell, E. Brian", title="Travel Distance Between Participants in US Telemedicine Sessions With Estimates of Emissions Savings: Observational Study", journal="J Med Internet Res", year="2024", month="May", day="15", volume="26", pages="e53437", keywords="air pollution", keywords="environmental health", keywords="telemedicine", keywords="greenhouse gases", keywords="clinical research informatics", keywords="informatics", keywords="data science", keywords="telehealth", keywords="eHealth", keywords="travel", keywords="air quality", keywords="pollutant", keywords="pollution", keywords="polluted", keywords="environment", keywords="environmental", keywords="greenhouse gas", keywords="emissions", keywords="retrospective", keywords="observational", keywords="United States", keywords="USA", keywords="North America", keywords="North American", keywords="cost", keywords="costs", keywords="economic", keywords="economics", keywords="saving", keywords="savings", keywords="finance", keywords="financial", keywords="finances", keywords="CO2", keywords="carbon dioxide", keywords="carbon footprint", abstract="Background: Digital health and telemedicine are potentially important strategies to decrease health care's environmental impact and contribution to climate change by reducing transportation-related air pollution and greenhouse gas emissions. However, we currently lack robust national estimates of emissions savings attributable to telemedicine. Objective: This study aimed to (1) determine the travel distance between participants in US telemedicine sessions and (2) estimate the net reduction in carbon dioxide (CO2) emissions attributable to telemedicine in the United States, based on national observational data describing the geographical characteristics of telemedicine session participants. Methods: We conducted a retrospective observational study of telemedicine sessions in the United States between January 1, 2022, and February 21, 2023, on the doxy.me platform. Using Google Distance Matrix, we determined the median travel distance between participating providers and patients for a proportional sample of sessions. Further, based on the best available public data, we estimated the total annual emissions costs and savings attributable to telemedicine in the United States. Results: The median round trip travel distance between patients and providers was 49 (IQR 21-145) miles. The median CO2 emissions savings per telemedicine session was 20 (IQR 8-59) kg CO2). Accounting for the energy costs of telemedicine and US transportation patterns, among other factors, we estimate that the use of telemedicine in the United States during the years 2021-2022 resulted in approximate annual CO2 emissions savings of 1,443,800 metric tons. Conclusions: These estimates of travel distance and telemedicine-associated CO2 emissions costs and savings, based on national data, indicate that telemedicine may be an important strategy in reducing the health care sector's carbon footprint. ", doi="10.2196/53437", url="https://www.jmir.org/2024/1/e53437", url="http://www.ncbi.nlm.nih.gov/pubmed/38536065" } @Article{info:doi/10.2196/47626, author="Chen, Li and Wang, Liping and Xing, Yi and Xie, Junqing and Su, Binbin and Geng, Mengjie and Ren, Xiang and Zhang, Yi and Liu, Jieyu and Ma, Tao and Chen, Manman and Miller, E. Jessica and Dong, Yanhui and Song, Yi and Ma, Jun and Sawyer, Susan", title="Persistence and Variation of the Indirect Effects of COVID-19 Restrictions on the Spectrum of Notifiable Infectious Diseases in China: Analysis of National Surveillance Among Children and Adolescents From 2018 to 2021", journal="JMIR Public Health Surveill", year="2024", month="May", day="15", volume="10", pages="e47626", keywords="children and adolescents", keywords="COVID-19", keywords="notifiable infectious diseases", abstract="Background: Beyond the direct effect of COVID-19 infection on young people, the wider impact of the pandemic on other infectious diseases remains unknown. Objective: This study aims to assess changes in the incidence and mortality of 42 notifiable infectious diseases during the pandemic among children and adolescents in China, compared with prepandemic levels. Methods: The Notifiable Infectious Disease Surveillance System of China was used to detect new cases and fatalities among individuals aged 5-22 years across 42 notifiable infectious diseases spanning from 2018 to 2021. These infectious diseases were categorized into 5 groups: respiratory, gastrointestinal and enterovirus, sexually transmitted and blood-borne, zoonotic, and vector-borne diseases. Each year (2018-2021) was segmented into 4 phases: phase 1 (January 1-22), phase 2 (January 23-April 7), phase 3 (April 8-August 31), and phase 4 (September 1-December 31) according to the varying intensities of pandemic restrictive measures in 2020. Generalized linear models were applied to assess the change in the incidence and mortality within each disease category, using 2018 and 2019 as the reference. Results: A total of 4,898,260 incident cases and 3701 deaths were included. The overall incidence of notifiable infectious diseases decreased sharply during the first year of the COVID-19 pandemic (2020) compared with prepandemic levels (2018 and 2019), and then rebounded in 2021, particularly in South China. Across the past 4 years, the number of deaths steadily decreased. The incidence of diseases rebounded differentially by the pandemic phase. For instance, although seasonal influenza dominated respiratory diseases in 2019, it showed a substantial decline during the pandemic (percent change in phase 2 2020: 0.21, 95\% CI 0.09-0.50), which persisted until 2021 (percent change in phase 4 2021: 1.02, 95\% CI 0.74-1.41). The incidence of gastrointestinal and enterovirus diseases decreased by 33.6\% during 2020 but rebounded by 56.9\% in 2021, mainly driven by hand, foot, and mouth disease (percent change in phase 3 2021: 1.28, 95\% CI 1.17-1.41) and infectious diarrhea (percent change in phase 3 2020: 1.22, 95\% CI 1.17-1.28). Sexually transmitted and blood-borne diseases were restrained during the first year of 2021 but rebounded quickly in 2021, mainly driven by syphilis (percent change in phase 3 2020: 1.31, 95\% CI 1.23-1.40) and gonorrhea (percent change in phase 3 2020: 1.10, 95\% CI 1.05-1.16). Zoonotic diseases were not dampened by the pandemic but continued to increase across the study period, mainly due to brucellosis (percent change in phase 2 2020: 0.94, 95\% CI 0.75-1.16). Vector-borne diseases showed a continuous decline during 2020, dominated by hemorrhagic fever (percent change in phase 2 2020: 0.68, 95\% CI 0.53-0.87), but rebounded in 2021. Conclusions: The COVID-19 pandemic was associated with a marked decline in notifiable infectious diseases in Chinese children and adolescents. These effects were not sustained, with evidence of a rebound to prepandemic levels by late 2021. To effectively address the postpandemic resurgence of infectious diseases in children and adolescents, it will be essential to maintain disease surveillance and strengthen the implementation of various initiatives. These include extending immunization programs, prioritizing the management of sexually transmitted infections, continuing feasible nonpharmaceutical intervention projects, and effectively managing imported infections. ", doi="10.2196/47626", url="https://publichealth.jmir.org/2024/1/e47626", url="http://www.ncbi.nlm.nih.gov/pubmed/38748469" } @Article{info:doi/10.2196/48564, author="Liu, Xiaoqi and Hu, Qingyuan and Wang, Jie and Wu, Xusheng and Hu, Dehua", title="Difference in Rumor Dissemination and Debunking Before and After the Relaxation of COVID-19 Prevention and Control Measures in China: Infodemiology Study", journal="J Med Internet Res", year="2024", month="May", day="15", volume="26", pages="e48564", keywords="new stage", keywords="public health emergency", keywords="information epidemic", keywords="propagation characteristic", keywords="debunking mechanism", keywords="China", abstract="Background: The information epidemic emerged along with the COVID-19 pandemic. While controlling the spread of COVID-19, the secondary harm of epidemic rumors to social order cannot be ignored. Objective: The objective of this paper was to understand the characteristics of rumor dissemination before and after the pandemic and the corresponding rumor management and debunking mechanisms. This study aimed to provide a theoretical basis and effective methods for relevant departments to establish a sound mechanism for managing network rumors related to public health emergencies such as COVID-19. Methods: This study collected data sets of epidemic rumors before and after the relaxation of the epidemic prevention and control measures, focusing on large-scale network rumors. Starting from 3 dimensions of rumor content construction, rumor propagation, and rumor-refuting response, the epidemic rumors were subdivided into 7 categories, namely, involved subjects, communication content, emotional expression, communication channels, communication forms, rumor-refuting subjects, and verification sources. Based on this framework, content coding and statistical analysis of epidemic rumors were carried out. Results: The study found that the rumor information was primarily directed at a clear target audience. The main themes of rumor dissemination were related to the public's immediate interests in the COVID-19 field, with significant differences in emotional expression and mostly negative emotions. Rumors mostly spread through social media interactions, community dissemination, and circle dissemination, with text content as the main form, but they lack factual evidence. The preferences of debunking subjects showed differences, and the frequent occurrence of rumors reflected the unsmooth channels of debunking. The $\chi$2 test of data before and after the pandemic showed that the P value was less than .05, indicating that the difference in rumor content before and after the pandemic had statistical significance. Conclusions: This study's results showed that the themes of rumors during the pandemic are closely related to the immediate interests of the public, and the emotions of the public accelerate the spread of these rumors, which are mostly disseminated through social networks. Therefore, to more effectively prevent and control the spread of rumors during the pandemic and to enhance the capability to respond to public health crises, relevant authorities should strengthen communication with the public, conduct emotional risk assessments, and establish a joint mechanism for debunking rumors. ", doi="10.2196/48564", url="https://www.jmir.org/2024/1/e48564", url="http://www.ncbi.nlm.nih.gov/pubmed/38748460" } @Article{info:doi/10.2196/40796, author="Haeri Mazanderani, Ahmad and Radebe, Lebohang and Sherman, G. Gayle", title="Attrition Rates in HIV Viral Load Monitoring and Factors Associated With Overdue Testing Among Children Within South Africa's Antiretroviral Treatment Program: Retrospective Descriptive Analysis", journal="JMIR Public Health Surveill", year="2024", month="May", day="14", volume="10", pages="e40796", keywords="HIV", keywords="monitoring", keywords="viral load", keywords="suppression", keywords="overdue", keywords="retention", keywords="VL test", keywords="attrition", keywords="child", keywords="youth", keywords="pediatric", keywords="paediatric", keywords="sexually transmitted", keywords="sexual transmission", keywords="virological failure", keywords="South Africa", keywords="infant", keywords="adolescent", keywords="big data", keywords="descriptive analysis", keywords="laboratory data", abstract="Background: Numerous studies in South Africa have reported low HIV viral load (VL) suppression and high attrition rates within the pediatric HIV treatment program. Objective: Using routine laboratory data, we evaluated HIV VL monitoring, including mobility and overdue VL (OVL) testing, within 5 priority districts in South Africa. Methods: We performed a retrospective descriptive analysis of National Health Laboratory Service (NHLS) data for children and adolescents aged 1-15 years having undergone HIV VL testing between May 1, 2019, and April 30, 2020, from 152 facilities within the City of Johannesburg, City of Tshwane, eThekwini, uMgungundlovu, and Zululand. HIV VL test--level data were deduplicated to patient-level data using the NHLS CDW (Corporate Data Warehouse) probabilistic record-linking algorithm and then further manually deduplicated. An OVL was defined as no subsequent VL determined within 18 months of the last test. Variables associated with the last VL test, including age, sex, VL findings, district type, and facility type, are described. A multivariate logistic regression analysis was performed to identify variables associated with an OVL test. Results: Among 21,338 children and adolescents aged 1-15 years who had an HIV VL test, 72.70\% (n=15,512) had a follow-up VL test within 18 months. Furthermore, 13.33\% (n=2194) of them were followed up at a different facility, of whom 3.79\% (n=624) were in a different district and 1.71\% (n=281) were in a different province. Among patients with a VL of ?1000 RNA copies/mL of plasma, the median time to subsequent testing was 6 (IQR 4-10) months. The younger the age of the patient, the greater the proportion with an OVL, ranging from a peak of 52\% among 1-year-olds to a trough of 21\% among 14-year-olds. On multivariate analysis, 2 consecutive HIV VL findings of ?1000 RNA copies/mL of plasma were associated with an increased adjusted odds ratio (AOR) of having an OVL (AOR 2.07, 95\% CI 1.71-2.51). Conversely, patients examined at a hospital (AOR 0.86, 95\% CI 0.77-0.96), those with ?2 previous tests (AOR 0.78, 95\% CI 0.70-0.86), those examined in a rural district (AOR 0.63, 95\% CI 0.54-0.73), and older age groups of 5-9 years (AOR 0.56, 95\% CI 0.47-0.65) and 10-14 years (AOR 0.51, 95\% CI 0.44-0.59) compared to 1-4 years were associated with a significantly decreased odds of having an OVL test. Conclusions: Considerable attrition occurs within South Africa's pediatric HIV treatment program, with over one-fourth of children having an OVL test 18 months subsequent to their previous test. In particular, younger children and those with virological failure were found to be at increased risk of having an OVL test. Improved HIV VL monitoring is essential for improving outcomes within South Africa's pediatric antiretroviral treatment program. ", doi="10.2196/40796", url="https://publichealth.jmir.org/2024/1/e40796", url="http://www.ncbi.nlm.nih.gov/pubmed/38743934" } @Article{info:doi/10.2196/49276, author="He, Yanyun and Yang, Qian and Alish, Yousef and Ma, Shaoying and Qiu, Zefeng and Chen, Jian and Wagener, Theodore and Shang, Ce", title="Relationship Between Product Features and the Prices of e-Cigarette Devices Sold in Web-Based Vape Shops: Comparison Study Using a Linear Regression Model", journal="JMIR Form Res", year="2024", month="May", day="9", volume="8", pages="e49276", keywords="e-cigarette devices", keywords="price", keywords="web-based vape shop", keywords="battery capacity", keywords="output wattage", keywords="e-cigarette", keywords="vape", keywords="vaping", keywords="consumers", keywords="costs", keywords="prices", keywords="pricing", keywords="feature", keywords="features", keywords="device", keywords="devices", keywords="consumer", keywords="cost", keywords="smoking products", keywords="product safety", keywords="consumer safety", keywords="smoking", keywords="smoker", keywords="smokers", keywords="tax", keywords="taxes", keywords="taxation", keywords="economic", keywords="economics", keywords="regression", keywords="regression model", keywords="health economics", abstract="Background: Open-system electronic cigarette (EC) product features, such as battery capacity, maximum output wattage, and so forth, are major components that drive product costs and may influence use patterns. Moreover, continued innovation and monitoring of product features and prices will provide critical information for designing appropriate taxation policies and product regulations. Objective: This study will examine how product features are associated with the prices of devices sold in web-based vape shops. Methods: We draw samples from 5 popular, US-based, web-based vape shops from April to August 2022 to examine starter kits, device-only products, and e-liquid container--only products. We implemented a linear regression model with a store-fixed effect to examine the association between device attributes and prices. Results: EC starter kits or devices vary significantly by type, with mod prices being much higher than pod and vape pen prices. The prices of mod starter kits were even lower than those of mod devices, suggesting that mod starter kits are discounted in web-based vape shops. The price of mod kits, mod device--only products, and pod kits increased as the battery capacity and output wattage increased. For vape pens, the price was positively associated with the volume size of the e-liquid container. On the other hand, the price of pod kits was positively associated with the number of containers. Conclusions: A unit-based specific tax, therefore, will impose a higher tax burden on lower-priced devices such as vape pens or pod systems and a lower tax burden on mod devices. A volume- or capacity-based specific tax on devices will impose a higher tax burden on vape pens with a larger container size. Meanwhile, ad valorem taxes pegged to wholesale or retail prices would apply evenly across device types, meaning those with advanced features such as higher battery capacities and output wattage would face higher rates. Therefore, policy makers could manipulate tax rates by device type to discourage the use of certain device products. ", doi="10.2196/49276", url="https://formative.jmir.org/2024/1/e49276", url="http://www.ncbi.nlm.nih.gov/pubmed/38723251" } @Article{info:doi/10.2196/48380, author="Choi, Young Yoon and Lee, Myeongjee and Kim, Hwa Eun and Lee, Eun Jae and Jung, Inkyung and Cheong, Jae-Ho", title="Risk of Subsequent Primary Cancers Among Adult-Onset 5-Year Cancer Survivors in South Korea: Retrospective Cohort Study", journal="JMIR Public Health Surveill", year="2024", month="May", day="8", volume="10", pages="e48380", keywords="cancer", keywords="survivors", keywords="subsequent primary cancer", keywords="adult", keywords="onset", keywords="primary cancer", keywords="risk", keywords="general population", keywords="screening", keywords="genetic testing", keywords="retrospective", keywords="cohort study", keywords="health Insurance", keywords="survivability", keywords="hereditary", keywords="FPC", keywords="SPC", keywords="subsequent cancer", abstract="Background: The number of cancer survivors who develop subsequent primary cancers (SPCs) is expected to increase. Objective: We evaluated the overall and cancer type--specific risks of SPCs among adult-onset cancer survivors by first primary cancer (FPC) types considering sex and age. Methods: We conducted a retrospective cohort study using the Health Insurance Review and Assessment database of South Korea including 5-year cancer survivors diagnosed with an FPC in 2009 to 2010 and followed them until December 31, 2019. We measured the SPC incidence per 10,000 person-years and the standardized incidence ratio (SIR) compared with the incidence expected in the general population. Results: Among 266,241 survivors (mean age at FPC: 55.7 years; 149,352/266,241, 56.1\% women), 7348 SPCs occurred during 1,003,008 person-years of follow-up (median 4.3 years), representing a 26\% lower risk of developing SPCs (SIR 0.74, 95\% CI 0.72-0.76). Overall, men with 14 of the 20 FPC types had a significantly lower risk of developing any SPCs; women with 7 of the 21 FPC types had a significantly lower risk of developing any SPCs. The risk of developing any SPC type differed by age; the risk was 28\% higher in young (<40 years) cancer survivors (SIR 1.28, 95\% CI 1.16-1.42; incidence: 30 per 10,000 person-years) and 27\% lower in middle-aged and older (?40 years) cancer survivors (SIR 0.73, 95\% CI 0.71-0.74; incidence: 80 per 10,000 person-years) compared with the age-corresponding general population. The most common types of FPCs were mainly observed as SPCs in cancer survivors, with lung (21.6\%) and prostate (15.2\%) cancers in men and breast (18.9\%) and lung (12.2\%) cancers in women. The risks of brain cancer in colorectal cancer survivors, lung cancer in laryngeal cancer survivors, and both kidney cancer and leukemia in thyroid cancer survivors were significantly higher for both sexes. Other high-risk SPCs varied by FPC type and sex. Strong positive associations among smoking-related cancers, such as laryngeal, head and neck, lung, and esophageal cancers, were observed. Substantial variation existed in the associations between specific types of FPC and specific types of SPC risk, which may be linked to hereditary cancer syndrome: for women, the risks of ovarian cancer for breast cancer survivors and uterus cancers for colorectal cancer survivors, and for men, the risk of pancreas cancer for kidney cancer survivors. Conclusions: The varying risk for SPCs by age, sex, and FPC types in cancer survivors implies the necessity for tailored prevention and screening programs targeting cancer survivors. Lifestyle modifications, such as smoking cessation, are essential to reduce the risk of SPCs in cancer survivors. In addition, genetic testing, along with proactive cancer screening and prevention strategies, should be implemented for young cancer survivors because of their elevated risk of developing SPCs. ", doi="10.2196/48380", url="https://publichealth.jmir.org/2024/1/e48380", url="http://www.ncbi.nlm.nih.gov/pubmed/38717807" } @Article{info:doi/10.2196/50588, author="Katumba, Godfrey and Mwanja, Herman and Mayito, Jonathan and Mbolanyi, Betty and Isaasi, Fred and Kibombo, Daniel and Namumbya, Judith and Musoke, David and Kabazzi, Jonathan and Sekamatte, Musa and Idrakua, Lillian and Walwema, Richard and Lamorde, Mohammed and Kakooza, Francis and Etimu, Simon", title="Establishing Antimicrobial Resistance Surveillance in the Water and Environment Sector in a Resource-Limited Setting: Methodical Qualitative and Quantitative Description of Uganda's Experience From 2021 to 2023", journal="JMIRx Bio", year="2024", month="May", day="7", volume="2", pages="e50588", keywords="antimicrobial resistance", keywords="surveillance system", keywords="water and environment sector", abstract="Background: Antimicrobial irrational use and poor disposal in the human and animal sectors promote antimicrobial resistance (AMR) in the environment as these antimicrobials and their active ingredients, coupled with resistant microbes, are released into the environment. While AMR containment programs in the human and animal sectors are well established in Uganda, those in the water and environment sector still need to be established and strengthened. Therefore, the Ministry of Water and Environment set out to establish an AMR surveillance program to bolster the One Health efforts for the containment of AMR under the National Action Plan 2018-2023. Objective: This study aims to describe Uganda's experience in establishing AMR surveillance in the water and environment sector. Methods: A methodical qualitative and quantitative description of the steps undertaken between August 2021 and March 2023 to establish an AMR surveillance system in the water and environment sector is provided. The Uganda Ministry of Water and Environment used a stepwise approach. Governance structures were streamlined, and sector-specific AMR surveillance guiding documents were developed, pretested, and rolled out. The National Water Quality Reference Laboratory infrastructure and microbiology capacity were enhanced to aid AMR detection and surveillance using conventional culture-based methods. A passive and targeted active surveillance hybrid was used to generate AMR data. Passive surveillance used remnants of water samples collected routinely for water quality monitoring while targeted active surveys were done at selected sites around the Kampala and Wakiso districts. Excel and Stata 15 statistical software were used for data analysis. Results: A sector-specific technical working group of 10 members and focal persons is in place, providing strategic direction and linkage to the national AMR surveillance program. The National Water Quality Reference Laboratory is now at biosafety level 2 and conducting microbiology testing using conventional culture-based techniques. Up to 460 water samples were processed and 602 bacterial isolates were recovered, of which 399 (66.3\%) and 203 (33.7\%) were priority pathogens and nonpriority pathogens, respectively. Of the 399 priority pathogens, 156 (39.1\%), 140 (35.1\%), 96 (24.1\%), and 7 (1.8\%) were Escherichia coli, Klebsiella species, Enterococcus species, and Salmonella species, respectively. E coli showed resistance to ampicillin (79\%), ciprofloxacin (29\%), and ceftriaxone (29\%). Similarly, Klebsiella species showed resistance to ampicillin (100\%), ciprofloxacin (17\%), and ceftriaxone (18\%). Enterococcus species showed resistance to ciprofloxacin (52\%), vancomycin (45\%), and erythromycin (56\%). Up to 254 (63.7\%) of the priority pathogens recovered exhibited multiple and extensive resistance to the different antibiotics set. Conclusions: Initial efforts to establish and implement AMR surveillance in the water and environment sector have succeeded in streamlining governance and laboratory systems to generate AMR data using conventional culture-based methods. ", doi="10.2196/50588", url="https://bio.jmirx.org/2024/1/e50588" } @Article{info:doi/10.2196/40792, author="Gilca, Rodica and Amini, Rachid and Carazo, Sara and Doggui, Radhouene and Frenette, Charles and Boivin, Guy and Charest, Hugues and Dumaresq, Jeannot", title="The Changing Landscape of Respiratory Viruses Contributing to Hospitalizations in Quebec, Canada: Results From an Active Hospital-Based Surveillance Study", journal="JMIR Public Health Surveill", year="2024", month="May", day="6", volume="10", pages="e40792", keywords="respiratory viruses", keywords="SARS-CoV-2", keywords="COVID-19", keywords="hospitalizations", keywords="acute respiratory infections", keywords="children", keywords="adults", keywords="coinfections", keywords="prepandemic", keywords="pandemic", abstract="Background: A comprehensive description of the combined effect of SARS-CoV-2 and respiratory viruses other than SARS-CoV-2 (ORVs) on acute respiratory infection (ARI) hospitalizations is lacking. Objective: This study aimed to compare the viral etiology of ARI hospitalizations before the pandemic (8 prepandemic influenza seasons, 2012-13 to 2019-20) and during 3 pandemic years (periods of increased SARS-CoV-2 and ORV circulation in 2020-21, 2021-22, and 2022-23) from an active hospital-based surveillance network in Quebec, Canada. Methods: We compared the detection of ORVs and SARS-CoV-2 during 3 pandemic years to that in 8 prepandemic influenza seasons among patients hospitalized with ARI who were tested systematically by the same multiplex polymerase chain reaction (PCR) assay during periods of intense respiratory virus (RV) circulation. The proportions of infections between prepandemic and pandemic years were compared by using appropriate statistical tests. Results: During prepandemic influenza seasons, overall RV detection was 92.7\% (1384/1493) (respiratory syncytial virus [RSV]: 721/1493, 48.3\%; coinfections: 456/1493, 30.5\%) in children (<18 years) and 62.8\% (2723/4339) (influenza: 1742/4339, 40.1\%; coinfections: 264/4339, 6.1\%) in adults. Overall RV detection in children was lower during pandemic years but increased from 58.6\% (17/29) in 2020-21 (all ORVs; coinfections: 7/29, 24.1\%) to 90.3\% (308/341) in 2021-22 (ORVs: 278/341, 82\%; SARS-CoV-2: 30/341, 8.8\%; coinfections: 110/341, 32.3\%) and 88.9\% (361/406) in 2022-23 (ORVs: 339/406, 84\%; SARS-CoV-2: 22/406, 5.4\%; coinfections: 128/406, 31.5\%). In adults, overall RV detection was also lower during pandemic years but increased from 43.7\% (333/762) in 2020-21 (ORVs: 26/762, 3.4\%; SARS-CoV-2: 307/762, 40.3\%; coinfections: 7/762, 0.9\%) to 57.8\% (731/1265) in 2021-22 (ORVs: 179/1265, 14.2\%; SARS-CoV-2: 552/1265, 43.6\%; coinfections: 42/1265, 3.3\%) and 50.1\% (746/1488) in 2022-23 (ORVs: 409/1488, 27.5\%; SARS-CoV-2: 337/1488, 22.6\%; coinfections: 36/1488, 2.4\%). No influenza or RSV was detected in 2020-21; however, their detection increased in the 2 subsequent years but did not reach prepandemic levels. Compared to the prepandemic period, the peaks of RSV hospitalization shifted in 2021-22 (16 weeks earlier) and 2022-23 (15 weeks earlier). Moreover, the peaks of influenza hospitalization shifted in 2021-22 (17 weeks later) and 2022-23 (4 weeks earlier). Age distribution was different compared to the prepandemic period, especially during the first pandemic year. Conclusions: Significant shifts in viral etiology, seasonality, and age distribution of ARI hospitalizations occurred during the 3 pandemic years. Changes in age distribution observed in our study may reflect modifications in the landscape of circulating RVs and their contribution to ARI hospitalizations. During the pandemic period, SARS-CoV-2 had a low contribution to pediatric ARI hospitalizations, while it was the main contributor to adult ARI hospitalizations during the first 2 seasons and dropped below ORVs during the third pandemic season. Evolving RVs epidemiology underscores the need for increased scrutiny of ARI hospitalization etiology to inform tailored public health recommendations. ", doi="10.2196/40792", url="https://publichealth.jmir.org/2024/1/e40792", url="http://www.ncbi.nlm.nih.gov/pubmed/38709551" } @Article{info:doi/10.2196/52691, author="Mohebbi, Fahimeh and Forati, Masoud Amir and Torres, Lucas and deRoon-Cassini, A. Terri and Harris, Jennifer and Tomas, W. Carissa and Mantsch, R. John and Ghose, Rina", title="Exploring the Association Between Structural Racism and Mental Health: Geospatial and Machine Learning Analysis", journal="JMIR Public Health Surveill", year="2024", month="May", day="3", volume="10", pages="e52691", keywords="machine learning", keywords="geospatial", keywords="racial disparities", keywords="social determinant of health", keywords="structural racism", keywords="mental health", keywords="health disparities", keywords="deep learning", abstract="Background: Structural racism produces mental health disparities. While studies have examined the impact of individual factors such as poverty and education, the collective contribution of these elements, as manifestations of structural racism, has been less explored. Milwaukee County, Wisconsin, with its racial and socioeconomic diversity, provides a unique context for this multifactorial investigation. Objective: This research aimed to delineate the association between structural racism and mental health disparities in Milwaukee County, using a combination of geospatial and deep learning techniques. We used secondary data sets where all data were aggregated and anonymized before being released by federal agencies. Methods: We compiled 217 georeferenced explanatory variables across domains, initially deliberately excluding race-based factors to focus on nonracial determinants. This approach was designed to reveal the underlying patterns of risk factors contributing to poor mental health, subsequently reintegrating race to assess the effects of racism quantitatively. The variable selection combined tree-based methods (random forest) and conventional techniques, supported by variance inflation factor and Pearson correlation analysis for multicollinearity mitigation. The geographically weighted random forest model was used to investigate spatial heterogeneity and dependence. Self-organizing maps, combined with K-means clustering, were used to analyze data from Milwaukee communities, focusing on quantifying the impact of structural racism on the prevalence of poor mental health. Results: While 12 influential factors collectively accounted for 95.11\% of the variability in mental health across communities, the top 6 factors---smoking, poverty, insufficient sleep, lack of health insurance, employment, and age---were particularly impactful. Predominantly, African American neighborhoods were disproportionately affected, which is 2.23 times more likely to encounter high-risk clusters for poor mental health. Conclusions: The findings demonstrate that structural racism shapes mental health disparities, with Black community members disproportionately impacted. The multifaceted methodological approach underscores the value of integrating geospatial analysis and deep learning to understand complex social determinants of mental health. These insights highlight the need for targeted interventions, addressing both individual and systemic factors to mitigate mental health disparities rooted in structural racism. ", doi="10.2196/52691", url="https://publichealth.jmir.org/2024/1/e52691", url="http://www.ncbi.nlm.nih.gov/pubmed/38701436" } @Article{info:doi/10.2196/52145, author="Ambrosio, Graca Maria Da and Lachman, M. Jamie and Zinzer, Paula and Gwebu, Hlengiwe and Vyas, Seema and Vallance, Inge and Calderon, Francisco and Gardner, Frances and Markle, Laurie and Stern, David and Facciola, Chiara and Schley, Anne and Danisa, Nompumelelo and Brukwe, Kanyisile and Melendez-Torres, GJ", title="A Factorial Randomized Controlled Trial to Optimize User Engagement With a Chatbot-Led Parenting Intervention: Protocol for the ParentText Optimisation Trial", journal="JMIR Res Protoc", year="2024", month="May", day="3", volume="13", pages="e52145", keywords="parenting intervention", keywords="chatbot-led public health intervention", keywords="engagement", keywords="implementation science", keywords="mobile phone", abstract="Background: Violence against children (VAC) is a serious public health concern with long-lasting adverse effects. Evidence-based parenting programs are one effective means to prevent VAC; however, these interventions are not scalable in their typical in-person group format, especially in low- and middle-income countries where the need is greatest. While digital delivery, including via chatbots, offers a scalable and cost-effective means to scale up parenting programs within these settings, it is crucial to understand the key pillars of user engagement to ensure their effective implementation. Objective: This study aims to investigate the most effective and cost-effective combination of external components to optimize user engagement with ParentText, an open-source chatbot-led parenting intervention to prevent VAC in Mpumalanga, South Africa. Methods: This study will use a mixed methods design incorporating a 2 {\texttimes} 2 factorial cluster-randomized controlled trial and qualitative interviews. Parents of adolescent girls (32 clusters, 120 participants [60 parents and 60 girls aged 10 to 17 years] per cluster; N=3840 total participants) will be recruited from the Ehlanzeni and Nkangala districts of Mpumalanga. Clusters will be randomly assigned to receive 1 of the 4 engagement packages that include ParentText alone or combined with in-person sessions and a facilitated WhatsApp support group. Quantitative data collected will include pretest-posttest parent- and adolescent-reported surveys, facilitator-reported implementation data, and digitally tracked engagement data. Qualitative data will be collected from parents and facilitators through in-person or over-the-phone individual semistructured interviews and used to expand the interpretation and understanding of the quantitative findings. Results: Recruitment and data collection started in August 2023 and were finalized in November 2023. The total number of participants enrolled in the study is 1009, with 744 caregivers having completed onboarding to the chatbot-led intervention. Female participants represent 92.96\% (938/1009) of the sample population, whereas male participants represent 7.03\% (71/1009). The average participant age is 43 (SD 9) years. Conclusions: The ParentText Optimisation Trial is the first study to rigorously test engagement with a chatbot-led parenting intervention in a low- or middle-income country. The results of this study will inform the final selection of external delivery components to support engagement with ParentText in preparation for further evaluation in a randomized controlled trial in 2024. Trial Registration: Open Science Framework (OSF); https://doi.org/10.17605/OSF.IO/WFXNE International Registered Report Identifier (IRRID): DERR1-10.2196/52145 ", doi="10.2196/52145", url="https://www.researchprotocols.org/2024/1/e52145", url="http://www.ncbi.nlm.nih.gov/pubmed/38700935" } @Article{info:doi/10.2196/49841, author="Resendez, Skyler and Brown, H. Steven and Ruiz Ayala, Sebastian Hugo and Rangan, Prahalad and Nebeker, Jonathan and Montella, Diane and Elkin, L. Peter", title="Defining the Subtypes of Long COVID and Risk Factors for Prolonged Disease: Population-Based Case-Crossover Study", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="30", volume="10", pages="e49841", keywords="long COVID", keywords="PASC", keywords="postacute sequelae of COVID-19", keywords="public health", keywords="policy initiatives", keywords="pandemic", keywords="diagnosis", keywords="COVID-19 treatment", keywords="long COVID cause", keywords="health care support", keywords="public safety", keywords="COVID-19", keywords="Veterans Affairs", keywords="United States", keywords="COVID-19 testing", keywords="clinician", keywords="mobile phone", abstract="Background: There have been over 772 million confirmed cases of COVID-19 worldwide. A significant portion of these infections will lead to long COVID (post--COVID-19 condition) and its attendant morbidities and costs. Numerous life-altering complications have already been associated with the development of long COVID, including chronic fatigue, brain fog, and dangerous heart rhythms. Objective: We aim to derive an actionable long COVID case definition consisting of significantly increased signs, symptoms, and diagnoses to support pandemic-related clinical, public health, research, and policy initiatives. Methods: This research employs a case-crossover population-based study using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) data generated at Veterans Affairs medical centers nationwide between January 1, 2020, and August 18, 2022. In total, 367,148 individuals with ICD-10-CM data both before and after a positive COVID-19 test were selected for analysis. We compared ICD-10-CM codes assigned 1 to 7 months following each patient's positive test with those assigned up to 6 months prior. Further, 350,315 patients had novel codes assigned during this window of time. We defined signs, symptoms, and diagnoses as being associated with long COVID if they had a novel case frequency of ?1:1000, and they significantly increased in our entire cohort after a positive test. We present odds ratios with CIs for long COVID signs, symptoms, and diagnoses, organized by ICD-10-CM functional groups and medical specialty. We used our definition to assess long COVID risk based on a patient's demographics, Elixhauser score, vaccination status, and COVID-19 disease severity. Results: We developed a long COVID definition consisting of 323 ICD-10-CM diagnosis codes grouped into 143 ICD-10-CM functional groups that were significantly increased in our 367,148 patient post--COVID-19 population. We defined 17 medical-specialty long COVID subtypes such as cardiology long COVID. Patients who were COVID-19--positive developed signs, symptoms, or diagnoses included in our long COVID definition at a proportion of at least 59.7\% (268,320/449,450, based on a denominator of all patients who were COVID-19--positive). The long COVID cohort was 8 years older with more comorbidities (2-year Elixhauser score 7.97 in the patients with long COVID vs 4.21 in the patients with non--long COVID). Patients who had a more severe bout of COVID-19, as judged by their minimum oxygen saturation level, were also more likely to develop long COVID. Conclusions: An actionable, data-driven definition of long COVID can help clinicians screen for and diagnose long COVID, allowing identified patients to be admitted into appropriate monitoring and treatment programs. This long COVID definition can also support public health, research, and policy initiatives. Patients with COVID-19 who are older or have low oxygen saturation levels during their bout of COVID-19, or those who have multiple comorbidities should be preferentially watched for the development of long COVID. ", doi="10.2196/49841", url="https://publichealth.jmir.org/2024/1/e49841", url="http://www.ncbi.nlm.nih.gov/pubmed/38687984" } @Article{info:doi/10.2196/46945, author="Anikamadu, Onyekachukwu and Ezechi, Oliver and Engelhart, Alexis and Nwaozuru, Ucheoma and Obiezu-Umeh, Chisom and Ogunjemite, Ponmile and Bale, Ismail Babatunde and Nwachukwu, Daniel and Gbaja-biamila, Titilola and Oladele, David and Musa, Z. Adesola and Mason, Stacey and Ojo, Temitope and Tucker, Joseph and Iwelunmor, Juliet", title="Expanding Youth-Friendly HIV Self-Testing Services During the COVID-19 Pandemic: Qualitative Analysis of a Crowdsourcing Open Call in Nigeria", journal="JMIR Form Res", year="2024", month="Apr", day="30", volume="8", pages="e46945", keywords="crowdsourcing", keywords="World AIDS Day", keywords="HIV", keywords="self-testing", keywords="young people", keywords="COVID-19 pandemic restrictions", keywords="Nigeria", keywords="HIV self-testing", keywords="health promotion", keywords="crowdsourcing open call", keywords="young adult", abstract="Background: HIV self-testing (HIVST) among young people is an effective approach to enhance the uptake of HIV testing recommended by the World Health Organization. However, the COVID-19 pandemic disrupted conventional facility-based HIV testing services, necessitating the exploration of innovative strategies for the effective delivery of HIVST. Objective: This study analyzed the outcomes of a digital World AIDS Day crowdsourcing open call, designed to elicit youth responses on innovative approaches to promote HIVST among young people (14-24 years) in Nigeria during COVID-19 restrictions. Methods: From November 2 to 22, 2020, a World AIDS Day 2020 crowdsourcing open call was held digitally due to COVID-19 restrictions. The crowdsourcing open call followed World Health Organization standardized steps, providing a structured framework for participant engagement. Young people in Nigeria, aged 10-24 years, participated by submitting ideas digitally through Google Forms or email in response to this crowdsourcing open call prompt: ``How will you promote HIV self-testing among young people during COVID-19 pandemic?'' Data and responses from each submission were analyzed, and proposed ideas were closely examined to identify common themes. Four independent reviewers (AE, SM, AZM, and TG) judged each submission based on the desirability, feasibility, and impact on a 9-point scale (3-9, with 3 being the lowest and 9 being the highest). Results: The crowdsourcing open call received 125 eligible entries, 44 from women and 65 from men. The median age of participants was 20 (IQR 24-20) years, with the majority having completed their highest level of education at the senior secondary school level. The majority of participants lived in the South-West region (n=61) and Lagos state (n=36). Of the 125 eligible entries, the top 20 submissions received an average total score of 7.5 (SD 2.73) or above. The panel of judges ultimately selected 3 finalists to receive a monetary award. Three prominent themes were identified from the 125 crowdsourcing open call submissions as specific ways that HIVST can adapt during the COVID-19 pandemic: (1) digital approaches (such as gamification, photoverification system, and digital media) to generate demand for HIVST and avoid risks associated with attending clinics, (2) awareness and sensitization through existing infrastructures (such as churches, schools, and health facilities), and (3) partnerships with influencers, role models, and leaders (such as religious and youth leaders and social influencers in businesses, churches, organizations, and schools) to build trust in HIVST services. Conclusions: The crowdsourcing open call effectively engaged a diverse number of young people who proposed a variety of ways to improve the uptake of HIVST during the COVID-19 pandemic. Findings contribute to the need for innovative HIVST strategies that close critical knowledge and practice gaps on ways to reach young people with HIVST during and beyond the pandemic. Trial Registration: ClinicalTrials.gov NCT04710784; https://clinicaltrials.gov/study/NCT04710784 ", doi="10.2196/46945", url="https://formative.jmir.org/2024/1/e46945", url="http://www.ncbi.nlm.nih.gov/pubmed/38687582" } @Article{info:doi/10.2196/38761, author="Chadwick, L. Verity and Saich, Freya and Freeman, Joseph and Martiniuk, Alexandra", title="Media Discourse Regarding COVID-19 Vaccinations for Children Aged 5 to 11 Years in Australia, Canada, the United Kingdom, and the United States: Comparative Analysis Using the Narrative Policy Framework", journal="JMIR Form Res", year="2024", month="Apr", day="29", volume="8", pages="e38761", keywords="COVID-19", keywords="SARS-CoV-2", keywords="vaccine", keywords="mRNA", keywords="Pfizer-BioNTech", keywords="pediatric", keywords="children", keywords="media", keywords="news", keywords="web-based", keywords="infodemic", keywords="disinformation", abstract="Background: Media narratives can shape public opinion and actions, influencing the uptake of pediatric COVID-19 vaccines. The COVID-19 pandemic has occurred at a time where infodemics, misinformation, and disinformation are present, impacting the COVID-19 response. Objective: This study aims to investigate how narratives about pediatric COVID-19 vaccines in the media of 4 English-speaking countries: the United States, Australia, Canada, and the United Kingdom. Methods: The Narrative Policy Framework was used to guide the comparative analyses of the major print and web-based news agencies' media regarding COVID-19 vaccines for children aged 5 to 11 years. Data were sought using systematic searching on Factiva (Dow Jones) of 4 key phases of pediatric vaccine approval and rollout. Results: A total of 400 articles (n=287, 71.8\% in the United States, n=40, 10\% in Australia, n=60, 15\% in Canada, and n=13, 3\% in the United Kingdom) met the search criteria and were included. Using the Narrative Policy Framework, the following were identified in each article: hero, villain, survivor, and plot. The United States was the earliest country to vaccinate children, and other countries' media often lauded the United States for this. Australian and Canadian media narratives about vaccines for children aged 5 to 11 years were commonly about protecting susceptible people in society, whereas the US and the UK narratives focused more on the vaccine helping children return to school. All 4 countries focused on the vaccines for children aged 5 to 11 years as being key to ``ending'' the pandemic. Australian and Canadian narratives frequently compared vaccine rollouts across states or provinces and bemoaned local progress in vaccine delivery compared with other countries globally. Canadian and US narratives highlighted the ``infodemic'' about the COVID-19 pandemic and disinformation regarding child vaccines as impeding uptake. All 4 countries---the United States, Australia, the United Kingdom, and Canada---used war imagery in reporting about COVID-19 vaccines for children. The advent of the Omicron variant demonstrated that populations were fatigued by the COVID-19 pandemic, and the media reporting increasingly blamed the unvaccinated. The UK media narrative was unique in describing vaccinating children as a distraction from adult COVID-19 vaccination efforts. The United States and Canada had narratives expressing anger about potential vaccine passports for children. In Australia, general practitioners were labelled as heroes. Finally, the Canadian narrative suggested altruistic forgoing of COVID-19 vaccine ``boosters'' as well as pediatric COVID-19 vaccines to benefit those in poorer nations. Conclusions: Public health emergencies require clear; compelling and accurate communication. The stories told during this pandemic are compelling because they contain the classic elements of a narrative; however, they can be reductive and inaccurate. ", doi="10.2196/38761", url="https://formative.jmir.org/2024/1/e38761", url="http://www.ncbi.nlm.nih.gov/pubmed/36383344" } @Article{info:doi/10.2196/52191, author="Mitchell, MH Ellen and Adejumo, Adedeji Olusola and Abdur-Razzaq, Hussein and Ogbudebe, Chidubem and Gidado, Mustapha", title="The Role of Trust as a Driver of Private-Provider Participation in Disease Surveillance: Cross-Sectional Survey From Nigeria", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="25", volume="10", pages="e52191", keywords="surveillance", keywords="trust", keywords="Integrated Disease Surveillance and Response", keywords="IDSR", keywords="tuberculosis", keywords="notification", keywords="public-private mix", keywords="infectious disease", keywords="disease surveillance", keywords="surveillance behavior", keywords="health care worker", keywords="health professional", keywords="public health", keywords="Nigeria", keywords="survey", keywords="behavior", keywords="self-reported", abstract="Background: Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny into private providers' intentions, motives, and obstacles to comply with an Integrated Disease Surveillance Response (IDSR) framework. Appreciation of how private providers' attitudes shape their tuberculosis (TB) notification behaviors can yield lessons for the surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among actors and institutions is an understudied part of the ``software'' of surveillance. Objective: We aimed to assess the self-reported knowledge, motivation, barriers, and TB case notification behavior of private health care providers to public health authorities in Lagos, Nigeria. We measured the concordance between self-reported notification, TB cases found in facility records, and actual notifications received. Methods: A representative, stratified sample of 278 private health care workers was surveyed on TB notification attitudes, behavior, and perceptions of public health authorities using validated scales. Record reviews were conducted to identify the TB treatment provided and facility case counts were abstracted from the records. Self-reports were triangulated against actual notification behavior for 2016. The complex health system framework was used to identify potential predictors of notification behavior. Results: Noncompliance with the legal obligations to notify infectious diseases was not attributable to a lack of knowledge. Private providers who were uncomfortable notifying TB cases via the IDSR system scored lower on the perceived benevolence subscale of trust. Health care workers who affirmed ``always'' notifying via IDSR monthly reported higher median trust in the state's public disease control capacity. Although self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, the self-report numbers did not tally with actual TB notifications. Conclusions: Providers perceived both risks and benefits to recording and reporting TB cases. To improve private providers' public health behaviors, policy makers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. Renewed attention to the ``software'' of health systems (eg, norms, values, and relationships) is vital to address pandemic threats. Surveys with private providers may overestimate their actual participation in public health surveillance. ", doi="10.2196/52191", url="https://publichealth.jmir.org/2024/1/e52191", url="http://www.ncbi.nlm.nih.gov/pubmed/38506095" } @Article{info:doi/10.2196/54041, author="Campagna, Davide and Farsalinos, Konstantinos and Costantino, Giorgio and Carpinteri, Giuseppe and Caponnetto, Pasquale and Cucuzza, Francesca and Polosa, Riccardo and ", title="Tobacco Smoking or Nicotine Phenotype and Severity of Clinical Presentation at the Emergency Department (SMOPHED): Protocol for a Noninterventional Observational Study", journal="JMIR Res Protoc", year="2024", month="Apr", day="24", volume="13", pages="e54041", keywords="NEWS", keywords="National Early Warning Score", keywords="emergency department", keywords="smoking", keywords="nicotine/tobacco use", keywords="electronic cigarettes", keywords="heated tobacco products", abstract="Background: In the last few years, several nicotine products have become available as alternatives to smoking tobacco. While laboratory and limited clinical studies suggest that these devices are less toxic compared to classic tobacco cigarettes, very little is known about their epidemiological impact. Visiting the emergency department (ED) often represents the first or even the only contact of patients with the health care system. Therefore, a study conducted at the ED to assess the impact of these products on health can be reliable and reflect a real-life setting. Objective: The aim of this noninterventional observational study (SMOPHED study) is to analyze the association between the severity of clinical presentation observed during ED visits among patients using various nicotine products and the subsequent outcomes, specifically hospitalization and mortality. Methods: Outcomes (hospitalization and mortality in the ED) will be examined in relation to various patterns of nicotine products use. We plan to enroll approximately 2000 participants during triage at the ED. These individuals will be characterized based on their patterns of tobacco and nicotine consumption, identified through a specific questionnaire. This categorization will allow for a detailed analysis of how different usage patterns of nicotine products correlate with the clinical diagnosis made during the ED visits and the consequent outcomes. Results: Enrollment into the study started in March 2024. We enrolled a total of 901 participants in 1 month (approximately 300 potential participants did not provide the informed consent to participate). The data will be analyzed by a statistician as soon as the database is completed. Full data will be published by December 2024. Conclusions: There is substantial debate about the harm reduction potential of alternative nicotine products in terms of their smoking-cessation and risk-reduction potential. This study represents an opportunity to document epidemiological data on the link between the use of different types of nicotine products and disease diagnosis and severity during an ED visit, and thus evaluate the harm reduction potential claims for these products. International Registered Report Identifier (IRRID): PRR1-10.2196/54041 ", doi="10.2196/54041", url="https://www.researchprotocols.org/2024/1/e54041", url="http://www.ncbi.nlm.nih.gov/pubmed/38657239" } @Article{info:doi/10.2196/48371, author="Arena, Sandy and Adams, Mackenzie and Burns, Jade", title="Exploring the Use of Customized Links to Improve Electronic Engagement With Sexual and Reproductive Health Care Among Young African American Male Individuals: Web-Based Survey Study", journal="JMIR Form Res", year="2024", month="Apr", day="24", volume="8", pages="e48371", keywords="African American", keywords="engagement", keywords="men's health", keywords="recruit", keywords="recruitment", keywords="reproductive health", keywords="sexual behavior", keywords="sexual health behavior", keywords="sexual health", keywords="sexual transmission", keywords="sexually transmitted", keywords="social media", keywords="STIs", keywords="young adult", keywords="young adults", abstract="Background: Research has shown that heterosexual African American male individuals aged 18-24 years have a higher prevalence of sexually transmitted infections (STIs) and are more likely to engage in risky sexual behavior. There is a critical need to promote sexual reproductive health (SRH) services among this population, especially in urban settings. Young African American male individuals use social media platforms to access health information, showcasing the potential of social media and web-based links as tools to leverage electronic engagement with this population to promote SRH care. Objective: This study aims to explore electronic engagement with young African American male individuals in discussions about SRH care. This paper focuses on the recruitment and social media marketing methods used to recruit young, heterosexual African American male individuals aged 18-24 years for the Stay Safe Project, a larger study that aims to promote SRH services among this population in Detroit, Michigan. We investigate the use of TinyURL, a URL shortener and customized tool, and culturally informed social media marketing strategies to promote electronic engagement within this population. Methods: Participants were recruited between December 2021 and February 2022 through various modes, including email listserves, Mailchimp, the UMHealthResearch website, X (formerly Twitter), Facebook, and Instagram. Images and vector graphics of African American male individuals were used to create social media advertisements that directed participants to click on a TinyURL that led to a recruitment survey for the study. Results: TinyURL metrics were used to monitor demographic and user data, analyzing the top countries, browsers, operating systems, and devices of individuals who engaged with the customized TinyURL links and the total human and unique clicks from various social media platforms. Mailchimp was the most successful platform for electronic engagement with human and unique clicks on the custom TinyURL link, followed by Instagram and Facebook. In contrast, X, traditional email, and research recruiting websites had the least engagement among our population. Success was determined based on the type of user and follower for each platform, whether gained in the community through sign-ups or promoted at peak user time and embedded and spotlighted on nontraditional media (eg, social media sites, blogs, and podcasts) for the user. Low engagement (eg, traditional email) from the target population, limited visibility, and fewer followers contributed to decreased engagement. Conclusions: This study provides insight into leveraging customized, shortened URLs, TinyURL metrics, and social media platforms to improve electronic engagement with young African American male individuals seeking information and resources about SRH care. The results of this study have been used to develop a pilot intervention for this population that will contribute to strategies for encouraging sexual well-being, clinic use, and appropriate linkage to SRH care services among young, heterosexual African American male individuals. ", doi="10.2196/48371", url="https://formative.jmir.org/2024/1/e48371", url="http://www.ncbi.nlm.nih.gov/pubmed/38656772" } @Article{info:doi/10.2196/44931, author="Kurita, Junko and Iwasaki, Yoshitaro", title="Effect of Long-Distance Domestic Travel Ban Policies in Japan on COVID-19 Outbreak Dynamics During Dominance of the Ancestral Strain: Ex Post Facto Retrospective Observation Study", journal="Online J Public Health Inform", year="2024", month="Apr", day="22", volume="16", pages="e44931", keywords="airport users", keywords="COVID-19", keywords="effective reproduction number", keywords="Go To Travel campaign", keywords="hotel visitors", keywords="mobility", keywords="long-distance travel", keywords="infection control", keywords="lockdown", keywords="travelling", keywords="travel", keywords="pandemic", abstract="Background: In Japan, long-distance domestic travel was banned while the ancestral SARS-CoV-2 strain was dominant under the first declared state of emergency from March 2020 until the end of May 2020. Subsequently, the ``Go To Travel'' campaign travel subsidy policy was activated, allowing long-distance domestic travel, until the second state of emergency as of January 7, 2021. The effects of this long-distance domestic travel ban on SARS-CoV-2 infectivity have not been adequately evaluated. Objective: We evaluated the effects of the long-distance domestic travel ban in Japan on SARS-CoV-2 infectivity, considering climate conditions, mobility, and countermeasures such as the ``Go To Travel'' campaign and emergency status. Methods: We calculated the effective reproduction number R(t), representing infectivity, using the epidemic curve in Kagoshima prefecture based on the empirical distribution of the incubation period and procedurally delayed reporting from an earlier study. Kagoshima prefecture, in southern Japan, has several resorts, with an airport commonly used for transportation to Tokyo or Osaka. We regressed R(t) on the number of long-distance domestic travelers (based on the number of airport limousine bus users provided by the operating company), temperature, humidity, mobility, and countermeasures such as state of emergency declarations and the ``Go To Travel'' campaign in Kagoshima. The study period was June 20, 2020, through February 2021, before variant strains became dominant. A second state of emergency was not declared in Kagoshima prefecture but was declared in major cities such as Tokyo and Osaka. Results: Estimation results indicated a pattern of declining infectivity with reduced long-distance domestic travel volumes as measured by the number of airport limousine bus users. Moreover, infectivity was lower during the ``Go To Travel'' campaign and the second state of emergency. Regarding mobility, going to restaurants, shopping malls, and amusement venues was associated with increased infectivity. However, going to grocery stores and pharmacies was associated with decreased infectivity. Climate conditions showed no significant association with infectivity patterns. Conclusions: The results of this retrospective analysis suggest that the volume of long-distance domestic travel might reduce SARS-CoV-2 infectivity. Infectivity was lower during the ``Go To Travel'' campaign period, during which long-distance domestic travel was promoted, compared to that outside this campaign period. These findings suggest that policies banning long-distance domestic travel had little legitimacy or rationale. Long-distance domestic travel with appropriate infection control measures might not increase SARS-CoV-2 infectivity in tourist areas. Even though this analysis was performed much later than the study period, if we had performed this study focusing on the period of April or May 2021, it would likely yield the same results. These findings might be helpful for government decision-making in considering restarting a ``Go To Travel'' campaign in light of evidence-based policy. ", doi="10.2196/44931", url="https://ojphi.jmir.org/2024/1/e44931", url="http://www.ncbi.nlm.nih.gov/pubmed/38648635" } @Article{info:doi/10.2196/50958, author="Liao, Qiuyan and Yuan, Jiehu and Wong, Ling Irene Oi and Ni, Yuxuan Michael and Cowling, John Benjamin and Lam, Tak Wendy Wing", title="Motivators and Demotivators for COVID-19 Vaccination Based on Co-Occurrence Networks of Verbal Reasons for Vaccination Acceptance and Resistance: Repetitive Cross-Sectional Surveys and Network Analysis", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="22", volume="10", pages="e50958", keywords="COVID-19", keywords="vaccination acceptance", keywords="vaccine hesitancy", keywords="motivators", keywords="co-occurrence network analysis", abstract="Background: Vaccine hesitancy is complex and multifaced. People may accept or reject a vaccine due to multiple and interconnected reasons, with some reasons being more salient in influencing vaccine acceptance or resistance and hence the most important intervention targets for addressing vaccine hesitancy. Objective: This study was aimed at assessing the connections and relative importance of motivators and demotivators for COVID-19 vaccination in Hong Kong based on co-occurrence networks of verbal reasons for vaccination acceptance and resistance from repetitive cross-sectional surveys. Methods: We conducted a series of random digit dialing telephone surveys to examine COVID-19 vaccine hesitancy among general Hong Kong adults between March 2021 and July 2022. A total of 5559 and 982 participants provided verbal reasons for accepting and resisting (rejecting or hesitating) a COVID-19 vaccine, respectively. The verbal reasons were initially coded to generate categories of motivators and demotivators for COVID-19 vaccination using a bottom-up approach. Then, all the generated codes were mapped onto the 5C model of vaccine hesitancy. On the basis of the identified reasons, we conducted a co-occurrence network analysis to understand how motivating or demotivating reasons were comentioned to shape people's vaccination decisions. Each reason's eigenvector centrality was calculated to quantify their relative importance in the network. Analyses were also stratified by age group. Results: The co-occurrence network analysis found that the perception of personal risk to the disease (egicentrality=0.80) and the social responsibility to protect others (egicentrality=0.58) were the most important comentioned reasons that motivate COVID-19 vaccination, while lack of vaccine confidence (egicentrality=0.89) and complacency (perceived low disease risk and low importance of vaccination; egicentrality=0.45) were the most important comentioned reasons that demotivate COVID-19 vaccination. For older people aged ?65 years, protecting others was a more important motivator (egicentrality=0.57), while the concern about poor health status was a more important demotivator (egicentrality=0.42); for young people aged 18 to 24 years, recovering life normalcy (egicentrality=0.20) and vaccine mandates (egicentrality=0.26) were the more important motivators, while complacency (egicentrality=0.77) was a more important demotivator for COVID-19 vaccination uptake. Conclusions: When disease risk is perceived to be high, promoting social responsibility to protect others is more important for boosting vaccination acceptance. However, when disease risk is perceived to be low and complacency exists, fostering confidence in vaccines to address vaccine hesitancy becomes more important. Interventions for promoting vaccination acceptance and reducing vaccine hesitancy should be tailored by age. ", doi="10.2196/50958", url="https://publichealth.jmir.org/2024/1/e50958", url="http://www.ncbi.nlm.nih.gov/pubmed/38648099" } @Article{info:doi/10.2196/53837, author="Major, G. Chelsea and Rodr{\'i}guez, M. Dania and S{\'a}nchez-Gonz{\'a}lez, Liliana and Rodr{\'i}guez-Estrada, Vanessa and Morales-Ort{\'i}z, Tatiana and Torres, Carolina and P{\'e}rez-Rodr{\'i}guez, M. Nicole and Medina-L{\'o}pes, A. Nicole and Alexander, Neal and Mabey, David and Ryff, Kyle and Tosado-Acevedo, Rafael and Mu{\~n}oz-Jord{\'a}n, Jorge and Adams, E. Laura and Rivera-Amill, Vanessa and Rolfes, Melissa and Paz-Bailey, Gabriela", title="Investigating SARS-CoV-2 Incidence and Morbidity in Ponce, Puerto Rico: Protocol and Baseline Results From a Community Cohort Study", journal="JMIR Res Protoc", year="2024", month="Apr", day="19", volume="13", pages="e53837", keywords="cohort studies", keywords="COVID-19", keywords="epidemiologic studies", keywords="Hispanic or Latino", keywords="incidence", keywords="prospective studies", keywords="research methodology", keywords="SARS-CoV-2", keywords="seroprevalence", abstract="Background: A better understanding of SARS-CoV-2 infection risk among Hispanic and Latino populations and in low-resource settings in the United States is needed to inform control efforts and strategies to improve health equity. Puerto Rico has a high poverty rate and other population characteristics associated with increased vulnerability to COVID-19, and there are limited data to date to determine community incidence. Objective: This study describes the protocol and baseline seroprevalence of SARS-CoV-2 in a prospective community-based cohort study (COPA COVID-19 [COCOVID] study) to investigate SARS-CoV-2 infection incidence and morbidity in Ponce, Puerto Rico. Methods: In June 2020, we implemented the COCOVID study within the Communities Organized to Prevent Arboviruses project platform among residents of 15 communities in Ponce, Puerto Rico, aged 1 year or older. Weekly, participants answered questionnaires on acute symptoms and preventive behaviors and provided anterior nasal swab samples for SARS-CoV-2 polymerase chain reaction testing; additional anterior nasal swabs were collected for expedited polymerase chain reaction testing from participants that reported 1 or more COVID-19--like symptoms. At enrollment and every 6 months during follow-up, participants answered more comprehensive questionnaires and provided venous blood samples for multiantigen SARS-CoV-2 immunoglobulin G antibody testing (an indicator of seroprevalence). Weekly follow-up activities concluded in April 2022 and 6-month follow-up visits concluded in August 2022. Primary study outcome measures include SARS-CoV-2 infection incidence and seroprevalence, relative risk of SARS-CoV-2 infection by participant characteristics, SARS-CoV-2 household attack rate, and COVID-19 illness characteristics and outcomes. In this study, we describe the characteristics of COCOVID participants overall and by SARS-CoV-2 seroprevalence status at baseline. Results: We enrolled a total of 1030 participants from 388 households. Relative to the general populations of Ponce and Puerto Rico, our cohort overrepresented middle-income households, employed and middle-aged adults, and older children (P<.001). Almost all participants (1021/1025, 99.61\%) identified as Latino/a, 17.07\% (175/1025) had annual household incomes less than US \$10,000, and 45.66\% (463/1014) reported 1 or more chronic medical conditions. Baseline SARS-CoV-2 seroprevalence was low (16/1030, 1.55\%) overall and increased significantly with later study enrollment time (P=.003). Conclusions: The COCOVID study will provide a valuable opportunity to better estimate the burden of SARS-CoV-2 and associated risk factors in a primarily Hispanic or Latino population, assess the limitations of surveillance, and inform mitigation measures in Puerto Rico and other similar populations. International Registered Report Identifier (IRRID): RR1-10.2196/53837 ", doi="10.2196/53837", url="https://www.researchprotocols.org/2024/1/e53837", url="http://www.ncbi.nlm.nih.gov/pubmed/38640475" } @Article{info:doi/10.2196/46360, author="Chen, Yi-Chu and Chen, Yun-Yuan and Su, Shih-Yung and Jhuang, Jing-Rong and Chiang, Chun-Ju and Yang, Ya-Wen and Lin, Li-Ju and Wu, Chao-Chun and Lee, Wen-Chung", title="Projected Time for the Elimination of Cervical Cancer Under Various Intervention Scenarios: Age-Period-Cohort Macrosimulation Study", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="18", volume="10", pages="e46360", keywords="age-period-cohort model", keywords="population attributable fraction", keywords="macrosimulation", keywords="cancer screening", keywords="human papillomavirus", keywords="HPV", keywords="cervical cancer", keywords="intervention", keywords="women", keywords="cervical screening", keywords="public health intervention", abstract="Background: The World Health Organization aims for the global elimination of cervical cancer, necessitating modeling studies to forecast long-term outcomes. Objective: This paper introduces a macrosimulation framework using age-period-cohort modeling and population attributable fractions to predict the timeline for eliminating cervical cancer in Taiwan. Methods: Data for cervical cancer cases from 1997 to 2016 were obtained from the Taiwan Cancer Registry. Future incidence rates under the current approach and various intervention strategies, such as scaled-up screening (cytology based or human papillomavirus [HPV] based) and HPV vaccination, were projected. Results: Our projections indicate that Taiwan could eliminate cervical cancer by 2050 with either 70\% compliance in cytology-based or HPV-based screening or 90\% HPV vaccination coverage. The years projected for elimination are 2047 and 2035 for cytology-based and HPV-based screening, respectively; 2050 for vaccination alone; and 2038 and 2033 for combined screening and vaccination approaches. Conclusions: The age-period-cohort macrosimulation framework offers a valuable policy analysis tool for cervical cancer control. Our findings can inform strategies in other high-incidence countries, serving as a benchmark for global efforts to eliminate the disease. ", doi="10.2196/46360", url="https://publichealth.jmir.org/2024/1/e46360", url="http://www.ncbi.nlm.nih.gov/pubmed/38635315" } @Article{info:doi/10.2196/51449, author="Cheng, Wei and Xu, Yun and Jiang, Haibo and Li, Jun and Hou, Zhigang and Meng, Haibin and Wang, Wei and Chai, Chengliang and Jiang, Jianmin", title="SARS-CoV-2 Infection, Hospitalization, and Associated Factors Among People Living With HIV in Southeastern China From December 2022 to February 2023: Cross-Sectional Survey", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="17", volume="10", pages="e51449", keywords="associated factors", keywords="COVID-19", keywords="hospitalization", keywords="infection", keywords="people living with HIV", keywords="SARS-CoV-2 Omicron variant", abstract="Background: Limited studies have explored the impact of the Omicron variant on SARS-CoV-2 infection, hospitalization, and associated factors among people living with HIV, particularly in China. The adjustment of preventive policies since December 2022 in China presents an opportunity to evaluate the real-world factors influencing SARS-CoV-2 infection and related hospitalization among people living with HIV. Objective: This study aimed to investigate SARS-CoV-2 infection, hospitalization rates, and associated factors among people living with HIV following the adjustment of preventive policies from December 2022 to February 2023 in southeastern China. Methods: A cross-sectional telephone or web-based survey was conducted among people living with HIV in 5 cities in southeastern China from December 2022 to February 2023. Demographic information, SARS-CoV-2 infection and related hospitalization, and HIV-specific characteristics were collected from existing databases and special investigations. Multivariate logistic regression analyses were conducted to determine the associated factors for infection and hospitalization rates of SARS-CoV-2. Additionally, subgroup analyses were conducted for the association between vaccination and infection across different vaccination statuses and time since the last vaccination. Results: Among people living with HIV with a COVID-19 testing history, the SARS-CoV-2 infection rate was 67.13\% (95\% CI 65.81\%-68.13\%), whereas the hospitalization rate was 0.71\% (95\% CI 0.46\%-0.97\%). Factors such as age, latest CD4 cell count, latest HIV viral load, and transmission route were found to be associated with SARS-CoV-2 infection, while age, cancer, latest CD4 cell count, and latest HIV viral load were associated with SARS-CoV-2 hospitalization. In terms of SARS-CoV-2 vaccination, compared to unvaccinated people living with HIV, there was a lower infection rate among those who had been vaccinated for <3 months in the booster vaccination group (adjusted odds ratio [aOR] 0.72, 95\% CI 0.53-0.98; P=.04); and there was also a lower risk of hospitalization among people living with HIV who had received vaccination in the past 6-12 months (aOR 0.33, 95\% CI 0.14-0.81; P=.02) and more than 12 months ago (aOR 0.22, 95\% CI 0.07-0.72; P=.01). Conclusions: After the ease of prevention and control measures in China, we observed a high SARS-CoV-2 infection rate but a low hospitalization rate. General risk factors, such as higher age and vaccination status, and HIV-related parameters, such as the latest CD4 cell count and HIV viral load, were associated with SARS-CoV-2 infection and hospitalization. A booster vaccination campaign for booster doses should be considered among people living with HIV in confronting possible COVID-19 epidemic emergencies in the near future. ", doi="10.2196/51449", url="https://publichealth.jmir.org/2024/1/e51449", url="http://www.ncbi.nlm.nih.gov/pubmed/38630534" } @Article{info:doi/10.2196/50139, author="Chepo, Macarena and Martin, Sam and D{\'e}om, No{\'e}mie and Khalid, Firas Ahmad and Vindrola-Padros, Cecilia", title="Twitter Analysis of Health Care Workers' Sentiment and Discourse Regarding Post--COVID-19 Condition in Children and Young People: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Apr", day="17", volume="26", pages="e50139", keywords="COVID-19", keywords="postacute sequelae of SARS-CoV-2", keywords="PASC", keywords="post--COVID-19 condition", keywords="children", keywords="vaccines", keywords="social media", keywords="social network analysis", keywords="Twitter", abstract="Background: The COVID-19 pandemic has had a significant global impact, with millions of cases and deaths. Research highlights the persistence of symptoms over time (post--COVID-19 condition), a situation of particular concern in children and young people with symptoms. Social media such as Twitter (subsequently rebranded as X) could provide valuable information on the impact of the post--COVID-19 condition on this demographic. Objective: With a social media analysis of the discourse surrounding the prevalence of post--COVID-19 condition in children and young people, we aimed to explore the perceptions of health care workers (HCWs) concerning post--COVID-19 condition in children and young people in the United Kingdom between January 2021 and January 2022. This will allow us to contribute to the emerging knowledge on post--COVID-19 condition and identify critical areas and future directions for researchers and policy makers. Methods: From a pragmatic paradigm, we used a mixed methods approach. Through discourse, keyword, sentiment, and image analyses, using Pulsar and InfraNodus, we analyzed the discourse about the experience of post--COVID-19 condition in children and young people in the United Kingdom shared on Twitter between January 1, 2021, and January 31, 2022, from a sample of HCWs with Twitter accounts whose biography identifies them as HCWs. Results: We obtained 300,000 tweets, out of which (after filtering for relevant tweets) we performed an in-depth qualitative sample analysis of 2588 tweets. The HCWs were responsive to announcements issued by the authorities regarding the management of the COVID-19 pandemic in the United Kingdom. The most frequent sentiment expressed was negative. The main themes were uncertainty about the future, policies and regulations, managing and addressing the COVID-19 pandemic and post--COVID-19 condition in children and young people, vaccination, using Twitter to share scientific literature and management strategies, and clinical and personal experiences. Conclusions: The perceptions described on Twitter by HCWs concerning the presence of the post--COVID-19 condition in children and young people appear to be a relevant and timely issue and responsive to the declarations and guidelines issued by health authorities over time. We recommend further support and training strategies for health workers and school staff regarding the manifestations and treatment of children and young people with post--COVID-19 condition. ", doi="10.2196/50139", url="https://www.jmir.org/2024/1/e50139", url="http://www.ncbi.nlm.nih.gov/pubmed/38630514" } @Article{info:doi/10.2196/50897, author="Ndlovu, Kagiso and Mauco, Leonard Kabelo and Makhura, Onalenna and Hu, Robin and Motlogelwa, Peace Nkwebi and Masizana, Audrey and Lo, Emily and Mphoyakgosi, Thongbotho and Moyo, Sikhulile", title="Experiences, Lessons, and Challenges With Adapting REDCap for COVID-19 Laboratory Data Management in a Resource-Limited Country: Descriptive Study", journal="JMIR Form Res", year="2024", month="Apr", day="16", volume="8", pages="e50897", keywords="REDCap", keywords="DHIS2", keywords="COVID-19", keywords="National Health Laboratory", keywords="eHealth", keywords="interoperability", keywords="data management", keywords="Botswana", abstract="Background: The COVID-19 pandemic brought challenges requiring timely health data sharing to inform accurate decision-making at national levels. In Botswana, we adapted and integrated the Research Electronic Data Capture (REDCap) and the District Health Information System version 2 (DHIS2) platforms to support timely collection and reporting of COVID-19 cases. We focused on establishing an effective COVID-19 data flow at the national public health laboratory, being guided by the needs of health care professionals at the National Health Laboratory (NHL). This integration contributed to automated centralized reporting of COVID-19 results at the Ministry of Health (MOH). Objective: This paper reports the experiences, challenges, and lessons learned while designing, adapting, and implementing the REDCap and DHIS2 platforms to support COVID-19 data management at the NHL in Botswana. Methods: A participatory design approach was adopted to guide the design, customization, and implementation of the REDCap platform in support of COVID-19 data management at the NHL. Study participants included 29 NHL and 4 MOH personnel, and the study was conducted from March 2, 2020, to June 30, 2020. Participants' requirements for an ideal COVID-19 data management system were established. NVivo 11 software supported thematic analysis of the challenges and resolutions identified during this study. These were categorized according to the 4 themes of infrastructure, capacity development, platform constraints, and interoperability. Results: Overall, REDCap supported the majority of perceived technical and nontechnical requirements for an ideal COVID-19 data management system at the NHL. Although some implementation challenges were identified, each had mitigation strategies such as procurement of mobile Internet routers, engagement of senior management to resolve conflicting policies, continuous REDCap training, and the development of a third-party web application to enhance REDCap's capabilities. Lessons learned informed next steps and further refinement of the REDCap platform. Conclusions: Implementation of REDCap at the NHL to streamline COVID-19 data collection and integration with the DHIS2 platform was feasible despite the urgency of implementation during the pandemic. By implementing the REDCap platform at the NHL, we demonstrated the possibility of achieving a centralized reporting system of COVID-19 cases, hence enabling timely and informed decision-making at a national level. Challenges faced presented lessons learned to inform sustainable implementation of digital health innovations in Botswana and similar resource-limited countries. ", doi="10.2196/50897", url="https://formative.jmir.org/2024/1/e50897", url="http://www.ncbi.nlm.nih.gov/pubmed/38625736" } @Article{info:doi/10.2196/53000, author="Karki, Saugat and Shaw, Sarah and Lieberman, Michael and P{\'e}rez, Alejandro and Pincus, Jonathan and Jakhmola, Priya and Tailor, Amrita and Ogunrinde, Bukky Oyinkansola and Sill, Danielle and Morgan, Shane and Alvarez, Miguel and Todd, Jonathan and Smith, Dawn and Mishra, Ninad", title="Clinical Decision Support System for Guidelines-Based Treatment of Gonococcal Infections, Screening for HIV, and Prescription of Pre-Exposure Prophylaxis: Design and Implementation Study", journal="JMIR Form Res", year="2024", month="Apr", day="15", volume="8", pages="e53000", keywords="clinical decision support systems", keywords="CDS", keywords="gonorrhea", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="HIV", keywords="sexually transmitted infections", keywords="electronic health records", keywords="guideline adherence", abstract="Background: The syndemic nature of gonococcal infections and HIV provides an opportunity to develop a synergistic intervention tool that could address the need for adequate treatment for gonorrhea, screen for HIV infections, and offer pre-exposure prophylaxis (PrEP) for persons who meet the criteria. By leveraging information available on electronic health records, a clinical decision support (CDS) system tool could fulfill this need and improve adherence to Centers for Disease Control and Prevention (CDC) treatment and screening guidelines for gonorrhea, HIV, and PrEP. Objective: The goal of this study was to translate portions of CDC treatment guidelines for gonorrhea and relevant portions of HIV screening and prescribing PrEP that stem from a diagnosis of gonorrhea as an electronic health record--based CDS intervention. We also assessed whether this CDS solution worked in real-world clinic. Methods: We developed 4 tools for this CDS intervention: a form for capturing sexual history information (SmartForm), rule-based alerts (best practice advisory), an enhanced sexually transmitted infection (STI) order set (SmartSet), and a documentation template (SmartText). A mixed methods pre-post design was used to measure the feasibility, use, and usability of the CDS solution. The study period was 12 weeks with a baseline patient sample of 12 weeks immediately prior to the intervention period for comparison. While the entire clinic had access to the CDS solution, we focused on a subset of clinicians who frequently engage in the screening and treatment of STIs within the clinical site under the name ``X-Clinic.'' We measured the use of the CDS solution within the population of patients who had either a confirmed gonococcal infection or an STI-related chief complaint. We conducted 4 midpoint surveys and 3 key informant interviews to quantify perception and impact of the CDS solution and solicit suggestions for potential future enhancements. The findings from qualitative data were determined using a combination of explorative and comparative analysis. Statistical analysis was conducted to compare the differences between patient populations in the baseline and intervention periods. Results: Within the X-Clinic, the CDS alerted clinicians (as a best practice advisory) in one-tenth (348/3451, 10.08\%) of clinical encounters. These 348 encounters represented 300 patients; SmartForms were opened for half of these patients (157/300, 52.33\%) and was completed for most for them (147/300, 89.81\%). STI test orders (SmartSet) were initiated by clinical providers in half of those patients (162/300, 54\%). HIV screening was performed during about half of those patient encounters (191/348, 54.89\%). Conclusions: We successfully built and implemented multiple CDC treatment and screening guidelines into a single cohesive CDS solution. The CDS solution was integrated into the clinical workflow and had a high rate of use. ", doi="10.2196/53000", url="https://formative.jmir.org/2024/1/e53000", url="http://www.ncbi.nlm.nih.gov/pubmed/38621237" } @Article{info:doi/10.2196/53665, author="Hebard, Stephen and Weaver, GracieLee and Hansen, B. William and Ruppert, Scarlett", title="Evaluation of a Pilot Program to Prevent the Misuse of Prescribed Opioids Among Health Care Workers: Repeated Measures Survey Study", journal="JMIR Form Res", year="2024", month="Apr", day="12", volume="8", pages="e53665", keywords="health care workers", keywords="opioid misuse", keywords="pain management", keywords="prescription opioids", keywords="prevention", keywords="substance abuse", keywords="substance use", keywords="workers", abstract="Background: Overprescription of opioids has led to increased misuse of opioids, resulting in higher rates of overdose. The workplace can play a vital role in an individual's intentions to misuse prescription opioids with injured workers being prescribed opioids, at a rate 3 times the national average. For example, health care workers are at risk for injuries, opioid dispensing, and diversion. Intervening within a context that may contribute to risks for opioid misuse while targeting individual psychosocial factors may be a useful complement to interventions at policy and prescribing levels. Objective: This pilot study assessed the effects of a mobile-friendly opioid misuse intervention prototype tailored for health care workers using the preparation phase of a multiphase optimization strategy design. Methods: A total of 33 health care practitioners participated in the pilot intervention, which included 10 brief web-based lessons aimed at impacting psychosocial measures that underlie opioid misuse. The lesson topics included: addiction beliefs, addiction control, Centers for Disease Control and Prevention guidelines and recommendations, beliefs about patient-provider relationships and communication, control in communicating with providers, beliefs about self-monitoring pain and side effects, control in self-monitoring pain and side effects, diversion and disposal beliefs, diversion and disposal control, and a conclusion lesson. Using a treatment-only design, pretest and posttest surveys were collected. A general linear repeated measures ANOVA was used to assess mean differences from pretest to posttest. Descriptive statistics were used to assess participant feedback about the intervention. Results: After completing the intervention, participants showed significant mean changes with increases in knowledge of opioids (+0.459; P<.001), less favorable attitudes toward opioids (--1.081; P=.001), more positive beliefs about communication with providers (+0.205; P=.01), more positive beliefs about pain management control (+0.969; P<.001), and increased intentions to avoid opioid use (+0.212; P=.03). Of the 33 practitioners who completed the program, most felt positive about the information presented, and almost 70\% (23/33) agreed or strongly agreed that other workers in the industry should complete a program like this. Conclusions: While attempts to address the opioid crisis have been made through public health policies and prescribing initiatives, opioid misuse continues to rise. Certain industries place workers at greater risk for injury and opioid dispensing, making interventions that target workers in these industries of particular importance. Results from this pilot study show positive impacts on knowledge, attitudes, and beliefs about communicating with providers and pain management control, as well as intentions to avoid opioid misuse. However, the dropout rate and small sample size are severe limitations, and the results lack generalizability. Results will be used to inform program revisions and future optimization trials, with the intention of providing insight for future intervention development and evaluation of mobile-friendly eHealth interventions for employees. ", doi="10.2196/53665", url="https://formative.jmir.org/2024/1/e53665", url="http://www.ncbi.nlm.nih.gov/pubmed/38607664" } @Article{info:doi/10.2196/47170, author="Verot, Elise and Chaux, Robin and Gagnaire, Julie and Bonjean, Paul and Gagneux-Brunon, Amandine and Berthelot, Philippe and Pelissier, Carole and Boulamail, Billal and Chauvin, Franck and Pozzetto, Bruno and Botelho-Nevers, Elisabeth", title="Evaluating the Knowledge of and Behavior Toward COVID-19 and the Possibility of Isolating at a City Level: Survey Study", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="11", volume="10", pages="e47170", keywords="SARS-CoV-2", keywords="COVID-19", keywords="health literacy", keywords="knowledge, attitude, and perception/practices (KAP)", keywords="public health", keywords="population", keywords="mass testing", keywords="screening", keywords="pandemic", keywords="sociological trends", keywords="COVID-19 screening", abstract="Background: Mass testing campaigns were proposed in France during the first wave of the COVID-19 pandemic to detect and isolate asymptomatic individuals infected by SARS-CoV-2. During mass testing in Saint-{\'E}tienne (February 2021), we performed a survey of the general population. Objective: We evaluated, on the scale of a city's population, the literacy level about SARS-CoV-2 transmission, barrier gesture respect, and isolation acceptability or possibility in case of SARS-CoV-2 infection. Methods: We used the validated CovQuest-CC questionnaire. Data were analyzed and correlated with volunteer characteristics and their SARS-CoV-2 screening results using multivariate analysis. Results: In total, 4707 participants completed the CovQuest-CC questionnaire. Multivariate analysis revealed that female sex was a determinant of a higher score of knowledge about SARS-CoV-2 transmission (adjusted $\beta$ coefficient=0.14, 95\% CI 0.04-0.23; corrected P=.02). Older ages of 50-59 years (adjusted $\beta$ coefficient=0.25, 95\% CI 0.19-0.31; corrected P<.001) and ?60 years (adjusted $\beta$ coefficient=0.25, 95\% CI 0.15-0.34; corrected P<.001) were determinants of a higher score on barrier gesture respect compared to ages 20-49 years considered as reference. Female sex was also a determinant of a higher score on barrier gesture respect (adjusted $\beta$ coefficient=0.10, 95\% CI 0.02-4.63; corrected P<.001). The knowledge score was correlated with the score on barrier gesture respect measures (adjusted $\beta$ coefficient=0.03, 95\% CI 0.001-0.004; corrected P=.001). Older ages of 50-59 years (adjusted $\beta$ coefficient=0.21, 95\% CI 0.13-0.29; corrected P<.001) and ?60 years (adjusted $\beta$ coefficient=0.25, 95\% CI 0.1-0.38; corrected P<.001) were determinants of a higher score on isolation acceptability or possibility compared to the age of 20-49 years considered as reference. Finally, the knowledge score regarding SARS-CoV-2 transmission was significantly associated with a lower risk of RT-PCR (reverse transcriptase--polymerase chain reaction) positivity (adjusted odds ratio 0.80,?95\% CI 0.69-0.94; corrected?P<.03), implying that a 1-point increase in the knowledge score lowers the risk of positivity by 20\% on average. Conclusions: This study identified factors associated with health literacy regarding SARS-CoV-2 infection in asymptomatic individuals in a large French city's population. We can confirm that in the context of the COVID-19 pandemic, the determinants of better health literacy are not the same as those in other contexts. It seems critical to obtain a more detailed understanding of the determinants of individual citizens' behavior, as part of a strategy to combat the large-scale spread of the virus. The harsh experience of this pandemic should teach us how to nurture research to structure customized interventions to encourage the adoption of ad hoc behaviors to engage citizens in adapting behaviors more favorable to their health. ", doi="10.2196/47170", url="https://publichealth.jmir.org/2024/1/e47170", url="http://www.ncbi.nlm.nih.gov/pubmed/38602767" } @Article{info:doi/10.2196/49433, author="Lee, Mi-Sun and Lee, Hooyeon", title="Chronic Disease Patterns and Their Relationship With Health-Related Quality of Life in South Korean Older Adults With the 2021 Korean National Health and Nutrition Examination Survey: Latent Class Analysis", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="10", volume="10", pages="e49433", keywords="chronic disease", keywords="latent class analysis", keywords="multimorbidity", keywords="older adults", keywords="quality of life", abstract="Background: Improved life expectancy has increased the prevalence of older adults living with multimorbidities, which likely deteriorates their health-related quality of life (HRQoL). Understanding which chronic conditions frequently co-occur can facilitate person-centered care tailored to the needs of individuals with specific multimorbidity profiles. Objective: The study objectives were to (1) examine the prevalence of multimorbidity among Korean older adults (ie, those aged 65 years and older), (2) investigate chronic disease patterns using latent class analysis, and (3) assess which chronic disease patterns are more strongly associated with HRQoL. Methods: A sample of 1806 individuals aged 65 years and older from the 2021 Korean National Health and Nutrition Examination Survey was analyzed. Latent class analysis was conducted to identify the clustering pattern of chronic diseases. HRQoL was assessed by an 8-item health-related quality of life scale (HINT-8). Multiple linear regression was used to analyze the association with the total score of the HINT-8. Logistic regression analysis was performed to evaluate the odds ratio of having problems according to the HINT-8 items. Results: The prevalence of multimorbidity in the sample was 54.8\%. Three chronic disease patterns were identified: relatively healthy, cardiometabolic condition, arthritis, allergy, or asthma. The total scores of the HINT-8 were the highest in participants characterized as arthritis, allergy, or asthma group, indicating the lowest quality of life. Conclusions: Current health care models are disease-oriented, meaning that the management of chronic conditions applies to a single condition and may not be relevant to those with multimorbidities. Identifying chronic disease patterns and their impact on overall health and well-being is critical for guiding integrated care. ", doi="10.2196/49433", url="https://publichealth.jmir.org/2024/1/e49433", url="http://www.ncbi.nlm.nih.gov/pubmed/38598275" } @Article{info:doi/10.2196/52198, author="Bychkov, David", title="Insider Threats to the Military Health System: A Systematic Background Check of TRICARE West Providers", journal="JMIRx Med", year="2024", month="Apr", day="9", volume="5", pages="e52198", keywords="TRICARE", keywords="health care fraud", keywords="Defense Health Agency", keywords="fraud", keywords="fraudulent", keywords="insurance", keywords="coverage", keywords="beneficiary", keywords="beneficiaries", keywords="background check", keywords="background checks", keywords="demographic", keywords="security clearance", keywords="FDA", keywords="Medicaid", keywords="Medicare", keywords="provider", keywords="provider referral", keywords="military", keywords="false claims act", keywords="HIPAA breach", keywords="OIG-LEIE", keywords="inspector general", keywords="misconduct", keywords="insider threat", keywords="information system", keywords="zero trust", keywords="data management", keywords="Food and Drug Administration", keywords="Health Insurance Portability and Accountability Act breach", keywords="Office of the Inspector General's List of Excluded Individuals and Entities", abstract="Background: To address the pandemic, the Defense Health Agency (DHA) expanded its TRICARE civilian provider network by 30.1\%. In 2022, the DHA Annual Report stated that TRICARE's provider directories were only 80\% accurate. Unlike Medicare, the DHA does not publicly reveal National Provider Identification (NPI) numbers. As a result, TRICARE's 9.6 million beneficiaries lack the means to verify their doctor's credentials. Since 2013, the Department of Health and Human Services' (HHS) Office of Inspector General (OIG) has excluded 17,706 physicians and other providers from federal health programs due to billing fraud, neglect, drug-related convictions, and other offenses. These providers and their NPIs are included on the OIG's List of Excluded Individuals and Entities (LEIE). Patients who receive care from excluded providers face higher risks of hospitalization and mortality. Objective: We sought to assess the extent to which TRICARE screens health care provider names on their referral website against criminal databases. Methods: Between January 1-31, 2023, we used TRICARE West's provider directory to search for all providers within a 5-mile radius of 798 zip codes (38 per state, ?10,000 residents each, randomly entered). We then copied and pasted all directory results' first and last names, business names, addresses, phone numbers, fax numbers, degree types, practice specialties, and active or closed statuses into a CSV file. We cross-referenced the search results against US and state databases for medical and criminal misconduct, including the OIG-LEIE and General Services Administration's (GSA) SAM.gov exclusion lists, the HHS Office of Civil Rights Health Insurance Portability and Accountability Act (HIPAA) breach reports, 15 available state Medicaid exclusion lists (state), the International Trade Administration's Consolidated Screening List (CSL), 3 Food and Drug Administration (FDA) debarment lists, the Federal Bureau of Investigation's (FBI) list of January 6 federal defendants, and the OIG-HHS list of fugitives (FUG). Results: Our provider search yielded 111,619 raw results; 54 zip codes contained no data. After removing 72,156 (64.65\%) duplicate entries, closed offices, and non-TRICARE West locations, we identified 39,463 active provider names. Within this baseline sample group, there were 2398 (6.08\%) total matches against all exclusion and sanction databases, including 2197 on the OIG-LEIE, 2311 on the GSA-SAM.gov list, 2 on the HIPAA list, 54 on the state Medicaid exclusion lists, 69 on the CSL, 3 on the FDA lists, 53 on the FBI list, and 10 on the FUG. Conclusions: TRICARE's civilian provider roster merits further scrutiny by law enforcement. Following the National Institute of Standards and Technology 800, the DHA can mitigate privacy, safety, and security clearance threats by implementing an insider threat management model, robust enforcement of the False Claims Act, and mandatory security risk assessments. These are the views of the author, not the Department of Defense or the US government. ", doi="10.2196/52198", url="https://xmed.jmir.org/2024/1/e52198" } @Article{info:doi/10.2196/48060, author="Rieckmann, Andreas and Nielsen, Sebastian and Dworzynski, Piotr and Amini, Heresh and Mogensen, Wengel S{\o}ren and Silva, Bartolomeu Isaquel and Chang, Y. Angela and Arah, A. Onyebuchi and Samek, Wojciech and Rod, Hulvej Naja and Ekstr{\o}m, Thorn Claus and Benn, Stabell Christine and Aaby, Peter and Fisker, B{\ae}rent Ane", title="Discovering Subgroups of Children With High Mortality in Urban Guinea-Bissau: Exploratory and Validation Cohort Study", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="9", volume="10", pages="e48060", keywords="child mortality", keywords="causal discovery", keywords="Guinea-Bissau", keywords="inductive-deductive", keywords="machine learning", keywords="targeted preventive and risk-mitigating interventions", abstract="Background: The decline in global child mortality is an important public health achievement, yet child mortality remains disproportionally high in many low-income countries like Guinea-Bissau. The persisting high mortality rates necessitate targeted research to identify vulnerable subgroups of children and formulate effective interventions. Objective: This study aimed to discover subgroups of children at an elevated risk of mortality in the urban setting of Bissau, Guinea-Bissau, West Africa. By identifying these groups, we intend to provide a foundation for developing targeted health interventions and inform public health policy. Methods: We used data from the health and demographic surveillance site, Bandim Health Project, covering 2003 to 2019. We identified baseline variables recorded before children reached the age of 6 weeks. The focus was on determining factors consistently linked with increased mortality up to the age of 3 years. Our multifaceted methodological approach incorporated spatial analysis for visualizing geographical variations in mortality risk, causally adjusted regression analysis to single out specific risk factors, and machine learning techniques for identifying clusters of multifactorial risk factors. To ensure robustness and validity, we divided the data set temporally, assessing the persistence of identified subgroups over different periods. The reassessment of mortality risk used the targeted maximum likelihood estimation (TMLE) method to achieve more robust causal modeling. Results: We analyzed data from 21,005 children. The mortality risk (6 weeks to 3 years of age) was 5.2\% (95\% CI 4.8\%-5.6\%) for children born between 2003 and 2011, and 2.9\% (95\% CI 2.5\%-3.3\%) for children born between 2012 and 2016. Our findings revealed 3 distinct high-risk subgroups with notably higher mortality rates, children residing in a specific urban area (adjusted mortality risk difference of 3.4\%, 95\% CI 0.3\%-6.5\%), children born to mothers with no prenatal consultations (adjusted mortality risk difference of 5.8\%, 95\% CI 2.6\%-8.9\%), and children from polygamous families born during the dry season (adjusted mortality risk difference of 1.7\%, 95\% CI 0.4\%-2.9\%). These subgroups, though small, showed a consistent pattern of higher mortality risk over time. Common social and economic factors were linked to a larger share of the total child deaths. Conclusions: The study's results underscore the need for targeted interventions to address the specific risks faced by these identified high-risk subgroups. These interventions should be designed to work to complement broader public health strategies, creating a comprehensive approach to reducing child mortality. We suggest future research that focuses on developing, testing, and comparing targeted intervention strategies unraveling the proposed hypotheses found in this study. The ultimate aim is to optimize health outcomes for all children in high-mortality settings, leveraging a strategic mix of targeted and general health interventions to address the varied needs of different child subgroups. ", doi="10.2196/48060", url="https://publichealth.jmir.org/2024/1/e48060", url="http://www.ncbi.nlm.nih.gov/pubmed/38592761" } @Article{info:doi/10.2196/52616, author="Awindaogo, Felix and Acheamfour-Akowuah, Emmanuel and Doku, Alfred and Kokuro, Collins and Agyekum, Francis and Owusu, Kofi Isaac", title="Assessing and Improving the Care of Patients With Heart Failure in Ghana: Protocol for a Prospective Observational Study and the Ghana Heart Initiative-Heart Failure Registry", journal="JMIR Res Protoc", year="2024", month="Apr", day="8", volume="13", pages="e52616", keywords="clinical", keywords="cross-sectional", keywords="epidemiology", keywords="Ghana", keywords="heart failure", keywords="heart", keywords="management", keywords="medium-term", keywords="monitoring", keywords="mortality", keywords="outcome", keywords="patient data", keywords="prevention", keywords="protocol", keywords="teaching", keywords="treatment", abstract="Background: Heart failure (HF) is a leading cause of morbidity and mortality globally, with a high disease burden. The prevalence of HF in Ghana is increasing rapidly, but epidemiological profiles, treatment patterns, and survival data are scarce. The national capacity to diagnose and manage HF appropriately is also limited. To address the growing epidemic of HF, it is crucial to recognize the epidemiological characteristics and medium-term outcomes of HF in Ghana and improve the capability to identify and manage HF promptly and effectively at all levels of care. Objective: This study aims to determine the epidemiological characteristics and medium-term HF outcomes in Ghana. Methods: We conducted a prospective, multicenter, multilevel cross-sectional observational study of patients with HF from January to December 2023. Approximately 5000 patients presenting with HF to 9 hospitals, including teaching, regional, and municipal hospitals, will be recruited and evaluated according to a standardized protocol, including the use of an echocardiogram and an N-terminal pro-brain natriuretic peptide (NT-proBNP) test. Guideline-directed medical treatment of HF will be initiated for 6 months, and the medium-term outcomes of interventions, including rehospitalization and mortality, will be assessed. Patient data will be collated into a HF registry for continuous assessment and monitoring. Results: This intervention will generate the necessary information on the etiology of HF, clinical presentations, the diagnostic yield of various tools, and management outcomes. In addition, it will build the necessary capacity and support for HF management in Ghana. As of July 30, 2023, the training and onboarding of all 9 centers had been completed. Preliminary analyses will be conducted by the end of the second quarter of 2024, and results are expected to be publicly available by the middle of 2024. Conclusions: This study will provide the necessary data on HF, which will inform decisions on the prevention and management of HF and form the basis for future research. Trial Registration: ISRCTN Registry (United Kingdom) ISRCTN18216214; https:www.isrctn.com/ISRCTN18216214 International Registered Report Identifier (IRRID): DERR1-10.2196/52616 ", doi="10.2196/52616", url="https://www.researchprotocols.org/2024/1/e52616", url="http://www.ncbi.nlm.nih.gov/pubmed/38588528" } @Article{info:doi/10.2196/54340, author="Borchering, K. Rebecca and Biggerstaff, Matthew and Brammer, Lynnette and Budd, Alicia and Garg, Shikha and Fry, M. Alicia and Iuliano, Danielle A. and Reed, Carrie", title="Responding to the Return of Influenza in the United States by Applying Centers for Disease Control and Prevention Surveillance, Analysis, and Modeling to Inform Understanding of Seasonal Influenza", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="8", volume="10", pages="e54340", keywords="disease burden", keywords="modeling", keywords="seasonal influenza", keywords="surveillance", doi="10.2196/54340", url="https://publichealth.jmir.org/2024/1/e54340", url="http://www.ncbi.nlm.nih.gov/pubmed/38587882" } @Article{info:doi/10.2196/50673, author="Xuan, Kun and Zhang, Ning and Li, Tao and Pang, Xingya and Li, Qingru and Zhao, Tianming and Wang, Binbing and Zha, Zhenqiu and Tang, Jihai", title="Epidemiological Characteristics of Varicella in Anhui Province, China, 2012-2021: Surveillance Study", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="5", volume="10", pages="e50673", keywords="varicella", keywords="incidence", keywords="epidemiology", keywords="spatial autocorrelation", keywords="contagious disease", keywords="chicken pox", keywords="varicella zoster virus", keywords="China", abstract="Background: Varicella is a mild, self-limited disease caused by varicella-zoster virus (VZV) infection. Recently, the disease burden of varicella has been gradually increasing in China; however, the epidemiological characteristics of varicella have not been reported for Anhui Province. Objective: The aim of this study was to analyze the epidemiology of varicella in Anhui from 2012 to 2021, which can provide a basis for the future study and formulation of varicella prevention and control policies in the province. Methods: Surveillance data were used to characterize the epidemiology of varicella in Anhui from 2012 to 2021 in terms of population, time, and space. Spatial autocorrelation of varicella was explored using the Moran index (Moran I). The Kulldorff space-time scan statistic was used to analyze the spatiotemporal aggregation of varicella. Results: A total of 276,115 cases of varicella were reported from 2012 to 2021 in Anhui, with an average annual incidence of 44.8 per 100,000, and the highest incidence was 81.2 per 100,000 in 2019. The male-to-female ratio of cases was approximately 1.26, which has been gradually decreasing in recent years. The population aged 5-14 years comprised the high-incidence group, although the incidence in the population 30 years and older has gradually increased. Students accounted for the majority of cases, and the proportion of cases in both home-reared children (aged 0-7 years who are not sent to nurseries, daycare centers, or school) and kindergarten children (aged 3-6 years) has changed slightly in recent years. There were two peaks of varicella incidence annually, except for 2020, and the incidence was typically higher in the winter peak than in summer. The incidence of varicella in southern Anhui was higher than that in northern Anhui. The average annual incidence at the county level ranged from 6.61 to 152.14 per 100,000, and the varicella epidemics in 2018-2021 were relatively severe. The spatial and temporal distribution of varicella in Anhui was not random, with a positive spatial autocorrelation found at the county level (Moran I=0.412). There were 11 districts or counties with high-high clusters, mainly distributed in the south of Anhui, and 3 districts or counties with high-low or low-high clusters. Space-time scan analysis identified five possible clusters of areas, and the most likely cluster was distributed in the southeastern region of Anhui. Conclusions: This study comprehensively describes the epidemiology and changing trend of varicella in Anhui from 2012 to 2021. In the future, preventive and control measures should be strengthened for the key populations and regions of varicella. ", doi="10.2196/50673", url="https://publichealth.jmir.org/2024/1/e50673", url="http://www.ncbi.nlm.nih.gov/pubmed/38579276" } @Article{info:doi/10.2196/51581, author="Lim, Heemoon and Lee, Hyejung", title="Eating Habits and Lifestyle Factors Related to Childhood Obesity Among Children Aged 5-6 Years: Cluster Analysis of Panel Survey Data in Korea", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="5", volume="10", pages="e51581", keywords="BMI", keywords="body mass index", keywords="childhood obesity", keywords="cluster analysis", keywords="healthy eating", keywords="healthy lifestyle", keywords="pediatric obesity", keywords="preschool child", keywords="prevention", keywords="unsupervised machine learning", abstract="Background: Childhood obesity has emerged as a major health issue due to the rapid growth in the prevalence of obesity among young children worldwide. Establishing healthy eating habits and lifestyles in early childhood may help children gain appropriate weight and further improve their health outcomes later in life. Objective: This study aims to classify clusters of young children according to their eating habits and identify the features of each cluster as they relate to childhood obesity. Methods: A total of 1280 children were selected from the Panel Study on Korean Children. Data on their eating habits (eating speed, mealtime regularity, consistency of food amount, and balanced eating), sleep hours per day, outdoor activity hours per day, and BMI were obtained. We performed a cluster analysis on the children's eating habits using k-means methods. We conducted ANOVA and chi-square analyses to identify differences in the children's BMI, sleep hours, physical activity, and the characteristics of their parents and family by cluster. Results: At both ages (ages 5 and 6 years), we identified 4 clusters based on the children's eating habits. Cluster 1 was characterized by a fast eating speed (fast eaters); cluster 2 by a slow eating speed (slow eaters); cluster 3 by irregular eating habits (poor eaters); and cluster 4 by a balanced diet, regular mealtimes, and consistent food amounts (healthy eaters). Slow eaters tended to have the lowest BMI (P<.001), and a low proportion had overweight and obesity at the age of 5 years (P=.03) and 1 year later (P=.005). There was a significant difference in sleep time (P=.01) and mother's education level (P=.03) at the age of 5 years. Moreover, there was a significant difference in sleep time (P=.03) and the father's education level (P=.02) at the age of 6 years. Conclusions: Efforts to establish healthy eating habits in early childhood may contribute to the prevention of obesity in children. Specifically, providing dietary guidance on a child's eating speed can help prevent childhood obesity. This research suggests that lifestyle modification could be a viable target to decrease the risk of childhood obesity and promote the development of healthy children. Additionally, we propose that future studies examine long-term changes in obesity resulting from lifestyle modifications in children from families with low educational levels. ", doi="10.2196/51581", url="https://publichealth.jmir.org/2024/1/e51581", url="http://www.ncbi.nlm.nih.gov/pubmed/38578687" } @Article{info:doi/10.2196/49527, author="Hall, William Eric and Sullivan, Sean Patrick and Bradley, Heather", title="Estimated Number of Injection-Involved Overdose Deaths in US States From 2000 to 2020: Secondary Analysis of Surveillance Data", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="5", volume="10", pages="e49527", keywords="death rate", keywords="death", keywords="drug abuse", keywords="drugs", keywords="injection drug use", keywords="injection", keywords="mortality", keywords="National Vital Statistics System", keywords="overdose death rate", keywords="overdose", keywords="state", keywords="substance abuse", keywords="Treatment Episode Dataset-Admission", keywords="treatment", abstract="Background: In the United States, both drug overdose mortality and injection-involved drug overdose mortality have increased nationally over the past 25 years. Despite documented geographic differences in overdose mortality and substances implicated in overdose mortality trends, injection-involved overdose mortality has not been summarized at a subnational level. Objective: We aimed to estimate the annual number of injection-involved overdose deaths in each US state from 2000 to 2020. Methods: We conducted a stratified analysis that used data from drug treatment admissions (Treatment Episodes Data Set--Admissions; TEDS-A) and the National Vital Statistics System (NVSS) to estimate state-specific percentages of reported drug overdose deaths that were injection-involved from 2000 to 2020. TEDS-A collects data on the route of administration and the type of substance used upon treatment admission. We used these data to calculate the percentage of reported injections for each drug type by demographic group (race or ethnicity, sex, and age group), year, and state. Additionally, using NVSS mortality data, the annual number of overdose deaths involving selected drug types was identified by the following specific multiple-cause-of-death codes: heroin or synthetic opioids other than methadone (T40.1, T40.4), natural or semisynthetic opioids and methadone (T40.2, T40.3), cocaine (T40.5), psychostimulants with abuse potential (T43.6), sedatives (T42.3, T42.4), and others (T36-T59.0). We used the probabilities of injection with the annual number of overdose deaths, by year, primary substance, and demographic groups to estimate the number of overdose deaths that were injection-involved. Results: In 2020, there were 91,071 overdose deaths among adults recorded in the United States, and 93.1\% (84,753/91,071) occurred in the 46 jurisdictions that reported data to TEDS-A. Slightly less than half (38,253/84,753, 45.1\%; 95\% CI 41.1\%-49.8\%) of those overdose deaths were estimated to be injection-involved, translating to 38,253 (95\% CI 34,839-42,181) injection-involved overdose deaths in 2020. There was large variation among states in the estimated injection-involved overdose death rate (median 14.72, range 5.45-31.77 per 100,000 people). The national injection-involved overdose death rate increased by 323\% (95\% CI 255\%-391\%) from 2010 (3.78, 95\% CI 3.33-4.31) to 2020 (15.97, 95\% CI 14.55-17.61). States in which the estimated injection-involved overdose death rate increased faster than the national average were disproportionately concentrated in the Northeast region. Conclusions: Although overdose mortality and injection-involved overdose mortality have increased dramatically across the country, these trends have been more pronounced in some regions. A better understanding of state-level trends in injection-involved mortality can inform the prioritization of public health strategies that aim to reduce overdose mortality and prevent downstream consequences of injection drug use. ", doi="10.2196/49527", url="https://publichealth.jmir.org/2024/1/e49527", url="http://www.ncbi.nlm.nih.gov/pubmed/38578676" } @Article{info:doi/10.2196/48963, author="Loeb, Talia and Willis, Kalai and Velishavo, Frans and Lee, Daniel and Rao, Amrita and Baral, Stefan and Rucinski, Katherine", title="Leveraging Routinely Collected Program Data to Inform Extrapolated Size Estimates for Key Populations in Namibia: Small Area Estimation Study", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="4", volume="10", pages="e48963", keywords="female sex workers", keywords="HIV", keywords="key populations", keywords="men who have sex with men", keywords="Namibia", keywords="population size estimation", keywords="small area estimation", abstract="Background: Estimating the size of key populations, including female sex workers (FSW) and men who have sex with men (MSM), can inform planning and resource allocation for HIV programs at local and national levels. In geographic areas where direct population size estimates (PSEs) for key populations have not been collected, small area estimation (SAE) can help fill in gaps using supplemental data sources known as auxiliary data. However, routinely collected program data have not historically been used as auxiliary data to generate subnational estimates for key populations, including in Namibia. Objective: To systematically generate regional size estimates for FSW and MSM in Namibia, we used a consensus-informed estimation approach with local stakeholders that included the integration of routinely collected HIV program data provided by key populations' HIV service providers. Methods: We used quarterly program data reported by key population implementing partners, including counts of the number of individuals accessing HIV services over time, to weight existing PSEs collected through bio-behavioral surveys using a Bayesian triangulation approach. SAEs were generated through simple imputation, stratified imputation, and multivariable Poisson regression models. We selected final estimates using an iterative qualitative ranking process with local key population implementing partners. Results: Extrapolated national estimates for FSW ranged from 4777 to 13,148 across Namibia, comprising 1.5\% to 3.6\% of female individuals aged between 15 and 49 years. For MSM, estimates ranged from 4611 to 10,171, comprising 0.7\% to 1.5\% of male individuals aged between 15 and 49 years. After the inclusion of program data as priors, the estimated proportion of FSW derived from simple imputation increased from 1.9\% to 2.8\%, and the proportion of MSM decreased from 1.5\% to 0.75\%. When stratified imputation was implemented using HIV prevalence to inform strata, the inclusion of program data increased the proportion of FSW from 2.6\% to 4.0\% in regions with high prevalence and decreased the proportion from 1.4\% to 1.2\% in regions with low prevalence. When population density was used to inform strata, the inclusion of program data also increased the proportion of FSW in high-density regions (from 1.1\% to 3.4\%) and decreased the proportion of MSM in all regions. Conclusions: Using SAE approaches, we combined epidemiologic and program data to generate subnational size estimates for key populations in Namibia. Overall, estimates were highly sensitive to the inclusion of program data. Program data represent a supplemental source of information that can be used to align PSEs with real-world HIV programs, particularly in regions where population-based data collection methods are challenging to implement. Future work is needed to determine how best to include and validate program data in target settings and in key population size estimation studies, ultimately bridging research with practice to support a more comprehensive HIV response. ", doi="10.2196/48963", url="https://publichealth.jmir.org/2024/1/e48963", url="http://www.ncbi.nlm.nih.gov/pubmed/38573760" } @Article{info:doi/10.2196/53367, author="McMurry, J. Andrew and Zipursky, R. Amy and Geva, Alon and Olson, L. Karen and Jones, R. James and Ignatov, Vladimir and Miller, A. Timothy and Mandl, D. Kenneth", title="Moving Biosurveillance Beyond Coded Data Using AI for Symptom Detection From Physician Notes: Retrospective Cohort Study", journal="J Med Internet Res", year="2024", month="Apr", day="4", volume="26", pages="e53367", keywords="natural language processing", keywords="COVID-19", keywords="artificial intelligence", keywords="AI", keywords="public health, biosurveillance", keywords="surveillance", keywords="respiratory", keywords="infectious", keywords="pulmonary", keywords="SARS-CoV-2", keywords="symptom", keywords="symptoms", keywords="detect", keywords="detection", keywords="pipeline", keywords="pipelines", keywords="clinical note", keywords="clinical notes", keywords="documentation", keywords="emergency", keywords="urgent", keywords="pediatric", keywords="pediatrics", keywords="paediatric", keywords="paediatrics", keywords="child", keywords="children", keywords="youth", keywords="adolescent", keywords="adolescents", keywords="teen", keywords="teens", keywords="teenager", keywords="teenagers", keywords="diagnose", keywords="diagnosis", keywords="diagnostic", keywords="diagnostics", abstract="Background: Real-time surveillance of emerging infectious diseases necessitates a dynamically evolving, computable case definition, which frequently incorporates symptom-related criteria. For symptom detection, both population health monitoring platforms and research initiatives primarily depend on structured data extracted from electronic health records. Objective: This study sought to validate and test an artificial intelligence (AI)--based natural language processing (NLP) pipeline for detecting COVID-19 symptoms from physician notes in pediatric patients. We specifically study patients presenting to the emergency department (ED) who can be sentinel cases in an outbreak. Methods: Subjects in this retrospective cohort study are patients who are 21 years of age and younger, who presented to a pediatric ED at a large academic children's hospital between March 1, 2020, and May 31, 2022. The ED notes for all patients were processed with an NLP pipeline tuned to detect the mention of 11 COVID-19 symptoms based on Centers for Disease Control and Prevention (CDC) criteria. For a gold standard, 3 subject matter experts labeled 226 ED notes and had strong agreement (F1-score=0.986; positive predictive value [PPV]=0.972; and sensitivity=1.0). F1-score, PPV, and sensitivity were used to compare the performance of both NLP and the International Classification of Diseases, 10th Revision (ICD-10) coding to the gold standard chart review. As a formative use case, variations in symptom patterns were measured across SARS-CoV-2 variant eras. Results: There were 85,678 ED encounters during the study period, including 4\% (n=3420) with patients with COVID-19. NLP was more accurate at identifying encounters with patients that had any of the COVID-19 symptoms (F1-score=0.796) than ICD-10 codes (F1-score =0.451). NLP accuracy was higher for positive symptoms (sensitivity=0.930) than ICD-10 (sensitivity=0.300). However, ICD-10 accuracy was higher for negative symptoms (specificity=0.994) than NLP (specificity=0.917). Congestion or runny nose showed the highest accuracy difference (NLP: F1-score=0.828 and ICD-10: F1-score=0.042). For encounters with patients with COVID-19, prevalence estimates of each NLP symptom differed across variant eras. Patients with COVID-19 were more likely to have each NLP symptom detected than patients without this disease. Effect sizes (odds ratios) varied across pandemic eras. Conclusions: This study establishes the value of AI-based NLP as a highly effective tool for real-time COVID-19 symptom detection in pediatric patients, outperforming traditional ICD-10 methods. It also reveals the evolving nature of symptom prevalence across different virus variants, underscoring the need for dynamic, technology-driven approaches in infectious disease surveillance. ", doi="10.2196/53367", url="https://www.jmir.org/2024/1/e53367", url="http://www.ncbi.nlm.nih.gov/pubmed/38573752" } @Article{info:doi/10.2196/49643, author="Choo, Mei Sim and Sartori, Daniele and Lee, Chet Sing and Yang, Hsuan-Chia and Syed-Abdul, Shabbir", title="Data-Driven Identification of Factors That Influence the Quality of Adverse Event Reports: 15-Year Interpretable Machine Learning and Time-Series Analyses of VigiBase and QUEST", journal="JMIR Med Inform", year="2024", month="Apr", day="3", volume="12", pages="e49643", keywords="pharmacovigilance", keywords="medication safety", keywords="big data analysis", keywords="feature selection", keywords="interpretable machine learning", abstract="Background: The completeness of adverse event (AE) reports, crucial for assessing putative causal relationships, is measured using the vigiGrade completeness score in VigiBase, the World Health Organization global database of reported potential AEs. Malaysian reports have surpassed the global average score (approximately 0.44), achieving a 5-year average of 0.79 (SD 0.23) as of 2019 and approaching the benchmark for well-documented reports (0.80). However, the contributing factors to this relatively high report completeness score remain unexplored. Objective: This study aims to explore the main drivers influencing the completeness of Malaysian AE reports in VigiBase over a 15-year period using vigiGrade. A secondary objective was to understand the strategic measures taken by the Malaysian authorities leading to enhanced report completeness across different time frames. Methods: We analyzed 132,738 Malaysian reports (2005-2019) recorded in VigiBase up to February 2021 split into historical International Drug Information System (INTDIS; n=63,943, 48.17\% in 2005-2016) and newer E2B (n=68,795, 51.83\% in 2015-2019) format subsets. For machine learning analyses, we performed a 2-stage feature selection followed by a random forest classifier to identify the top features predicting well-documented reports. We subsequently applied tree Shapley additive explanations to examine the magnitude, prevalence, and direction of feature effects. In addition, we conducted time-series analyses to evaluate chronological trends and potential influences of key interventions on reporting quality. Results: Among the analyzed reports, 42.84\% (56,877/132,738) were well documented, with an increase of 65.37\% (53,929/82,497) since 2015. Over two-thirds (46,186/68,795, 67.14\%) of the Malaysian E2B reports were well documented compared to INTDIS reports at 16.72\% (10,691/63,943). For INTDIS reports, higher pharmacovigilance center staffing was the primary feature positively associated with being well documented. In recent E2B reports, the top positive features included reaction abated upon drug dechallenge, reaction onset or drug use duration of <1 week, dosing interval of <1 day, reports from public specialist hospitals, reports by pharmacists, and reaction duration between 1 and 6 days. In contrast, reports from product registration holders and other health care professionals and reactions involving product substitution issues negatively affected the quality of E2B reports. Multifaceted strategies and interventions comprising policy changes, continuity of education, and human resource development laid the groundwork for AE reporting in Malaysia, whereas advancements in technological infrastructure, pharmacovigilance databases, and reporting tools concurred with increases in both the quantity and quality of AE reports. Conclusions: Through interpretable machine learning and time-series analyses, this study identified key features that positively or negatively influence the completeness of Malaysian AE reports and unveiled how Malaysia has developed its pharmacovigilance capacity via multifaceted strategies and interventions. These findings will guide future work in enhancing pharmacovigilance and public health. ", doi="10.2196/49643", url="https://medinform.jmir.org/2024/1/e49643", url="http://www.ncbi.nlm.nih.gov/pubmed/38568722" } @Article{info:doi/10.2196/50189, author="Le, H. Lan T. and Hoang, Anh Thi Ngoc and Nguyen, T. Tan and Dao, D. Tien and Do, N. Binh and Pham, M. Khue and Vu, H. Vinh and Pham, V. Linh and Nguyen, H. Lien T. and Nguyen, C. Hoang and Tran, V. Tuan and Nguyen, H. Trung and Nguyen, T. Anh and Nguyen, V. Hoan and Nguyen, B. Phuoc and Nguyen, T. Hoai T. and Pham, M. Thu T. and Le, T. Thuy and Nguyen, P. Thao T. and Tran, Q. Cuong and Quach, Ha-Linh and Nguyen, T. Kien and Duong, Van Tuyen", title="Sex Differences in Clustering Unhealthy Lifestyles Among Survivors of COVID-19: Latent Class Analysis", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="2", volume="10", pages="e50189", keywords="sex difference", keywords="cluster", keywords="lifestyle behavior", keywords="COVID-19 recovery", keywords="latent class analysis", keywords="sex", keywords="unhealthy", keywords="lifestyle", keywords="adult", keywords="long COVID-19", keywords="infected", keywords="survivor", keywords="public health", keywords="intervention", keywords="promote", keywords="well-being", keywords="COVID-19", keywords="adults", keywords="mobile phone", abstract="Background: The COVID-19 pandemic has underscored the significance of adopting healthy lifestyles to mitigate the risk of severe outcomes and long-term consequences. Objective: This study focuses on assessing the prevalence and clustering of 5 unhealthy lifestyle behaviors among Vietnamese adults after recovering from COVID-19, with a specific emphasis on sex differences. Methods: The cross-sectional data of 5890 survivors of COVID-19 in Vietnam were analyzed from December 2021 to October 2022. To examine the sex differences in 5 unhealthy lifestyle behaviors (smoking, drinking, unhealthy diet, physical inactivity, and sedentary behavior), the percentages were plotted along with their corresponding 95\% CI for each behavior. Latent class analysis was used to identify 2 distinct classes of individuals based on the clustering of these behaviors: the ``less unhealthy'' group and the ``more unhealthy'' group. We examined the sociodemographic characteristics associated with each identified class and used logistic regression to investigate the factors related to the ``more unhealthy'' group. Results: The majority of individuals (male participants: 2432/2447, 99.4\% and female participants: 3411/3443, 99.1\%) exhibited at least 1 unhealthy behavior, with male participants being more susceptible to multiple unhealthy behaviors. The male-to-female ratio for having a single behavior was 1.003, but it escalated to 25 for individuals displaying all 5 behaviors. Male participants demonstrated a higher prevalence of combining alcohol intake with sedentary behavior (949/2447, 38.8\%) or an unhealthy diet (861/2447, 35.2\%), whereas female participants tended to exhibit physical inactivity combined with sedentary behavior (1305/3443, 37.9\%) or an unhealthy diet (1260/3443, 36.6\%). Married male participants had increased odds of falling into the ``more unhealthy'' group compared to their single counterparts (odds ratio [OR] 1.45, 95\% CI 1.14-1.85), while female participants exhibited lower odds (OR 0.65, 95\% CI 0.51-0.83). Female participants who are underweight showed a higher likelihood of belonging to the ``more unhealthy'' group (OR 1.11, 95\% CI 0.89-1.39), but this was not observed among male participants (OR 0.6, 95\% CI 0.41-0.89). In both sexes, older age, dependent employment, high education, and obesity were associated with higher odds of being in the ``more unhealthy'' group. Conclusions: The study identified notable sex differences in unhealthy lifestyle behaviors among survivors of COVID-19. Male survivors are more likely to engage in unhealthy behaviors compared to female survivors. These findings emphasize the importance of tailored public health interventions targeting sex-specific unhealthy behaviors. Specifically, addressing unhealthy habits is crucial for promoting post--COVID-19 health and well-being. ", doi="10.2196/50189", url="https://publichealth.jmir.org/2024/1/e50189", url="http://www.ncbi.nlm.nih.gov/pubmed/38564248" } @Article{info:doi/10.2196/41559, author="Mishra, Vishala and Dexter, P. Joseph", title="Response of Unvaccinated US Adults to Official Information About the Pause in Use of the Johnson \& Johnson--Janssen COVID-19 Vaccine: Cross-Sectional Survey Study", journal="J Med Internet Res", year="2024", month="Apr", day="1", volume="26", pages="e41559", keywords="Centers for Disease Control and Prevention", keywords="CDC", keywords="COVID-19", keywords="health communication", keywords="health information", keywords="health literacy", keywords="public health", keywords="risk perception", keywords="SARS-CoV-2", keywords="vaccine hesitancy", keywords="web-based surveys", doi="10.2196/41559", url="https://www.jmir.org/2024/1/e41559", url="http://www.ncbi.nlm.nih.gov/pubmed/38557597" } @Article{info:doi/10.2196/57280, author="Agley, Jon and Henderson, Cris and Seo, Dong-Chul and Parker, Maria and Golzarri-Arroyo, Lilian and Dickinson, Stephanie and Tidd, David", title="The Feasibility of Using the National PulsePoint Cardiopulmonary Resuscitation Responder Network to Facilitate Overdose Education and Naloxone Distribution: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Mar", day="29", volume="13", pages="e57280", keywords="naloxone", keywords="PulsePoint", keywords="randomized controlled trial", keywords="RCT", keywords="first responder", keywords="overdose", keywords="community engagement", keywords="citizen mobilization", keywords="opioids", keywords="Narcan", keywords="mobile phone", abstract="Background: The use of naloxone, an opioid antagonist, is a critical component of the US response to fatal opioid-involved overdoses. The importance and utility of naloxone in preventing fatal overdoses have been widely declaimed by medical associations and government officials and are supported by strong research evidence. Still, there are gaps in the current US national strategy because many opioid-involved overdose fatalities have no evidence of naloxone administration. Improving the likelihood that naloxone will be used to prevent fatal overdoses is predicated on facilitating an environment wherein naloxone is available near each overdose and can be accessed by someone who is willing and able to use it. How to accomplish this on a national scale has been unclear. However, there exists a national network of >1 million cardiopulmonary resuscitation (CPR) layperson responders and 4800 emergency responder agencies linked through a mobile phone app called PulsePoint Respond. PulsePoint responders certify that they are trained to administer CPR and are willing to respond to possible cardiac events in public. When such an event occurs near their mobile phone's location, they receive an alert to respond. These motivated citizens are ideally positioned to carry naloxone and reverse overdoses that occur in public. Objective: This randomized controlled trial will examine the feasibility of recruiting first responder agencies and layperson CPR responders who already use PulsePoint to obtain overdose education and carry naloxone. Methods: This will be a 3-arm parallel-group randomized controlled trial. We will randomly select 180 first responder agencies from the population of agencies contracting with the PulsePoint Foundation. The 3 study arms will include a standard recruitment arm, a misperception-correction recruitment arm, and a control arm (1:1:1 allocation, with random allocation stratified by zip code designation [rural or nonrural]). We will study agency recruitment and, among the agencies we successfully recruit, responder certification of receiving overdose and naloxone education, carrying naloxone, or both. Hypothesis 1 contrasts agency recruitment success between arms 1 and 2, and hypothesis 2 contrasts the ratios of layperson certification across all 3 arms. The primary analyses will be a logistic regression comparing the recruitment rates among the arms, adjusting for rural or nonrural zip code designation. Results: This study was reviewed by the Indiana University Institutional Review Board (20218 and 20219). This project was funded beginning September 14, 2023, by the National Institute on Drug Abuse. Conclusions: The hypotheses in this study will test whether a specific type of messaging is particularly effective in recruiting agencies and layperson responders. Although we hypothesize that arm 2 will outperform the other arms, our intention is to use the best-performing approach in the next phase of this study if any of our approaches demonstrates feasibility. Trial Registration: OSF Registries osf.io/egn3z; https://osf.io/egn3z International Registered Report Identifier (IRRID): PRR1-10.2196/57280 ", doi="10.2196/57280", url="https://www.researchprotocols.org/2024/1/e57280", url="http://www.ncbi.nlm.nih.gov/pubmed/38551636" } @Article{info:doi/10.2196/52587, author="Rigby, C. Ryan and Ferdinand, O. Alva and Kum, Hye-Chung and Schmit, Cason", title="Data Sharing in a Decentralized Public Health System: Lessons From COVID-19 Syndromic Surveillance", journal="JMIR Public Health Surveill", year="2024", month="Mar", day="28", volume="10", pages="e52587", keywords="syndromic surveillance", keywords="federalism", keywords="COVID-19", keywords="public health", keywords="SARS-CoV-2", keywords="COVID-19 pandemic", keywords="United States", keywords="decentralized", keywords="data sharing", keywords="digital health", keywords="ethical guidelines", keywords="risk score", keywords="technology", keywords="innovation", keywords="information system", keywords="collaborative framework", keywords="infodemiology", keywords="digital technology", keywords="health information", keywords="health data", keywords="health policy", keywords="surveillance", doi="10.2196/52587", url="https://publichealth.jmir.org/2024/1/e52587", url="http://www.ncbi.nlm.nih.gov/pubmed/38546731" } @Article{info:doi/10.2196/50552, author="Xue, Jia and Zhang, Qiaoru and Zhang, Yun and Shi, Hong and Zheng, Chengda and Fan, Jingchuan and Zhang, Linxiao and Chen, Chen and Li, Luye and Shier, L. Micheal", title="Bridging and Bonding Social Capital by Analyzing the Demographics, User Activities, and Social Network Dynamics of Sexual Assault Centers on Twitter: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Mar", day="27", volume="26", pages="e50552", keywords="social media", keywords="Twitter", keywords="sexual assault", keywords="nonprofits", keywords="Canada", keywords="violence", keywords="geolocation", keywords="communication", abstract="Background: Social media platforms have gained popularity as communication tools for organizations to engage with clients and the public, disseminate information, and raise awareness about social issues. From a social capital perspective, relationship building is seen as an investment, involving a complex interplay of tangible and intangible resources. Social media--based social capital signifies the diverse social networks that organizations can foster through their engagement on social media platforms. Literature underscores the great significance of further investigation into the scope and nature of social media use, particularly within sectors dedicated to service delivery, such as sexual assault organizations. Objective: This study aims to fill a research gap by investigating the use of Twitter by sexual assault support agencies in Canada. It seeks to understand the demographics, user activities, and social network structure within these organizations on Twitter, focusing on building social capital. The research questions explore the demographic profile, geographic distribution, and Twitter activity of these organizations as well as the social network dynamics of bridging and bonding social capital. Methods: This study used purposive sampling to investigate sexual assault centers in Canada with active Twitter accounts, resulting in the identification of 124 centers. The Twitter handles were collected, yielding 113 unique handles, and their corresponding Twitter IDs were obtained and validated. A total of 294,350 tweets were collected from these centers, covering >93.54\% of their Twitter activity. Preprocessing was conducted to prepare the data, and descriptive analysis was used to determine the center demographics and age. Furthermore, geolocation mapping was performed to visualize the center locations. Social network analysis was used to explore the intricate relationships within the network of sexual assault center Twitter accounts, using various metrics to assess the network structure and connectivity dynamics. Results: The results highlight the substantial presence of sexual assault organizations on Twitter, particularly in provinces such as Ontario, British Columbia, and Quebec, underscoring the importance of tailored engagement strategies considering regional disparities. The analysis of Twitter account creation years shows a peak in 2012, followed by a decline in new account creations in subsequent years. The monthly tweet activity shows November as the most active month, whereas July had the lowest activity. The study also reveals variations in Twitter activity, account creation patterns, and social network dynamics, identifying influential social queens and marginalized entities within the network. Conclusions: This study presents a comprehensive landscape of the demographics and activities of sexual assault centers in Canada on Twitter. This study suggests that future research should explore the long-term consequences of social media use and examine stakeholder perceptions, providing valuable insights to improve communication practices within the nonprofit human services sector and further the missions of these organizations. ", doi="10.2196/50552", url="https://www.jmir.org/2024/1/e50552", url="http://www.ncbi.nlm.nih.gov/pubmed/38536222" } @Article{info:doi/10.2196/43585, author="Deji, Zhuoga and Tong, Yuantao and Huang, Honglian and Zhang, Zeyu and Fang, Meng and Crabbe, C. M. James and Zhang, Xiaoyan and Wang, Ying", title="Influence of Environmental Factors and Genome Diversity on Cumulative COVID-19 Cases in the Highland Region of China: Comparative Correlational Study", journal="Interact J Med Res", year="2024", month="Mar", day="25", volume="13", pages="e43585", keywords="COVID-19", keywords="environmental factors", keywords="altitude", keywords="population density", keywords="virus mutation", abstract="Background: The novel coronavirus SARS-CoV-2 caused the global COVID-19 pandemic. Emerging reports support lower mortality and reduced case numbers in highland areas; however, comparative studies on the cumulative impact of environmental factors and viral genetic diversity on COVID-19 infection rates have not been performed to date. Objective: The aims of this study were to determine the difference in COVID-19 infection rates between high and low altitudes, and to explore whether the difference in the pandemic trend in the high-altitude region of China compared to that of the lowlands is influenced by environmental factors, population density, and biological mechanisms. Methods: We examined the correlation between population density and COVID-19 cases through linear regression. A zero-shot model was applied to identify possible factors correlated to COVID-19 infection. We further analyzed the correlation of meteorological and air quality factors with infection cases using the Spearman correlation coefficient. Mixed-effects multiple linear regression was applied to evaluate the associations between selected factors and COVID-19 cases adjusting for covariates. Lastly, the relationship between environmental factors and mutation frequency was evaluated using the same correlation techniques mentioned above. Results: Among the 24,826 confirmed COVID-19 cases reported from 40 cities in China from January 23, 2020, to July 7, 2022, 98.4\% (n=24,430) were found in the lowlands. Population density was positively correlated with COVID-19 cases in all regions ($\rho$=0.641, P=.003). In high-altitude areas, the number of COVID-19 cases was negatively associated with temperature, sunlight hours, and UV index (P=.003, P=.001, and P=.009, respectively) and was positively associated with wind speed ($\rho$=0.388, P<.001), whereas no correlation was found between meteorological factors and COVID-19 cases in the lowlands. After controlling for covariates, the mixed-effects model also showed positive associations of fine particulate matter (PM2.5) and carbon monoxide (CO) with COVID-19 cases (P=.002 and P<.001, respectively). Sequence variant analysis showed lower genetic diversity among nucleotides for each SARS-CoV-2 genome (P<.001) and three open reading frames (P<.001) in high altitudes compared to 300 sequences analyzed from low altitudes. Moreover, the frequencies of 44 nonsynonymous mutations and 32 synonymous mutations were significantly different between the high- and low-altitude groups (P<.001, mutation frequency>0.1). Key nonsynonymous mutations showed positive correlations with altitude, wind speed, and air pressure and showed negative correlations with temperature, UV index, and sunlight hours. Conclusions: By comparison with the lowlands, the number of confirmed COVID-19 cases was substantially lower in high-altitude regions of China, and the population density, temperature, sunlight hours, UV index, wind speed, PM2.5, and CO influenced the cumulative pandemic trend in the highlands. The identified influence of environmental factors on SARS-CoV-2 sequence variants adds knowledge of the impact of altitude on COVID-19 infection, offering novel suggestions for preventive intervention. ", doi="10.2196/43585", url="https://www.i-jmr.org/2024/1/e43585", url="http://www.ncbi.nlm.nih.gov/pubmed/38526532" } @Article{info:doi/10.2196/50898, author="Bindhu, Shwetha and Nattam, Anunita and Xu, Catherine and Vithala, Tripura and Grant, Tiffany and Dariotis, K. Jacinda and Liu, Hexuan and Wu, Y. Danny T.", title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review", journal="Online J Public Health Inform", year="2024", month="Mar", day="20", volume="16", pages="e50898", keywords="health literacy", keywords="social determinants of health", keywords="SDoH", keywords="social determinants", keywords="systematic review", keywords="patient education", keywords="health education", keywords="health information", keywords="information needs", keywords="information comprehension", keywords="patient counseling", keywords="barriers to care", keywords="language proficiency", abstract="Background: Health literacy (HL) is the ability to make informed decisions using health information. As health data and information availability increase due to online clinic notes and patient portals, it is important to understand how HL relates to social determinants of health (SDoH) and the place of informatics in mitigating disparities. Objective: This systematic literature review aims to examine the role of HL in interactions with SDoH and to identify feasible HL-based interventions that address low patient understanding of health information to improve clinic note-sharing efficacy. Methods: The review examined 2 databases, Scopus and PubMed, for English-language articles relating to HL and SDoH. We conducted a quantitative analysis of study characteristics and qualitative synthesis to determine the roles of HL and interventions. Results: The results (n=43) were analyzed quantitatively and qualitatively for study characteristics, the role of HL, and interventions. Most articles (n=23) noted that HL was a result of SDoH, but other articles noted that it could also be a mediator for SdoH (n=6) or a modifiable SdoH (n=14) itself. Conclusions: The multivariable nature of HL indicates that it could form the basis for many interventions to combat low patient understandability, including 4 interventions using informatics-based solutions. HL is a crucial, multidimensional skill in supporting patient understanding of health materials. Designing interventions aimed at improving HL or addressing poor HL in patients can help increase comprehension of health information, including the information contained in clinic notes shared with patients. ", doi="10.2196/50898", url="https://ojphi.jmir.org/2024/1/e50898", url="http://www.ncbi.nlm.nih.gov/pubmed/38506914" } @Article{info:doi/10.2196/51113, author="Xian, Xuechang and Neuwirth, J. Rostam and Chang, Angela", title="Government-Nongovernmental Organization (NGO) Collaboration in Macao's COVID-19 Vaccine Promotion: Social Media Case Study", journal="JMIR Infodemiology", year="2024", month="Mar", day="19", volume="4", pages="e51113", keywords="COVID-19", keywords="government", keywords="vaccine", keywords="automated content analysis", keywords="Granger causality test", keywords="network agenda setting", keywords="QAP", keywords="social media", abstract="Background: The COVID-19 pandemic triggered unprecedented global vaccination efforts, with social media being a popular tool for vaccine promotion. Objective: This study probes into Macao's COVID-19 vaccine communication dynamics, with a focus on the multifaceted impacts of government agendas on social media. Methods: We scrutinized 22,986 vaccine-related Facebook posts from January 2020 to August 2022 in Macao. Using automated content analysis and advanced statistical methods, we unveiled intricate agenda dynamics between government and nongovernment entities. Results: ``Vaccine importance'' and ``COVID-19 risk'' were the most prominent topics co-occurring in the overall vaccine communication. The government tended to emphasize ``COVID-19 risk'' and ``vaccine effectiveness,'' while regular users prioritized vaccine safety and distribution, indicating a discrepancy in these agendas. Nonetheless, the government has limited impact on regular users in the aspects of vaccine importance, accessibility, affordability, and trust in experts. The agendas of government and nongovernment users intertwined, illustrating complex interactions. Conclusions: This study reveals the influence of government agendas on public discourse, impacting environmental awareness, public health education, and the social dynamics of inclusive communication during health crises. Inclusive strategies, accommodating public concerns, and involving diverse stakeholders are paramount for effective social media communication during health crises. ", doi="10.2196/51113", url="https://infodemiology.jmir.org/2024/1/e51113", url="http://www.ncbi.nlm.nih.gov/pubmed/38502184" } @Article{info:doi/10.2196/52150, author="Holl, Felix and Kircher, Jennifer and Hertelendy, J. Attila and Sukums, Felix and Swoboda, Walter", title="Tanzania's and Germany's Digital Health Strategies and Their Consistency With the World Health Organization's Global Strategy on Digital Health 2020-2025: Comparative Policy Analysis", journal="J Med Internet Res", year="2024", month="Mar", day="18", volume="26", pages="e52150", keywords="digital health strategies", keywords="comparative policy analysis", keywords="DHS", keywords="eHealth", keywords="digital health", keywords="strategy", keywords="strategies", keywords="policy", keywords="policies", keywords="document analysis", keywords="document analyses", keywords="GSDH", keywords="Germany", keywords="Europe", keywords="Africa", keywords="Tanzania", abstract="Background: In recent years, the fast-paced adoption of digital health (DH) technologies has transformed health care delivery. However, this rapid evolution has also led to challenges such as uncoordinated development and information silos, impeding effective health care integration. Recognizing these challenges, nations have developed digital health strategies (DHSs), aligning with their national health priorities and guidance from global frameworks. The World Health Organization (WHO)'s Global Strategy on Digital Health 2020-2025 (GSDH) guides national DHSs. Objective: This study analyzes the DHSs of Tanzania and Germany as case studies and assesses their alignment with the GSDH and identifies strengths, shortcomings, and areas for improvement. Methods: A comparative policy analysis was conducted, focusing on the DHSs of Tanzania and Germany as case studies, selected for their contrasting health care systems and cooperative history. The analysis involved a three-step process: (1) assessing consistency with the GSDH, (2) comparing similarities and differences, and (3) evaluating the incorporation of emergent technologies. Primary data sources included national eHealth policy documents and related legislation. Results: Both Germany's and Tanzania's DHSs align significantly with the WHO's GSDH, incorporating most of its 35 elements, but each missing 5 distinct elements. Specifically, Tanzania's DHS lacks in areas such as knowledge management and capacity building for leaders, while Germany's strategy falls short in engaging health care service providers and beneficiaries in development phases and promoting health equity. Both countries, however, excel in other aspects like collaboration, knowledge transfer, and advancing national DHSs, reflecting their commitment to enhancing DH infrastructures. The high ratings of both countries on the Global Digital Health Monitor underscore their substantial progress in DH, although challenges persist in adopting the rapidly advancing technologies and in the need for more inclusive and comprehensive strategies. Conclusions: This study reveals that both Tanzania and Germany have made significant strides in aligning their DHSs with the WHO's GSDH. However, the rapid evolution of technologies like artificial intelligence and machine learning presents challenges in keeping strategies up-to-date. This study recommends the development of more comprehensive, inclusive strategies and regular revisions to align with emerging technologies and needs. The research underscores the importance of context-specific adaptations in DHSs and highlights the need for broader, strategic guidelines to direct the future development of the DH ecosystem. The WHO's GSDH serves as a crucial blueprint for national DHSs. This comparative analysis demonstrates the value and challenges of aligning national strategies with global guidelines. Both Tanzania and Germany offer valuable insights into developing and implementing effective DHSs, highlighting the importance of continuous adaptation and context-specific considerations. Future policy assessments require in-depth knowledge of the country's health care needs and structure, supplemented by stakeholder input for a comprehensive evaluation. ", doi="10.2196/52150", url="https://www.jmir.org/2024/1/e52150", url="http://www.ncbi.nlm.nih.gov/pubmed/38498021" } @Article{info:doi/10.2196/45070, author="Dang, Huyen Thi Thanh and Carnahan, Emily and Nguyen, Linh and Mvundura, Mercy and Dao, Sang and Duong, Hong Thi and Nguyen, Trung and Nguyen, Doan and Nguyen, Tu and Werner, Laurie and Ryman, K. Tove and Nguyen, Nga", title="Outcomes and Costs of the Transition From a Paper-Based Immunization System to a Digital Immunization System in Vietnam: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Mar", day="18", volume="26", pages="e45070", keywords="eHealth", keywords="digital health", keywords="immunization information system", keywords="electronic immunization registry", keywords="immunization", keywords="data quality", keywords="data use", keywords="costing", abstract="Background: The electronic National Immunization Information System (NIIS) was introduced nationwide in Vietnam in 2017. Health workers were expected to use the NIIS alongside the legacy paper-based system. Starting in 2018, Hanoi and Son La provinces transitioned to paperless reporting. Interventions to support this transition included data guidelines and training, internet-based data review meetings, and additional supportive supervision visits. Objective: This study aims to assess (1) changes in NIIS data quality and use, (2) changes in immunization program outcomes, and (3) the economic costs of using the NIIS versus the traditional paper system. Methods: This mixed methods study took place in Hanoi and Son La provinces. It aimed to analyses pre- and postintervention data from various sources including the NIIS; household and health facility surveys; and interviews to measure NIIS data quality, data use, and immunization program outcomes. Financial data were collected at the national, provincial, district, and health facility levels through record review and interviews. An activity-based costing approach was conducted from a health system perspective. Results: NIIS data timeliness significantly improved from pre- to postintervention in both provinces. For example, the mean number of days from birth date to NIIS registration before and after intervention dropped from 18.6 (SD 65.5) to 5.7 (SD 31.4) days in Hanoi (P<.001) and from 36.1 (SD 94.2) to 11.7 (40.1) days in Son La (P<.001). Data from Son La showed that the completeness and accuracy improved, while Hanoi exhibited mixed results, possibly influenced by the COVID-19 pandemic. Data use improved; at postintervention, 100\% (667/667) of facilities in both provinces used NIIS data for activities beyond monthly reporting compared with 34.8\% (202/580) in Hanoi and 29.4\% (55/187) in Son La at preintervention. Across nearly all antigens, the percentage of children who received the vaccine on time was higher in the postintervention cohort compared with the preintervention cohort. Up-front costs associated with developing and deploying the NIIS were estimated at US \$0.48 per child in the study provinces. The commune health center level showed cost savings from changing from the paper system to the NIIS, mainly driven by human resource time savings. At the administrative level, incremental costs resulted from changing from the paper system to the NIIS, as some costs increased, such as labor costs for supportive supervision and additional capital costs for equipment associated with the NIIS. Conclusions: The Hanoi and Son La provinces successfully transitioned to paperless reporting while maintaining or improving NIIS data quality and data use. However, improvements in data quality were not associated with improvements in the immunization program outcomes in both provinces. The COVID-19 pandemic likely had a negative influence on immunization program outcomes, particularly in Hanoi. These improvements entail up-front financial costs. ", doi="10.2196/45070", url="https://www.jmir.org/2024/1/e45070", url="http://www.ncbi.nlm.nih.gov/pubmed/38498020" } @Article{info:doi/10.2196/52093, author="Divi, Nomita and Mantero, Ja? and Libel, Marlo and Leal Neto, Onicio and Schultheiss, Marinanicole and Sewalk, Kara and Brownstein, John and Smolinski, Mark", title="Using EpiCore to Enable Rapid Verification of Potential Health Threats: Illustrated Use Cases and Summary Statistics", journal="JMIR Public Health Surveill", year="2024", month="Mar", day="15", volume="10", pages="e52093", keywords="disease surveillance", keywords="surveillance", keywords="verification", keywords="early detection", keywords="epidemic intelligence, risk assessment", keywords="threat", keywords="threats", keywords="crisis", keywords="crises", keywords="outbreak", keywords="outbreaks", keywords="warning", keywords="warnings", keywords="crowdsource", keywords="crowdsourcing", keywords="digital health", keywords="detect", keywords="detection", keywords="risk", keywords="risks", abstract="Background: The proliferation of digital disease-detection systems has led to an increase in earlier warning signals, which subsequently have resulted in swifter responses to emerging threats. Such highly sensitive systems can also produce weak signals needing additional information for action. The delays in the response to a genuine health threat are often due to the time it takes to verify a health event. It was the delay in outbreak verification that was the main impetus for creating EpiCore. Objective: This paper describes the potential of crowdsourcing information through EpiCore, a network of voluntary human, animal, and environmental health professionals supporting the verification of early warning signals of potential outbreaks and informing risk assessments by monitoring ongoing threats. Methods: This paper uses summary statistics to assess whether EpiCore is meeting its goal to accelerate the time to verification of identified potential health events for epidemic and pandemic intelligence purposes from around the world. Data from the EpiCore platform from January 2018 to December 2022 were analyzed to capture request for information response rates and verification rates. Illustrated use cases are provided to describe how EpiCore members provide information to facilitate the verification of early warning signals of potential outbreaks and for the monitoring and risk assessment of ongoing threats through EpiCore and its utilities. Results: Since its launch in 2016, EpiCore network membership grew to over 3300 individuals during the first 2 years, consisting of professionals in human, animal, and environmental health, spanning 161 countries. The overall EpiCore response rate to requests for information increased by year between 2018 and 2022 from 65.4\% to 68.8\% with an initial response typically received within 24 hours (in 2022, 94\% of responded requests received a first contribution within 24 h). Five illustrated use cases highlight the various uses of EpiCore. Conclusions: As the global demand for data to facilitate disease prevention and control continues to grow, it will be crucial for traditional and nontraditional methods of disease surveillance to work together to ensure health threats are captured earlier. EpiCore is an innovative approach that can support health authorities in decision-making when used complementarily with official early detection and verification systems. EpiCore can shorten the time to verification by confirming early detection signals, informing risk-assessment activities, and monitoring ongoing events. ", doi="10.2196/52093", url="https://publichealth.jmir.org/2024/1/e52093", url="http://www.ncbi.nlm.nih.gov/pubmed/38488832" } @Article{info:doi/10.2196/56683, author="Bal{\'a}n, C. Iv{\'a}n and Marone, O. Ruben and Barreda, Victoria and Naar, Sylvie and Wang, Yuxia", title="Integration of an Electronic Screening, Brief Intervention, and Referral to Treatment Program Into an HIV Testing Program to Reduce Substance Use and HIV Risk Behavior Among Men Who Have Sex With Men: Protocol for Intervention Development and a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Mar", day="14", volume="13", pages="e56683", keywords="HIV", keywords="substance use", keywords="community health", keywords="implementation science", keywords="eHealth", abstract="Background: Men who have sex with men (MSM) are disproportionally affected by HIV and drug and alcohol use; however, few effective HIV prevention interventions for MSM who use substances exist. Screening, Brief Intervention, and Referral to Treatment is an early intervention for non--treatment-seeking individuals with problematic substance use and for timely referral to treatment for those with substance use disorders. Electronic screening and brief interventions (e-SBIs) reduce implementation challenges. An e-SBI tailored for MSM at the time of HIV testing might be particularly opportune to strengthen their motivation to reduce substance use and HIV risk behavior. Objective: This study aims to develop a tailored e-SBI program to reduce substance use and HIV risk behavior among MSM seeking HIV testing at Nexo Asociaci{\'o}n Civil, our community partners in Argentina (primary); assess the feasibility and acceptability of integrating the e-SBI into the Nexo HIV testing program (primary); assess the feasibility and acceptability of implementing an adapted Men's Health Project (MHP) at Nexo (secondary); and finally, explore preliminary findings on substance use and sexual risk reduction outcomes (exploratory). Methods: This mixed methods study has 2 stages. During stage 1 (development), we will use the User Centered Rapid App Design process consisting of focus groups (n=16), individual interviews (n=24), and a pilot deployment of the e-SBI (n=50) to iteratively develop the e-SBI. Quantitative and qualitative assessments at each step will inform the revision of the e-SBI. Furthermore, we will use the assessment, decision, administration, production, topic experts, integration, training, testing framework to adapt MHP. During stage 2 (pilot randomized controlled trial [RCT]), we will randomize 200 MSM coming to Nexo for HIV testing. They will complete a baseline assessment and then their assigned intervention (e-SBI vs screening only) and will be followed-up for 6 months. We will also conduct in-depth interviews with up to 45 participants: 15 participants from either study condition who entered or completed MHP or other substance abuse treatment and 15 from each arm who met the criteria for MHP but did not request it. Results: The study began recruitment in October 2022, and the stage-1 pilot study is near completion. Preliminary findings from stage 1 show high e-SBI acceptability. Data analysis of the stage-1 pilot is now beginning. The stage-2 pilot RCT will be launched in March 2024, with all data collection completed by May 2025. Conclusions: This study will allow us to assess the acceptability and feasibility of e-SBI implementation during HIV testing encounters. We will also build the necessary research infrastructure for a subsequent RCT to assess the efficacy of e-SBIs in reducing substance use and HIV sexual risk behavior among MSM in this setting. Trial Registration: ClinicalTrials.gov NCT05542914; https://tinyurl.com/yyjj64dm. International Registered Report Identifier (IRRID): DERR1-10.2196/56683 ", doi="10.2196/56683", url="https://www.researchprotocols.org/2024/1/e56683", url="http://www.ncbi.nlm.nih.gov/pubmed/38483463" } @Article{info:doi/10.2196/50431, author="Carboni, Alexa and Martini, Olnita and Kirk, Jessica and Marroquin, A. Nathaniel and Ricci, Corinne and Cheng, Melissa and Szeto, D. Mindy and Pulsipher, J. Kayd and Dellavalle, P. Robert", title="Does Male Skin Care Content on Instagram Neglect Skin Cancer Prevention?", journal="JMIR Dermatol", year="2024", month="Mar", day="13", volume="7", pages="e50431", keywords="men", keywords="male", keywords="male skin care", keywords="male skincare", keywords="sunscreen", keywords="sun protection", keywords="photoprotection", keywords="anti-aging", keywords="skin cancer prevention", keywords="Instagram", keywords="social media", keywords="marketing", keywords="advertising", keywords="dermatology", keywords="dermatologist", keywords="skin", keywords="man", keywords="oncology", keywords="oncologist", doi="10.2196/50431", url="https://derma.jmir.org/2024/1/e50431", url="http://www.ncbi.nlm.nih.gov/pubmed/38477962" } @Article{info:doi/10.2196/48977, author="Sinha, Jayati and Serin, Nuket", title="Online Health Information Seeking and Preventative Health Actions: Cross-Generational Online Survey Study", journal="J Med Internet Res", year="2024", month="Mar", day="11", volume="26", pages="e48977", keywords="digital natives", keywords="digital immigrants", keywords="online health information seeking", keywords="preventative health actions", keywords="mobile phone", abstract="Background: The popularity of online health information seeking (OHIS) has increased significantly owing to its accessibility and affordability. To facilitate better health management, it is essential to comprehend the generational differences in OHIS behavior and preventative health actions after seeking online health information (OHI). Objective: This study investigates the variations in OHIS and engagement in preventative health actions between 2 generations based on their technology use (digital natives [aged 18-42 years] and digital immigrants [aged ?43 years]). Additionally, this research explores the mediating role of OHIS types on the generational effect on preventative health actions and the moderating role of OHI search frequency, gender, and the presence of chronic diseases on the generational effect on OHIS types and preventative health actions. Methods: A preregistered online survey was conducted on the Prolific online data collection platform using stratified sampling of 2 generations (digital natives and digital immigrants) from the United States in November 2023. Overall, 3 types of OHIS were collected: health wellness information search, health guidance information search, and health management information search. A 1-way analysis of covariance tested the generational differences in types of OHIS and preventative health actions, and a 2-way analysis of covariance tested the moderating role of OHIS search frequency, gender, and the presence of chronic diseases using 7 control variables. The PROCESS Macro Model 4 was used to conduct mediation analyses, testing OHI search types as mediators. Linear regression analyses tested age as a predictor of OHIS and preventative health actions. Results: The analysis of 1137 responses revealed generational differences in OHIS. Digital natives searched for health wellness information more frequently (P<.001), whereas digital immigrants searched for health guidance (P<.001) and health management information (P=.001) more frequently. There were no significant differences between the 2 generations regarding preventative health actions (P=.85). Moreover, all 3 types of OHIS mediated the relationship between generational differences and preventative health actions. Furthermore, as people aged, they searched for significantly less health wellness information (P<.001) and more health guidance (P<.001), and health management information (P=.003). Age was not a significant predictor of preventative health actions (P=.48). The frequency of OHI searches did not moderate the effect of generations on OHIS types and preventative health actions. Gender only moderated the relationship between generation and health guidance information search (P=.02), and chronic diseases only moderated the relationship between generation and health wellness information search (P=.03). Conclusions: To the best of our knowledge, this study is the first to explore how 2 digital generations vary in terms of searching for OHI and preventative health behaviors. As the older adult population grows, it is crucial to understand their OHIS behavior and how they engage in preventative health actions to enhance their quality of life. ", doi="10.2196/48977", url="https://www.jmir.org/2024/1/e48977", url="http://www.ncbi.nlm.nih.gov/pubmed/38466985" } @Article{info:doi/10.2196/47448, author="Vincent, Wilson", title="Willingness to Use Digital Health Screening and Tracking Tools for Public Health in Sexual Minority Populations in a National Probability Sample: Quantitative Intersectional Analysis", journal="J Med Internet Res", year="2024", month="Mar", day="8", volume="26", pages="e47448", keywords="COVID-19", keywords="demographics", keywords="digital health", keywords="disparities", keywords="intersectionality", keywords="mHealth", keywords="mobile health", keywords="psychometric properties", keywords="sexual minority populations", abstract="Background: Little is known about sexual minority adults' willingness to use digital health tools, such as pandemic-related tools for screening and tracking, outside of HIV prevention and intervention efforts for sexual minority men, specifically. Additionally, given the current cultural climate in the United States, heterosexual and sexual minority adults may differ in their willingness to use digital health tools, and there may be within-group differences among sexual minority adults. Objective: This study compared sexual minority and heterosexual adults' willingness to use COVID-19--related digital health tools for public health screening and tracking and tested whether sexual minority adults differed from each other by age group, gender, and race or ethnicity. Methods: We analyzed data from a cross-sectional, national probability survey (n=2047) implemented from May 30 to June 8, 2020, in the United States during the height of the public health response to the COVID-19 pandemic. Using latent-variable modeling, heterosexual and sexual minority adults were tested for differences in their willingness to use digital health tools for public health screening and tracking. Among sexual minority adults, specifically, associations with age, gender, and race or ethnicity were assessed. Results: On average, sexual minority adults showed greater willingness to use digital health tools for screening and tracking than heterosexual adults (latent factor mean difference 0.46, 95\% CI 0.15-0.77). Among sexual minority adults, there were no differences by age group, gender, or race or ethnicity. However, African American (b=0.41, 95\% CI 0.19-0.62), Hispanic or Latino (b=0.36, 95\% CI 0.18-0.55), and other racial or ethnic minority (b=0.54, 95\% CI 0.31-0.77) heterosexual adults showed greater willingness to use digital health tools for screening and tracking than White heterosexual adults. Conclusions: In the United States, sexual minority adults were more willing to use digital health tools for screening and tracking than heterosexual adults. Sexual minority adults did not differ from each other by age, gender, or race or ethnicity in terms of their willingness to use these digital health tools, so no sexual orientation-based or intersectional disparities were identified. Furthermore, White heterosexual adults were less willing to use these tools than racial or ethnic minority heterosexual adults. Findings support the use of digital health tools with sexual minority adults, which could be important for other public health-related concerns (eg, the recent example of mpox). Additional studies are needed regarding the decision-making process of White heterosexual adults regarding the use of digital health tools to address public health crises, including pandemics or outbreaks that disproportionately affect minoritized populations. ", doi="10.2196/47448", url="https://www.jmir.org/2024/1/e47448", url="http://www.ncbi.nlm.nih.gov/pubmed/38457790" } @Article{info:doi/10.2196/54000, author="Boatman, Dannell and Starkey, Abby and Acciavatti, Lori and Jarrett, Zachary and Allen, Amy and Kennedy-Rea, Stephenie", title="Using Social Listening for Digital Public Health Surveillance of Human Papillomavirus Vaccine Misinformation Online: Exploratory Study", journal="JMIR Infodemiology", year="2024", month="Mar", day="8", volume="4", pages="e54000", keywords="human papillomavirus", keywords="HPV", keywords="vaccine", keywords="vaccines", keywords="vaccination", keywords="vaccinations", keywords="sexually transmitted infection", keywords="STI", keywords="sexually transmitted disease", keywords="STD", keywords="sexual transmission", keywords="sexually transmitted", keywords="social media", keywords="social listening", keywords="cancer", keywords="surveillance", keywords="health communication", keywords="misinformation", keywords="artificial intelligence", keywords="AI", keywords="infodemiology", keywords="infoveillance", keywords="oncology", doi="10.2196/54000", url="https://infodemiology.jmir.org/2024/1/e54000", url="http://www.ncbi.nlm.nih.gov/pubmed/38457224" } @Article{info:doi/10.2196/48026, author="Kong, Weitao and Li, Yuanyuan and Luo, Aijing and Xie, Wenzhao", title="Status and Influencing Factors of Social Media Addiction in Chinese Workers: Cross-Sectional Survey Study", journal="J Med Internet Res", year="2024", month="Mar", day="6", volume="26", pages="e48026", keywords="social media addiction", keywords="job burnout", keywords="mindfulness", keywords="mobile phone", keywords="technology addiction", keywords="cross-sectional survey", abstract="Background: Social media addiction (SMA) caused by excessive dependence on social media is becoming a global problem. At present, most of the SMA studies recruit college students as research participants, with very few studies involving workers and other age groups, especially in China. Objective: This study aims to investigate the current status of SMA among Chinese workers and analyze its influencing factors. Methods: From November 1, 2022, to January 30, 2023, we conducted an anonymous web-based questionnaire survey in mainland China, and a total of 5176 participants completed the questionnaire. The questionnaire included the Social Networking Service Addiction Scale, Maslach Burnout Inventory--General Survey scale, Mindful Attention Awareness Scale, as well as questionnaires regarding participants' social media use habits and demographic information. Results: Through strict screening, 3468 valid questionnaires were included in this study. The main findings of this study revealed the following: the average SMA score of workers was higher (mean 53.19, SD 12.04), and some of them (393/3468, 11.33\%) relied heavily on social media; there were statistically significant differences in SMA scores among workers in different industries (F14,3453=3.98; P<.001); single workers (t3106=8.6; P<.001) and workers in a relationship (t2749=5.67; P<.001) had higher SMA scores than married workers, but some married workers (214/3468, 6.17\%) were highly dependent on social media; the level of SMA among female workers was higher than that of male workers (t3466=3.65; P<.001), and the SMA score of workers negatively correlated with age (r=?0.22; P<.001) and positively correlated with education level (r=0.12; P<.001); the frequency of using social media for entertainment during work (r=0.33; P<.001) and the frequency of staying up late using social media (r=0.14; P<.001) were positively correlated with the level of SMA in workers; and the level of SMA in workers was significantly positively correlated with their level of burnout (r=0.35; P<.001), whereas it was significantly negatively correlated with their level of mindfulness (r=?0.55; P<.001). Conclusions: The results of this study suggest that SMA among Chinese workers is relatively serious and that the SMA problem among workers requires more attention from society and academia. In particular, female workers, young workers, unmarried workers, highly educated workers, workers with bad social media habits, workers with high levels of job burnout, and workers with low levels of mindfulness were highly dependent on social media. In addition, occupation is an important influencing factor in SMA. Thus, the government should strengthen the supervision of social media companies. Medical institutions should provide health education on SMA and offer intervention programs for those addicted to social media. Workers should cultivate healthy habits while using social media. ", doi="10.2196/48026", url="https://www.jmir.org/2024/1/e48026", url="http://www.ncbi.nlm.nih.gov/pubmed/38446542" } @Article{info:doi/10.2196/48255, author="Kumwichar, Ponlagrit and Poonsiri, Chittawan and Botwright, Siobhan and Sirichumroonwit, Natchalaikorn and Loharjun, Bootsakorn and Thawillarp, Supharerk and Cheewaruangroj, Nontawit and Chokchaisiripakdee, Amorn and Teerawattananon, Yot and Chongsuvivatwong, Virasakdi", title="Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data", journal="JMIR Public Health Surveill", year="2024", month="Mar", day="5", volume="10", pages="e48255", keywords="COVID-19", keywords="heterologous vaccine", keywords="vaccine", keywords="vaccine effectiveness", keywords="durability", keywords="time", keywords="waning", keywords="real-world", keywords="public health", keywords="vaccination strategy", keywords="health outcome", keywords="vaccines", keywords="vaccination", keywords="unvaccinated", keywords="big data", keywords="registry", keywords="registries", keywords="health outcomes", keywords="effectiveness", keywords="SARS-CoV-2", keywords="cohort", keywords="database", keywords="databases", keywords="vaccinated", keywords="Cochran-Mantel-Haenszel", keywords="Mantel-Haenszel", keywords="regression", keywords="risk", keywords="risks", keywords="association", keywords="associations", keywords="odds ratio", keywords="odds ratios", abstract="Background: The durability of heterologous COVID-19 vaccine effectiveness (VE) has been primarily studied in high-income countries, while evaluation of heterologous vaccine policies in low- and middle-income countries remains limited. Objective: We aimed to evaluate the duration during which the VE of heterologous COVID-19 vaccine regimens in mitigating serious outcomes, specifically severe COVID-19 and death following hospitalization with COVID-19, remains over 50\%. Methods: We formed a dynamic cohort by linking records of Thai citizens aged ?18 years from citizen vital, COVID-19 vaccine, and COVID-19 cases registry databases between May 2021 and July 2022. Encrypted citizen identification numbers were used to merge the data between the databases. This study focuses on 8 common heterologous vaccine sequences: CoronaVac/ChAdOx1, ChAdOx1/BNT162b2, CoronaVac/CoronaVac/ChAdOx1, CoronaVac/ChAdOx1/ChAdOx1, CoronaVac/ChAdOx1/BNT162b2, BBIBP-CorV/BBIBP-CorV/BNT162b2, ChAdOx1/ChAdOx1/BNT162b2, and ChAdOx1/ChAdOx1/mRNA-1273. Nonimmunized individuals were considered for comparisons. The cohort was stratified according to the vaccination status, age, sex, province location, month of vaccination, and outcome. Data analysis employed logistic regression to determine the VE, accounting for potential confounders and durability over time, with data observed over a follow-up period of 7 months. Results: This study includes 52,580,841 individuals, with approximately 17,907,215 and 17,190,975 receiving 2- and 3-dose common heterologous vaccines (not mutually exclusive), respectively. The 2-dose heterologous vaccinations offered approximately 50\% VE against severe COVID-19 and death following hospitalization with COVID-19 for 2 months; however, the protection significantly declined over time. The 3-dose heterologous vaccinations sustained over 50\% VE against both outcomes for at least 8 months, as determined by logistic regression with durability time-interaction modeling. The vaccine sequence consisting of CoronaVac/CoronaVac/ChAdOx1 demonstrated >80\% VE against both outcomes, with no evidence of VE waning. The final monthly measured VE of CoronaVac/CoronaVac/ChAdOx1 against severe COVID-19 and death following hospitalization at 7 months after the last dose was 82\% (95\% CI 80.3\%-84\%) and 86.3\% (95\% CI 83.6\%-84\%), respectively. Conclusions: In Thailand, within a 7-month observation period, the 2-dose regimens could not maintain a 50\% VE against severe and fatal COVID-19 for over 2 months, but all of the 3-dose regimens did. The CoronaVac/CoronaVac/ChAdOx1 regimen showed the best protective effect against severe and fatal COVID-19. The estimated durability of 50\% VE for at least 8 months across all 3-dose heterologous COVID-19 vaccine regimens supports the adoption of heterologous prime-boost vaccination strategies, with a primary series of inactivated virus vaccine and boosting with either a viral vector or an mRNA vaccine, to prevent similar pandemics in low- and middle-income countries. ", doi="10.2196/48255", url="https://publichealth.jmir.org/2024/1/e48255", url="http://www.ncbi.nlm.nih.gov/pubmed/38441923" } @Article{info:doi/10.2196/49139, author="Deiner, S. Michael and Deiner, A. Natalie and Hristidis, Vagelis and McLeod, D. Stephen and Doan, Thuy and Lietman, M. Thomas and Porco, C. Travis", title="Use of Large Language Models to Assess the Likelihood of Epidemics From the Content of Tweets: Infodemiology Study", journal="J Med Internet Res", year="2024", month="Mar", day="1", volume="26", pages="e49139", keywords="conjunctivitis", keywords="microblog", keywords="social media", keywords="generative large language model", keywords="Generative Pre-trained Transformers", keywords="GPT-3.5", keywords="GPT-4", keywords="epidemic detection", keywords="Twitter", keywords="X formerly known as Twitter", keywords="infectious eye disease", abstract="Background: Previous work suggests that Google searches could be useful in identifying conjunctivitis epidemics. Content-based assessment of social media content may provide additional value in serving as early indicators of conjunctivitis and other systemic infectious diseases. Objective: We investigated whether large language models, specifically GPT-3.5 and GPT-4 (OpenAI), can provide probabilistic assessments of whether social media posts about conjunctivitis could indicate a regional outbreak. Methods: A total of 12,194 conjunctivitis-related tweets were obtained using a targeted Boolean search in multiple languages from India, Guam (United States), Martinique (France), the Philippines, American Samoa (United States), Fiji, Costa Rica, Haiti, and the Bahamas, covering the time frame from January 1, 2012, to March 13, 2023. By providing these tweets via prompts to GPT-3.5 and GPT-4, we obtained probabilistic assessments that were validated by 2 human raters. We then calculated Pearson correlations of these time series with tweet volume and the occurrence of known outbreaks in these 9 locations, with time series bootstrap used to compute CIs. Results: Probabilistic assessments derived from GPT-3.5 showed correlations of 0.60 (95\% CI 0.47-0.70) and 0.53 (95\% CI 0.40-0.65) with the 2 human raters, with higher results for GPT-4. The weekly averages of GPT-3.5 probabilities showed substantial correlations with weekly tweet volume for 44\% (4/9) of the countries, with correlations ranging from 0.10 (95\% CI 0.0-0.29) to 0.53 (95\% CI 0.39-0.89), with larger correlations for GPT-4. More modest correlations were found for correlation with known epidemics, with substantial correlation only in American Samoa (0.40, 95\% CI 0.16-0.81). Conclusions: These findings suggest that GPT prompting can efficiently assess the content of social media posts and indicate possible disease outbreaks to a degree of accuracy comparable to that of humans. Furthermore, we found that automated content analysis of tweets is related to tweet volume for conjunctivitis-related posts in some locations and to the occurrence of actual epidemics. Future work may improve the sensitivity and specificity of these methods for disease outbreak detection. ", doi="10.2196/49139", url="https://www.jmir.org/2024/1/e49139", url="http://www.ncbi.nlm.nih.gov/pubmed/38427404" } @Article{info:doi/10.2196/44861, author="Lightfoot, Marguerita and Campbell, Chadwick and Maragh-Bass, C. Allysha and Jackson-Morgan, Joi and Taylor, Kelly", title="What Adolescents Say in Text Messages to Motivate Peer Networks to Access Health Care and Sexually Transmitted Infection Testing: Qualitative Thematic Analysis", journal="J Med Internet Res", year="2024", month="Feb", day="28", volume="26", pages="e44861", keywords="adolescents", keywords="clinics", keywords="HIV/STI testing", keywords="intervention", keywords="mobile health", keywords="peer", keywords="screening", keywords="sexually active", keywords="STI", keywords="text messaging", keywords="young adult", abstract="Background: While rates of HIV and sexually transmitted infections (STIs) are extremely high among adolescents and young adults in the United States, rates of HIV and STI testing remain low. Given the ubiquity of mobile phones and the saliency of peers for youths, text messaging strategies may successfully promote HIV or STI testing among youths. Objective: This study aimed to understand the types of messages youths believe were motivating and persuasive when asked to text friends to encourage them to seek HIV or STI testing services at a neighborhood clinic. Methods: We implemented an adolescent peer-based text messaging intervention to encourage clinic attendance and increase STI and HIV testing among youths (n=100) at an adolescent clinic in San Francisco, California. Participants were asked to send a text message to 5 friends they believed were sexually active to encourage their friends to visit the clinic and receive STI or HIV screening. Thematic analysis was used to analyze the content of the text messages sent and received during the clinic visit. Member checking and consensus coding were used to ensure interrater reliability and significance of themes. Results: We identified four themes in the messages sent by participants: (1) calls to action to encourage peers to get tested, (2) personalized messages with sender-specific information, (3) clinic information such as location and hours, and (4) self-disclosure of personal clinic experience. We found that nearly all text messages included some combination of 2 or more of these broad themes. We also found that youths were inclined to send messages they created themselves, as opposed to sending the same message to each peer, which they tailored to each individual to whom they were sent. Many (40/100, 40\%) received an immediate response to their message, and most participants reported receiving at least 1 positive response, while a few reported that they had received at least 1 negative response. There were some differences in responses depending on the type of message sent. Conclusions: Given the high rates of STI and HIV and low rates of testing among adolescents, peer-driven text messaging interventions to encourage accessing care may be successful at reaching this population. This study suggests that youths are willing to text message their friends, and there are clear types of messages they develop and use. Future research should use these methods with a large, more diverse sample of youths and young adults for long-term evaluation of care seeking and care retention outcomes to make progress in reducing HIV and STI among adolescents and young adults. ", doi="10.2196/44861", url="https://www.jmir.org/2024/1/e44861", url="http://www.ncbi.nlm.nih.gov/pubmed/38416541" } @Article{info:doi/10.2196/47570, author="Ma, Shaoying and Kaareen, Aadeeba and Park, Hojin and He, Yanyun and Jiang, Shuning and Qiu, Zefeng and Xie, Zidian and Li, Dongmei and Chen, Jian and O'Connor, J. Richard and Fong, T. Geoffrey and Shang, Ce", title="How to Identify e-Cigarette Brands Available in the United States During 2020-2022: Development and Usability Study", journal="JMIR Form Res", year="2024", month="Feb", day="28", volume="8", pages="e47570", keywords="tobacco", keywords="electronic cigarette", keywords="e-cigarette", keywords="electronic nicotine delivery systems", keywords="electronic nicotine delivery system", keywords="vaping", keywords="market surveillance", keywords="tobacco marketing", abstract="Background: Prior studies have demonstrated that the e-cigarette market contains a large number of brands. Identifying these existing e-cigarette brands is a key element of market surveillance, which will further assist in policy making and compliance checks. Objective: To facilitate the surveillance of the diverse product landscape in the e-cigarette market, we constructed a semantic database of e-cigarette brands that have appeared in the US market as of 2020-2022. Methods: In order to build the brand database, we searched and compiled e-cigarette brands from a comprehensive list of retail channels and sources, including (1) e-liquid and disposable brands sold in web-based stores, (2) e-cigarette brands sold in brick-and-mortar stores and collected by the Nielsen Retail Scanner Data, (3) e-cigarette brands compiled by Wikipedia, (4) self-reported e-cigarette brands from the 2020 International Tobacco Control Four-Country Smoking and Vaping (ITC 4CV) US survey, and (5) e-cigarette brands on Twitter. We also estimated the top 5 e-cigarette brands by sales volume in brick-and-mortar stores, by the frequency and variety of offerings in web-based shops, and by the frequency of self-reported brands from the 2020 ITC 4CV US survey. Results: As of 2020-2022, a total of 912 e-cigarette brands have been sold by various retail channels. During 2020-2022, the top 5 brands are JUUL, vuse, njoy, blu, and logic in brick-and-mortar stores; blu, king, monster, twist, and air factory for e-liquids in web-based stores; hyde, pod mesh, suorin, vaporlax, and xtra for disposables sold in web-based stores; and smok, aspire, vaporesso, innokin, and eleaf based on self-reported survey data. Conclusions: As the US Food and Drug Administration enforces the premarket tobacco market authorization, many e-cigarette brands may become illegal in the US market. In this context, how e-cigarette brands evolve and consolidate in different retail channels will be critical for understanding the regulatory impacts on product availability. Our semantic database of e-cigarette brands can serve as a useful tool to monitor product and marketplace development, conduct compliance checks, assess manufacturers' marketing behaviors, and identify regulatory impacts. ", doi="10.2196/47570", url="https://formative.jmir.org/2024/1/e47570", url="http://www.ncbi.nlm.nih.gov/pubmed/38416562" } @Article{info:doi/10.2196/45536, author="Dreyer, A. Nancy and Knuth, B. Kendall and Xie, Yiqiong and Reynolds, W. Matthew and Mack, D. Christina", title="COVID-19 Vaccination Reactions and Risk of Breakthrough Infections Among People With Diabetes: Cohort Study Derived From Community Reporters", journal="JMIR Diabetes", year="2024", month="Feb", day="27", volume="9", pages="e45536", keywords="COVID-19", keywords="diabetes", keywords="vaccine", keywords="vaccine hesitancy", keywords="registry", keywords="person-generated health data", keywords="patient-reported outcomes", keywords="side effects", keywords="vaccination", keywords="infection", keywords="nondiabetic adult", keywords="clinical data", keywords="fatigue", keywords="headache", keywords="risk", keywords="patient data", keywords="medication", keywords="community health", abstract="Background: This exploratory study compares self-reported COVID-19 vaccine side effects and breakthrough infections in people who described themselves as having diabetes with those who did not identify as having diabetes. Objective: The study uses person-reported data to evaluate differences in the perception of COVID-19 vaccine side effects between adults with diabetes and those who did not report having diabetes. Methods: This is a retrospective cohort study conducted using data provided online by adults aged 18 years and older residing in the United States. The participants who voluntarily self-enrolled between March 19, 2021, and July 16, 2022, in the IQVIA COVID-19 Active Research Experience project reported clinical and demographic information, COVID-19 vaccination, whether they had experienced any side effects, test-confirmed infections, and consented to linkage with prescription claims. No distinction was made for this study to differentiate prediabetes or type 1 and type 2 diabetes nor to verify reports of positive COVID-19 tests. Person-reported medication use was validated using pharmacy claims and a subset of the linked data was used for a sensitivity analysis of medication effects. Multivariate logistic regression was used to estimate the adjusted odds ratios of vaccine side effects or breakthrough infections by diabetic status, adjusting for age, gender, education, race, ethnicity (Hispanic or Latino), BMI, smoker, receipt of an influenza vaccine, vaccine manufacturer, and all medical conditions. Evaluations of diabetes medication-specific vaccine side effects are illustrated graphically to support the examination of the magnitude of side effect differences for various medications and combinations of medications used to manage diabetes. Results: People with diabetes (n=724) reported experiencing fewer side effects within 2 weeks of vaccination for COVID-19 than those without diabetes (n=6417; mean 2.7, SD 2.0 vs mean 3.1, SD 2.0). The adjusted risk of having a specific side effect or any side effect was lower among those with diabetes, with significant reductions in fatigue and headache but no differences in breakthrough infections over participants' maximum follow-up time. Diabetes medication use did not consistently affect the risk of specific side effects, either using self-reported medication use or using only diabetes medications that were confirmed by pharmacy health insurance claims for people who also reported having diabetes. Conclusions: People with diabetes reported fewer vaccine side effects than participants not reporting having diabetes, with a similar risk of breakthrough infection. Trial Registration: ClinicalTrials.gov NCT04368065; https://clinicaltrials.gov/study/NCT04368065 ", doi="10.2196/45536", url="https://diabetes.jmir.org/2024/1/e45536", url="http://www.ncbi.nlm.nih.gov/pubmed/38412008" } @Article{info:doi/10.2196/49381, author="Hood, Nicole and Benbow, Nanette and Jaggi, Chandni and Whitby, Shamaya and Sullivan, Sean Patrick and ", title="AIDSVu Cities' Progress Toward HIV Care Continuum Goals: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Feb", day="26", volume="10", pages="e49381", keywords="HIV", keywords="epidemiology", keywords="surveillance", keywords="HIV care continuum", keywords="cities", keywords="HIV public health", keywords="HIV prevention", keywords="diagnosis", keywords="HIV late diagnosis", abstract="Background: Public health surveillance data are critical to understanding the current state of the HIV and AIDS epidemics. Surveillance data provide significant insight into patterns within and progress toward achieving targets for each of the steps in the HIV care continuum. Such targets include those outlined in the National HIV/AIDS Strategy (NHAS) goals. If these data are disseminated, they can be used to prioritize certain steps in the continuum, geographic locations, and groups of people. Objective: We sought to develop and report indicators of progress toward the NHAS goals for US cities and to characterize progress toward those goals with categorical metrics. Methods: Health departments used standardized SAS code to calculate care continuum indicators from their HIV surveillance data to ensure comparability across jurisdictions. We report 2018 descriptive statistics for continuum steps (timely diagnosis, linkage to medical care, receipt of medical care, and HIV viral load suppression) for 36 US cities and their progress toward 2020 NHAS goals as of 2018. Indicators are reported categorically as met or surpassed the goal, within 25\% of attaining the goal, or further than 25\% from achieving the goal. Results: Cities were closest to meeting NHAS goals for timely diagnosis compared to the goals for linkage to care, receipt of care, and viral load suppression, with all cities (n=36, 100\%) within 25\% of meeting the goal for timely diagnosis. Only 8\% (n=3) of cities were >25\% from achieving the goal for receipt of care, but 69\% (n=25) of cities were >25\% from achieving the goal for viral suppression. Conclusions: Display of progress with graphical indicators enables communication of progress to stakeholders. AIDSVu analyses of HIV surveillance data facilitate cities' ability to benchmark their progress against that of other cities with similar characteristics. By identifying peer cities (eg, cities with analogous populations or similar NHAS goal concerns), the public display of indicators can promote dialogue between cities with comparable challenges and opportunities. ", doi="10.2196/49381", url="https://publichealth.jmir.org/2024/1/e49381", url="http://www.ncbi.nlm.nih.gov/pubmed/38407961" } @Article{info:doi/10.2196/48324, author="Gu, Dongxiao and Wang, Qin and Chai, Yidong and Yang, Xuejie and Zhao, Wang and Li, Min and Zolotarev, Oleg and Xu, Zhengfei and Zhang, Gongrang", title="Identifying the Risk Factors of Allergic Rhinitis Based on Zhihu Comment Data Using a Topic-Enhanced Word-Embedding Model: Mixed Method Study and Cluster Analysis", journal="J Med Internet Res", year="2024", month="Feb", day="22", volume="26", pages="e48324", keywords="social media platforms", keywords="disease risk factor identification", keywords="chronic disease management", keywords="topic-enhanced word embedding", keywords="text mining", abstract="Background: Allergic rhinitis (AR) is a chronic disease, and several risk factors predispose individuals to the condition in their daily lives, including exposure to allergens and inhalation irritants. Analyzing the potential risk factors that can trigger AR can provide reference material for individuals to use to reduce its occurrence in their daily lives. Nowadays, social media is a part of daily life, with an increasing number of people using at least 1 platform regularly. Social media enables users to share experiences among large groups of people who share the same interests and experience the same afflictions. Notably, these channels promote the ability to share health information. Objective: This study aims to construct an intelligent method (TopicS-ClusterREV) for identifying the risk factors of AR based on these social media comments. The main questions were as follows: How many comments contained AR risk factor information? How many categories can these risk factors be summarized into? How do these risk factors trigger AR? Methods: This study crawled all the data from May 2012 to May 2022 under the topic of allergic rhinitis on Zhihu, obtaining a total of 9628 posts and 33,747 comments. We improved the Skip-gram model to train topic-enhanced word vector representations (TopicS) and then vectorized annotated text items for training the risk factor classifier. Furthermore, cluster analysis enabled a closer look into the opinions expressed in the category, namely gaining insight into how risk factors trigger AR. Results: Our classifier identified more comments containing risk factors than the other classification models, with an accuracy rate of 96.1\% and a recall rate of 96.3\%. In general, we clustered texts containing risk factors into 28 categories, with season, region, and mites being the most common risk factors. We gained insight into the risk factors expressed in each category; for example, seasonal changes and increased temperature differences between day and night can disrupt the body's immune system and lead to the development of allergies. Conclusions: Our approach can handle the amount of data and extract risk factors effectively. Moreover, the summary of risk factors can serve as a reference for individuals to reduce AR in their daily lives. The experimental data also provide a potential pathway that triggers AR. This finding can guide the development of management plans and interventions for AR. ", doi="10.2196/48324", url="https://www.jmir.org/2024/1/e48324", url="http://www.ncbi.nlm.nih.gov/pubmed/38386404" } @Article{info:doi/10.2196/50392, author="Buller, B. David and Sussman, L. Andrew and Thomson, A. Cynthia and Kepka, Deanna and Taren, Douglas and Henry, L. Kimberly and Warner, L. Echo and Walkosz, J. Barbara and Woodall, Gill W. and Nuss, Kayla and Blair, K. Cindy and Guest, D. Dolores and Borrayo, A. Evelinn and Gordon, S. Judith and Hatcher, Jennifer and Wetter, W. David and Kinsey, Alishia and Jones, F. Christopher and Yung, K. Angela and Christini, Kaila and Berteletti, Julia and Torres, A. John and Barraza Perez, Yessenya Emilia and Small, Annelise", title="\#4Corners4Health Social Media Cancer Prevention Campaign for Emerging Adults: Protocol for a Randomized Stepped-Wedge Trial", journal="JMIR Res Protoc", year="2024", month="Feb", day="22", volume="13", pages="e50392", keywords="cancer prevention", keywords="young adults", keywords="rural", keywords="social media", keywords="physical activity", keywords="diet", keywords="alcohol", keywords="tobacco control", keywords="sunburn", keywords="human papillomavirus", keywords="HPV vaccination", abstract="Background: Many emerging adults (EAs) are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among EAs delivered over social media is limited. Cancer prevention information and recommendations may reach EAs more effectively over social media than in settings such as health care, schools, and workplaces, particularly for EAs residing in rural areas. Objective: This pragmatic randomized trial aims to evaluate a multirisk factor intervention using a social media campaign designed with community advisers aimed at decreasing cancer risk factors among EAs. The trial will target EAs from diverse backgrounds living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah. Methods: We will recruit a sample of EAs (n=1000) aged 18 to 26 years residing in rural counties (Rural-Urban Continuum Codes 4 to 9) in the Four Corners states from the Qualtrics' research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and human papillomavirus vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Campaign posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and EAs and focus groups with EAs. The EAs will complete assessments at baseline and at 12, 26, 39, 52, and 104 weeks after randomization. Assessments will measure 6 cancer risk behaviors, theoretical mediators, and participants' engagement with the social media campaign. Results: The trial is in its start-up phase. It is being led by a steering committee. Team members are working in 3 subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by EAs, and community resources available. A framework for the social media campaign with topics, format, and theoretical mediators has been created, along with protocols for campaign management. Conclusions: Social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among EAs. Because of the popularity of web-based information sources among EAs, an innovative, multirisk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors. Trial Registration: ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158 International Registered Report Identifier (IRRID): PRR1-10.2196/50392 ", doi="10.2196/50392", url="https://www.researchprotocols.org/2024/1/e50392", url="http://www.ncbi.nlm.nih.gov/pubmed/38386396" } @Article{info:doi/10.2196/46638, author="Benton, S. Jack and French, P. David", title="Untapped Potential of Unobtrusive Observation for Studying Health Behaviors", journal="JMIR Public Health Surveill", year="2024", month="Feb", day="21", volume="10", pages="e46638", keywords="health behavior", keywords="environments", keywords="context", keywords="unobtrusive observation", keywords="video technology", keywords="computer vision", doi="10.2196/46638", url="https://publichealth.jmir.org/2024/1/e46638", url="http://www.ncbi.nlm.nih.gov/pubmed/38381483" } @Article{info:doi/10.2196/54414, author="Berg, Valeska and Arabiat, Diana and Morelius, Evalotte and Kervin, Lisa and Zgambo, Maggie and Robinson, Suzanne and Jenkins, Mark and Whitehead, Lisa", title="Young Children and the Creation of a Digital Identity on Social Networking Sites: Scoping Review", journal="JMIR Pediatr Parent", year="2024", month="Feb", day="21", volume="7", pages="e54414", keywords="digital identity", keywords="children", keywords="social networking sites", keywords="sharenting", keywords="scoping review", keywords="perspectives", abstract="Background: There is limited understanding of the concept of the digital identity of young children created through engagement on social networking sites. Objective: The objective of this scoping review was to identify key characteristics of the concept of digital identity for children from conception to the age of 8 years on social networking sites. Methods: This scoping review was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The key databases searched were EBSCO, Web of Science, ProQuest ERIC, and Scopus. Gray literature sources (National Grey Literature Collection, ProQuest Dissertations and Theses, and Google Scholar) were also searched to identify unpublished studies. Articles were selected if they were published in English and reported data on the digital identity of children in relation to social networking sites. Results: The key terms used in the literature were sharenting, followed by digital footprints and children's identities. Our study revealed 2 approaches to the creation of digital identity: social digital identity and performative digital identity. The articles in this review most commonly used the term sharenting to describe the behavior parents engage in to create digital identities for children on social networking sites. Motivations to post information about children differed among parents; however, the most common reasons were to share with friends and family and create digital archives of childhood photos, termed social digital identity. The second motivation was categorized as performative digital identity. The risk of digital kidnapping and identity theft associated with the creation of digital identities also influenced parents' behaviors. Conclusions: The creation of a digital identity for children is an emerging concept. Our review develops a deeper understanding of sharenting behaviors that can be used to better support parents and their children in creating a digital identity with children and awareness of the potential future impact. We recommend that future studies explore the perspectives of children as key stakeholders in the creation of their digital identity. ", doi="10.2196/54414", url="https://pediatrics.jmir.org/2024/1/e54414", url="http://www.ncbi.nlm.nih.gov/pubmed/38381499" } @Article{info:doi/10.2196/51727, author="Hashtarkhani, Soheil and Schwartz, L. David and Shaban-Nejad, Arash", title="Enhancing Health Care Accessibility and Equity Through a Geoprocessing Toolbox for Spatial Accessibility Analysis: Development and Case Study", journal="JMIR Form Res", year="2024", month="Feb", day="21", volume="8", pages="e51727", keywords="geographical information system", keywords="geoprocessing tool", keywords="health disparities", keywords="health equity", keywords="health services management", keywords="hemodialysis services", keywords="spatial accessibility", abstract="Background: Access to health care services is a critical determinant of population health and well-being. Measuring spatial accessibility to health services is essential for understanding health care distribution and addressing potential inequities. Objective: In this study, we developed a geoprocessing toolbox including Python script tools for the ArcGIS Pro environment to measure the spatial accessibility of health services using both classic and enhanced versions of the 2-step floating catchment area method. Methods: Each of our tools incorporated both distance buffers and travel time catchments to calculate accessibility scores based on users' choices. Additionally, we developed a separate tool to create travel time catchments that is compatible with both locally available network data sets and ArcGIS Online data sources. We conducted a case study focusing on the accessibility of hemodialysis services in the state of Tennessee using the 4 versions of the accessibility tools. Notably, the calculation of the target population considered age as a significant nonspatial factor influencing hemodialysis service accessibility. Weighted populations were calculated using end-stage renal disease incidence rates in different age groups. Results: The implemented tools are made accessible through ArcGIS Online for free use by the research community. The case study revealed disparities in the accessibility of hemodialysis services, with urban areas demonstrating higher scores compared to rural and suburban regions. Conclusions: These geoprocessing tools can serve as valuable decision-support resources for health care providers, organizations, and policy makers to improve equitable access to health care services. This comprehensive approach to measuring spatial accessibility can empower health care stakeholders to address health care distribution challenges effectively. ", doi="10.2196/51727", url="https://formative.jmir.org/2024/1/e51727", url="http://www.ncbi.nlm.nih.gov/pubmed/38381503" } @Article{info:doi/10.2196/47040, author="Siemer, Lutz and Pieterse, E. Marcel and Ben Allouch, Somaya and Postel, G. Marloes and Brusse-Keizer, J. Marjolein G.", title="Comparing the Effectiveness of the Blended Delivery Mode With the Face-to-Face Delivery Mode of Smoking Cessation Treatment: Noninferiority Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Feb", day="20", volume="26", pages="e47040", keywords="tobacco", keywords="blended treatment", keywords="smoking cessation", keywords="randomized controlled trial", keywords="effectiveness", keywords="noninferiority", keywords="evaluation", keywords="mobile phone", abstract="Background: Tobacco consumption is a leading cause of death and disease, killing >8 million people each year. Smoking cessation significantly reduces the risk of developing smoking-related diseases. Although combined treatment for addiction is promising, evidence of its effectiveness is still emerging. Currently, there is no published research comparing the effectiveness of blended smoking cessation treatments (BSCTs) with face-to-face (F2F) treatments, where web-based components replace 50\% of the F2F components in blended treatment. Objective: The primary objective of this 2-arm noninferiority randomized controlled trial was to determine whether a BSCT is noninferior to an F2F treatment with identical ingredients in achieving abstinence rates. Methods: This study included 344 individuals who smoke (at least 1 cigarette per day) attending an outpatient smoking cessation clinic in the Netherlands. The participants received either a blended 50\% F2F and 50\% web-based BSCT or only F2F treatment with similar content and intensity. The primary outcome measure was cotinine-validated abstinence rates from all smoking products at 3 and 15 months after treatment initiation. Additional measures included carbon monoxide--validated point prevalence abstinence; self-reported point prevalence abstinence; and self-reported continuous abstinence rates at 3, 6, 9, and 15 months after treatment initiation. Results: None of the 13 outcomes showed statistically confirmed noninferiority of the BSCT, whereas 4 outcomes showed significantly (P<.001) inferior abstinence rates of the BSCT: cotinine-validated point prevalence abstinence rate at 3 months (difference 12.7, 95\% CI 6.2-19.4), self-reported point prevalence abstinence rate at 6 months (difference 19.3, 95\% CI 11.5-27.0) and at 15 months (difference 11.7, 95\% CI 5.8-17.9), and self-reported continuous abstinence rate at 6 months (difference 13.8, 95\% CI 6.8-20.8). The remaining 9 outcomes, including the cotinine-validated point prevalence abstinence rate at 15 months, were inconclusive. Conclusions: In this high-intensity outpatient smoking cessation trial, the blended mode was predominantly less effective than the traditional F2F mode. The results contradict the widely assumed potential benefits of blended treatment and suggest that further research is needed to identify the critical factors in the design of blended interventions. Trial Registration: Netherlands Trial Register 27150; https://onderzoekmetmensen.nl/nl/trial/27150 International Registered Report Identifier (IRRID): RR2-doi.org/10.1186/s12889-016-3851-x ", doi="10.2196/47040", url="https://www.jmir.org/2024/1/e47040", url="http://www.ncbi.nlm.nih.gov/pubmed/38376901" } @Article{info:doi/10.2196/44258, author="Kopila{\vs}, Vanja and Nasadiuk, Khrystyna and Martinelli, Lucia and Lhotska, Lenka and Todorovic, Zoran and Vidmar, Matjaz and Machado, Helena and Svalastog, Lydia Anna and Gajovi{\'c}, Sre{\'c}ko", title="Perspectives on the COVID-19 Vaccination Rollout in 17 Countries: Reflexive Thematic and Frequency Analysis Based on the Strengths, Weaknesses, Opportunities, and Threats (SWOT) Framework", journal="JMIR Hum Factors", year="2024", month="Feb", day="19", volume="11", pages="e44258", keywords="SARS-CoV-2 virus", keywords="COVID-19 vaccination", keywords="pandemic", keywords="hesitancy", keywords="safety", keywords="vaccination", keywords="COVID-19", keywords="tool", keywords="implementation", keywords="vaccine hesitancy", keywords="effectiveness", keywords="sociocultural", keywords="communication", keywords="disinformation", abstract="Background: As the SARS-CoV-2 virus created a global pandemic and rapidly became an imminent threat to the health and lives of people worldwide, the need for a vaccine and its quick distribution among the population was evident. Due to the urgency, and on the back of international collaboration, vaccines were developed rapidly. However, vaccination rollouts showed different success rates in different countries and some also led to increased vaccine hesitancy. Objective: The aim of this study was to identify the role of information sharing and context sensitivity in various vaccination programs throughout the initial COVID-19 vaccination rollout in different countries. Moreover, we aimed to identify factors in national vaccination programs related to COVID-19 vaccine hesitancy, safety, and effectiveness. Toward this end, multidisciplinary and multinational opinions from members of the Navigating Knowledge Landscape (NKL) network were analyzed. Methods: From May to July 2021, 25 completed questionnaires from 27 NKL network members were collected. These contributors were from 17 different countries. The responses reflected the contributors' subjective viewpoints on the status and details of the COVID-19 vaccination rollout in their countries. Contributors were asked to identify strengths, weaknesses, opportunities, and threats (ie, SWOT) of the respective vaccination programs. The responses were analyzed using reflexive thematic analysis, followed by frequency analysis of identified themes according to the represented countries. Results: The perspectives of NKL network members showed a link between organizational elements of the vaccination rollout and the accompanying societal response, both of which were related to strengths and weaknesses of the process. External sociocultural variables, improved public communication around vaccination-related issues, ethical controversies, and the spread of disinformation were the dominant themes related to opportunities and challenges. In the SWOT 2{\texttimes}2 matrix, Availability and Barriers emerged as internal categories, whereas Transparent communication and promotion and Societal divide emerged as key external categories. Conclusions: Inventory of themes and categories inspired by elements of the SWOT framework provides an informative multidisciplinary perspective for effective implementation of public health strategies in the battle against COVID-19 or any future pandemics of a similar nature. ", doi="10.2196/44258", url="https://humanfactors.jmir.org/2024/1/e44258", url="http://www.ncbi.nlm.nih.gov/pubmed/38373020" } @Article{info:doi/10.2196/47216, author="Cordova, David and Bauermeister, A. Jos{\'e} and Warner, Sydni and and Wells, Patricia and MacLeod, Jennifer and Neilands, B. Torsten and Mendoza Lua, Frania and Delva, Jorge and Fessler, Bondy Kathryn and Smith Jr, Versell and Khreizat, Sarah and Boyer, Cherrie", title="Efficacy of a Digital Health Preventive Intervention for Adolescents With HIV or Sexually Transmitted Infections and Substance Use Disorder: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Feb", day="19", volume="13", pages="e47216", keywords="youth", keywords="mHealth", keywords="HIV", keywords="STI", keywords="illicit drugs", keywords="primary care", keywords="prevention", keywords="public health", keywords="USA", keywords="teens", keywords="drugs", keywords="drug use", keywords="sex", keywords="racial minority", keywords="risk behavior", keywords="engagement", keywords="tool", keywords="substance use disorder", abstract="Background: HIV or sexually transmitted infections remain a significant public health concern in the United States, with adolescents affected disproportionately. Adolescents engage in HIV/STI risk behaviors, including drug use and condomless sex, which increase the risk for HIV/STIs. At-risk adolescents, many of whom are racial minorities, experience HIV/STI disparities. Although at-risk adolescents are disproportionately affected by HIV/STI risk behaviors and infections and although the Centers for Disease Control and Prevention recommends routine HIV/STI testing for adolescents, relatively few adolescents report having ever been tested for HIV/STI. With expected increases in health clinic visits as a result of the Affordable Care Act combined with technological advances, health clinics and mobile health (mHealth), including apps, provide innovative contexts and tools to engage at-risk adolescents in HIV/STI prevention programs. Yet, there is a dearth of efficacious mHealth interventions in health clinics to prevent and reduce both condomless sex and drug use and increase HIV/STI testing for at-risk adolescents. Objective: To address this gap in knowledge, we developed a theory-driven, culturally congruent mHealth intervention (hereon referred to as S4E [Storytelling 4 Empowerment]) that has demonstrated feasibility and acceptability in a clinical setting. The next step is to examine the preliminary efficacy of S4E on adolescent HIV/STI testing and risk behaviors. This goal will be accomplished by 2 aims: the first aim is to develop a cross-platform and universal version of S4E. The cross-platform and universal version of S4E will be compatible with both iOS and Android operating systems and multiple mobile devices, aimed at providing adolescents with ongoing access to the intervention once they leave the clinic, and the second aim is to evaluate the preliminary efficacy of S4E, relative to usual care control condition, in preventing or reducing drug use and condomless sex and increasing HIV/STI testing in a clinical sample of at-risk adolescents aged 14-21 years living in Southeast Michigan. Methods: In this study, 100 adolescents recruited from a youth-centered community health clinic will be randomized via blocked randomization with random sequences of block sizes to one of the 2 conditions: S4E mHealth intervention or usual care. Theory-driven and culturally congruent, S4E is an mHealth adaptation of face-to-face storytelling for empowerment, which is registered with the Substance Abuse and Mental Health Services Administration's National Registry of Evidence-Based Programs and Practices. Results: This paper describes the protocol of our study. The recruitment began on May 1, 2018. This study was registered on December 11, 2017, in ClinicalTrials.gov. All participants have been recruited. Data analysis will be complete by the end of March 2024, with study findings available by December 2024. Conclusions: This study has the potential to improve public health by preventing HIV/STI and substance use disorders. Trial Registration: ClinicalTrials.gov NCT03368456; https://clinicaltrials.gov/study/NCT03368456 International Registered Report Identifier (IRRID): DERR1-10.2196/47216 ", doi="10.2196/47216", url="https://www.researchprotocols.org/2024/1/e47216", url="http://www.ncbi.nlm.nih.gov/pubmed/38373025" } @Article{info:doi/10.2196/40491, author="Kufoof, Lara and Hajjeh, Rana and Al Nsour, Mohannad and Saad, Randa and B{\'e}lorgeot, Victoria and Abubakar, Abdinasir and Khader, Yousef and Rawaf, Salman", title="Learning From COVID-19: What Would It Take to Be Better Prepared in the Eastern Mediterranean Region?", journal="JMIR Public Health Surveill", year="2024", month="Feb", day="15", volume="10", pages="e40491", keywords="COVID-19", keywords="integration", keywords="pandemic preparedness", keywords="primary health care", keywords="public health", doi="10.2196/40491", url="https://publichealth.jmir.org/2024/1/e40491", url="http://www.ncbi.nlm.nih.gov/pubmed/38359418" } @Article{info:doi/10.2196/51473, author="Lee, Hojae and Cho, Ki Joong and Park, Jaeyu and Lee, Hyeri and Fond, Guillaume and Boyer, Laurent and Kim, Jin Hyeon and Park, Seoyoung and Cho, Wonyoung and Lee, Hayeon and Lee, Jinseok and Yon, Keon Dong", title="Machine Learning--Based Prediction of Suicidality in Adolescents With Allergic Rhinitis: Derivation and Validation in 2 Independent Nationwide Cohorts", journal="J Med Internet Res", year="2024", month="Feb", day="14", volume="26", pages="e51473", keywords="machine learning", keywords="allergic rhinitis", keywords="prediction", keywords="random forest", keywords="suicidality", abstract="Background: Given the additional risk of suicide-related behaviors in adolescents with allergic rhinitis (AR), it is important to use the growing field of machine learning (ML) to evaluate this risk. Objective: This study aims to evaluate the validity and usefulness of an ML model for predicting suicide risk in patients with AR. Methods: We used data from 2 independent survey studies, Korea Youth Risk Behavior Web-based Survey (KYRBS; n=299,468) for the original data set and Korea National Health and Nutrition Examination Survey (KNHANES; n=833) for the external validation data set, to predict suicide risks of AR in adolescents aged 13 to 18 years, with 3.45\% (10,341/299,468) and 1.4\% (12/833) of the patients attempting suicide in the KYRBS and KNHANES studies, respectively. The outcome of interest was the suicide attempt risks. We selected various ML-based models with hyperparameter tuning in the discovery and performed an area under the receiver operating characteristic curve (AUROC) analysis in the train, test, and external validation data. Results: The study data set included 299,468 (KYRBS; original data set) and 833 (KNHANES; external validation data set) patients with AR recruited between 2005 and 2022. The best-performing ML model was the random forest model with a mean AUROC of 84.12\% (95\% CI 83.98\%-84.27\%) in the original data set. Applying this result to the external validation data set revealed the best performance among the models, with an AUROC of 89.87\% (sensitivity 83.33\%, specificity 82.58\%, accuracy 82.59\%, and balanced accuracy 82.96\%). While looking at feature importance, the 5 most important features in predicting suicide attempts in adolescent patients with AR are depression, stress status, academic achievement, age, and alcohol consumption. Conclusions: This study emphasizes the potential of ML models in predicting suicide risks in patients with AR, encouraging further application of these models in other conditions to enhance adolescent health and decrease suicide rates. ", doi="10.2196/51473", url="https://www.jmir.org/2024/1/e51473", url="http://www.ncbi.nlm.nih.gov/pubmed/38354043" } @Article{info:doi/10.2196/51172, author="Huang, Gang and Cheng, Wei and Xu, Yun and Yang, Jiezhe and Jiang, Jun and Pan, Xiaohong and Zhou, Xin and Jiang, Jianmin and Chai, Chengliang", title="Spatiotemporal Pattern and Its Determinants for Newly Reported HIV/AIDS Among Older Adults in Eastern China From 2004 to 2021: Retrospective Analysis Study", journal="JMIR Public Health Surveill", year="2024", month="Feb", day="13", volume="10", pages="e51172", keywords="HIV/AIDS", keywords="men who have sex with men", keywords="newly reported infections", keywords="older adults", keywords="spatiotemporal analysis", abstract="Background: In recent years, the number and proportion of newly reported HIV/AIDS cases among older adults have increased dramatically. However, research on the pattern of temporal and spatial changes in newly reported HIV/AIDS among older adults remains limited. Objective: This study analyzed the spatial and temporal distribution of HIV/AIDS cases and its influencing factors among older adults in Eastern China from 2004 to 2021, with the goal of improving HIV/AIDS prevention and intervention. Methods: We extracted data on newly reported HIV/AIDS cases between 2004 and 2021 from a case-reporting system and used a Joinpoint regression model and an age-period-cohort model to analyze the temporal trends in HIV/AIDS prevalence. Spatial autocorrelation and geographically weighted regression models were used for spatial aggregation and influence factor analysis. Results: A total of 12,376 participants with HIV/AIDS were included in the study. The newly reported HIV infections among older adults increased from 0.13 cases per 100,000 people in 2004 to 7.00 cases per 100,000 people in 2021. The average annual percent change in newly reported HIV infections was 28.0\% (95\% CI --21.6\% to 34.8\%). The results of the age-period-cohort model showed that age, period, and cohort factors affected the newly reported HIV infections among older adults. The newly reported HIV/AIDS cases among men who have sex with men (MSM) had spatial clustering, and the hotspots were mainly concentrated in Hangzhou. The disposable income of urban residents, illiteracy rate among people aged 15 years or older, and number of hospital beds per 1000 residents showed a positive association with the newly reported HIV infections among older MSM in the Zhejiang province. Conclusions: HIV/AIDS among older adults showed an increasing trend and was influenced by age, period, and cohort effects. Older MSM with HIV/AIDS showed regional clustering and was associated with factors such as the disposable income of urban residents, the illiteracy rate among people aged 15 years or older, and the number of hospital beds per 1000 people. Targeted prevention and control measures are needed to reduce HIV infection among those at higher risk. ", doi="10.2196/51172", url="https://publichealth.jmir.org/2024/1/e51172", url="http://www.ncbi.nlm.nih.gov/pubmed/38349727" } @Article{info:doi/10.2196/44111, author="Mulwa, Sarah and Baker, Venetia and Cawood, Cherie and Khanyile, David and O'Donnell, Dominique and Sarrassat, Sophie and Cousens, Simon and Birdthistle, Isolde", title="Evaluating the Intensity of Exposure to MTV Shuga, an Edutainment Program for HIV Prevention: Cross-Sectional Study in Eastern Cape, South Africa", journal="JMIR Form Res", year="2024", month="Feb", day="13", volume="8", pages="e44111", keywords="young people", keywords="media", keywords="evaluation", keywords="dose-response", keywords="edutainment", keywords="HIV prevention", keywords="mobile phone", abstract="Background: MTV Shuga is an edutainment campaign designed to equip young people with knowledge, motivation, and informed choices to protect themselves from HIV infection. From 2019 to 2020, a total of 10 episodes of a new dramatic series, MTV Shuga ``Down South 2'' (DS2), were broadcast via television and the internet, alongside complementary media activities. Objective: This study aims to investigate whether the intensity of DS2 exposure was linked with positive HIV prevention outcomes in a setting with high HIV prevalence and relatively low levels of HIV testing. Methods: We analyzed data from a web-based survey of participants aged 15 to 24 years in South Africa in 2020. The survey was promoted via social media platforms of schools, universities, and communities in Eastern Cape, South Africa. The primary exposure of interest was the intensity of exposure to DS2, measured by the number of episodes of DS2 watched on the television or the internet or listened to on the radio (out of 10 episodes). Individuals who had not watched or listened to any DS2 episode were classified according to other MTV Shuga content that they had accessed. We estimated associations between the intensity of DS2 exposure and HIV-related outcomes, including knowledge of HIV status, awareness of HIV self-testing (HIVST) and pre-exposure prophylaxis (PrEP), uptake of HIVST, and demand for HIVST and PrEP, adjusting for potential confounders using multivariable logistic regression. Results: Among the 3431 survey participants, 827 (24.1\%) were exposed to DS2. Specifically, 18.1\% (622/3431) watched or listened to only 1 DS2 episode, and 2.4\% (82/3431), 1.7\% (58/3431), and 1.8\% (62/3431) watched or listened to 2 to 4, 5 to 7, and 8 to 10 DS2 episodes, respectively. Increasing the exposure to DS2 was associated with improvements in most outcomes. Exposure to multiple episodes (eg, 2-4, 5-7, and 8-10) was associated with successively higher odds of knowing one's HIV status, awareness of PrEP and HIVST, and uptake of HIVST compared with no MTV Shuga exposure, albeit with statistical uncertainty around some estimates. The interest in using HIVST or PrEP was high overall (>80\%), with no measurable differences by DS2 intensity. Conclusions: We found evidence consistent with a dose-response relationship between MTV Shuga DS2 exposure and outcomes, including knowledge of HIV status, awareness and uptake of HIVST, and awareness of PrEP among young people in Eastern Cape. This indicates that greater engagement with a youth-focused edutainment campaign can improve HIV testing and prevention options in a setting and population with high need. However, only a few participants accessed multiple DS2 episodes despite its availability on multiple media platforms. We conclude that there is potential to benefit more young people by increasing access to and interest in the show. ", doi="10.2196/44111", url="https://formative.jmir.org/2024/1/e44111", url="http://www.ncbi.nlm.nih.gov/pubmed/38349729" } @Article{info:doi/10.2196/47703, author="Benda, Natalie and Dougherty, Kylie and Gebremariam Gobezayehu, Abebe and Cranmer, N. John and Zawtha, Sakie and Andreadis, Katerina and Biza, Heran and Masterson Creber, Ruth", title="Designing Electronic Data Capture Systems for Sustainability in Low-Resource Settings: Viewpoint With Lessons Learned From Ethiopia and Myanmar", journal="JMIR Public Health Surveill", year="2024", month="Feb", day="12", volume="10", pages="e47703", keywords="low and middle income countries", keywords="LMIC", keywords="electronic data capture", keywords="population health surveillance, sociotechnical system", keywords="data infrastructure", keywords="electronic data system", keywords="health care system", keywords="technology", keywords="information system", keywords="health program development", keywords="intervention", doi="10.2196/47703", url="https://publichealth.jmir.org/2024/1/e47703", url="http://www.ncbi.nlm.nih.gov/pubmed/38345833" } @Article{info:doi/10.2196/46687, author="Lau, Y. Kitty and Kang, Jian and Park, Minah and Leung, Gabriel and Wu, T. Joseph and Leung, Kathy", title="Estimating the Epidemic Size of Superspreading Coronavirus Outbreaks in Real Time: Quantitative Study", journal="JMIR Public Health Surveill", year="2024", month="Feb", day="12", volume="10", pages="e46687", keywords="coronavirus", keywords="superspreading event", keywords="SSE", keywords="epidemic size", keywords="severe acute respiratory syndrome", keywords="SARS", keywords="Middle East respiratory syndrome", keywords="MERS", keywords="coronavirus disease 2019", keywords="COVID-19", abstract="Background: Novel coronaviruses have emerged and caused major epidemics and pandemics in the past 2 decades, including SARS-CoV-1, MERS-CoV, and SARS-CoV-2, which led to the current COVID-19 pandemic. These coronaviruses are marked by their potential to produce disproportionally large transmission clusters from superspreading events (SSEs). As prompt action is crucial to contain and mitigate SSEs, real-time epidemic size estimation could characterize the transmission heterogeneity and inform timely implementation of control measures. Objective: This study aimed to estimate the epidemic size of SSEs to inform effective surveillance and rapid mitigation responses. Methods: We developed a statistical framework based on back-calculation to estimate the epidemic size of ongoing coronavirus SSEs. We first validated the framework in simulated scenarios with the epidemiological characteristics of SARS, MERS, and COVID-19 SSEs. As case studies, we retrospectively applied the framework to the Amoy Gardens SARS outbreak in Hong Kong in 2003, a series of nosocomial MERS outbreaks in South Korea in 2015, and 2 COVID-19 outbreaks originating from restaurants in Hong Kong in 2020. Results: The accuracy and precision of the estimation of epidemic size of SSEs improved with longer observation time; larger SSE size; and more accurate prior information about the epidemiological characteristics, such as the distribution of the incubation period and the distribution of the onset-to-confirmation delay. By retrospectively applying the framework, we found that the 95\% credible interval of the estimates contained the true epidemic size after 37\% of cases were reported in the Amoy Garden SARS SSE in Hong Kong, 41\% to 62\% of cases were observed in the 3 nosocomial MERS SSEs in South Korea, and 76\% to 86\% of cases were confirmed in the 2 COVID-19 SSEs in Hong Kong. Conclusions: Our framework can be readily integrated into coronavirus surveillance systems to enhance situation awareness of ongoing SSEs. ", doi="10.2196/46687", url="https://publichealth.jmir.org/2024/1/e46687", url="http://www.ncbi.nlm.nih.gov/pubmed/38345850" } @Article{info:doi/10.2196/45114, author="Shen, Chen and Smith, B. Rachel and Heller, Joel and Spiers, V. Alexander D. and Thompson, Rhiannon and Ward, Helen and Roiser, P. Jonathan and Nicholls, Dasha and Toledano, B. Mireille", title="Depression and Anxiety in Adolescents During the COVID-19 Pandemic in Relation to the Use of Digital Technologies: Longitudinal Cohort Study", journal="J Med Internet Res", year="2024", month="Feb", day="7", volume="26", pages="e45114", keywords="COVID-19", keywords="depression", keywords="anxiety", keywords="public health", keywords="adolescence", keywords="digital technology use", keywords="sleep", keywords="mobile phone", abstract="Background: Adolescents are susceptible to mental illness and have experienced substantial disruption owing to the COVID-19 pandemic. The digital environment is increasingly important in the context of a pandemic when in-person social connection is restricted. Objective: This study aims to estimate whether depression and anxiety had worsened compared with the prepandemic period and examine potential associations with sociodemographic characteristics and behavioral factors, particularly digital behaviors. Methods: We analyzed cross-sectional and longitudinal data from a large, representative Greater London adolescent cohort study: the Study of Cognition, Adolescents and Mobile Phones (SCAMP). Participants completed surveys at T1 between November 2016 and July 2018 (N=4978; aged 13 to 15 years) and at T2 between July 2020 and June 2021 (N=1328; aged 16 to 18 years). Depression and anxiety were measured using the Patient Health Questionnaire and Generalized Anxiety Disorder scale, respectively. Information on the duration of total mobile phone use, social network site use, and video gaming was also collected using questionnaires. Multivariable logistic regression was used to assess the cross-sectional and longitudinal associations of sociodemographic characteristics, digital technology use, and sleep duration with clinically significant depression and anxiety. Results: The proportion of adolescents who had clinical depression and anxiety significantly increased at T2 (depression: 140/421, 33.3\%; anxiety: 125/425, 29.4\%) compared with the proportion of adolescents at T1 (depression: 57/421, 13.5\%; anxiety: 58/425, 13.6\%; P for 2-proportion z test <.001 for both depression and anxiety). Depression and anxiety levels were similar between the summer holiday, school opening, and school closures. Female participants had higher odds of new incident depression (odds ratio [OR] 2.5, 95\% CI 1.5-4.18) and anxiety (OR 2.11, 95\% CI 1.23-3.61) at T2. A high level of total mobile phone use at T1 was associated with developing depression at T2 (OR 1.89, 95\% CI 1.02-3.49). Social network site use was associated with depression and anxiety cross-sectionally at T1 and T2 but did not appear to be associated with developing depression or anxiety longitudinally. Insufficient sleep at T1 was associated with developing depression at T2 (OR 2.26, 95\% CI 1.31-3.91). Conclusions: The mental health of this large sample of adolescents from London deteriorated during the pandemic without noticeable variations relating to public health measures. The deterioration was exacerbated in girls, those with preexisting high total mobile phone use, and those with preexisting disrupted sleep. Our findings suggest the necessity for allocating resources to address these modifiable factors and target high-risk groups. ", doi="10.2196/45114", url="https://www.jmir.org/2024/1/e45114", url="http://www.ncbi.nlm.nih.gov/pubmed/38324379" } @Article{info:doi/10.2196/42140, author="Kwon, Cordelia and Essayei, Lernik and Spencer, Michael and Etheridge, Tom and Venkatesh, Rengaraj and Vengadesan, Natrajan and Thiel, L. Cassandra", title="The Environmental Impacts of Electronic Medical Records Versus Paper Records at a Large Eye Hospital in India: Life Cycle Assessment Study", journal="J Med Internet Res", year="2024", month="Feb", day="6", volume="26", pages="e42140", keywords="carbon emissions", keywords="electronic health records", keywords="electronic medical records", keywords="environmental impact", keywords="greenhouse gases", keywords="life cycle assessment", keywords="low middle income country", keywords="medical records", keywords="paper medical records", keywords="sustainability", abstract="Background: Health care providers worldwide are rapidly adopting electronic medical record (EMR) systems, replacing paper record-keeping systems. Despite numerous benefits to EMRs, the environmental emissions associated with medical record-keeping are unknown. Given the need for urgent climate action, understanding the carbon footprint of EMRs will assist in decarbonizing their adoption and use. Objective: We aimed to estimate and compare the environmental emissions associated with paper medical record-keeping and its replacement EMR system at a high-volume eye care facility in southern India. Methods: We conducted the life cycle assessment methodology per the ISO (International Organization for Standardization) 14040 standard, with primary data supplied by the eye care facility. Data on the paper record-keeping system include the production, use, and disposal of paper and writing utensils in 2016. The EMR system was adopted at this location in 2018. Data on the EMR system include the allocated production and disposal of capital equipment (such as computers and routers); the production, use, and disposal of consumable goods like paper and writing utensils; and the electricity required to run the EMR system. We excluded built infrastructure and cooling loads (eg. buildings and ventilation) from both systems. We used sensitivity analyses to model the effects of practice variation and data uncertainty and Monte Carlo assessments to statistically compare the 2 systems, with and without renewable electricity sources. Results: This location's EMR system was found to emit substantially more greenhouse gases (GHGs) than their paper medical record system (195,000 kg carbon dioxide equivalents [CO2e] per year or 0.361 kg CO2e per patient visit compared with 20,800 kg CO2e per year or 0.037 kg CO2e per patient). However, sensitivity analyses show that the effect of electricity sources is a major factor in determining which record-keeping system emits fewer GHGs. If the study hospital sourced all electricity from renewable sources such as solar or wind power rather than the Indian electric grid, their EMR emissions would drop to 24,900 kg CO2e (0.046 kg CO2e per patient), a level comparable to the paper record-keeping system. Energy-efficient EMR equipment (such as computers and monitors) is the next largest factor impacting emissions, followed by equipment life spans. Multimedia Appendix 1 includes other emissions impact categories. Conclusions: The climate-changing emissions associated with an EMR system are heavily dependent on the sources of electricity. With a decarbonized electricity source, the EMR system's GHG emissions are on par with paper medical record-keeping, and decarbonized grids would likely have a much broader benefit to society. Though we found that the EMR system produced more emissions than a paper record-keeping system, this study does not account for potential expanded environmental gains from EMRs, including expanding access to care while reducing patient travel and operational efficiencies that can reduce unnecessary or redundant care. ", doi="10.2196/42140", url="https://www.jmir.org/2024/1/e42140", url="http://www.ncbi.nlm.nih.gov/pubmed/38319701" } @Article{info:doi/10.2196/46746, author="Burke, Colin and Triplett, Cynthia and Rubanovich, Kseniya Caryn and Karnaze, M. Melissa and Bloss, S. Cinnamon", title="Attitudes Toward School-Based Surveillance of Adolescents' Social Media Activity: Convergent Parallel Mixed Methods Survey", journal="JMIR Form Res", year="2024", month="Feb", day="6", volume="8", pages="e46746", keywords="social media", keywords="surveillance", keywords="privacy", keywords="public health", keywords="students", keywords="schools", keywords="social media monitoring", keywords="SMM", keywords="school safety", keywords="mental health", keywords="adolescents", abstract="Background: US schools increasingly implement commercially available technology for social media monitoring (SMM) of students, purportedly to address youth mental health and school safety. However, little is known about how SMM is perceived by stakeholders, including the students who are the focus of these efforts. Objective: We aimed to assess attitudes toward SMM in schools among 4 stakeholder groups and examine reasons for holding supportive, neutral, or unsupportive views toward the technology. We also sought to explore whether any differences in attitudes were associated with binary sex, race, ethnicity, sexual orientation, or gender identity. Methods: In October 2019, we conducted a convergent parallel mixed methods web-based survey of young adults (aged 18-22 y; n=206), parents (n=205), teachers (n=77), and school administrators (n=41) via Qualtrics web-based panels. We included Likert-type survey items to assess perceived benefits, risks, and overall support of SMM in schools and test for differences based on stakeholder group or demographic characteristics. We also included open-ended questions, and the responses to these items were analyzed using thematic content analysis of reasons given for holding supportive, neutral, or unsupportive views. Results: The tests of group differences showed that young adults perceived lower benefit (P<.001) as well as higher risk (P<.001) and expressed lower overall support (P<.001) of the use of SMM in schools than all other stakeholder groups. Individuals identifying as nonheterosexual also perceived lower benefit (P=.002) and higher risk (P=.02) and expressed lower overall support (P=.02) than their heterosexual counterparts; respondents who identified as people of racial and ethnic minorities also perceived higher risk (P=.04) than their White counterparts. Qualitative thematic content analysis revealed greater nuance in concerns about SMM. Specifically, the primary reasons given for not supporting SMM across all stakeholder groups were (1) skepticism about its utility, (2) perceived privacy violations, and (3) fears of inappropriate or discriminatory use of the data. Within the young adult group in particular, concerns were also raised about (4) unintended and adverse consequences, including the erosion of trust between students and school institutions and administrators, and the chronic adverse effects of constant or prolonged surveillance. Thematic analysis also showed that individuals in every stakeholder group who indicated overall support of SMM were likely to cite the potential for enhanced school safety as the reason. Young adults' overall stances toward SMM were the most polarized, either strongly for or strongly against SMM, and responses from teachers indicated similar polarization but more often favored support of SMM in schools. Conclusions: This study found differing perspectives among stakeholder groups regarding SMM in schools. More work is needed to assess the ways in which this type of surveillance is being implemented and the range and complexity of possible effects, particularly on students. ", doi="10.2196/46746", url="https://formative.jmir.org/2024/1/e46746", url="http://www.ncbi.nlm.nih.gov/pubmed/38319696" } @Article{info:doi/10.2196/50388, author="Heaton, Dan and Nichele, Elena and Clos, J{\'e}r{\'e}mie and Fischer, E. Joel", title="Perceptions of the Agency and Responsibility of the NHS COVID-19 App on Twitter: Critical Discourse Analysis", journal="J Med Internet Res", year="2024", month="Feb", day="1", volume="26", pages="e50388", keywords="COVID-19", keywords="information system", keywords="automated decisions", keywords="agency metaphor", keywords="corpus linguistics", keywords="decision-making algorithm", keywords="transitivity", abstract="Background: Since September 2020, the National Health Service (NHS) COVID-19 contact-tracing app has been used to mitigate the spread of COVID-19 in the United Kingdom. Since its launch, this app has been a part of the discussion regarding the perceived social agency of decision-making algorithms. On the social media website Twitter, a plethora of views about the app have been found but only analyzed for sentiment and topic trajectories thus far, leaving the perceived social agency of the app underexplored. Objective: We aimed to examine the discussion of social agency in social media public discourse regarding algorithm-operated decisions, particularly when the artificial intelligence agency responsible for specific information systems is not openly disclosed in an example such as the COVID-19 contact-tracing app. To do this, we analyzed the presentation of the NHS COVID-19 App on Twitter, focusing on the portrayal of social agency and the impact of its deployment on society. We also aimed to discover what the presentation of social agents communicates about the perceived responsibility of the app. Methods: Using corpus linguistics and critical discourse analysis, underpinned by social actor representation, we used the link between grammatical and social agency and analyzed a corpus of 118,316 tweets from September 2020 to July 2021 to see whether the app was portrayed as a social actor. Results: We found that active presentations of the app---seen mainly through personalization and agency metaphor---dominated the discourse. The app was presented as a social actor in 96\% of the cases considered and grew in proportion to passive presentations over time. These active presentations showed the app to be a social actor in 5 main ways: informing, instructing, providing permission, disrupting, and functioning. We found a small number of occasions on which the app was presented passively through backgrounding and exclusion. Conclusions: Twitter users presented the NHS COVID-19 App as an active social actor with a clear sense of social agency. The study also revealed that Twitter users perceived the app as responsible for their welfare, particularly when it provided instructions or permission, and this perception remained consistent throughout the discourse, particularly during significant events. Overall, this study contributes to understanding how social agency is discussed in social media discourse related to algorithmic-operated decisions This research offers valuable insights into public perceptions of decision-making digital contact-tracing health care technologies and their perceptions on the web, which, even in a postpandemic world, may shed light on how the public might respond to forthcoming interventions. ", doi="10.2196/50388", url="https://www.jmir.org/2024/1/e50388", url="http://www.ncbi.nlm.nih.gov/pubmed/38300688" } @Article{info:doi/10.2196/54439, author="Ramjee, Serena and Hasan, Zeeshaan-ul", title="Strengthening TikTok Content Analysis in Academia Using Follower Count and Engagement", journal="JMIR Dermatol", year="2024", month="Jan", day="30", volume="7", pages="e54439", keywords="social media", keywords="skin of color", keywords="skin of colour", keywords="representation", keywords="TikTok", keywords="atopic dermatitis", keywords="dermatology", keywords="dermatologist", doi="10.2196/54439", url="https://derma.jmir.org/2024/1/e54439", url="http://www.ncbi.nlm.nih.gov/pubmed/38289654" } @Article{info:doi/10.2196/46087, author="Kaur, Mahakprit and Cargill, Taylor and Hui, Kevin and Vu, Minh and Bragazzi, Luigi Nicola and Kong, Dzevela Jude", title="A Novel Approach for the Early Detection of Medical Resource Demand Surges During Health Care Emergencies: Infodemiology Study of Tweets", journal="JMIR Form Res", year="2024", month="Jan", day="29", volume="8", pages="e46087", keywords="COVID-19", keywords="Twitter", keywords="social media", keywords="medical supply shortage", keywords="pandemic", keywords="global health", keywords="Granger", keywords="convergent cross-mapping", keywords="causal analysis", keywords="intensive care unit bed", keywords="ICU bed", abstract="Background: The COVID-19 pandemic has highlighted gaps in the current handling of medical resource demand surges and the need for prioritizing scarce medical resources to mitigate the risk of health care facilities becoming overwhelmed. Objective: During a health care emergency, such as the COVID-19 pandemic, the public often uses social media to express negative sentiment (eg, urgency, fear, and frustration) as a real-time response to the evolving crisis. The sentiment expressed in COVID-19 posts may provide valuable real-time information about the relative severity of medical resource demand in different regions of a country. In this study, Twitter (subsequently rebranded as X) sentiment analysis was used to investigate whether an increase in negative sentiment COVID-19 tweets corresponded to a greater demand for hospital intensive care unit (ICU) beds in specific regions of the United States, Brazil, and India. Methods: Tweets were collected from a publicly available data set containing COVID-19 tweets with sentiment labels and geolocation information posted between February 1, 2020, and March 31, 2021. Regional medical resource shortage data were gathered from publicly available data sets reporting a time series of ICU bed demand across each country. Negative sentiment tweets were analyzed using the Granger causality test and convergent cross-mapping (CCM) analysis to assess the utility of the time series of negative sentiment tweets in forecasting ICU bed shortages. Results: For the United States (30,742,934 negative sentiment tweets), the results of the Granger causality test (for whether negative sentiment COVID-19 tweets forecast ICU bed shortage, assuming a stochastic system) were significant (P<.05) for 14 (28\%) of the 50 states that passed the augmented Dickey-Fuller test at lag 2, and the results of the CCM analysis (for whether negative sentiment COVID-19 tweets forecast ICU bed shortage, assuming a dynamic system) were significant (P<.05) for 46 (92\%) of the 50 states. For Brazil (3,004,039 negative sentiment tweets), the results of the Granger causality test were significant (P<.05) for 6 (22\%) of the 27 federative units, and the results of the CCM analysis were significant (P<.05) for 26 (96\%) of the 27 federative units. For India (4,199,151 negative sentiment tweets), the results of the Granger causality test were significant (P<.05) for 6 (23\%) of the 26 included regions (25 states and the national capital region of Delhi), and the results of the CCM analysis were significant (P<.05) for 26 (100\%) of the 26 included regions. Conclusions: This study provides a novel approach for identifying the regions of high hospital bed demand during a health care emergency scenario by analyzing Twitter sentiment data. Leveraging analyses that take advantage of natural language processing--driven tweet extraction systems has the potential to be an effective method for the early detection of medical resource demand surges. ", doi="10.2196/46087", url="https://formative.jmir.org/2024/1/e46087", url="http://www.ncbi.nlm.nih.gov/pubmed/38285495" } @Article{info:doi/10.2196/49575, author="Leal Neto, Onicio and Von Wyl, Viktor", title="Digital Transformation of Public Health for Noncommunicable Diseases: Narrative Viewpoint of Challenges and Opportunities", journal="JMIR Public Health Surveill", year="2024", month="Jan", day="25", volume="10", pages="e49575", keywords="digital public health", keywords="artificial intelligence", keywords="non-communicable diseases", keywords="digital health", keywords="surveillance", keywords="well being", keywords="technological advancement", keywords="public health efficiency", keywords="digital innovation", doi="10.2196/49575", url="https://publichealth.jmir.org/2024/1/e49575", url="http://www.ncbi.nlm.nih.gov/pubmed/38271097" } @Article{info:doi/10.2196/49756, author="Yin, Shuhua and Chen, Shi and Ge, Yaorong", title="Dynamic Associations Between Centers for Disease Control and Prevention Social Media Contents and Epidemic Measures During COVID-19: Infoveillance Study", journal="JMIR Infodemiology", year="2024", month="Jan", day="23", volume="4", pages="e49756", keywords="infoveillance", keywords="social media", keywords="COVID-19", keywords="US Centers for Disease Control and Prevention", keywords="CDC", keywords="topic modeling", keywords="multivariate time series analysis", abstract="Background: Health agencies have been widely adopting social media to disseminate important information, educate the public on emerging health issues, and understand public opinions. The Centers for Disease Control and Prevention (CDC) widely used social media platforms during the COVID-19 pandemic to communicate with the public and mitigate the disease in the United States. It is crucial to understand the relationships between the CDC's social media communications and the actual epidemic metrics to improve public health agencies' communication strategies during health emergencies. Objective: This study aimed to identify key topics in tweets posted by the CDC during the pandemic, investigate the temporal dynamics between these key topics and the actual COVID-19 epidemic measures, and make recommendations for the CDC's digital health communication strategies for future health emergencies. Methods: Two types of data were collected: (1) a total of 17,524 COVID-19--related English tweets posted by the CDC between December 7, 2019, and January 15, 2022, and (2) COVID-19 epidemic measures in the United States from the public GitHub repository of Johns Hopkins University from January 2020 to July 2022. Latent Dirichlet allocation topic modeling was applied to identify key topics from all COVID-19--related tweets posted by the CDC, and the final topics were determined by domain experts. Various multivariate time series analysis techniques were applied between each of the identified key topics and actual COVID-19 epidemic measures to quantify the dynamic associations between these 2 types of time series data. Results: Four major topics from the CDC's COVID-19 tweets were identified: (1) information on the prevention of health outcomes of COVID-19; (2) pediatric intervention and family safety; (3) updates of the epidemic situation of COVID-19; and (4) research and community engagement to curb COVID-19. Multivariate analyses showed that there were significant variabilities of progression between the CDC's topics and the actual COVID-19 epidemic measures. Some CDC topics showed substantial associations with the COVID-19 measures over different time spans throughout the pandemic, expressing similar temporal dynamics between these 2 types of time series data. Conclusions: Our study is the first to comprehensively investigate the dynamic associations between topics discussed by the CDC on Twitter and the COVID-19 epidemic measures in the United States. We identified 4 major topic themes via topic modeling and explored how each of these topics was associated with each major epidemic measure by performing various multivariate time series analyses. We recommend that it is critical for public health agencies, such as the CDC, to update and disseminate timely and accurate information to the public and align major topics with key epidemic measures over time. We suggest that social media can help public health agencies to inform the public on health emergencies and to mitigate them effectively. ", doi="10.2196/49756", url="https://infodemiology.jmir.org/2024/1/e49756", url="http://www.ncbi.nlm.nih.gov/pubmed/38261367" } @Article{info:doi/10.2196/49185, author="Clark, C. Emily and Neumann, Sophie and Hopkins, Stephanie and Kostopoulos, Alyssa and Hagerman, Leah and Dobbins, Maureen", title="Changes to Public Health Surveillance Methods Due to the COVID-19 Pandemic: Scoping Review", journal="JMIR Public Health Surveill", year="2024", month="Jan", day="19", volume="10", pages="e49185", keywords="public health", keywords="surveillance", keywords="digital surveillance", keywords="COVID-19", keywords="screening", keywords="infodemiology", keywords="big data", keywords="mobility tracking", keywords="wastewater", keywords="ethics", keywords="decision making", keywords="public health surveillance", abstract="Background: Public health surveillance plays a vital role in informing public health decision-making. The onset of the COVID-19 pandemic in early 2020 caused a widespread shift in public health priorities. Global efforts focused on COVID-19 monitoring and contact tracing. Existing public health programs were interrupted due to physical distancing measures and reallocation of resources. The onset of the COVID-19 pandemic intersected with advancements in technologies that have the potential to support public health surveillance efforts. Objective: This scoping review aims to explore emergent public health surveillance methods during the early COVID-19 pandemic to characterize the impact of the pandemic on surveillance methods. Methods: A scoping search was conducted in multiple databases and by scanning key government and public health organization websites from March 2020 to January 2022. Published papers and gray literature that described the application of new or revised approaches to public health surveillance were included. Papers that discussed the implications of novel public health surveillance approaches from ethical, legal, security, and equity perspectives were also included. The surveillance subject, method, location, and setting were extracted from each paper to identify trends in surveillance practices. Two public health epidemiologists were invited to provide their perspectives as peer reviewers. Results: Of the 14,238 unique papers, a total of 241 papers describing novel surveillance methods and changes to surveillance methods are included. Eighty papers were review papers and 161 were single studies. Overall, the literature heavily featured papers detailing surveillance of COVID-19 transmission (n=187). Surveillance of other infectious diseases was also described, including other pathogens (n=12). Other public health topics included vaccines (n=9), mental health (n=11), substance use (n=4), healthy nutrition (n=1), maternal and child health (n=3), antimicrobial resistance (n=2), and misinformation (n=6). The literature was dominated by applications of digital surveillance, for example, by using big data through mobility tracking and infodemiology (n=163). Wastewater surveillance was also heavily represented (n=48). Other papers described adaptations to programs or methods that existed prior to the COVID-19 pandemic (n=9). The scoping search also found 109 papers that discuss the ethical, legal, security, and equity implications of emerging surveillance methods. The peer reviewer public health epidemiologists noted that additional changes likely exist, beyond what has been reported and available for evidence syntheses. Conclusions: The COVID-19 pandemic accelerated advancements in surveillance and the adoption of new technologies, especially for digital and wastewater surveillance methods. Given the investments in these systems, further applications for public health surveillance are likely. The literature for surveillance methods was dominated by surveillance of infectious diseases, particularly COVID-19. A substantial amount of literature on the ethical, legal, security, and equity implications of these emerging surveillance methods also points to a need for cautious consideration of potential harm. ", doi="10.2196/49185", url="https://publichealth.jmir.org/2024/1/e49185", url="http://www.ncbi.nlm.nih.gov/pubmed/38241067" } @Article{info:doi/10.2196/40493, author="Demeke, Jemal and Djiadeu, Pascal and Yusuf, Abban and Whitfield, Lovell Darren and Lightfoot, David and Worku, Fiqir and Abu-Ba'are, Rabiu Gamji and Mbuagbaw, Lawrence and Giwa, Sulaimon and Nelson, E. LaRon", title="HIV Prevention and Treatment Interventions for Black Men Who Have Sex With Men in Canada: Scoping Systematic Review", journal="JMIR Public Health Surveill", year="2024", month="Jan", day="18", volume="10", pages="e40493", keywords="men who have sex with men", keywords="African, Caribbean, Black", keywords="HIV and AIDS", keywords="epidemiology", keywords="public health", keywords="HIV", keywords="health care", keywords="prevention", abstract="Background: Black men who have sex with men (MSM) experience disproportionately high HIV incidence globally. A comprehensive, intersectional approach (race, gender, and sexuality or sexual behavior) in understanding the experiences of Black MSM in Canada along the HIV prevention and care continuums has yet to be explored. Objective: This scoping review aims to examine the available evidence on the access, quality, gaps, facilitators, and barriers of engagement and identify interventions relevant to the HIV prevention and care continuum for Black MSM in Canada. Methods: We conducted a systematic database search, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, of the available studies on HIV health experience and epidemiology concerning Black MSM living with or without HIV in Canada and were published after 1983 in either English or French. Searched databases include MEDLINE, Excerpta, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, the NHUS Economic Development Database, Global Health, PsycInfo, PubMed, Scopus, and Web of Science. From the 3095 articles identified, 19 met the inclusion criteria and were analyzed. Results: Black MSM in Canada consistently report multiple forms of stigma and lack of community support contributing to an increased HIV burden. They experience discrimination based on their intersectional identities while accessing HIV preventative and treatment interventions. Available data demonstrate that Black MSM have higher HIV incidences than Black men who have sex with women (MSW) and White MSM, and low preexposure prophylaxis knowledge and HIV literacy. Black MSM experience significant disparities in HIV prevention and care knowledge, access, and use. Structural barriers, including anti-Black racism, homophobia, and xenophobia, are responsible for gaps in HIV prevention and care continuums, poor quality of care and linkage to HIV services, as well as a higher incidence of HIV. Conclusions: Considering the lack of targeted interventions, there is a clear need for interventions that reduce HIV diagnoses among Black MSM, increase access and reduce structural barriers that significantly affect the ability of Black MSM to engage with HIV prevention and care, and address provider's capacity for care and the structural barriers. These findings can inform future interventions, programming, and tools that may alleviate this HIV inequity. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-043055 ", doi="10.2196/40493", url="https://publichealth.jmir.org/2024/1/e40493", url="http://www.ncbi.nlm.nih.gov/pubmed/38236626" } @Article{info:doi/10.2196/49749, author="Garg, Ashvita and Nyitray, G. Alan and Roberts, R. James and Shungu, Nicholas and Ruggiero, J. Kenneth and Chandler, Jessica and Damgacioglu, Haluk and Zhu, Yenan and Brownstein, C. Naomi and Sterba, R. Katherine and Deshmukh, A. Ashish and Sonawane, Kalyani", title="Consumption of Health-Related Videos and Human Papillomavirus Awareness: Cross-Sectional Analyses of a US National Survey and YouTube From the Urban-Rural Context", journal="J Med Internet Res", year="2024", month="Jan", day="15", volume="26", pages="e49749", keywords="awareness", keywords="health awareness", keywords="health information", keywords="health videos", keywords="HINTS", keywords="HPV vaccine", keywords="HPV", keywords="information behavior", keywords="information behaviors", keywords="information seeking", keywords="online information", keywords="reproductive health", keywords="rural", keywords="sexual health", keywords="sexually transmitted", keywords="social media", keywords="STD", keywords="STI", keywords="urban", keywords="video", keywords="videos", keywords="YouTube", abstract="Background: Nearly 70\% of Americans use the internet as their first source of information for health-related questions. Contemporary data on the consumption of web-based videos containing health information among American adults by urbanity or rurality is currently unavailable, and its link with health topic awareness, particularly for human papillomavirus (HPV), is not known. Objective: We aim to describe trends and patterns in the consumption of health-related videos on social media from an urban-rural context, examine the association between exposure to health-related videos on social media and awareness of health topics (ie, HPV and HPV vaccine), and understand public interest in HPV-related video content through search terms and engagement analytics. Methods: We conducted a cross-sectional analysis of the US Health Information National Trends Survey 6, a nationally representative survey that collects data from civilian, noninstitutionalized adults aged 18 years or older residing in the United States. Bivariable analyses were used to estimate the prevalence of consumption of health-related videos on social media among US adults overall and by urbanity or rurality. Multivariable logistic regression models were used to examine the association between the consumption of health-related videos and HPV awareness among urban and rural adults. To provide additional context on the public's interest in HPV-specific video content, we examined search volumes (quantitative) and related query searches (qualitative) for the terms ``HPV'' and ``HPV vaccine'' on YouTube. Results: In 2022, 59.6\% of US adults (152.3 million) consumed health-related videos on social media, an increase of nearly 100\% from 2017 to 2022. Prevalence increased among adults living in both urban (from 31.4\% in 2017 to 59.8\% in 2022; P<.001) and rural (from 22.4\% in 2017 to 58\% in 2022; P<.001) regions. Within the urban and rural groups, consumption of health-related videos on social media was most prevalent among adults aged between 18 and 40 years and college graduates or higher-educated adults. Among both urban and rural groups, adults who consumed health-related videos had a significantly higher probability of being aware of HPV and the HPV vaccine compared with those who did not watch health videos on the internet. The term ``HPV'' was more frequently searched on YouTube compared with ``HPV vaccine.'' Individuals were most commonly searching for videos that covered content about the HPV vaccine, HPV in males, and side effects of the HPV vaccine. Conclusions: The consumption of health-related videos on social media in the United States increased dramatically between 2017 and 2022. The rise was prominent among both urban and rural adults. Watching a health-related video on social media was associated with a greater probability of being aware of HPV and the HPV vaccine. Additional research on designing and developing social media strategies is needed to increase public awareness of health topics. ", doi="10.2196/49749", url="https://www.jmir.org/2024/1/e49749", url="http://www.ncbi.nlm.nih.gov/pubmed/38224476" } @Article{info:doi/10.2196/47308, author="Rutter, Sophie and Sanger, Sally and Madden, D. Andrew and Ehdeed, Sukaina and Stones, Catherine", title="Office Workers' Views About the Uses, Concerns, and Acceptance of Hand Hygiene Data Collected From Smart Sanitizers: Exploratory Qualitative Interview Study", journal="JMIR Form Res", year="2024", month="Jan", day="11", volume="8", pages="e47308", keywords="hand hygiene", keywords="smart sanitizers", keywords="Internet of Things", keywords="IoT", keywords="offices", keywords="workplaces", keywords="smart systems", abstract="Background: COVID-19 and the prospect of future pandemics have emphasized the need to reduce disease transmission in workplaces. Despite the well-established link between good hand hygiene (HH) and employee health, HH in nonclinical workplaces has received little attention. Smart sanitizers have been deployed in clinical settings to motivate and enforce HH. This study is part of a large project that explores the potential of smart sanitizers in office settings. Objective: Our previous study found that for office workers to accept the deployment of smart sanitizers, they would need to find the data generated as useful and actionable. The objectives of this study were to identify (1) the potential uses and actions that could be taken from HH data collected by smart sanitizers (2) the concerns of office workers for the identified uses and actions and (3) the circumstances in which office workers accept HH monitoring. Methods: An interview study was conducted with 18 office workers from various professions. Interview questions were developed using a framework from personal informatics. Transcripts were analyzed thematically. Results: A wide range of uses of smart sanitizer data was identified including managing hygiene resources and workflows, finding operating sanitizers, communicating the (high) standard of organizational hygiene, promoting and enforcing organizational hygiene policies, improving workers' own hygiene practices, executing more effective interventions, and identifying the causes of outbreaks. However, hygiene is mostly considered as a private matter, and it is also possible that no action would be taken. Office workers were also concerned about bullying, coercion, and use of hygiene data for unintended purposes. They were also worried that the data could be inaccurate or incomplete, leading to misrepresentation of hygiene practices. Office workers suggested that they would be more likely to accept monitoring in situations where hygiene is considered important, when there are clear benefits to data collection, if their privacy is respected, if they have some control over how their data are collected, and if the ways in which the data will be used are clearly communicated. Conclusions: Smart sanitizers could have a valuable role in improving hygiene practices in offices and reducing disease transmission. Many actionable uses for data collected from smart systems were identified. However, office workers consider HH as a personal matter, and acceptance of smart systems is likely to be dynamic and will depend on the broad situation. Except when there are disease outbreaks, smart systems may need to be restricted to uses that do not require the sharing of personal data. Should organizations wish to implement smart sanitizers in offices, it would be advisable to consult widely with staff and develop systems that are customizable and personalizable. ", doi="10.2196/47308", url="https://formative.jmir.org/2024/1/e47308", url="http://www.ncbi.nlm.nih.gov/pubmed/38206674" } @Article{info:doi/10.2196/47673, author="Ramos, P. Pablo Ivan and Marcilio, Izabel and Bento, I. Ana and Penna, O. Gerson and de Oliveira, F. Juliane and Khouri, Ricardo and Andrade, S. Roberto F. and Carreiro, P. Roberto and Oliveira, A. Vinicius de and Galv{\~a}o, C. Luiz Augusto and Landau, Luiz and Barreto, L. Mauricio and van der Horst, Kay and Barral-Netto, Manoel and ", title="Combining Digital and Molecular Approaches Using Health and Alternate Data Sources in a Next-Generation Surveillance System for Anticipating Outbreaks of Pandemic Potential", journal="JMIR Public Health Surveill", year="2024", month="Jan", day="9", volume="10", pages="e47673", keywords="data integration", keywords="digital public health", keywords="infectious disease surveillance", keywords="pandemic preparedness", keywords="prevention", keywords="response", doi="10.2196/47673", url="https://publichealth.jmir.org/2024/1/e47673", url="http://www.ncbi.nlm.nih.gov/pubmed/38194263" } @Article{info:doi/10.2196/48940, author="Eachus, Emily and Schwartz, Kayla and Rasul, Taha and Bergholz, Daniel and Keri, Jonette and Henderson, Armen", title="REDCap as a Platform for Cutaneous Disease Management in Street Medicine: Descriptive Study", journal="JMIR Dermatol", year="2024", month="Jan", day="9", volume="7", pages="e48940", keywords="REDCap", keywords="unsheltered homelessness", keywords="street medicine", keywords="informatics", keywords="cutaneous", keywords="homeless", keywords="homelessness", keywords="data capture", keywords="data collection", keywords="skin", keywords="dermatology", keywords="vulnerable", keywords="low income", keywords="low resource", keywords="database", keywords="chart", keywords="health record", keywords="health records", keywords="EHR", keywords="electronic health record", doi="10.2196/48940", url="https://derma.jmir.org/2024/1/e48940", url="http://www.ncbi.nlm.nih.gov/pubmed/38194246" } @Article{info:doi/10.2196/50379, author="Galvez-Hernandez, Pablo and Gonzalez-Viana, Angelina and Gonzalez-de Paz, Luis and Shankardass, Ketan and Muntaner, Carles", title="Generating Contextual Variables From Web-Based Data for Health Research: Tutorial on Web Scraping, Text Mining, and Spatial Overlay Analysis", journal="JMIR Public Health Surveill", year="2024", month="Jan", day="8", volume="10", pages="e50379", keywords="web scraping", keywords="text mining", keywords="spatial overlay analysis", keywords="program evaluation", keywords="social environment", keywords="contextual variables", keywords="health assets", keywords="social connection", keywords="multilevel analysis", keywords="health services research", abstract="Background: Contextual variables that capture the characteristics of delimited geographic or jurisdictional areas are vital for health and social research. However, obtaining data sets with contextual-level data can be challenging in the absence of monitoring systems or public census data. Objective: We describe and implement an 8-step method that combines web scraping, text mining, and spatial overlay analysis (WeTMS) to transform extensive text data from government websites into analyzable data sets containing contextual data for jurisdictional areas. Methods: This tutorial describes the method and provides resources for its application by health and social researchers. We used this method to create data sets of health assets aimed at enhancing older adults' social connections (eg, activities and resources such as walking groups and senior clubs) across the 374 health jurisdictions in Catalonia from 2015 to 2022. These assets are registered on a web-based government platform by local stakeholders from various health and nonhealth organizations as part of a national public health program. Steps 1 to 3 involved defining the variables of interest, identifying data sources, and using Python to extract information from 50,000 websites linked to the platform. Steps 4 to 6 comprised preprocessing the scraped text, defining new variables to classify health assets based on social connection constructs, analyzing word frequencies in titles and descriptions of the assets, creating topic-specific dictionaries, implementing a rule-based classifier in R, and verifying the results. Steps 7 and 8 integrate the spatial overlay analysis to determine the geographic location of each asset. We conducted a descriptive analysis of the data sets to report the characteristics of the assets identified and the patterns of asset registrations across areas. Results: We identified and extracted data from 17,305 websites describing health assets. The titles and descriptions of the activities and resources contained 12,560 and 7301 unique words, respectively. After applying our classifier and spatial analysis algorithm, we generated 2 data sets containing 9546 health assets (5022 activities and 4524 resources) with the potential to enhance social connections among older adults. Stakeholders from 318 health jurisdictions registered identified assets on the platform between July 2015 and December 2022. The agreement rate between the classification algorithm and verified data sets ranged from 62.02\% to 99.47\% across variables. Leisure and skill development activities were the most prevalent (1844/5022, 36.72\%). Leisure and cultural associations, such as social clubs for older adults, were the most common resources (878/4524, 19.41\%). Health asset registration varied across areas, ranging between 0 and 263 activities and 0 and 265 resources. Conclusions: The sequential use of WeTMS offers a robust method for generating data sets containing contextual-level variables from internet text data. This study can guide health and social researchers in efficiently generating ready-to-analyze data sets containing contextual variables. ", doi="10.2196/50379", url="https://publichealth.jmir.org/2024/1/e50379", url="http://www.ncbi.nlm.nih.gov/pubmed/38190245" } @Article{info:doi/10.2196/46085, author="Subramanyam, Chaitra and Becker, Alyssa and Rizzo, Julianne and Afzal, Najiba and Nong, Yvonne and Sivamani, Raja", title="Visibility of Board-Certified Dermatologists on TikTok", journal="JMIR Dermatol", year="2024", month="Jan", day="5", volume="7", pages="e46085", keywords="board", keywords="certification", keywords="board certification", keywords="health", keywords="media", keywords="public", keywords="social", keywords="TikTok", keywords="social media", keywords="health information", keywords="misinformation", keywords="diagnosis", keywords="users", keywords="medical training", keywords="training", keywords="media content", keywords="skin", keywords="derma", keywords="derm", keywords="dermatologist", keywords="dermatology", keywords="epidermis", keywords="dermatitis", keywords="cellulitis", keywords="skin doctor", keywords="hair", keywords="nail", doi="10.2196/46085", url="https://derma.jmir.org/2024/1/e46085", url="http://www.ncbi.nlm.nih.gov/pubmed/38180786" } @Article{info:doi/10.2196/46277, author="Chen, Yuling and Turkson-Ocran, Ruth-Alma and Koirala, Binu and Davidson, M. Patricia and Commodore-Mensah, Yvonne and Himmelfarb, Dennison Cheryl", title="Association Between the Composite Cardiovascular Risk and mHealth Use Among Adults in the 2017-2020 Health Information National Trends Survey: Cross-Sectional Study", journal="J Med Internet Res", year="2024", month="Jan", day="4", volume="26", pages="e46277", keywords="mobile health", keywords="usage", keywords="cardiovascular risk", keywords="association", keywords="mobile phone", abstract="Background: Numerous studies have suggested that the relationship between cardiovascular disease (CVD) risk and the usage of mobile health (mHealth) technology may vary depending on the total number of CVD risk factors present. However, whether higher CVD risk is associated with a greater likelihood of engaging in specific mHealth use among US adults is currently unknown. Objective: We aim to assess the associations between the composite CVD risk and each component of mHealth use among US adults regardless of whether they have a history of CVD or not. Methods: This study used cross-sectional data from the 2017 to 2020 Health Information National Trends Survey. The exposure was CVD risk (diabetes, hypertension, smoking, physical inactivity, and overweight or obesity). We defined low, moderate, and high CVD risk as having 0-1, 2-3, and 4-5 CVD risk factors, respectively. The outcome variables of interest were each component of mHealth use, including using mHealth to make health decisions, track health progress, share health information, and discuss health decisions with health providers. We used multivariable logistic regression models to examine the association between CVD risk and mHealth use adjusted for demographic factors. Results: We included 10,531 adults, with a mean age of 54 (SD 16.2) years. Among the included participants, 50.2\% were men, 65.4\% were non-Hispanic White, 41.9\% used mHealth to make health decisions, 50.8\% used mHealth to track health progress toward a health-related goal, 18.3\% used mHealth to share health information with health providers, and 37.7\% used mHealth to discuss health decisions with health providers (all are weighted percentages). Adults with moderate CVD risk were more likely to use mHealth to share health information with health providers (adjusted odds ratio 1.49, 95\% CI 1.24-1.80) and discuss health decisions with health providers (1.22, 95\% CI 1.04-1.44) compared to those with low CVD risk. Similarly, having high CVD risk was associated with higher odds of using mHealth to share health information with health providers (2.61, 95\% CI 1.93-3.54) and discuss health decisions with health providers (1.56, 95\% CI 1.17-2.10) compared to those with low CVD risk. Upon stratifying by age and gender, we observed age and gender disparities in the relationship between CVD risk and the usage of mHealth to discuss health decisions with health providers. Conclusions: Adults with a greater number of CVD risk factors were more likely to use mHealth to share health information with health providers and discuss health decisions with health providers. These findings suggest a promising avenue for enhancing health care communication and advancing both primary and secondary prevention efforts related to managing CVD risk factors through the effective usage of mHealth technology. ", doi="10.2196/46277", url="https://www.jmir.org/2024/1/e46277", url="http://www.ncbi.nlm.nih.gov/pubmed/38175685" } @Article{info:doi/10.2196/44249, author="Chung, Kei Ming and Hart, Brian and Santillana, Mauricio and Patel, J. Chirag", title="Pediatric and Young Adult Household Transmission of the Initial Waves of SARS-CoV-2 in the United States: Administrative Claims Study", journal="J Med Internet Res", year="2024", month="Jan", day="4", volume="26", pages="e44249", keywords="household transmission", keywords="infectivity", keywords="pediatric", keywords="COVID-19", keywords="children", keywords="claims data", keywords="administrative data", keywords="transmission", keywords="risk factor", keywords="logistic regression", keywords="regression", keywords="multivariable logistics regression", keywords="multiple logistic regression statistics", keywords="cohort", keywords="retrospective cohort", keywords="laboratory", keywords="LOINC", keywords="infant", keywords="toddler", keywords="newborn", abstract="Background: The correlates responsible for the temporal changes of intrahousehold SARS-CoV-2 transmission in the United States have been understudied mainly due to a lack of available surveillance data. Specifically, early analyses of SARS-CoV-2 household secondary attack rates (SARs) were small in sample size and conducted cross-sectionally at single time points. From these limited data, it has been difficult to assess the role that different risk factors have had on intrahousehold disease transmission in different stages of the ongoing COVID-19 pandemic, particularly in children and youth. Objective: This study aimed to estimate the transmission dynamic and infectivity of SARS-CoV-2 among pediatric and young adult index cases (age 0 to 25 years) in the United States through the initial waves of the pandemic. Methods: Using administrative claims, we analyzed 19 million SARS-CoV-2 test records between January 2020 and February 2021. We identified 36,241 households with pediatric index cases and calculated household SARs utilizing complete case information. Using a retrospective cohort design, we estimated the household SARS-CoV-2 transmission between 4 index age groups (0 to 4 years, 5 to 11 years, 12 to 17 years, and 18 to 25 years) while adjusting for sex, family size, quarter of first SARS-CoV-2 positive record, and residential regions of the index cases. Results: After filtering all household records for greater than one member in a household and missing information, only 36,241 (0.85\%) of 4,270,130 households with a pediatric case remained in the analysis. Index cases aged between 0 and 17 years were a minority of the total index cases (n=11,484, 11\%). The overall SAR of SARS-CoV-2 was 23.04\% (95\% CI 21.88-24.19). As a comparison, the SAR for all ages (0 to 65+ years) was 32.4\% (95\% CI 32.1-32.8), higher than the SAR for the population between 0 and 25 years of age. The highest SAR of 38.3\% was observed in April 2020 (95\% CI 31.6-45), while the lowest SAR of 15.6\% was observed in September 2020 (95\% CI 13.9-17.3). It consistently decreased from 32\% to 21.1\% as the age of index groups increased. In a multiple logistic regression analysis, we found that the youngest pediatric age group (0 to 4 years) had 1.69 times (95\% CI 1.42-2.00) the odds of SARS-CoV-2 transmission to any family members when compared with the oldest group (18 to 25 years). Family size was significantly associated with household viral transmission (odds ratio 2.66, 95\% CI 2.58-2.74). Conclusions: Using retrospective claims data, the pediatric index transmission of SARS-CoV-2 during the initial waves of the COVID-19 pandemic in the United States was associated with location and family characteristics. Pediatric SAR (0 to 25 years) was less than the SAR for all age other groups. Less than 1\% (n=36,241) of all household data were retained in the retrospective study for complete case analysis, perhaps biasing our findings. We have provided measures of baseline household pediatric transmission for tracking and comparing the infectivity of later SARS-CoV-2 variants. ", doi="10.2196/44249", url="https://www.jmir.org/2024/1/e44249", url="http://www.ncbi.nlm.nih.gov/pubmed/37967280" } @Article{info:doi/10.2196/40216, author="Gertz, Autumn and Rader, Benjamin and Sewalk, Kara and Varrelman, J. Tanner and Smolinski, Mark and Brownstein, S. John", title="Decreased Seasonal Influenza Rates Detected in a Crowdsourced Influenza-Like Illness Surveillance System During the COVID-19 Pandemic: Prospective Cohort Study", journal="JMIR Public Health Surveill", year="2023", month="Dec", day="28", volume="9", pages="e40216", keywords="participatory surveillance", keywords="influenza", keywords="crowdsourced data", keywords="disease surveillance", keywords="surveillance", keywords="COVID-19", keywords="respiratory", keywords="transmission", keywords="detection", keywords="survey", keywords="sore throat", keywords="fever", keywords="cough", keywords="vaccination", keywords="diagnosis", keywords="precautions", abstract="Background: Seasonal respiratory viruses had lower incidence during their 2019-2020 and 2020-2021 seasons, which overlapped with the COVID-19 pandemic. The widespread implementation of precautionary measures to prevent transmission of SARS-CoV-2 has been seen to also mitigate transmission of seasonal influenza. The COVID-19 pandemic also led to changes in care seeking and access. Participatory surveillance systems have historically captured mild illnesses that are often missed by surveillance systems that rely on encounters with a health care provider for detection. Objective: This study aimed to assess if a crowdsourced syndromic surveillance system capable of detecting mild influenza-like illness (ILI) also captured the globally observed decrease in ILI in the 2019-2020 and 2020-2021 influenza seasons, concurrent with the COVID-19 pandemic. Methods: Flu Near You (FNY) is a web-based participatory syndromic surveillance system that allows participants in the United States to report their health information using a brief weekly survey. Reminder emails are sent to registered FNY participants to report on their symptoms and the symptoms of household members. Guest participants may also report. ILI was defined as fever and sore throat or fever and cough. ILI rates were determined as the number of ILI reports over the total number of reports and assessed for the 2016-2017, 2017-2018, 2018-2019, 2019-2020, and 2020-2021 influenza seasons. Baseline season (2016-2017, 2017-2018, and 2018-2019) rates were compared to the 2019-2020 and 2020-2021 influenza seasons. Self-reported influenza diagnosis and vaccination status were captured and assessed as the total number of reported events over the total number of reports submitted. CIs for all proportions were calculated via a 1-sample test of proportions. Results: ILI was detected in 3.8\% (32,239/848,878) of participants in the baseline seasons (2016-2019), 2.58\% (7418/287,909) in the 2019-2020 season, and 0.27\% (546/201,079) in the 2020-2021 season. Both influenza seasons that overlapped with the COVID-19 pandemic had lower ILI rates than the baseline seasons. ILI decline was observed during the months with widespread implementation of COVID-19 precautions, starting in February 2020. Self-reported influenza diagnoses decreased from early 2020 through the influenza season. Self-reported influenza positivity among ILI cases varied over the observed time period. Self-reported influenza vaccination rates in FNY were high across all observed seasons. Conclusions: A decrease in ILI was detected in the crowdsourced FNY surveillance system during the 2019-2020 and 2020-2021 influenza seasons, mirroring trends observed in other influenza surveillance systems. Specifically, the months within seasons that overlapped with widespread pandemic precautions showed decreases in ILI and confirmed influenza. Concerns persist regarding respiratory pathogens re-emerging with changes to COVID-19 guidelines. Traditional surveillance is subject to changes in health care behaviors. Systems like FNY are uniquely situated to detect disease across disease severity and care seeking, providing key insights during public health emergencies. ", doi="10.2196/40216", url="https://publichealth.jmir.org/2023/1/e40216", url="http://www.ncbi.nlm.nih.gov/pubmed/38153782" } @Article{info:doi/10.2196/46413, author="Valvi, Nimish and McFarlane, Timothy and Allen, S. Katie and Gibson, Joseph P. and Dixon, Edward Brian", title="Identification of Hypertension in Electronic Health Records Through Computable Phenotype Development and Validation for Use in Public Health Surveillance: Retrospective Study", journal="JMIR Form Res", year="2023", month="Dec", day="27", volume="7", pages="e46413", keywords="computable phenotypes", keywords="electronic health records", keywords="health information exchange", keywords="hypertension", keywords="population surveillance", keywords="public health informatics", abstract="Background: Electronic health record (EHR) systems are widely used in the United States to document care delivery and outcomes. Health information exchange (HIE) networks, which integrate EHR data from the various health care providers treating patients, are increasingly used to analyze population-level data. Existing methods for population health surveillance of essential hypertension by public health authorities may be complemented using EHR data from HIE networks to characterize disease burden at the community level. Objective: We aimed to derive and validate computable phenotypes (CPs) to estimate hypertension prevalence for population-based surveillance using an HIE network. Methods: Using existing data available from an HIE network, we developed 6 candidate CPs for essential (primary) hypertension in an adult population from a medium-sized Midwestern metropolitan area in the United States. A total of 2 independent clinician reviewers validated the phenotypes through a manual chart review of 150 randomly selected patient records. We assessed the precision of CPs by calculating sensitivity, specificity, positive predictive value (PPV), F1-score, and validity of chart reviews using prevalence-adjusted bias-adjusted $\kappa$. We further used the most balanced CP to estimate the prevalence of hypertension in the population. Results: Among a cohort of 548,232 adults, 6 CPs produced PPVs ranging from 71\% (95\% CI 64.3\%-76.9\%) to 95.7\% (95\% CI 84.9\%-98.9\%). The F1-score ranged from 0.40 to 0.91. The prevalence-adjusted bias-adjusted $\kappa$ revealed a high percentage agreement of 0.88 for hypertension. Similarly, interrater agreement for individual phenotype determination demonstrated substantial agreement (range 0.70-0.88) for all 6 phenotypes examined. A phenotype based solely on diagnostic codes possessed reasonable performance (F1-score=0.63; PPV=95.1\%) but was imbalanced with low sensitivity (47.6\%). The most balanced phenotype (F1-score=0.91; PPV=83.5\%) included diagnosis, blood pressure measurements, and medications and identified 210,764 (38.4\%) individuals with hypertension during the study period (2014-2015). Conclusions: We identified several high-performing phenotypes to identify essential hypertension prevalence for local public health surveillance using EHR data. Given the increasing availability of EHR systems in the United States and other nations, leveraging EHR data has the potential to enhance surveillance of chronic disease in health systems and communities. Yet given variability in performance, public health authorities will need to decide whether to seek optimal balance or declare a preference for algorithms that lean toward sensitivity or specificity to estimate population prevalence of disease. ", doi="10.2196/46413", url="https://formative.jmir.org/2023/1/e46413", url="http://www.ncbi.nlm.nih.gov/pubmed/38150296" } @Article{info:doi/10.2196/49469, author="Smith, Patrice Brandi and Hoots, Brooke and DePadilla, Lara and Roehler, R. Douglas and Holland, M. Kristin and Bowen, A. Daniel and Sumner, A. Steven", title="Using Transformer-Based Topic Modeling to Examine Discussions of Delta-8 Tetrahydrocannabinol: Content Analysis", journal="J Med Internet Res", year="2023", month="Dec", day="21", volume="25", pages="e49469", keywords="social media", keywords="natural language processing", keywords="public health surveillance", keywords="machine learning", keywords="topic modeling", keywords="delta-8 tetrahydrocannabinol", keywords="cannabis", keywords="marijuana", abstract="Background: Delta-8 tetrahydrocannabinol (THC) is a psychoactive cannabinoid found in small amounts naturally in the cannabis plant; it can also be synthetically produced in larger quantities from hemp-derived cannabidiol. Most states permit the sale of hemp and hemp-derived cannabidiol products; thus, hemp-derived delta-8 THC products have become widely available in many state hemp marketplaces, even where delta-9 THC, the most prominently occurring THC isomer in cannabis, is not currently legal. Health concerns related to the processing of delta-8 THC products and their psychoactive effects remain understudied. Objective: The goal of this study is to implement a novel topic modeling approach based on transformers, a state-of-the-art natural language processing architecture, to identify and describe emerging trends and topics of discussion about delta-8 THC from social media discourse, including potential symptoms and adverse health outcomes experienced by people using delta-8 THC products. Methods: Posts from January 2008 to December 2021 discussing delta-8 THC were isolated from cannabis-related drug forums on Reddit (Reddit Inc), a social media platform that hosts the largest web-based drug forums worldwide. Unsupervised topic modeling with state-of-the-art transformer-based models was used to cluster posts into topics and assign labels describing the kinds of issues being discussed with respect to delta-8 THC. Results were then validated by human subject matter experts. Results: There were 41,191 delta-8 THC posts identified and 81 topics isolated, the most prevalent being (1) discussion of specific brands or products, (2) comparison of delta-8 THC to other hemp-derived cannabinoids, and (3) safety warnings. About 5\% (n=1220) of posts from the resulting topics included content discussing health-related symptoms such as anxiety, sleep disturbance, and breathing problems. Until 2020, Reddit posts contained fewer than 10 mentions of delta-8-THC for every 100,000 cannabis posts annually. However, in 2020, these rates increased by 13 times the 2019 rate (to 99.2 mentions per 100,000 cannabis posts) and continued to increase into 2021 (349.5 mentions per 100,000 cannabis posts). Conclusions: Our study provides insights into emerging public health concerns around delta-8 THC, a novel substance about which little is known. Furthermore, we demonstrate the use of transformer-based unsupervised learning approaches to derive intelligible topics from highly unstructured discussions of delta-8 THC, which may help improve the timeliness of identification of emerging health concerns related to new substances. ", doi="10.2196/49469", url="https://www.jmir.org/2023/1/e49469", url="http://www.ncbi.nlm.nih.gov/pubmed/38127427" } @Article{info:doi/10.2196/44912, author="Frennesson, Felicia Nessie and McQuire, Cheryl and Aijaz Khan, Saher and Barnett, Julie and Zuccolo, Luisa", title="Evaluating Messaging on Prenatal Health Behaviors Using Social Media Data: Systematic Review", journal="J Med Internet Res", year="2023", month="Dec", day="20", volume="25", pages="e44912", keywords="acceptability", keywords="design", keywords="development", keywords="effectiveness", keywords="health behavior", keywords="health messaging", keywords="messaging", keywords="prenatal health", keywords="prenatal", keywords="social media data", keywords="social media", keywords="tool", abstract="Background: Social media platforms are increasingly being used to disseminate messages about prenatal health. However, to date, we lack a systematic assessment of how to evaluate the impact of official prenatal health messaging and campaigns using social media data. Objective: This study aims to review both the published and gray literature on how official prenatal health messaging and campaigns have been evaluated to date in terms of impact, acceptability, effectiveness, and unintended consequences, using social media data. Methods: A total of 6 electronic databases were searched and supplemented with the hand-searching of reference lists. Both published and gray literature were eligible for review. Data were analyzed using content analysis for descriptive data and a thematic synthesis approach to summarize qualitative evidence. A quality appraisal tool, designed especially for use with social media data, was used to assess the quality of the included articles. Results: A total of 11 studies were eligible for the review. The results showed that the most common prenatal health behavior targeted was alcohol consumption, and Facebook was the most commonly used source of social media data. The majority (n=6) of articles used social media data for descriptive purposes only. The results also showed that there was a lack of evaluation of the effectiveness, acceptability, and unintended consequences of the prenatal health message or campaign. Conclusions: Social media is a widely used and potentially valuable resource for communicating and evaluating prenatal health messaging. However, this review suggests that there is a need to develop and adopt sound methodology on how to evaluate prenatal health messaging using social media data, for the benefit of future research and to inform public health practice. ", doi="10.2196/44912", url="https://www.jmir.org/2023/1/e44912", url="http://www.ncbi.nlm.nih.gov/pubmed/38117557" } @Article{info:doi/10.2196/47981, author="De La Cerda, Isela and Bauer, X. Cici and Zhang, Kehe and Lee, Miryoung and Jones, Michelle and Rodriguez, Arturo and McCormick, B. Joseph and Fisher-Hoch, P. Susan", title="Evaluation of a Targeted COVID-19 Community Outreach Intervention: Case Report for Precision Public Health", journal="JMIR Public Health Surveill", year="2023", month="Dec", day="20", volume="9", pages="e47981", keywords="community interventions", keywords="emergency preparedness", keywords="health disparities", keywords="intervention evaluation", keywords="precision public health", keywords="public health informatics", keywords="public health intervention", keywords="public health", keywords="spatial epidemiology", keywords="surveillance", abstract="Background: Cameron County, a low-income south Texas-Mexico border county marked by severe health disparities, was consistently among the top counties with the highest COVID-19 mortality in Texas at the onset of the pandemic. The disparity in COVID-19 burden within Texas counties revealed the need for effective interventions to address the specific needs of local health departments and their communities. Publicly available COVID-19 surveillance data were not sufficiently timely or granular to deliver such targeted interventions. An agency-academic collaboration in Cameron used novel geographic information science methods to produce granular COVID-19 surveillance data. These data were used to strategically target an educational outreach intervention named ``Boots on the Ground'' (BOG) in the City of Brownsville (COB). Objective: This study aimed to evaluate the impact of a spatially targeted community intervention on daily COVID-19 test counts. Methods: The agency-academic collaboration between the COB and UTHealth Houston led to the creation of weekly COVID-19 epidemiological reports at the census tract level. These reports guided the selection of census tracts to deliver targeted BOG between April 21 and June 8, 2020. Recordkeeping of the targeted BOG tracts and the intervention dates, along with COVID-19 daily testing counts per census tract, provided data for intervention evaluation. An interrupted time series design was used to evaluate the impact on COVID-19 test counts 2 weeks before and after targeted BOG. A piecewise Poisson regression analysis was used to quantify the slope (sustained) and intercept (immediate) change between pre- and post-BOG COVID-19 daily test count trends. Additional analysis of COB tracts that did not receive targeted BOG was conducted for comparison purposes. Results: During the intervention period, 18 of the 48 COB census tracts received targeted BOG. Among these, a significant change in the slope between pre- and post-BOG daily test counts was observed in 5 tracts, 80\% (n=4) of which had a positive slope change. A positive slope change implied a significant increase in daily COVID-19 test counts 2 weeks after targeted BOG compared to the testing trend observed 2 weeks before intervention. In an additional analysis of the 30 census tracts that did not receive targeted BOG, significant slope changes were observed in 10 tracts, of which positive slope changes were only observed in 20\% (n=2). In summary, we found that BOG-targeted tracts had mostly positive daily COVID-19 test count slope changes, whereas untargeted tracts had mostly negative daily COVID-19 test count slope changes. Conclusions: Evaluation of spatially targeted community interventions is necessary to strengthen the evidence base of this important approach for local emergency preparedness. This report highlights how an academic-agency collaboration established and evaluated the impact of a real-time, targeted intervention delivering precision public health to a small community. ", doi="10.2196/47981", url="https://publichealth.jmir.org/2023/1/e47981", url="http://www.ncbi.nlm.nih.gov/pubmed/38117549" } @Article{info:doi/10.2196/49687, author="Tang, Chia-Chun and Chen, Hsi and Tsai, Shao-Yu and Wu, Wei-Wen", title="Factors Associated With Levels of Public Engagement in Protective Behaviors During the Early COVID-19 Pandemic: Causal-Comparative Study Based on the Health Belief Model", journal="JMIR Hum Factors", year="2023", month="Dec", day="19", volume="10", pages="e49687", keywords="infectious disease", keywords="protective behavior", keywords="COVID", keywords="health belief model", keywords="causal comparative", keywords="causal", keywords="protective", keywords="prevention", keywords="opinion", keywords="opinions", keywords="attitude", keywords="attitudes", keywords="COVID-19", keywords="pandemic", keywords="infection control", keywords="public safety", keywords="public health", keywords="survey", keywords="surveys", abstract="Background: While the challenges of COVID-19 are still unfolding, the enhancement of protective behavior remains a top priority in global health care. However, current behavior-promoting strategies may be inefficient without first identifying the individuals with lower engagement in protective behavior and the associating factors. Objective: This study aimed to identify individuals with and potential contributing factors to low engagement in protective behavior during the COVID-19 pandemic. Methods: This is a causal-comparative study. A theory-based web-based survey was used to investigate individuals' protective behavior and potential associating factors. During June 2020, the distribution of the survey was targeted to 3 areas: Taiwan, Japan, and North America. Based on the theory of the health belief model (HBM), the survey collected participants' various perceptions toward COVID-19 and a collection of protective behaviors. In addition to the descriptive analysis, cluster analysis, ANOVA, and Fisher exact and chi-square tests were used. Results: A total of 384 responses were analyzed. More than half of the respondents lived in Taiwan, followed by Japan, then North America. The respondents were grouped into 3 clusters according to their engagement level in all protective behaviors. These 3 clusters were significantly different from each other in terms of the participants' sex, residency, perceived barriers, self-efficacy, and cues of action. Conclusions: This study used an HBM-based questionnaire to assess protective behaviors against COVID-19 and the associated factors across multiple countries. The findings indicate significant differences in various HBM concepts among individuals with varying levels of behavioral engagement. ", doi="10.2196/49687", url="https://humanfactors.jmir.org/2023/1/e49687" } @Article{info:doi/10.2196/49352, author="Kreniske, Philip and Namuyaba, Imelda Olive and Kasumba, Robert and Namatovu, Phionah and Ssewamala, Fred and Wingood, Gina and Wei, Ying and Ybarra, L. Michele and Oloya, Charlotte and Tindyebwa, Costella and Ntulo, Christina and Mujune, Vincent and Chang, W. Larry and Mellins, A. Claude and Santelli, S. John", title="Mobile Phone Technology for Preventing HIV and Related Youth Health Problems, Sexual Health, Mental Health, and Substance Use Problems in Southwest Uganda (Youth Health SMS): Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Dec", day="19", volume="12", pages="e49352", keywords="adolescence", keywords="PrEP", keywords="pre-exposure prophylaxis", keywords="HIV", keywords="mental health", keywords="substance use", keywords="sexual health", keywords="mobile phones", keywords="randomized controlled trial", keywords="adaptation", keywords="Uganda", abstract="Background: East and Southern Africa have the highest HIV incidence and prevalence in the world, with adolescents and young adults being at the greatest risk. Despite effective combination prevention tools, including the recently available pre-exposure prophylaxis (PrEP), HIV incidence among adolescents and young adults in Uganda remains high, and PrEP use remains low. Mental health and substance use (behavioral health) play a role in sexual behavior and decision-making, contributing to an increase in the risk for acquiring HIV. Interventions that target multiple HIV risk factors, including sexual and mental health and problematic substance use, are crucial to ending the HIV epidemic. Yet few interventions addressing HIV related health disparities and comorbidities among adolescents and young adults in East and Southern Africa currently exist. Objective: This study aims to evaluate the acceptability and feasibility of Kirabo, an SMS text message intervention informed by the information, motivation, and behavior model and to be disseminated through secondary schools. The study will gather preliminary estimates of Kirabo's effectiveness in increasing HIV testing and linking users to mental health counselors. Methods: We identified Mobile 4 Reproductive Health for adaptation using the assessment, decision, administration, production, topical experts, integration, training, testing (ADAPT-ITT) framework. Mobile 4 Reproductive Health is an evidence-based automated 2-way SMS text messaging and interactive voice response platform that offers sexual and reproductive health information and links users to HIV clinics in East Africa. Through ADAPT-ITT we refined our approach and created Kirabo, an SMS text message--based intervention for linking adolescents and young adults to health services, including HIV testing and mental health counseling. We will conduct a 2-arm randomized controlled trial in Masaka, Uganda. Adolescents (N=200) will be recruited from local schools. Baseline sociodemographic characteristics, HIV test history, and behavioral health symptoms will be assessed. We will evaluate acceptability and feasibility using surveys, interviews, and mobile phone data. The preliminary efficacy of Kirabo in increasing HIV testing and linking users to mental health counselors will be evaluated immediately after the intervention and at the 3-month follow-up. We will also assess the intervention's impact on self-efficacy in testing for HIV, adopting PrEP, and contacting a mental health counselor. Results: Intervention adaptation began in 2019. A pretest was conducted in 2021. The randomized controlled trial, including usability and feasibility assessments and effectiveness measurements, commenced in August 2023. Conclusions: Kirabo is a tool that assists in the efforts to end the HIV epidemic by targeting the health disparities and comorbidities among adolescents in Uganda. The intervention includes local HIV clinic information, PrEP information, and behavioral health screening, with referrals as needed. Increasing access to prevention strategies and mitigating factors that make adolescents and young adults susceptible to HIV acquisition can contribute to global efforts to end the HIV epidemic. Trial Registration: ClinicalTrials.gov NCT05130151; https://clinicaltrials.gov/study/NCT05130151 International Registered Report Identifier (IRRID): DERR1-10.2196/49352 ", doi="10.2196/49352", url="https://www.researchprotocols.org/2023/1/e49352", url="http://www.ncbi.nlm.nih.gov/pubmed/38113102" } @Article{info:doi/10.2196/45238, author="Frimpong, A. Jemima and Liu, Xun and Liu, Lingrui and Zhang, Ruoqiuyan", title="Adoption of Electronic Health Record Among Substance Use Disorder Treatment Programs: Nationwide Cross-Sectional Survey Study", journal="J Med Internet Res", year="2023", month="Dec", day="14", volume="25", pages="e45238", keywords="adoption of technology", keywords="barriers to adoption", keywords="electronic health record", keywords="health information technology", keywords="opioid treatment programs", keywords="substance use disorder", abstract="Background: Electronic health record (EHR) systems have been shown to be associated with improvements in care processes, quality of care, and patient outcomes. EHR also has a crucial role in the delivery of substance use disorder (SUD) treatment and is considered important for addressing SUD crises, including the opioid epidemic. However, little is known about the adoption of EHR in SUD treatment programs or the organizational-level factors associated with the adoption of EHR in SUD treatment. Objective: We examined the adoption of EHR in SUD programs, with a focus on changes in adoption from 2014 to 2017, and identified organizational-level factors associated with EHR adoption. Methods: We used data from the 2014 and 2017 National Drug Abuse Treatment System Surveys. Our analysis included 1027 SUD programs (531 in 2014 and 496 in 2017). We used chi-square and Mann-Whitney U tests for categorical and continuous variables, respectively, to assess changes in EHR adoption, technology use, program, and client characteristics. We also investigated differences in characteristics and barriers to adoption by EHR adoption status (adopted EHR vs had not adopted or were planning to adopt EHR). We then conducted multivariate logistic regressions to examine internal and external factors associated with EHR adoption. Results: The adoption of EHR increased significantly from 57.6\% (306/531) in 2014 to 69.2\% (343/496) in 2017 (P<.001), showing that nearly one-third (153/496, 30.8\%) of SUD programs had not yet adopted an EHR system by 2017. We identified a significant increase in technology use and ownership by a parent company (P=.01 and P<.001) and a decrease in the percentage of uninsured patients in 2017 (P<.001), compared to 2014. Our analysis further showed significant differences by adoption status for three major barriers to adoption: (1) start-up costs, (2) ongoing financial costs, and (3) privacy or security concerns (P<.001). Programs that used computerized scheduling (adjusted odds ratio [AOR] 3.02, 95\% CI 2.23-4.09) and billing systems (AOR 2.29, 95\% CI 1.62-3.25) were more likely to adopt EHR. Similarly, ownership type, such as private nonprofit (AOR 1.86, 95\% CI 1.31-2.65) and public (AOR 2.14, 95\% CI 1.27-3.67), or interest in participating in a patient-centered medical home (AOR 1.93, 95\% CI 1.29-2.92), were associated with an increased likelihood to adopt EHR. Overall, SUD programs were more likely to adopt an EHR system in 2017 compared to 2014 (AOR 1.44, 95\% CI 1.07-1.94). Conclusions: Our findings highlighted that SUD programs may be on track to achieve widespread EHR adoption. However, there is a need for focused strategies, resources, and policies explicitly designed to systematically address barriers and tackle obstacles to expanding the adoption of EHR systems. These efforts must be holistic and address factors at multiple organizational levels. ", doi="10.2196/45238", url="https://www.jmir.org/2023/1/e45238", url="http://www.ncbi.nlm.nih.gov/pubmed/38096006" } @Article{info:doi/10.2196/47706, author="Fuad, Anis and Tiara, Agi and Kusumasari, Amalia Rizqiani and Rimawati, Rimawati and Murhandarwati, Herdiana E. Elsa", title="Introducing a Regulatory Sandbox Into the Indonesian Health System Using e-Malaria as a Use Case: Participatory Action Study", journal="J Med Internet Res", year="2023", month="Dec", day="5", volume="25", pages="e47706", keywords="regulatory sandbox", keywords="digital health", keywords="disruptive technologies", keywords="e-malaria", keywords="participatory action research", keywords="Indonesia", abstract="Background: Regulatory sandboxes offer an alternative solution to address regulatory challenges in adopting disruptive technologies. Although regulatory sandboxes have been widely implemented in the financial sector across more than 50 countries, their application to the health sector remains limited. Objective: This study aims to explore stakeholders' perspectives on introducing a regulatory sandbox into the Indonesian health system using e-malaria as a use case. Methods: Using a participatory action research approach, this study conducted qualitative research, including desk reviews, focus group discussions, and in-depth interviews with stakeholders. This study sought to understand stakeholders' concerns and interests regarding the regulatory sandbox and to collaboratively develop a regulatory sandbox model to support the malaria program. Results: The study revealed that most stakeholders had limited awareness of the regulatory sandbox concept. Concerns have been raised regarding the time required to establish regulations, knowledge gaps among stakeholders, data protection issues, and limited digital infrastructure in malaria endemic areas. Existing regulations have been found to be inadequate to accommodate disruptive healthtech for malaria. Nevertheless, through a collaborative process, stakeholders successfully developed a regulatory sandbox model specifically for e-malaria, with the crucial support of the Ministry of Health. Conclusions: The regulatory sandbox holds the potential for adoption in the Indonesian health system to address the limited legal framework and to facilitate the rapid and safe adoption of disruptive healthtech in support of the malaria elimination program. Through stakeholder involvement, guidelines for implementing the regulatory sandbox were developed and innovators were successfully invited to participate in the first-ever trial of a health regulatory sandbox for e-malaria in Indonesia. Future studies should provide further insights into the challenges encountered during the e-malaria regulatory sandbox pilot study, offering a detailed account of the implementation process. ", doi="10.2196/47706", url="https://www.jmir.org/2023/1/e47706", url="http://www.ncbi.nlm.nih.gov/pubmed/38051555" } @Article{info:doi/10.2196/45870, author="Lu, Yixiao and Zhu, Hansong and Hu, Zhijian and He, Fei and Chen, Guangmin", title="Epidemic Characteristics, Spatiotemporal Pattern, and Risk Factors of Other Infectious Diarrhea in Fujian Province From 2005 to 2021: Retrospective Analysis", journal="JMIR Public Health Surveill", year="2023", month="Nov", day="30", volume="9", pages="e45870", keywords="other infectious diarrhea", keywords="spatiotemporal pattern", keywords="disease cluster", keywords="epidemiological trends", keywords="spatial autocorrelation", keywords="meteorological factors", keywords="environmental factors", abstract="Background: Other infectious diarrhea (OID) continues to pose a significant public health threat to all age groups in Fujian Province. There is a need for an in-depth analysis to understand the epidemiological pattern of OID and its associated risk factors in the region. Objective: In this study, we aimed to describe the overall epidemic characteristics and spatiotemporal pattern of OID in Fujian Province from 2005 to 2021 and explore the linkage between sociodemographic and environmental factors and the occurrence of OID within the study area. Methods: Notification data for OID in Fujian were extracted from the China Information System for Disease Control and Prevention. The spatiotemporal pattern of OID was analyzed using Moran index and Kulldorff scan statistics. The seasonality of and short-term impact of meteorological factors on OID were examined using an additive decomposition model and a generalized additive model. Geographical weighted regression and generalized linear mixed model were used to identify potential risk factors. Results: A total of 388,636 OID cases were recorded in Fujian Province from January 2005 to December 2021, with an average annual incidence of 60.3 (SD 16.7) per 100,000 population. Children aged <2 years accounted for 50.7\% (196,905/388,636) of all cases. There was a steady increase in OID from 2005 to 2017 and a clear seasonal shift in OID cases from autumn to winter and spring between 2005 and 2020. Higher maximum temperature, atmospheric pressure, humidity, and precipitation were linked to a higher number of deseasonalized OID cases. The spatial and temporal aggregations were concentrated in Zhangzhou City and Xiamen City for 17 study years. Furthermore, the clustered areas exhibited a dynamic spreading trend, expanding from the southernmost Fujian to the southeast and then southward over time. Factors such as densely populated areas with a large <1-year-old population, less economically developed areas, and higher pollution levels contributed to OID cases in Fujian Province. Conclusions: This study revealed a distinct distribution of OID incidence across different population groups, seasons, and regions in Fujian Province. Zhangzhou City and Xiamen City were identified as the major hot spots for OID. Therefore, prevention and control efforts should prioritize these specific hot spots and highly susceptible groups. ", doi="10.2196/45870", url="https://publichealth.jmir.org/2023/1/e45870", url="http://www.ncbi.nlm.nih.gov/pubmed/38032713" } @Article{info:doi/10.2196/51387, author="McCormack, Heather and Wand, Handan and Newman, E. Christy and Bourne, Christopher and Kennedy, Catherine and Guy, Rebecca", title="Exploring Whether the Electronic Optimization of Routine Health Assessments Can Increase Testing for Sexually Transmitted Infections and Provider Acceptability at an Aboriginal Community Controlled Health Service: Mixed Methods Evaluation", journal="JMIR Med Inform", year="2023", month="Nov", day="30", volume="11", pages="e51387", keywords="sexual health", keywords="sexually transmitted infection", keywords="STI", keywords="primary care", keywords="Indigenous health", keywords="electronic medical record", keywords="EMR", keywords="medical records", keywords="electronic health record", keywords="EHR", keywords="health record", keywords="health records", keywords="Indigenous", keywords="Native", keywords="Aboriginal", keywords="sexual transmission", keywords="sexually transmitted", keywords="time series", keywords="testing", keywords="uptake", keywords="acceptance", keywords="acceptability", keywords="adoption", keywords="syphilis", keywords="sexually transmitted disease", keywords="STD", keywords="systems change", keywords="health assessment", keywords="health assessments", keywords="prompt", keywords="prompts", keywords="implementation", keywords="youth", keywords="young people", keywords="adolescent", keywords="adolescents", abstract="Background: In the context of a syphilis outbreak in neighboring states, a multifaceted systems change to increase testing for sexually transmitted infections (STIs) among young Aboriginal people aged 15 to 29 years was implemented at an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales, Australia. The components included electronic medical record prompts and automated pathology test sets to increase STI testing in annual routine health assessments, the credentialing of nurses and Aboriginal health practitioners to conduct STI tests independently, pathology request forms presigned by a physician, and improved data reporting. Objective: We aimed to determine whether the systems change increased the integration of STI testing into routine health assessments by clinicians between April 2019 and March 2020, the inclusion of syphilis tests in STI testing, and STI testing uptake overall. We also explored the understandings of factors contributing to the acceptability and normalization of the systems change among staff. Methods: We used a mixed methods design to evaluate the effectiveness and acceptability of the systems change implemented in 2019. We calculated the annual proportion of health assessments that included tests for chlamydia, gonorrhea, and syphilis, as well as an internal control (blood glucose level). We conducted an interrupted time series analysis of quarterly proportions 24 months before and 12 months after the systems change and in-depth semistructured interviews with ACCHS staff using normalization process theory. Results: Among 2461 patients, the annual proportion of health assessments that included any STI test increased from 16\% (38/237) in the first year of the study period to 42.9\% (94/219) after the implementation of the systems change. There was an immediate and large increase when the systems change occurred (coefficient=0.22; P=.003) with no decline for 12 months thereafter. The increase was greater for male individuals, with no change for the internal control. Qualitative data indicated that nurse- and Aboriginal health practitioner--led testing and presigned pathology forms proved more difficult to normalize than electronic prompts and shortcuts. The interviews identified that staff understood the modifications to have encouraged cultural change around the role of sexual health care in routine practice. Conclusions: This study provides evidence for the first time that optimizing health assessments electronically is an effective and acceptable strategy to increase and sustain clinician integration and the completeness of STI testing among young Aboriginal people attending an ACCHS. Future strategies should focus on increasing the uptake of health assessments and promote whole-of-service engagement and accountability. ", doi="10.2196/51387", url="https://medinform.jmir.org/2023/1/e51387", url="http://www.ncbi.nlm.nih.gov/pubmed/38032729" } @Article{info:doi/10.2196/43185, author="Solberg, M. Laurence and Duckworth, J. Laurie and Dunn, M. Elizabeth and Dickinson, Theresa and Magoc, Tanja and Snigurska, A. Urszula and Ser, E. Sarah and Celso, Brian and Bailey, Meghan and Bowen, Courtney and Radhakrishnan, Nila and Patel, R. Chirag and Lucero, Robert and Bjarnadottir, I. Ragnhildur", title="Use of a Data Repository to Identify Delirium as a Presenting Symptom of COVID-19 Infection in Hospitalized Adults: Cross-Sectional Cohort Pilot Study", journal="JMIR Aging", year="2023", month="Nov", day="30", volume="6", pages="e43185", keywords="COVID-19", keywords="delirium", keywords="neurocognitive disorder", keywords="data repository", keywords="adults", keywords="pilot study", keywords="symptom", keywords="electronic health record", keywords="viral infection", keywords="clinical", keywords="patient", keywords="research", keywords="diagnosis", keywords="disorder", keywords="memory", keywords="covid", keywords="memory loss", keywords="old", keywords="old age", abstract="Background: Delirium, an acute confusional state highlighted by inattention, has been reported to occur in 10\% to 50\% of patients with COVID-19. People hospitalized with COVID-19 have been noted to present with or develop delirium and neurocognitive disorders. Caring for patients with delirium is associated with more burden for nurses, clinicians, and caregivers. Using information in electronic health record data to recognize delirium and possibly COVID-19 could lead to earlier treatment of the underlying viral infection and improve outcomes in clinical and health care systems cost per patient. Clinical data repositories can further support rapid discovery through cohort identification tools, such as the Informatics for Integrating Biology and the Bedside tool. Objective: The specific aim of this research was to investigate delirium in hospitalized older adults as a possible presenting symptom in COVID-19 using a data repository to identify neurocognitive disorders with a novel group of International Classification of Diseases, Tenth Revision (ICD-10) codes. Methods: We analyzed data from 2 catchment areas with different demographics. The first catchment area (7 counties in the North-Central Florida) is predominantly rural while the second (1 county in North Florida) is predominantly urban. The Integrating Biology and the Bedside data repository was queried for patients with COVID-19 admitted to inpatient units via the emergency department (ED) within the health center from April 1, 2020, and April 1, 2022. Patients with COVID-19 were identified by having a positive COVID-19 laboratory test or a diagnosis code of U07.1. We identified neurocognitive disorders as delirium or encephalopathy, using ICD-10 codes. Results: Less than one-third (1437/4828, 29.8\%) of patients with COVID-19 were diagnosed with a co-occurring neurocognitive disorder. A neurocognitive disorder was present on admission for 15.8\% (762/4828) of all patients with COVID-19 admitted through the ED. Among patients with both COVID-19 and a neurocognitive disorder, 56.9\% (817/1437) were aged ?65 years, a significantly higher proportion than those with no neurocognitive disorder (P<.001). The proportion of patients aged <65 years was significantly higher among patients diagnosed with encephalopathy only than patients diagnosed with delirium only and both delirium and encephalopathy (P<.001). Most (1272/4828, 26.3\%) patients with COVID-19 admitted through the ED during our study period were admitted during the Delta variant peak. Conclusions: The data collected demonstrated that an increased number of older patients with neurocognitive disorder present on admission were infected with COVID-19. Knowing that delirium increases the staffing, nursing care needs, hospital resources used, and the length of stay as previously noted, identifying delirium early may benefit hospital administration when planning for newly anticipated COVID-19 surges. A robust and accessible data repository, such as the one used in this study, can provide invaluable support to clinicians and clinical administrators in such resource reallocation and clinical decision-making. ", doi="10.2196/43185", url="https://aging.jmir.org/2023/1/e43185", url="http://www.ncbi.nlm.nih.gov/pubmed/37910448" } @Article{info:doi/10.2196/49639, author="Matthias, Katja and Honekamp, Ivonne and Heinrich, Monique and De Santis, Karolina Karina", title="Consideration of Sex, Gender, or Age on Outcomes of Digital Technologies for Treatment and Monitoring of Chronic Obstructive Pulmonary Disease: Overview of Systematic Reviews", journal="J Med Internet Res", year="2023", month="Nov", day="29", volume="25", pages="e49639", keywords="digital technologies", keywords="digital intervention", keywords="COPD", keywords="AMSTAR 2", keywords="chronic obstructive pulmonary disease", keywords="gender", keywords="sex", keywords="age", keywords="overview", keywords="systematic review", keywords="treatment", keywords="monitoring", keywords="chronic disease", keywords="chronic illness", keywords="outcome reporting", keywords="review methodology", keywords="critical appraisal", abstract="Background: Several systematic reviews have addressed digital technology use for treatment and monitoring of chronic obstructive pulmonary disease (COPD). Objective: This study aimed to assess if systematic reviews considered the effects of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD through an overview of such systematic reviews. The objectives of this overview were to (1) describe the definitions of sex or gender used in reviews; (2) determine whether the consideration of sex, gender, or age was planned in reviews; (3) determine whether sex, gender, or age was reported in review results; (4) determine whether sex, gender, or age was incorporated in implications for clinical practice in reviews; and (5) create an evidence map for development of individualized clinical recommendations for COPD based on sex, gender, or age diversity. Methods: MEDLINE, the Cochrane Library, Epistemonikos, Web of Science, and the bibliographies of the included systematic reviews were searched to June 2022. Inclusion was based on the PICOS framework: (1) population (COPD), (2) intervention (any digital technology), (3) comparison (any), (4) outcome (any), and (5) study type (systematic review). Studies were independently selected by 2 authors based on title and abstract and full-text screening. Data were extracted by 1 author and checked by another author. Data items included systematic review characteristics; PICOS criteria; and variables related to sex, gender, or age. Systematic reviews were appraised using A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2). Data were synthesized using descriptive statistics. Results: Of 1439 records, 30 systematic reviews published between 2010 and 2022 were included in this overview. The confidence in the results of 25 of the 30 (83\%) reviews was critically low according to AMSTAR 2. The reviews focused on user outcomes that potentially depend on sex, gender, or age, such as efficacy or effectiveness (25/30, 83\%) and acceptance, satisfaction, or adherence (3/30, 10\%) to digital technologies for COPD. Reviews reported sex or gender (19/30 systematic reviews) or age (25/30 systematic reviews) among primary study characteristics. However, only 1 of 30 reviews included age in a subgroup analysis, and 3 of 30 reviews identified the effects of sex, gender, or age as evidence gaps. Conclusions: This overview shows that the effects of sex, gender, or age were rarely considered in 30 systematic reviews of digital technologies for COPD treatment and monitoring. Furthermore, systematic reviews did not incorporate sex, gender, nor age in their implications for clinical practice. We recommend that future systematic reviews should (1) evaluate the effects of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD and (2) better adhere to reporting guidelines to improve the confidence in review results. Trial Registration: PROSPERO CRD42022322924; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=322924 International Registered Report Identifier (IRRID): RR2-10.2196/40538 ", doi="10.2196/49639", url="https://www.jmir.org/2023/1/e49639/" } @Article{info:doi/10.2196/44728, author="Baron, Ruth and Hamdiui, Nora and Helms, B. Yannick and Crutzen, Rik and G{\"o}tz, M. Hannelore and Stein, L. Mart", title="Evaluating the Added Value of Digital Contact Tracing Support Tools for Citizens: Framework Development", journal="JMIR Res Protoc", year="2023", month="Nov", day="29", volume="12", pages="e44728", keywords="contact tracing", keywords="digital tools", keywords="citizen involvement", keywords="COVID-19", keywords="infectious disease outbreak", keywords="framework", keywords="mobile phone", abstract="Background: The COVID-19 pandemic revealed that with high infection rates, health services conducting contact tracing (CT) could become overburdened, leading to limited or incomplete CT. Digital CT support (DCTS) tools are designed to mimic traditional CT, by transferring a part of or all the tasks of CT into the hands of citizens. Besides saving time for health services, these tools may help to increase the number of contacts retrieved during the contact identification process, quantity and quality of contact details, and speed of the contact notification process. The added value of DCTS tools for CT is currently unknown. Objective: To help determine whether DCTS tools could improve the effectiveness of CT, this study aims to develop a framework for the comprehensive assessment of these tools. Methods: A framework containing evaluation topics, research questions, accompanying study designs, and methods was developed based on consultations with CT experts from municipal public health services and national public health authorities, complemented with scientific literature. Results: These efforts resulted in a framework aiming to assist with the assessment of the following aspects of CT: speed; comprehensiveness; effectiveness with regard to contact notification; positive case detection; potential workload reduction of public health professionals; demographics related to adoption and reach; and user experiences of public health professionals, index cases, and contacts. Conclusions: This framework provides guidance for researchers and policy makers in designing their own evaluation studies, the findings of which can help determine how and the extent to which DCTS tools should be implemented as a CT strategy for future infectious disease outbreaks. ", doi="10.2196/44728", url="https://www.researchprotocols.org/2023/1/e44728", url="http://www.ncbi.nlm.nih.gov/pubmed/38019583" } @Article{info:doi/10.2196/47066, author="Biasiotto, Roberta and Viberg Johansson, Jennifer and Alemu, Birhanu Melaku and Romano, Virginia and Bentzen, Beate Heidi and Kaye, Jane and Ancillotti, Mirko and Blom, Catharina Johanna Maria and Chassang, Gauthier and Hallinan, Dara and J{\'o}nsd{\'o}ttir, Andrea Gu?bj{\"o}rg and Monasterio Astobiza, An{\'i}bal and Rial-Sebbag, Emmanuelle and Rodr{\'i}guez-Arias, David and Shah, Nisha and Skovgaard, Lea and Staunton, Ciara and Tschigg, Katharina and Veldwijk, Jorien and Mascalzoni, Deborah", title="Public Preferences for Digital Health Data Sharing: Discrete Choice Experiment Study in 12 European Countries", journal="J Med Internet Res", year="2023", month="Nov", day="23", volume="25", pages="e47066", keywords="governance", keywords="digital health data", keywords="preferences", keywords="Europe", keywords="discrete choice experiment", keywords="data use", keywords="data sharing", keywords="secondary use of data", abstract="Background: With new technologies, health data can be collected in a variety of different clinical, research, and public health contexts, and then can be used for a range of new purposes. Establishing the public's views about digital health data sharing is essential for policy makers to develop effective harmonization initiatives for digital health data governance at the European level. Objective: This study investigated public preferences for digital health data sharing. Methods: A discrete choice experiment survey was administered to a sample of European residents in 12 European countries (Austria, Denmark, France, Germany, Iceland, Ireland, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom) from August 2020 to August 2021. Respondents answered whether hypothetical situations of data sharing were acceptable for them. Each hypothetical scenario was defined by 5 attributes (``data collector,'' ``data user,'' ``reason for data use,'' ``information on data sharing and consent,'' and ``availability of review process''), which had 3 to 4 attribute levels each. A latent class model was run across the whole data set and separately for different European regions (Northern, Central, and Southern Europe). Attribute relative importance was calculated for each latent class's pooled and regional data sets. Results: A total of 5015 completed surveys were analyzed. In general, the most important attribute for respondents was the availability of information and consent during health data sharing. In the latent class model, 4 classes of preference patterns were identified. While respondents in 2 classes strongly expressed their preferences for data sharing with opposing positions, respondents in the other 2 classes preferred not to share their data, but attribute levels of the situation could have had an impact on their preferences. Respondents generally found the following to be the most acceptable: a national authority or academic research project as the data user; being informed and asked to consent; and a review process for data transfer and use, or transfer only. On the other hand, collection of their data by a technological company and data use for commercial communication were the least acceptable. There was preference heterogeneity across Europe and within European regions. Conclusions: This study showed the importance of transparency in data use and oversight of health-related data sharing for European respondents. Regional and intraregional preference heterogeneity for ``data collector,'' ``data user,'' ``reason,'' ``type of consent,'' and ``review'' calls for governance solutions that would grant data subjects the ability to control their digital health data being shared within different contexts. These results suggest that the use of data without consent will demand weighty and exceptional reasons. An interactive and dynamic informed consent model combined with oversight mechanisms may be a solution for policy initiatives aiming to harmonize health data use across Europe. ", doi="10.2196/47066", url="https://www.jmir.org/2023/1/e47066", url="http://www.ncbi.nlm.nih.gov/pubmed/37995125" } @Article{info:doi/10.2196/50814, author="Herrera-Espejel, Sofia Paula and Rach, Stefan", title="The Use of Machine Translation for Outreach and Health Communication in Epidemiology and Public Health: Scoping Review", journal="JMIR Public Health Surveill", year="2023", month="Nov", day="20", volume="9", pages="e50814", keywords="machine translation", keywords="public health", keywords="epidemiology", keywords="population-based", keywords="recruitment", keywords="outreach", keywords="multilingual", keywords="culturally and linguistically diverse communities", abstract="Background: Culturally and linguistically diverse groups are often underrepresented in population-based research and surveillance efforts, leading to biased study results and limited generalizability. These groups, often termed ``hard-to-reach,'' commonly encounter language barriers in the public health (PH) outreach material and information campaigns, reducing their involvement with the information. As a result, these groups are challenged by 2 effects: the medical and health knowledge is less tailored to their needs, and at the same time, it is less accessible for to them. Modern machine translation (MT) tools might offer a cost-effective solution to PH material language accessibility problems. Objective: This scoping review aims to systematically investigate current use cases of MT specific to the fields of PH and epidemiology, with a particular interest in its use for population-based recruitment methods. Methods: PubMed, PubMed Central, Scopus, ACM Digital Library, and IEEE Xplore were searched to identify articles reporting on the use of MT in PH and epidemiological research for this PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews)--compliant scoping review. Information on communication scenarios, study designs and the principal findings of each article were mapped according to a settings approach, the World Health Organization monitoring and evaluation framework and the service readiness level framework, respectively. Results: Of the 7186 articles identified, 46 (0.64\%) were included in this review, with the earliest study dating from 2009. Most of the studies (17/46, 37\%) discussed the application of MT to existing PH materials, limited to one-way communication between PH officials and addressed audiences. No specific article investigated the use of MT for recruiting linguistically diverse participants to population-based studies. Regarding study designs, nearly three-quarters (34/46, 74\%) of the articles provided technical assessments of MT from 1 language (mainly English) to a few others (eg, Spanish, Chinese, or French). Only a few (12/46, 26\%) explored end-user attitudes (mainly of PH employees), whereas none examined the legal or ethical implications of using MT. The experiments primarily involved PH experts with language proficiencies. Overall, more than half (38/70, 54\% statements) of the summarizing results presented mixed and inconclusive views on the technical readiness of MT for PH information. Conclusions: Using MT in epidemiology and PH can enhance outreach to linguistically diverse populations. The translation quality of current commercial MT solutions (eg, Google Translate and DeepL Translator) is sufficient if postediting is a mandatory step in the translation workflow. Postediting of legally or ethically sensitive material requires staff with adequate content knowledge in addition to sufficient language skills. Unsupervised MT is generally not recommended. Research on whether machine-translated texts are received differently by addressees is lacking, as well as research on MT in communication scenarios that warrant a response from the addressees. ", doi="10.2196/50814", url="https://publichealth.jmir.org/2023/1/e50814", url="http://www.ncbi.nlm.nih.gov/pubmed/37983078" } @Article{info:doi/10.2196/48896, author="Santiago-Torres, Margarita and Mull, E. Kristin and Sullivan, M. Brianna and Bricker, B. Jonathan", title="Use of e-Cigarettes in Cigarette Smoking Cessation: Secondary Analysis of a Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2023", month="Nov", day="9", volume="11", pages="e48896", keywords="acceptance and commitment therapy", keywords="cigarette smoking", keywords="digital behavioral interventions", keywords="e-cigarettes", keywords="smoking cessation", keywords="smartphone apps", keywords="vaping", keywords="mobile phone", abstract="Background: Many adults use e-cigarettes to help them quit cigarette smoking. However, the impact of self-selected use of e-cigarettes on cigarette smoking cessation, particularly when concurrently receiving app-based behavioral interventions, remains unexplored. Objective: This study used data from a randomized trial of 2 smartphone apps to compare 12-month cigarette smoking cessation rates between participants who used e-cigarettes on their own (ie, adopters: n=465) versus those who did not (ie, nonadopters: n=1097). Methods: The study population included all participants who did not use e-cigarettes at baseline. ``Adopters'' were those who self-reported the use of e-cigarettes at either 3- or 6-month follow-ups. ``Nonadopters'' were those who self-reported no use of e-cigarettes at either follow-up time point. The primary cessation outcome was self-reported, complete-case, 30-day point prevalence abstinence from cigarette smoking at 12 months. Secondary outcomes were missing-as-smoking and multiple imputation analyses of the primary outcome, prolonged abstinence, and cessation of all nicotine and tobacco products at 12 months. In logistic regression models, we first examined the potential interaction between e-cigarette use and treatment arm (iCanQuit vs QuitGuide) on the primary cessation outcome. Subsequently, we compared 12-month cigarette smoking cessation rates between adopters and nonadopters separately for each app. Results: There was suggestive evidence for an interaction between e-cigarette use and treatment arm on cessation (P=.05). In the iCanQuit arm, 12-month cigarette smoking cessation rates were significantly lower among e-cigarette adopters compared with nonadopters (41/193, 21.2\% vs 184/527, 34.9\%; P=.003; odds ratio 0.55, 95\% CI 0.37-0.81). In contrast, in the QuitGuide arm, 12-month cigarette smoking cessation rates did not differ between adopters and nonadopters (46/246, 18.7\% vs 104/522, 19.9\%; P=.64; odds ratio 0.91, 95\% CI 0.62-1.35). Conclusions: The use of e-cigarettes while concurrently receiving an app-based smoking cessation intervention was associated with either a lower or an unimproved likelihood of quitting cigarette smoking compared to no use. Future behavioral treatments for cigarette smoking cessation should consider including information on the potential consequences of e-cigarette use. Trial Registration: ClinicalTrials.gov NCT02724462; https://clinicaltrials.gov/study/NCT02724462 ", doi="10.2196/48896", url="https://mhealth.jmir.org/2023/1/e48896", url="http://www.ncbi.nlm.nih.gov/pubmed/37943594" } @Article{info:doi/10.2196/47219, author="Wang, Hsiao-Chi and Lin, Ting-Yu and Yao, Yu-Chin and Hsu, Chen-Yang and Yang, Chang-Jung and Chen, Hsiu-Hsi Tony and Yeh, Yen-Po", title="Community-Based Digital Contact Tracing of Emerging Infectious Diseases: Design and Implementation Study With Empirical COVID-19 Cases", journal="J Med Internet Res", year="2023", month="Nov", day="8", volume="25", pages="e47219", keywords="COVID-19", keywords="digital contact tracing", keywords="public health", keywords="surveillance", abstract="Background: Contact tracing for containing emerging infectious diseases such as COVID-19 is resource intensive and requires digital transformation to enable timely decision-making. Objective: This study demonstrates the design and implementation of digital contact tracing using multimodal health informatics to efficiently collect personal information and contain community outbreaks. The implementation of digital contact tracing was further illustrated by 3 empirical SARS-CoV-2 infection clusters. Methods: The implementation in Changhua, Taiwan, served as a demonstration of the multisectoral informatics and connectivity between electronic health systems needed for digital contact tracing. The framework incorporates traditional travel, occupation, contact, and cluster approaches and a dynamic contact process enabled by digital technology. A centralized registry system, accessible only to authorized health personnel, ensures privacy and data security. The efficiency of the digital contact tracing system was evaluated through a field study in Changhua. Results: The digital contact tracing system integrates the immigration registry, communicable disease report system, and national health records to provide real-time information about travel, occupation, contact, and clusters for potential contacts and to facilitate a timely assessment of the risk of COVID-19 transmission. The digitalized system allows for informed decision-making regarding quarantine, isolation, and treatment, with a focus on personal privacy. In the first cluster infection, the system monitored 665 contacts and isolated 4 (0.6\%) cases; none of the contacts (0/665, 0\%) were infected during quarantine. The estimated reproduction number of 0.92 suggests an effective containment strategy for preventing community-acquired outbreak. The system was also used in a cluster investigation involving foreign workers, where none of the 462 contacts (0/462, 0\%) tested positive for SARS-CoV-2. Conclusions: By integrating the multisectoral database, the contact tracing process can be digitalized to provide the information required for risk assessment and decision-making in a timely manner to contain a community-acquired outbreak when facing the outbreak of emerging infectious disease. ", doi="10.2196/47219", url="https://www.jmir.org/2023/1/e47219", url="http://www.ncbi.nlm.nih.gov/pubmed/37938887" } @Article{info:doi/10.2196/47982, author="Anil Kumar Vaidhyam, Sneha and Huang, Kuo-Ting", title="Social Determinants of Health and Patients' Technology Acceptance of Telehealth During the COVID-19 Pandemic: Pilot Survey", journal="JMIR Hum Factors", year="2023", month="Nov", day="7", volume="10", pages="e47982", keywords="social determinants of health", keywords="telehealth", keywords="COVID-19", keywords="technology adoption", abstract="Background: Telehealth has been widely adopted by patients during the COVID-19 pandemic. Many social determinants of health influence the adoption. Objective: This pilot study aimed to understand the social determinants of patients' adoption of telehealth in the context of the pandemic. Methods: A survey methodology was used to capture data from 215 participants using Amazon Mechanical Turk. The study was guided by the technology acceptance model and the social determinants of health framework. The questionnaire included technology acceptance model variables (eg, perceived usefulness [PU] and perceived ease of use [PEOU]), social determinants (eg, access to health care, socioeconomic status, education, and health literacy), and demographic information (eg, age, sex, race, and ethnicity). A series of ordinary least squares regressions were conducted to analyze the data using SPSS Statistics (IBM Corp). Results: The results showed that social determinant factors---safe neighborhood and built environment (P=.01) and economic stability (P=.05)---are predictors of the PEOU of telehealth adoption at a statistically significant or marginally statistically significant level. Furthermore, a moderated mediation model (PROCESS model 85) was used to analyze the effects of COVID-19 on the neighborhood, built environment, and economic stability. PEOU and PU significantly positively affected users' intention to use technology for both variables. Conclusions: This study draws attention to 2 research frameworks that address unequal access to health technologies. It also adds empirical evidence to telehealth research on the adoption of patient technology. Finally, regarding practical implications, this study will provide government agencies, health care organizations, and health care companies with a better perspective of patients' digital health use. This will further guide them in designing better technology by considering factors such as social determinants of health. ", doi="10.2196/47982", url="https://humanfactors.jmir.org/2023/1/e47982", url="http://www.ncbi.nlm.nih.gov/pubmed/37934556" } @Article{info:doi/10.2196/49753, author="Zhou, Xinyu and Song, Suhang and Zhang, Ying and Hou, Zhiyuan", title="Deep Learning Analysis of COVID-19 Vaccine Hesitancy and Confidence Expressed on Twitter in 6 High-Income Countries: Longitudinal Observational Study", journal="J Med Internet Res", year="2023", month="Nov", day="6", volume="25", pages="e49753", keywords="COVID-19 vaccine", keywords="hesitancy", keywords="confidence", keywords="social media", keywords="machine learning", abstract="Background: An ongoing monitoring of national and subnational trajectory of COVID-19 vaccine hesitancy could offer support in designing tailored policies on improving vaccine uptake. Objective: We aim to track the temporal and spatial distribution of COVID-19 vaccine hesitancy and confidence expressed on Twitter during the entire pandemic period in major English-speaking countries. Methods: We collected 5,257,385 English-language tweets regarding COVID-19 vaccination between January 1, 2020, and June 30, 2022, in 6 countries---the United States, the United Kingdom, Australia, New Zealand, Canada, and Ireland. Transformer-based deep learning models were developed to classify each tweet as intent to accept or reject COVID-19 vaccination and the belief that COVID-19 vaccine is effective or unsafe. Sociodemographic factors associated with COVID-19 vaccine hesitancy and confidence in the United States were analyzed using bivariate and multivariable linear regressions. Results: The 6 countries experienced similar evolving trends of COVID-19 vaccine hesitancy and confidence. On average, the prevalence of intent to accept COVID-19 vaccination decreased from 71.38\% of 44,944 tweets in March 2020 to 34.85\% of 48,167 tweets in June 2022 with fluctuations. The prevalence of believing COVID-19 vaccines to be unsafe continuously rose by 7.49 times from March 2020 (2.84\% of 44,944 tweets) to June 2022 (21.27\% of 48,167 tweets). COVID-19 vaccine hesitancy and confidence varied by country, vaccine manufacturer, and states within a country. The democrat party and higher vaccine confidence were significantly associated with lower vaccine hesitancy across US states. Conclusions: COVID-19 vaccine hesitancy and confidence evolved and were influenced by the development of vaccines and viruses during the pandemic. Large-scale self-generated discourses on social media and deep learning models provide a cost-efficient approach to monitoring routine vaccine hesitancy. ", doi="10.2196/49753", url="https://www.jmir.org/2023/1/e49753", url="http://www.ncbi.nlm.nih.gov/pubmed/37930788" } @Article{info:doi/10.2196/44795, author="Pan, Xiaogao and Hounye, Houssou Alphonse and Zhao, Yuqi and Cao, Cong and Wang, Jiaoju and Abidi, Venunye Mimi and Hou, Muzhou and Xiong, Li and Chai, Xiangping", title="A Digital Mask-Voiceprint System for Postpandemic Surveillance and Tracing Based on the STRONG Strategy", journal="J Med Internet Res", year="2023", month="Nov", day="6", volume="25", pages="e44795", keywords="COVID-19", keywords="surveillance", keywords="digital tracing", keywords="mask management", keywords="voiceprint", keywords="Spatiotemporal Reporting Over Network and GPS", keywords="STRONG", keywords="STRONG strategy", keywords="living with the virus", keywords="dynamic clearance", keywords="digital surveillance", keywords="pandemic", keywords="vaccine", keywords="public health", keywords="mental", keywords="social", keywords="communication technology", keywords="communication", keywords="tracing", doi="10.2196/44795", url="https://www.jmir.org/2023/1/e44795", url="http://www.ncbi.nlm.nih.gov/pubmed/37856760" } @Article{info:doi/10.2196/47586, author="de Ruiter, Hans-Peter and Clisbee, David and Houston, Rebecca and Sk{\"a}rs{\"a}ter, Ingela", title="The Ethical, Care, and Client-Caregiver Relationship Impacts Resulting From Introduction of Digital Communication and Surveillance Technologies in the Home Setting: Qualitative Inductive Study", journal="JMIR Hum Factors", year="2023", month="Nov", day="3", volume="10", pages="e47586", keywords="home care", keywords="caregivers", keywords="ethical implications", keywords="communication technology", keywords="surveillance technology", keywords="public health nursing practices", keywords="digital vulnerability", keywords="care of the elderly", abstract="Background: Embedding communication and surveillance technology into the home health care setting has demonstrated the capacity for increased data efficiency, assumptions of convenience, and smart solutions to pressing problems such as caregiver shortages amid a rise in the aging population. The race to develop and implement these technologies within home care and public health nursing often leaves several ethical questions needing to be answered. Objective: The aim of this study was to understand the ethical and care implications of implementing digital communication and surveillance technologies in the home setting as perceived by health caregivers practicing in the region of Halland in Sweden with clients receiving home care services. Methods: A questionnaire was completed by 1260 home health caregivers and the written responses were evaluated by qualitative inductive content analysis. The researchers reviewed data independently and consensus was used to determine themes. Results: This study identified three main themes that illustrate ethical issues and unintended effects as perceived by caregivers of introducing digital communication and surveillance technologies in the home: (1) digital dependence vulnerability, (2) moral distress, and (3) interruptions to caregiving. This study highlights the consequences of technology developers and health systems leaders unintentionally ignoring the perspectives of caregivers who practice the intuitive artistry of providing care to other humans. Conclusions: Beyond the obtrusiveness of devices and impersonal data collection designed to emphasize health care system priorities, this study discovered a multifaceted shadow side of unintended consequences that arise from misalignment between system priorities and caregiver expertise, resulting in ethical issues. To develop communication and surveillance technologies that meet the needs of all stakeholders, it is important to involve caregivers who work with clients in the development process of new health care technology to improve both the quality of life of clients and the services offered by caregivers. ", doi="10.2196/47586", url="https://humanfactors.jmir.org/2023/1/e47586", url="http://www.ncbi.nlm.nih.gov/pubmed/37921843" } @Article{info:doi/10.2196/49300, author="Dai, Jing and Lyu, Fang and Yu, Lin and He, Yunyu", title="Temporal and Emotional Variations in People's Perceptions of Mass Epidemic Infectious Disease After the COVID-19 Pandemic Using Influenza A as an Example: Topic Modeling and Sentiment Analysis Based on Weibo Data", journal="J Med Internet Res", year="2023", month="Nov", day="2", volume="25", pages="e49300", keywords="mass epidemic infections", keywords="sentiment analysis", keywords="text mining", keywords="spatial differences", keywords="temporal differences", keywords="influenza A", keywords="COVID-19", abstract="Background: The COVID-19 pandemic has had profound impacts on society, including public health, the economy, daily life, and social interactions. Social distancing measures, travel restrictions, and the influx of pandemic-related information on social media have all led to a significant shift in how individuals perceive and respond to health crises. In this context, there is a growing awareness of the role that social media platforms such as Weibo, among the largest and most influential social media sites in China, play in shaping public sentiment and influencing people's behavior during public health emergencies. Objective: This study aims to gain a comprehensive understanding of the sociospatial impact of mass epidemic infectious disease by analyzing the spatiotemporal variations and emotional orientations of the public after the COVID-19 pandemic. We use the outbreak of influenza A after the COVID-19 pandemic as a case study. Through temporal and spatial analyses, we aim to uncover specific variations in the attention and emotional orientations of people living in different provinces in China regarding influenza A. We sought to understand the societal impact of large-scale infectious diseases and the public's stance after the COVID-19 pandemic to improve public health policies and communication strategies. Methods: We selected Weibo as the data source and collected all influenza A--related Weibo posts from November 1, 2022, to March 31, 2023. These data included user names, geographic locations, posting times, content, repost counts, comments, likes, user types, and more. Subsequently, we used latent Dirichlet allocation topic modeling to analyze the public's focus as well as the bidirectional long short-term memory model to conduct emotional analysis. We further classified the focus areas and emotional orientations of different regions. Results: The research findings indicate that, compared with China's western provinces, the eastern provinces exhibited a higher volume of Weibo posts, demonstrating a greater interest in influenza A. Moreover, inland provinces displayed elevated levels of concern compared with coastal regions. In addition, female users of Weibo exhibited a higher level of engagement than male users, with regular users comprising the majority of user types. The public's focus was categorized into 23 main themes, with the overall emotional sentiment predominantly leaning toward negativity (making up 7562 out of 9111 [83\%] sentiments). Conclusions: The results of this study underscore the profound societal impact of the COVID-19 pandemic. People tend to be pessimistic toward new large-scale infectious diseases, and disparities exist in the levels of concern and emotional sentiments across different regions. This reflects diverse societal responses to health crises. By gaining an in-depth understanding of the public's attitudes and focal points regarding these infectious diseases, governments and decision makers can better formulate policies and action plans to cater to the specific needs of different regions and enhance public health awareness. ", doi="10.2196/49300", url="https://www.jmir.org/2023/1/e49300", url="http://www.ncbi.nlm.nih.gov/pubmed/37917144" } @Article{info:doi/10.2196/50833, author="Gilmore, K. Amanda and Fortson, Kennicia and Mullican, Nicole K. and Garc{\'i}a-Ram{\'i}rez, Grisel and Hutchins, Anna and Bartlett, M. Alyssa and Gooding, C. Holly and Wallis, Elizabeth and Levy, Sharon and Ruggiero, J. Kenneth and Kaysen, Debra and Danielson, Kmett Carla and Platner, Robert and Hartman, April and Self-Brown, Shannon", title="An eHealth Prevention Program for Substance Use, Sexual Assault, and Sexual Risk Behaviors for Adolescents in Primary Care: Pilot Feasibility Randomized Controlled Trial of Teen Well Check", journal="JMIR Form Res", year="2023", month="Nov", day="2", volume="7", pages="e50833", keywords="prevention", keywords="adolescents", keywords="eHealth", keywords="drug use", keywords="sexual assault", keywords="sexual health", abstract="Background: Substance use, sexual assault, and sexual risk behaviors are common among adolescents and are interrelated. Nearly 1 in 5 adolescents use substances before sexual encounters, placing these young people at risk for both sexual assault and sexual risk behaviors. Primary care visits present a unique opportunity to address multiple health risk behaviors. Objective: Teen Well Check is a web-based integrated prevention program for substance use, sexual assault, and sexual risk behaviors with demonstrated usability and acceptability among patients and providers. The aim of this study was to conduct a pilot randomized controlled trial to assess feasibility. Methods: Adolescents (n=123) aged 14 to 18 years from diverse backgrounds were recruited from primarily Medicaid-serving pediatric primary care clinics. Participants completed a baseline survey; were randomized to receive Teen Well Check or an assessment-only control; and completed 1-, 3-, and 6-month follow-up surveys. Feasibility was assessed in terms of recruitment and retention rates. Preliminary changes from baseline to follow-up periods were examined separately in the Teen Well Check and control conditions. Results: We recruited 123 participants (Teen Well Check: n=61, 49.6\%; control: n=62, 50.4\%). Of the 61 participants assigned to the Teen Well Check condition, 55 (90\%) completed the full program and viewed all intervention content. Of the 123 participants, 105 (85.4\%) were retained across at least 1 follow-up period, and there was no difference in follow-up rates between the conditions ($\chi$21=0.6; P=.43). The completion of Teen Well Check took an average of 6.2 (SD 5.8) minutes. Preliminary analyses revealed that there were significant reductions in perceived peer norms (descriptive norms) for substance use before sex across follow-ups among participants in the Teen Well Check condition (P=.001 from baseline to 6 months), whereas there were significant increases among participants in the control condition (P=.003 from baseline to 6 months). In addition, there were nonsignificant reductions in substance misuse risk from baseline to the 6-month follow-up among participants in the Teen Well Check condition (P=.16). Conclusions: These findings support the feasibility of Teen Well Check delivery within pediatric primary care clinics. A randomized clinical trial is needed to assess efficacy. Trial Registration: ClinicalTrials.gov NCT3489434; https://www.clinicaltrials.gov/study/NCT03489434 ", doi="10.2196/50833", url="https://formative.jmir.org/2023/1/e50833", url="http://www.ncbi.nlm.nih.gov/pubmed/37917146" } @Article{info:doi/10.2196/49137, author="Luo, Rui and Xie, Zhi and Silenzio, B. Vincent M. and Kuang, Yun and Luo, Dan", title="Gay App Use, Sexuality Traits, and High-Risk Sexual Behaviors Among Men Who Have Sex With Men in China: Mediation Analysis", journal="J Med Internet Res", year="2023", month="Nov", day="1", volume="25", pages="e49137", keywords="geosocial networking apps", keywords="men who have sex with men", keywords="respondent-driven sampling", keywords="high-risk sexual behaviors", keywords="sexuality traits", keywords="mobile phone", abstract="Background: Gay geosocial networking apps, also known as ``gay apps,'' have gained increasing popularity in the men who have sex with men (MSM) community. Certain sexuality traits and gay app use are both associated with high-risk sexual behaviors among MSM. However, little is known about the underlying mechanism of such relationships. Objective: Based on the uses and gratifications theory, this study aimed to test the mediation effect of gay app use on the relationship between sexuality traits (sexual compulsivity and sexual sensation seeking) and high-risk sexual behaviors (multiple sexual partners and unprotected anal intercourse) among MSM. Methods: A cross-sectional, multicenter study was conducted in Wuhan and Changsha, China, from August to October 2020. A representative sample of 402 MSM was recruited through respondent-driven sampling. A self-administered web-based structured questionnaire was used to collect data on sociodemographic information, high-risk sexual behaviors, gay app use, sexual compulsivity, and sexual sensation seeking. Path analysis was conducted to assess the mediation effect. Results: Our study revealed that 67.42\% (n=271) of MSM used gay apps for seeking potential sexual partners, with 37.06\% (n=149) of them engaging in unprotected anal intercourse, and 45.42\% (n=218) of them having multiple sexual partners. Of the participants, 17.16\% (n=69) reported significant sexual compulsivity, while 29.10\% (n=117) reported significant sexual sensation seeking. Notably, gay app usage partially mediated the relationship between sexual compulsivity and multiple sexual partners but fully mediated the relationship between sexual compulsivity and unprotected anal intercourse. Furthermore, gay app usage partially mediated the relationship between sexual sensation seeking and multiple sexual partners but fully mediated the relationship between sexual sensation seeking and unprotected anal intercourse. Conclusions: High-risk sexual behaviors are common among MSM. Most MSM rely on gay apps to find sexual partners, which, when combined with higher levels of sexual compulsivity and sexual sensation seeking, can increase the likelihood of engaging in high-risk sexual behaviors. Therefore, interventions aimed at reducing these behaviors among MSM should focus on addressing the use of gay apps, while also considering the influence of their sexuality traits on gay app use. ", doi="10.2196/49137", url="https://www.jmir.org/2023/1/e49137", url="http://www.ncbi.nlm.nih.gov/pubmed/37910154" } @Article{info:doi/10.2196/46897, author="Seth, Rajeev and Dhaliwal, K. Baldeep and Miller, Emily and Best, Tyler and Sullivan, Alexis and Thankachen, Betty and Qaiyum, Yawar and Shet, Anita", title="Leveling the Research Playing Field: Decolonizing Global Health Research Through Web-Based Platforms", journal="J Med Internet Res", year="2023", month="Oct", day="31", volume="25", pages="e46897", keywords="decolonization", keywords="vaccination", keywords="community", keywords="community engagement", keywords="health equity", keywords="health research", keywords="online", keywords="online platform", keywords="web-based platform", keywords="systemic barrier", keywords="diversity", keywords="marginalized", keywords="promote", keywords="equity", keywords="research", doi="10.2196/46897", url="https://www.jmir.org/2023/1/e46897", url="http://www.ncbi.nlm.nih.gov/pubmed/37906225" } @Article{info:doi/10.2196/47563, author="De Gaetano, Alessandro and Bajardi, Paolo and Gozzi, Nicol{\`o} and Perra, Nicola and Perrotta, Daniela and Paolotti, Daniela", title="Behavioral Changes Associated With COVID-19 Vaccination: Cross-National Online Survey", journal="J Med Internet Res", year="2023", month="Oct", day="31", volume="25", pages="e47563", keywords="COVID-19", keywords="vaccines", keywords="social behaviors", keywords="online surveys", keywords="nonpharmaceutical interventions", keywords="survey", keywords="vaccination", keywords="behavior", keywords="NPIs", keywords="prevention", abstract="Background: During the initial phases of the vaccination campaign worldwide, nonpharmaceutical interventions (NPIs) remained pivotal in the fight against the COVID-19 pandemic. In this context, it is important to understand how the arrival of vaccines affected the adoption of NPIs. Indeed, some individuals might have seen the start of mass vaccination campaigns as the end of the emergency and, as a result, relaxed their COVID-safe behaviors, facilitating the spread of the virus in a delicate epidemic phase such as the initial rollout. Objective: The aim of this study was to collect information about the possible relaxation of protective behaviors following key events of the vaccination campaign in four countries and to analyze possible associations of these behavioral tendencies with the sociodemographic characteristics of participants. Methods: We developed an online survey named ``COVID-19 Prevention and Behavior Survey'' that was conducted between November 26 and December 22, 2021. Participants were recruited using targeted ads on Facebook in four different countries: Brazil, Italy, South Africa, and the United Kingdom. We measured the onset of relaxation of protective measures in response to key events of the vaccination campaign, namely personal vaccination and vaccination of the most vulnerable population. Through calculation of odds ratios (ORs) and regression analysis, we assessed the strength of association between compliance with NPIs and sociodemographic characteristics of participants. Results: We received 2263 questionnaires from the four countries. Participants reported the most significant changes in social activities such as going to a restaurant or the cinema and visiting relatives and friends. This is in good agreement with validated psychological models of health-related behavioral change such as the Health Belief Model, according to which activities with higher costs and perceived barriers (eg, social activities) are more prone to early relaxation. Multivariate analysis using a generalized linear model showed that the two main determinants of the drop of social NPIs were (1) having previously tested positive for COVID-19 (after the second vaccine dose: OR 2.46, 95\% CI 1.73-3.49) and (2) living with people at risk (after the second vaccine dose: OR 1.57, 95\% CI 1.22-2.03). Conclusions: This work shows that particular caution has to be taken during vaccination campaigns. Indeed, people might relax their safe behaviors regardless of the dynamics of the epidemic. For this reason, it is crucial to maintain high compliance with NPIs to avoid hindering the beneficial effects of the vaccine. ", doi="10.2196/47563", url="https://www.jmir.org/2023/1/e47563", url="http://www.ncbi.nlm.nih.gov/pubmed/37906219" } @Article{info:doi/10.2196/46890, author="Lin, Yuxi and Ren, Ci and Liao, Meizhen and Kang, Dianmin and Li, Chuanxi and Jiao, Kedi and Wang, Lin and Yan, Yu and Li, Yijun and Wu, Taoyu and Cheng, Chunxiao and Zhao, Zhe and Xu, Zece and Tang, Weiming and Tucker, D. Joseph and Ma, Wei", title="Digital, Crowdsourced, Multilevel Intervention to Promote HIV Testing Among Men Who Have Sex With Men: Cluster Randomized Controlled Trial", journal="J Med Internet Res", year="2023", month="Oct", day="30", volume="25", pages="e46890", keywords="men who have sex with men", keywords="HIV testing", keywords="digital intervention", keywords="multilevel intervention", keywords="cluster randomized controlled trial", keywords="China", abstract="Background: Despite great efforts in HIV prevention worldwide, HIV testing uptake among men who have sex with men (MSM) remains suboptimal. The effectiveness of digital, crowdsourced, multilevel interventions in improving HIV testing is still unclear. Objective: The aim of this study was to evaluate the effect of a digital, crowdsourced, multilevel intervention in improving HIV testing uptake among MSM in China. Methods: We conducted a 2-arm cluster randomized controlled trial among MSM in 11 cities in Shandong province, China, from August 2019 to April 2020. Participants were men who were HIV seronegative or had unknown serum status, had anal sex with a man in the past 12 months, and had not been tested for HIV in the past 3 months. Participants were recruited through a gay dating app and community-based organizations from preselected cities; these cities were matched into 5 blocks (2 clusters per block) and further randomly assigned (1:1) to receive a digital, crowdsourced, multilevel intervention (intervention arm) or routine intervention (control arm). The digital multilevel intervention was developed through crowdsourced open calls tailored for MSM, consisting of digital intervention images and videos, the strategy of providing HIV self-testing services through digital tools, and peer-moderated discussion within WeChat groups. The primary outcome was self-reported HIV testing uptake in the previous 3 months. An intention-to-treat approach was used to examine the cluster-level effect of the intervention in the 12-month study period using generalized linear mixed models and the individual-level effect using linear mixed models. Results: A total of 935 MSM were enrolled (404 intervention participants and 531 controls); 751 participants (80.3\%) completed at least one follow-up survey. Most participants were younger than 30 years (n=601, 64.3\%), single (n=681, 72.8\%), had a college degree or higher (n=629, 67.3\%), and had an HIV testing history (n=785, 84\%). Overall, the proportion of testing for HIV in the past 3 months at the 3-, 6-, 9-, and 12-month follow-ups was higher in the intervention arm (139/279, 49.8\%; 148/266, 55.6\%; 189/263, 71.9\%; and 171/266, 64.3\%, respectively) than the control arm (183/418, 43.8\%; 178/408, 43.6\%; 206/403, 51.1\%; and 182/397, 48.4\%, respectively), with statistically significant differences at the 6-, 9-, and 12-month follow-ups. At the cluster level, the proportion of participants who had tested for HIV increased 11.62\% (95\% CI 0.74\%-22.5\%; P=.04) with the intervention. At the individual level, participants in the intervention arm had 69\% higher odds for testing for HIV in the past 3 months compared with control participants, but the result was not statistically significant (risk ratio 1.69, 95\% CI 0.87-3.27; P=.11). Conclusions: The intervention effectively improved HIV testing uptake among Chinese MSM. Our findings highlight that digital, crowdsourced, multilevel interventions should be made more widely available for HIV prevention and other public health issues. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900024350; http://www.chictr.org.cn/showproj.aspx?proj=36718. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04860-8 ", doi="10.2196/46890", url="https://www.jmir.org/2023/1/e46890", url="http://www.ncbi.nlm.nih.gov/pubmed/37902831" } @Article{info:doi/10.2196/51605, author="Waters, R. Austin and Turner, Cindy and Easterly, W. Caleb and Tovar, Ida and Mulvaney, Megan and Poquadeck, Matt and Johnston, Hailey and Ghazal, V. Lauren and Rains, A. Stephen and Cloyes, G. Kristin and Kirchhoff, C. Anne and Warner, L. Echo", title="Exploring Online Crowdfunding for Cancer-Related Costs Among LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer, Plus) Cancer Survivors: Integration of Community-Engaged and Technology-Based Methodologies", journal="JMIR Cancer", year="2023", month="Oct", day="30", volume="9", pages="e51605", keywords="community-engaged", keywords="LGBT", keywords="SGM", keywords="financial burden", keywords="crowdfunding", keywords="sexual monitory", keywords="sexual minorities", keywords="crowdfund", keywords="fund", keywords="funding", keywords="fundraising", keywords="fundraise", keywords="engagement", keywords="finance", keywords="financial", keywords="campaign", keywords="campaigns", keywords="web scraping", keywords="cancer", keywords="oncology", keywords="participatory", keywords="dictionary", keywords="term", keywords="terms", keywords="terminology", keywords="terminologies", keywords="classification", keywords="underrepresented", keywords="equity", keywords="inequity", keywords="inequities", keywords="cost", keywords="costs", abstract="Background: Cancer survivors frequently experience cancer-related financial burdens. The extent to which Lesbian, Gay, Bisexual, Transgender, Queer, Plus (LGBTQ+) populations experience cancer-related cost-coping behaviors such as crowdfunding is largely unknown, owing to a lack of sexual orientation and gender identity data collection and social stigma. Web-scraping has previously been used to evaluate inequities in online crowdfunding, but these methods alone do not adequately engage populations facing inequities. Objective: We describe the methodological process of integrating technology-based and community-engaged methods to explore the financial burden of cancer among LGBTQ+ individuals via online crowdfunding. Methods: To center the LGBTQ+ community, we followed community engagement guidelines by forming a study advisory board (SAB) of LGBTQ+ cancer survivors, caregivers, and professionals who were involved in every step of the research. SAB member engagement was tracked through quarterly SAB meeting attendance and an engagement survey. We then used web-scraping methods to extract a data set of online crowdfunding campaigns. The study team followed an integrated technology-based and community-engaged process to develop and refine term dictionaries for analyses. Term dictionaries were developed and refined in order to identify crowdfunding campaigns that were cancer- and LGBTQ+-related. Results: Advisory board engagement was high according to metrics of meeting attendance, meeting participation, and anonymous board feedback. In collaboration with the SAB, the term dictionaries were iteratively edited and refined. The LGBTQ+ term dictionary was developed by the study team, while the cancer term dictionary was refined from an existing dictionary. The advisory board and analytic team members manually coded against the term dictionary and performed quality checks until high confidence in correct classification was achieved using pairwise agreement. Through each phase of manual coding and quality checks, the advisory board identified more misclassified campaigns than the analytic team alone. When refining the LGBTQ+ term dictionary, the analytic team identified 11.8\% misclassification while the SAB identified 20.7\% misclassification. Once each term dictionary was finalized, the LGBTQ+ term dictionary resulted in a 95\% pairwise agreement, while the cancer term dictionary resulted in an 89.2\% pairwise agreement. Conclusions: The classification tools developed by integrating community-engaged and technology-based methods were more accurate because of the equity-based approach of centering LGBTQ+ voices and their lived experiences. This exemplar suggests integrating community-engaged and technology-based methods to study inequities is highly feasible and has applications beyond LGBTQ+ financial burden research. ", doi="10.2196/51605", url="https://cancer.jmir.org/2023/1/e51605", url="http://www.ncbi.nlm.nih.gov/pubmed/37902829" } @Article{info:doi/10.2196/47050, author="Kuehl, Kerry and Elliot, Diane and DeFrancesco, Carol and McGinnis, Wendy and Ek, Susanna and Garg, Bharti", title="A Web-Based Total Worker Health Intervention for Those Fighting Wildland Fires: Mixed Methods Development and Effectiveness Trial", journal="J Med Internet Res", year="2023", month="Oct", day="25", volume="25", pages="e47050", keywords="wildland", keywords="firefighter", keywords="Total Worker Health", keywords="web-based", keywords="occupational safety", keywords="health promotion", keywords="wildland firefighter", keywords="web-based safety", keywords="mixed methods", keywords="occupational health", keywords="health and safety", keywords="health care worker", keywords="mobile phone", abstract="Background: Fire seasons are longer, with more and larger wildfires, placing increased demands and risks on those fighting wildland fires. There are multiple agencies involved with fighting wildland fires and unique worksite conditions make meeting these workers' needs a challenge. Objective: The aim of the study is to develop and establish the effectiveness of a web-based safety and health program for those fighting wildland fires. Methods: This mixed methods project had 3 phases. The initial qualitative phase assessed the needs of 150 diverse firefighters through interviews and focus groups across 11 US sites to establish and prioritize program content. Interview transcripts were read for thematic content with iterative readings used to identify, code, and rank health and safety issues. The second phase used that information to build a comprehensive Total Worker Health program for those fighting wildfires. The program content was based on the qualitative interview data and consisted of 6 core and 8 elective 30-minute, web-based modules primarily done individually on a smartphone or computer. The final, third phase evaluated the program with a quantitative prospective proof-of-concept, usability, and effectiveness trial among wildland firefighter participants. Effectiveness was assessed with paired 2-tailed t tests for pre- and post-Likert agreement scale survey items, adjusted for multiple comparisons. In addition to assessing mean and SD at baseline and postsurvey, observed effect sizes were calculated (Cohen d). Usability and reaction to the program among firefighters who responded to postsurvey were also assessed. Results: The qualitative themes and subthemes were used to inform the program's content. For the effectiveness trial, 131 firefighters completed the presurvey, and 50 (38.2\%) completed the postsurvey. The majority of the participants were White (n=123, 93.9\%), male (n=117, 89.3\%), with an average age of 41 (SD 12.9) years. Significant increases in knowledge and desired health and safety behaviors were found for both cancer (P<.001) and cardiovascular risk (P=.01), nutrition behaviors (P=.01), hydration or overheating (P=.001), binge drinking (P=.002), and getting medical checkups (P=.001). More than 80\% (n=40) of postsurvey respondents agreed or strongly agreed that the program was easy to use and would recommend it to others. Conclusions: An innovative web-based safety and health promotion program for those fighting wildland fires was feasible, scalable, and usable. It improved the health and safety of those fighting wildland fires. Trial Registration: ClinicalTrials.gov NCT05753358; https://classic.clinicaltrials.gov/ct2/show/NCT05753358 ", doi="10.2196/47050", url="https://www.jmir.org/2023/1/e47050", url="http://www.ncbi.nlm.nih.gov/pubmed/37878362" } @Article{info:doi/10.2196/49955, author="Bahattab, Awsan and Hanna, Michel and Teo Voicescu, George and Hubloue, Ives and Della Corte, Francesco and Ragazzoni, Luca", title="e-Learning Evaluation Framework and Tools for Global Health and Public Health Education: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2023", month="Oct", day="24", volume="12", pages="e49955", keywords="computer-assisted instruction", keywords="disaster medicine", keywords="disaster", keywords="e-learning", keywords="educational assessment", keywords="global health", keywords="medical education", keywords="public health", keywords="evaluation", keywords="scoping", keywords="review methods", keywords="review methodology", keywords="education", keywords="educational", abstract="Background: There has been a significant increase in the use of e-learning for global and public health education recently, especially following the COVID-19 pandemic. e-Learning holds the potential to offer equal opportunities, overcoming barriers like physical limitations and training costs. However, its effectiveness remains debated, with institutions unprepared for the sudden shift during the pandemic. To effectively evaluate the outcomes of e-learning, a standardized and rigorous approach is necessary. However, the existing literature on this subject often lacks standardized assessment tools and theoretical foundations, leading to ambiguity in the evaluation process. Consequently, it becomes imperative to identify a clear theoretical foundation and practical approach for evaluating global and public health e-learning outcomes. Objective: This protocol for a scoping review aims to map the state of e-learning evaluation in global and public health education to determine the existing theoretical evaluation frameworks, methods, tools, and domains and the gaps in research and practice. Methods: The scoping review will be conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The initial search was performed in PubMed, Education Resource Information Center, Web of Science, and Scopus to identify peer-reviewed articles that report on the use of evaluation and assessment for e-learning training. The search strings combined the concepts of e-learning, public health, and health science education, along with evaluation and frameworks. After the initial search, a screening process will be carried out to determine the relevance of the identified studies to the research question. Data related to the characteristics of the included studies, the characteristics of the e-learning technology used in the studies, and the study outcomes will be extracted from the eligible articles. The extracted data will then undergo a structured, descriptive, quantitative, and qualitative content analysis to synthesize the information from the selected studies. Results: ?Initial database searches yielded a total of 980 results. Duplicates have been removed, and title and abstract screening of the 805 remaining extracted articles are underway. Quantitative and qualitative findings from the reviewed articles will be presented to answer the study objective. Conclusions: This scoping review will provide global and public health educators with a comprehensive overview of the current state of e-learning evaluation. By identifying existing e-learning frameworks and tools, the findings will offer valuable guidance for further advancements in global and public health e-learning evaluation. The study will also enable the creation of a comprehensive, evidence-based e-learning evaluation framework and tools, which will improve the quality and accountability of global health and public health education. Ultimately, this will contribute to better health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/49955 ", doi="10.2196/49955", url="https://www.researchprotocols.org/2023/1/e49955", url="http://www.ncbi.nlm.nih.gov/pubmed/37874640" } @Article{info:doi/10.2196/50199, author="Unlu, Ali and Truong, Sophie and Tammi, Tuukka and Lohiniva, Anna-Leena", title="Exploring Political Mistrust in Pandemic Risk Communication: Mixed-Method Study Using Social Media Data Analysis", journal="J Med Internet Res", year="2023", month="Oct", day="20", volume="25", pages="e50199", keywords="political trust", keywords="social media", keywords="text classification", keywords="topic modeling", keywords="COVID-19", keywords="Finland", keywords="trust", keywords="authority", keywords="public health outcome", keywords="pandemic", keywords="perception", keywords="mistrust", keywords="interaction", keywords="Twitter", keywords="Facebook", keywords="analysis", keywords="computational method", keywords="natural language processing", keywords="misinformation", keywords="communication", keywords="crisis", abstract="Background: This research extends prior studies by the Finnish Institute for Health and Welfare on pandemic-related risk perception, concentrating on the role of trust in health authorities and its impact on public health outcomes. Objective: The paper aims to investigate variations in trust levels over time and across social media platforms, as well as to further explore 12 subcategories of political mistrust. It seeks to understand the dynamics of political trust, including mistrust accumulation, fluctuations over time, and changes in topic relevance. Additionally, the study aims to compare qualitative research findings with those obtained through computational methods. Methods: Data were gathered from a large-scale data set consisting of 13,629 Twitter and Facebook posts from 2020 to 2023 related to COVID-19. For analysis, a fine-tuned FinBERT model with an 80\% accuracy rate was used for predicting political mistrust. The BERTopic model was also used for superior topic modeling performance. Results: Our preliminary analysis identifies 43 mistrust-related topics categorized into 9 major themes. The most salient topics include COVID-19 mortality, coping strategies, polymerase chain reaction testing, and vaccine efficacy. Discourse related to mistrust in authority is associated with perceptions of disease severity, willingness to adopt health measures, and information-seeking behavior. Our findings highlight that the distinct user engagement mechanisms and platform features of Facebook and Twitter contributed to varying patterns of mistrust and susceptibility to misinformation during the pandemic. Conclusions: The study highlights the effectiveness of computational methods like natural language processing in managing large-scale engagement and misinformation. It underscores the critical role of trust in health authorities for effective risk communication and public compliance. The findings also emphasize the necessity for transparent communication from authorities, concluding that a holistic approach to public health communication is integral for managing health crises effectively. ", doi="10.2196/50199", url="https://www.jmir.org/2023/1/e50199", url="http://www.ncbi.nlm.nih.gov/pubmed/37862088" } @Article{info:doi/10.2196/48968, author="Mansor, Norain and Ahmad, Norliza and Md Said, Salmiah and Tan, Kit-Aun and Sutan, Rosnah", title="Effectiveness of a Theory-Based Digital Animated Video Intervention to Reduce Intention and Willingness to Sext Among Diploma Students: Cluster Randomized Controlled Trial", journal="J Med Internet Res", year="2023", month="Oct", day="20", volume="25", pages="e48968", keywords="sexting", keywords="randomized controlled trial", keywords="YouTube", keywords="intention", keywords="willingness", keywords="young adult", keywords="Malaysia, diploma students", keywords="digital content", keywords="digital health intervention", keywords="attrition rate", keywords="primary outcome", keywords="sexual risk", keywords="sexual health", keywords="WhatsApp", abstract="Background: Sexting refers to the exchange of sexually explicit digital content in the form of texts, photos, or videos. In recent years, sexting has become a public health concern. Surveys in Malaysia show a high prevalence of young adults engaged in sexting. Given that sexting is associated with sexual risk behavior, cyberbullying, and mental health issues, this behavior needs intervention to alleviate the resulting public health burden. However, there is a scarcity of theory-based intervention programs on the prevention of intention and willingness to sext among young adults. Objective: This study aimed to develop and implement a sexting intervention module guided by the prototype willingness model (PWM), delivered using web-based animated video, and evaluate its effectiveness among diploma students from a public higher educational institution. The primary outcomes were intention and willingness to sext, while the secondary outcomes were knowledge, attitude, perceived norms, and prototype perceptions of sexting. Methods: This 2-armed, parallel, single-blinded cluster randomized controlled trial was conducted in a public higher educational institution in the state of Melaka, Malaysia. Diploma students from 12 programs were randomly allocated into intervention and control groups. Both groups answered a self-administered web-based questionnaire assessing the outcomes at the baseline. The intervention group received a newly developed intervention module based on the PWM in the form of 5 animated videos posted on a private YouTube platform, while the control group was put on the waitlist. The intervention group was encouraged to discuss any issues raised with the researchers via WhatsApp private chat after viewing the videos. All participants were observed immediately and 3 months postintervention. Data analysis was performed with SPSS (version 26; IBM Corp). A generalized linear mixed model was used to determine the effectiveness of the intervention. Results: There were a total of 300 participants with an attrition rate of 8.3\% (n=25). After adjusting for age, sex, relationship status, and the amount of time spent on the web, there were significant differences in the intention to sext ($\beta$=--.12; P=.002; Cohen d=0.23), willingness to sext ($\beta$=--.16; P<.001; Cohen d=0.40), knowledge ($\beta$=.12; P<.001; Cohen d=0.39), attitude ($\beta$=--.11; P=.001; Cohen d=0.31), perceived norms ($\beta$=--.06; P=.04; Cohen d=0.18), and prototype perceptions ($\beta$=--.11; P<.001; Cohen d=0.35) between the intervention and control groups over 3 months. Conclusions: In this study, the sexting intervention module using the PWM that was delivered via web-based animated videos was effective in reducing intention and willingness to sext as well as in improving knowledge of sexting, attitudes, perceived norms, and prototype perceptions. Therefore, relevant agencies involved in the promotion of sexual and reproductive health among young adults in Malaysia can consider the implementation of this module. Trial Registration: Thai Clinical Trial Registry TCTR20201010002; https://www.thaiclinicaltrials.org/show/TCTR20201002001 ", doi="10.2196/48968", url="https://www.jmir.org/2023/1/e48968", url="http://www.ncbi.nlm.nih.gov/pubmed/37862090" } @Article{info:doi/10.2196/45715, author="Kaburi, Benduri Basil and Wyss, Kaspar and Kenu, Ernest and Asiedu-Bekoe, Franklin and Hauri, M. Anja and Laryea, Odai Dennis and Klett-Tammen, J. Carolina and Leone, Fr{\'e}d{\'e}ric and Walter, Christin and Krause, G{\'e}rard", title="Facilitators and Barriers in the Implementation of a Digital Surveillance and Outbreak Response System in Ghana Before and During the COVID-19 Pandemic: Qualitative Analysis of Stakeholder Interviews", journal="JMIR Form Res", year="2023", month="Oct", day="20", volume="7", pages="e45715", keywords="implementation", keywords="Surveillance Outbreak Response Management and Analysis System", keywords="SORMAS", keywords="barriers", keywords="facilitators", keywords="digital disease surveillance", keywords="outbreak response", keywords="COVID-19", keywords="pandemic", keywords="Ghana", keywords="mobile phone", abstract="Background: In the past 2 decades, many countries have recognized the use of electronic systems for disease surveillance and outbreak response as an important strategy for disease control and prevention. In low- and middle-income countries, the adoption of these electronic systems remains a priority and has attracted the support of global health players. However, the successful implementation and institutionalization of electronic systems in low- and middle-income countries have been challenged by the local capacity to absorb technologies, decisiveness and strength of leadership, implementation costs, workforce attitudes toward innovation, and organizational factors. In November 2019, Ghana piloted the Surveillance Outbreak Response Management and Analysis System (SORMAS) for routine surveillance and subsequently used it for the national COVID-19 response. Objective: This study aims to identify the facilitators of and barriers to the sustainable implementation and operation of SORMAS in Ghana. Methods: Between November 2021 and March 2022, we conducted a qualitative study among 22 resource persons representing different stakeholders involved in the implementation of SORMAS in Ghana. We interviewed study participants via telephone using in-depth interview guides developed consistent with the model of diffusion of innovations in health service organizations. We transcribed the interviews verbatim and performed independent validation of transcripts and pseudonymization. We performed deductive coding using 7 a priori categories: innovation, adopting health system, adoption and assimilation, diffusion and dissemination, outer context, institutionalization, and linkages among the aspects of implementation. We used MAXQDA Analytics Pro for transcription, coding, and analysis. Results: The facilitators of SORMAS implementation included its coherent design consistent with the Integrated Disease Surveillance and Response system, adaptability to evolving local needs, relative advantages for task performance (eg, real-time reporting, generation of case-base data, improved data quality, mobile offline capability, and integration of laboratory procedures), intrinsic motivation of users, and a smartphone-savvy workforce. Other facilitators were its alignment with health system goals, dedicated national leadership, political endorsement, availability of in-country IT capacities, and financial and technical support from inventors and international development partners. The main barriers were unstable technical interoperability between SORMAS and existing health information systems, reliance on a private IT company for data hosting, unreliable internet connectivity, unstable national power supply, inadequate numbers and poor quality of data collection devices, and substantial dependence on external funding. Conclusions: The facilitators of and barriers to SORMAS implementation are multiple and interdependent. Important success conditions for implementation include enhanced scope and efficiency of task performance, strong technical and political stewardship, and a self-motivated workforce. Inadequate funding, limited IT infrastructure, and lack of software development expertise are mutually reinforcing barriers to implementation and progress to country ownership. Some barriers are external, relate to the overall national infrastructural development, and are not amenable even to unlimited project funding. ", doi="10.2196/45715", url="https://formative.jmir.org/2023/1/e45715", url="http://www.ncbi.nlm.nih.gov/pubmed/37862105" } @Article{info:doi/10.2196/48641, author="Chau, Brian and Taba, Melody and Dodd, Rachael and McCaffery, Kirsten and Bonner, Carissa", title="Twitch Data in Health Promotion Research: Protocol for a Case Study Exploring COVID-19 Vaccination Views Among Young People", journal="JMIR Res Protoc", year="2023", month="Oct", day="18", volume="12", pages="e48641", keywords="twitch", keywords="social media", keywords="COVID-19", keywords="vaccination communication", keywords="video gaming", keywords="gaming", keywords="health promotion", keywords="streaming", abstract="Background: Social media platforms have emerged as a useful channel for health promotion communication, offering different channels to reach targeted populations. For example, social media has recently been used to disseminate information about COVID-19 vaccination across various demographics. Traditional modes of health communication such as television, health events, and newsletters may not reach all groups within a community. Health communications for younger generations are increasingly disseminated through social media to reflect key information sources. This paper explores a social media gaming platform as an alternative way to reach young people in health promotion research. Objective: This protocol study aimed to pilot-test the potential of Twitch, a live streaming platform initially designed for video gaming, to conduct health promotion research with young people. We used COVID-19 vaccination as a topical case study that was recommended by Australian health authorities at the time of the research. Methods: The research team worked with a Twitch Account Manager to design and test a case study within the guidelines and ethics protocols required by Twitch, identify suitable streamers to approach and establish a protocol for conducting research on the platform. This involved conducting a poll to initiate discussion about COVID-19 vaccination, monitoring the chat in 3 live Twitch sessions with 2 streamers to pilot the protocol, and briefly analyze Twitch chat logs to observe the range of response types that may be acquired from this methodology. Results: The Twitch streams provided logs and videos on demand that were derived from the live session. These included demographics of viewers, chat logs, and polling results. The results of the poll showed a range of engagement in health promotion for the case study topic: the majority of participants had received their vaccination by the time of the poll; however, there was still a proportion that had not received their vaccination yet or had decided to not be vaccinated. Analysis of the Twitch chat logs demonstrated a range of both positive and negative themes regarding health promotion for the case study topic. This included irrelevant comments, misinformation (compared to health authority information at the time of this study), comedic and conspiracy responses, as well as vaccine status, provaccine comments, and vaccine-hesitant comments. Conclusions: This study developed and tested a protocol for using Twitch data for health promotion research with young people. With live polling, open text discussion between participants and immediate responses to questions, Twitch can be used to collect both quantitative and qualitative research data from demographics that use social media. The platform also presents some challenges when engaging with independent streamers and sensitive health topics. This study provides an initial protocol for future researchers to use and build on. International Registered Report Identifier (IRRID): RR1-10.2196/48641 ", doi="10.2196/48641", url="https://www.researchprotocols.org/2023/1/e48641", url="http://www.ncbi.nlm.nih.gov/pubmed/37851494" } @Article{info:doi/10.2196/45085, author="Yang, Liuyang and Zhang, Ting and Han, Xuan and Yang, Jiao and Sun, Yanxia and Ma, Libing and Chen, Jialong and Li, Yanming and Lai, Shengjie and Li, Wei and Feng, Luzhao and Yang, Weizhong", title="Influenza Epidemic Trend Surveillance and Prediction Based on Search Engine Data: Deep Learning Model Study", journal="J Med Internet Res", year="2023", month="Oct", day="17", volume="25", pages="e45085", keywords="early warning", keywords="epidemic intelligence", keywords="infectious disease", keywords="influenza-like illness", keywords="surveillance", abstract="Background: Influenza outbreaks pose a significant threat to global public health. Traditional surveillance systems and simple algorithms often struggle to predict influenza outbreaks in an accurate and timely manner. Big data and modern technology have offered new modalities for disease surveillance and prediction. Influenza-like illness can serve as a valuable surveillance tool for emerging respiratory infectious diseases like influenza and COVID-19, especially when reported case data may not fully reflect the actual epidemic curve. Objective: This study aimed to develop a predictive model for influenza outbreaks by combining Baidu search query data with traditional virological surveillance data. The goal was to improve early detection and preparedness for influenza outbreaks in both northern and southern China, providing evidence for supplementing modern intelligence epidemic surveillance methods. Methods: We collected virological data from the National Influenza Surveillance Network and Baidu search query data from January 2011 to July 2018, totaling 3,691,865 and 1,563,361 respective samples. Relevant search terms related to influenza were identified and analyzed for their correlation with influenza-positive rates using Pearson correlation analysis. A distributed lag nonlinear model was used to assess the lag correlation of the search terms with influenza activity. Subsequently, a predictive model based on the gated recurrent unit and multiple attention mechanisms was developed to forecast the influenza-positive trend. Results: This study revealed a high correlation between specific Baidu search terms and influenza-positive rates in both northern and southern China, except for 1 term. The search terms were categorized into 4 groups: essential facts on influenza, influenza symptoms, influenza treatment and medicine, and influenza prevention, all of which showed correlation with the influenza-positive rate. The influenza prevention and influenza symptom groups had a lag correlation of 1.4-3.2 and 5.0-8.0 days, respectively. The Baidu search terms could help predict the influenza-positive rate 14-22 days in advance in southern China but interfered with influenza surveillance in northern China. Conclusions: Complementing traditional disease surveillance systems with information from web-based data sources can aid in detecting warning signs of influenza outbreaks earlier. However, supplementation of modern surveillance with search engine information should be approached cautiously. This approach provides valuable insights for digital epidemiology and has the potential for broader application in respiratory infectious disease surveillance. Further research should explore the optimization and customization of search terms for different regions and languages to improve the accuracy of influenza prediction models. ", doi="10.2196/45085", url="https://www.jmir.org/2023/1/e45085", url="http://www.ncbi.nlm.nih.gov/pubmed/37847532" } @Article{info:doi/10.2196/40149, author="Chen, Mu and Li, Cheng and Zhang, Jiwei and Cui, Xin and Tian, Wenqi and Liao, Peng and Wang, Qunshan and Sun, Jian and Luo, Li and Wu, Hong and Li, Yi-Gang", title="Cancer and Atrial Fibrillation Comorbidities Among 25 Million Citizens in Shanghai, China: Medical Insurance Database Study", journal="JMIR Public Health Surveill", year="2023", month="Oct", day="17", volume="9", pages="e40149", keywords="cardiovascular", keywords="malignancy", keywords="arrhythmia", keywords="cardio-oncology", keywords="prevalence", keywords="epidemiology", keywords="atrial fibrillation", abstract="Background: With population aging, the prevalence of both cancer and atrial fibrillation (AF) have increased. However, there is scarce epidemiological data concerning the comorbid state of cancer and AF in low- and middle-income countries, including China. Objective: We aimed to evaluate the site-, sex-, and age-specific profiles of cancer and AF comorbidities in Chinese populations. Methods: Data from the Shanghai Municipal Health Commission database between 2015 and 2020 were screened, covering all medical records of Shanghai residents with medical insurance. Site-specific cancer profiles were evaluated for the population with AF relative to the age- and sex-adjusted population of residents without AF. The sex distribution and peak age of cancer diagnosis were also assessed. Results: A total of 25,964,447 adult patients were screened. Among them, 22,185 patients presented cancers comorbid with AF (median 77, IQR 67-82 years of age; men: n=13,631, 61.44\%), while 839,864 presented cancers without AF (median 67, IQR 57-72 years of age; men: n=419,020, 49.89\%), thus yielding a higher cancer prevalence among residents with AF (8.27\%) than among those without AF (6.05\%; P<.001). In the population with AF, the most prevalent cancer type was lung cancer, followed by colorectal, male genital organ, stomach, breast, liver, bladder, thyroid, leukemia, and esophageal cancers. AF was associated with an average of nearly 1.4-fold (prevalence ratio [PR] 1.37, 95\% CI 1.35-1.38) increased prevalence of cancer after adjusting for age and sex. For site-specific analyses, an increased prevalence of cancer in the population with AF was observed in 20 of 21 cancer sites. This increased prevalence was most prominent for nonsolid tumors, including multiple myeloma (PR 2.56, 95\% CI 2.28-2.87), leukemia (PR 1.73, 95\% CI 1.57-1.90), and non-Hodgkin lymphoma (PR 1.59, 95\% CI 1.43-1.77); intrathoracic malignancies, including mediastinum (PR 2.34, 95\% CI 1.89-2.90), lung (PR 1.64, 95\% CI 1.59-1.69), and esophageal cancers (PR 1.41, 95\% CI 1.28-1.56); bone and soft tissue neoplasms (PR 1.56, 95\% CI 1.37-1.77); and kidney cancer (PR 1.53, 95\% CI 1.36-1.72). Cancer prevalence in the population with AF relative to that in the population without AF was higher in men than in women in 14 of 18 cancer sites, and female predominance was only observed for thyroid cancer. The peak age of index cancer diagnosis was lower in the population with AF (age group: 70-74 years) than in that without AF (age group: 75-79 years), especially for specific cancer types, including thyroid, central nervous system, mediastinum, esophageal, bladder, and biliary cancers. Conclusions: Patients with AF are associated with increased prevalence, heightened male predominance, and younger peak age of cancer. Further studies are needed to determine whether early screening of specific cancers is cost-effective and beneficial for patients with AF. ", doi="10.2196/40149", url="https://publichealth.jmir.org/2023/1/e40149", url="http://www.ncbi.nlm.nih.gov/pubmed/37847541" } @Article{info:doi/10.2196/51103, author="Zapata, Pablo Juan and Hirshfield, Sabina and Nelson, Kimberly and Horvath, Keith and John, A. Steven", title="Preferred Characteristics for mHealth Interventions Among Young Sexual Minoritized Men to Support HIV Testing and PrEP Decision-Making: Focus Group Study", journal="JMIR Form Res", year="2023", month="Oct", day="16", volume="7", pages="e51103", keywords="mobile health", keywords="eHealth", keywords="minority health", keywords="male adolescents", keywords="HIV prevention", keywords="sexual health", keywords="support", keywords="HIV testing", keywords="prevention", keywords="decision-making", keywords="men", keywords="sexual minority men", keywords="youth", keywords="adolescent", keywords="mobile simulation", keywords="virtual simulation", keywords="user-friendly", keywords="design", keywords="implementation", keywords="mobile phone", abstract="Background: Epidemiological trends in the United States have shown an increase in HIV cases among young sexual minoritized men. Using mobile health (mHealth), which refers to health services and information delivered or enhanced through the internet and related technologies, is a crucial strategy to address HIV disparities. However, despite its potential, the practical implementation of mHealth remains limited. Additionally, it is important to consider that young individuals may become accustomed to, distracted from, or lose interest in these apps, highlighting the need for regular updates and monitoring of relevant content. Objective: In this study, we sought to highlight the voices of young sexual minoritized men aged 17-24 years and explored preferred mHealth intervention characteristics and willingness to adopt these technologies among a diverse, nationwide sample of young sexual minoritized men. Methods: From April to September 2020, we recruited participants through web-based platforms such as social media and geosocial networking apps for men. These individuals were invited to participate in synchronous web-based focus group discussions centered around topics pertaining to HIV testing and prevention and their preferences for mHealth technologies. Results: A total of 41 young sexual minoritized men, aged between 17 and 24 years, participated in 9 focus group discussions spanning April to September 2020, with 3-7 participants in each group. The findings shed light on three key insights regarding young sexual minoritized men's preferences: (1) the need for personalized and representative content, (2) a preference for mobile and web-based simulation of prevention scenarios, and (3) a preference for digital software with individually tailored content. As expected, preference for mHealth apps was high, which supports the potential and need to develop or adapt interventions that use smartphones as a platform for engaging young sexual minoritized men in HIV prevention. This study expands on previous research in multiple meaningful ways, delving into the use and perceptions of mHealth information amid the COVID-19 pandemic. This study also highlighted the importance of streamlined access to health care providers, especially in light of the barriers faced by young people during the COVID-19 pandemic. In terms of presentation and navigation, participants favored a user-friendly design that was easy to use and appropriate for their age, which was effectively addressed through the implementation of web-based simulations. Conclusions: Ultimately, this study provides valuable insight into the preferences of young sexual minoritized men when it comes to mHealth interventions and highlights the need for further research in order to develop effective and tailored HIV prevention tools. A future direction for researchers is to evaluate how best to address participants' desire for personalized content within mHealth apps. Additionally, as technology rapidly evolves, there is a need to re-assess the effectiveness of web-based simulations, particularly those that are used in HIV prevention. ", doi="10.2196/51103", url="https://formative.jmir.org/2023/1/e51103", url="http://www.ncbi.nlm.nih.gov/pubmed/37713640" } @Article{info:doi/10.2196/48459, author="Davis-Ewart, Leah and Grov, Christian and Verhagen, Rachel and Manuel, Jennifer and Viamonte, Michael and Dilworth, Samantha and O'Dell, Nicole and Valentin, Omar and Carr, Sidney and Cherenack, Emily and Henderson, Chelsea and Doblecki-Lewis, Susanne and Nahum-Shani, Inbal and Carrico, W. Adam", title="Motivational Enhancement Interventions to Increase Pre-Exposure Prophylaxis Use in Sexual Minority Men Who Use Stimulants: Protocol for a Pilot Sequential Multiple Assignment Randomized Trial", journal="JMIR Res Protoc", year="2023", month="Oct", day="13", volume="12", pages="e48459", keywords="cocaine", keywords="contingency management", keywords="methamphetamine", keywords="motivational interviewing", keywords="pre-exposure prophylaxis", keywords="intervention", keywords="men", keywords="stimulant", keywords="condom", keywords="HIV testing", keywords="prevention", keywords="HIV", keywords="effectiveness", keywords="telehealth", keywords="motivation", abstract="Background: Although pre-exposure prophylaxis (PrEP) could substantially mitigate HIV risk, sexual minority men who use stimulants commonly experience difficulties with engaging in PrEP clinical services. Motivational interviewing (MI) and contingency management (CM) reduce substance use and condomless anal sex (CAS) in this population, but these motivational enhancement interventions require modifications to promote engagement along the PrEP care continuum. Objective: PrEP Readiness Interventions for Supporting Motivation (PRISM) is a pilot sequential multiple assignment randomized trial testing the feasibility, acceptability, and preliminary effectiveness of distinct combinations of telehealth MI and CM in 70 cisgender sexual minority men who use stimulants that are not currently taking PrEP. Methods: A national sample was recruited via social networking applications to complete a baseline assessment and mail-in HIV testing. Those with nonreactive HIV results were randomized to receive either (1) a 2-session MI intervention focusing on PrEP use (session 1) and concomitant stimulant use or CAS (session 2) or (2) a CM intervention with financial incentives for documented evidence of PrEP clinical evaluation by a medical provider (US \$50) and filling a PrEP prescription (US \$50). At the 3-month follow-up assessment, participants who reported they had not filled a prescription for PrEP were randomized a second time to either (1) switch to a second-stage intervention (ie, MI+CM or CM+MI) or (2) continue with assessments only. Outcomes for both responders and nonresponders were reassessed at a 6-month follow-up. The primary outcome is documented evidence of filling a PrEP prescription over 6 months. Self-reported secondary outcomes include PrEP clinical evaluation by a medical provider, stimulant use, and CAS. Qualitative exit interviews were conducted with a subgroup of responders and nonresponders to characterize their experiences with the MI and CM interventions. Results: Implementation of PRISM underscores challenges in reaching sexual minority men who use stimulants to optimize HIV prevention efforts. Approximately 1 in 10 (104/1060) eligible participants have enrolled. Of the 104 who enrolled, 87 (84\%) completed mail-in HIV testing. We delivered 5 preliminary HIV-positive results, including posttest counseling with referrals to confirmatory testing. Conclusions: Lessons learned from PRISM underscore the central importance of a flexible, participant-centered approach to support the engagement of sexual minority men who use stimulants. Leveraging telehealth platforms to deliver motivational enhancement interventions also expanded their reach and potential public health impact with this high-priority population. Further research is needed to determine the effectiveness of telehealth MI and CM for supporting PrEP use in sexual minority men who use stimulants. Trial Registration: ClinicalTrials.gov NCT04205487; https://clinicaltrials.gov/study/NCT04205487 International Registered Report Identifier (IRRID): DERR1-10.2196/48459 ", doi="10.2196/48459", url="https://www.researchprotocols.org/2023/1/e48459", url="http://www.ncbi.nlm.nih.gov/pubmed/37831485" } @Article{info:doi/10.2196/39919, author="Bagasra, Anisah and Allen, T. Christopher and Doan, Sara", title="Perceived Effectiveness of COVID-19 Preventive Practices and Behavioral Intention: Survey of a Representative Adult Sample in the United States", journal="JMIR Hum Factors", year="2023", month="Oct", day="10", volume="10", pages="e39919", keywords="health promotion", keywords="health communication", keywords="health risk behavior", keywords="behavioral intention", keywords="public health", keywords="COVID-19", keywords="vaccination", keywords="prevention", keywords="health education", abstract="Background: Using existing models of behavioral health promotion, specifically the Extended Parallel Process Model, previous research has identified factors that may impact engagement in preventive health behaviors during the COVID-19 pandemic such as perceived threat, perceived susceptibility to the threat, perceived severity, and perceived efficacy. Objective: This study aims to examine the role of perceived effectiveness of COVID-19 preventive behaviors, perceived susceptibility, perceived threat, and perceived severity of COVID-19 in participants' intentions to engage in Centers for Disease Control (CDC)--recommended individual health behaviors in the first year of the pandemic. Methods: In October 2020, a representative sample of 506 US adults completed a web-based survey through the RAND American Life Panel. Results: The study primarily found that participants who perceived that CDC-recommended health practices were effective had stronger intentions to engage in those practices. The second strongest correlate was participants' perceived severity of COVID-19 across the United States. Perceived effectiveness of recommended practices accounted for the largest variance in behavioral intention. However, analysis of individual behaviors indicated a mismatch in the behaviors perceived to be the most effective (avoiding sick people and mask-wearing) and those participants indicated intention to engage in (throwing away used tissues, avoiding sick people, and coughing into their elbows) in the next 30 days. Conclusions: The authors recommend tailoring public health messaging to address the perceived threat of COVID-19 and self-efficacy. Thus, health promotion efforts should emphasize the effectiveness of CDC-recommended practices while highlighting the pandemic's severity. Additionally, rebuilding trust in public health messaging and messengers is necessary to increase perceived self-efficacy. As the COVID-19 pandemic continues, health messaging must continue to promote and build trust in CDC-recommended health practices and educate regarding the efficacy of vaccination and other preventive behaviors. ", doi="10.2196/39919", url="https://humanfactors.jmir.org/2023/1/e39919", url="http://www.ncbi.nlm.nih.gov/pubmed/37815862" } @Article{info:doi/10.2196/46747, author="Black, C. Joshua and Burkett, L. Hannah and Rockhill, M. Karilynn and Olson, Richard and Dart, C. Richard and Iwanicki, Janetta", title="Initiation Patterns and Transitions Among Adults Using Stimulant Drugs: Latent Transition Analysis", journal="J Med Internet Res", year="2023", month="Oct", day="5", volume="25", pages="e46747", keywords="stimulant misuse", keywords="high dimensional analysis", keywords="latent transition analysis", keywords="general population", keywords="stimulant drug", keywords="drug misuse", keywords="overdose", keywords="behavioral trajectory", keywords="drug overdose", keywords="stimulant initiation", keywords="drugs", keywords="substance abuse", keywords="analysis", abstract="Background: The fourth wave of the drug overdose epidemic in the United States includes increasing rates of stimulant-involved overdose. Recent studies of transitions leading to stimulant misuse have shown complex patterns that are not universally applicable because they have isolated individual populations or individual behaviors. A comprehensive analysis of transitions between behaviors and the associations with present-day problematic drug use has not been conducted. Objective: This study aims to determine whether adults from the general population who use stimulants initiate use through a heterogeneous combination of behaviors and quantify the association between these typologies with present-day problematic drug use. Methods: Individuals who have reported use of any stimulant in their lifetime were recruited from the 2021 Survey of Nonmedical Use of Prescription Drugs Program, a nationally representative web-based survey on drug use, to participate in a rapid follow-up survey about their past stimulant use. Individuals were asked which stimulants they used, the reasons for use, the routes of administration, and the sources of the stimulant. For each stimulant-related behavior, they were asked at what age, between 6 and 30 years, they initiated each behavior in a 6-year time window. A latent transition analysis was used to characterize heterogeneity in initiation typologies. Mutually exclusive pathways of initiation were identified manually by the researchers. The association of these pathways with present-day problematic drug use was calculated using logistic regression adjusted by the current age of the respondent. Results: From a total of 1329 participants, 740 (55.7\%) reported lifetime prescription stimulant use and 1077 (81\%) reported lifetime illicit stimulant use. Three typologies were identified. The first typology was characterized by illicit stimulant initiation to get high, usually via oral or snorting routes and acquisition from friends or family or a dealer (illicit experimentation). The second typology was characterized by low, but approximately equal probabilities of initiating 1-2 new behaviors in a time window, but no singular set of behaviors characterized the typology (conservative initiation). The third was characterized by a high probability of initiating many diverse combinations of behaviors (nondiscriminatory experimentation). The choice of drug initiated was not a strong differentiator. Categorization of pathways showed those who were only in an illicit experimentation status (reference) had the lowest odds of having severe present-day problematic drug use. Odds were higher for a conservative initiation-only status (odds ratio [OR] 1.84, 95\% CI 1.14-2.94), which is higher still for those moving from illicit experimentation to conservative initiation (OR 3.50, 95\% CI 2.13-5.74), and highest for a nondiscriminatory experimentation status (OR 5.45, 95\% CI 3.39-8.77). Conclusions: Initiation of stimulant-related use behaviors occurred across many time windows, indicating that multiple intervention opportunities are presented. Screening should be continued throughout adulthood to address unhealthy drug use before developing into full substance use disorders. ", doi="10.2196/46747", url="https://www.jmir.org/2023/1/e46747", url="http://www.ncbi.nlm.nih.gov/pubmed/37796607" } @Article{info:doi/10.2196/47608, author="Sadler, Sean and Gerrard, James and Searle, Angela and Lanting, Sean and West, Matthew and Wilson, Rhonda and Ginige, Athula and Fang, Y. Kerry and Chuter, Vivienne", title="The Use of mHealth Apps for the Assessment and Management of Diabetes-Related Foot Health Outcomes: Systematic Review", journal="J Med Internet Res", year="2023", month="Oct", day="4", volume="25", pages="e47608", keywords="First Nations", keywords="Aboriginal", keywords="Torres Strait Islander", keywords="mobile health", keywords="mHealth", keywords="diabetes", keywords="diabetic", keywords="foot", keywords="systematic review", keywords="review methodology", keywords="mobile app", keywords="mobile apps", keywords="mobile phone", abstract="Background: Globally, diabetes affects approximately 500 million people and is predicted to affect up to 700 million people by 2045. In Australia, the ongoing impact of colonization produces inequity in health care delivery and inequality in health care outcomes for First Nations Peoples, with diabetes rates 4 times those of non-Indigenous Australians. Evidence-based clinical practice has been shown to reduce complications of diabetes-related foot disease, including ulceration and amputation, by 50\%. However, factors such as a lack of access to culturally safe care, geographical remoteness, and high costs associated with in-person care are key barriers for First Nations Peoples in accessing evidence-based care, leading to the development of innovative mobile health (mHealth) apps as a way to increase access to health services and improve knowledge and self-care management for people with diabetes. Objective: This study aims to evaluate studies investigating the use of mHealth apps for the assessment and management of diabetes-related foot health in First Nations Peoples in Australia and non-Indigenous populations globally. Methods: PubMed, Informit's Indigenous Collection database, Ovid MEDLINE, Embase, CINAHL Complete, and Scopus were searched from inception to September 8, 2022. Hand searches of gray literature and reference lists of included studies were conducted. Studies describing mHealth apps developed for the assessment and management of diabetes-related foot health were eligible. Studies must include an evaluation (qualitative or quantitative) of the mHealth app. No language, publication date, or publication status restrictions were used. Quality appraisal was performed using the revised Cochrane risk-of-bias tool for randomized trials and the Health Evidence Bulletins Wales checklists for observational, cohort, and qualitative studies. Results: No studies specifically including First Nations Peoples in Australia were identified. Six studies in non-Indigenous populations with 361 participants were included. Foot care education was the main component of all mHealth apps. Of the 6 mHealth apps, 2 (33\%) provided functionality for participants to enter health-related data; 1 (17\%) included a messaging interface. The length of follow-up ranged from 1-6 months. Of the 6 studies, 1 (17\%) reported high levels of acceptability of the mHealth app content for self-care by people with diabetes and diabetes specialists; the remaining 5 (83\%) reported that participants had improved diabetes-related knowledge and self-management skills after using their mHealth app. Conclusions: The findings from this systematic review provide an overview of the features deployed in mHealth apps and indicate that this type of intervention can improve knowledge and self-care management skills in non-Indigenous people with diabetes. Future research needs to focus on mHealth apps for populations where there is inadequate or ineffective service delivery, including for First Nations Peoples and those living in geographically remote areas, as well as evaluate direct effects on diabetes-related foot disease outcomes. Trial Registration: PROSPERO CRD42022349087; https://tinyurl.com/35u6mmzd ", doi="10.2196/47608", url="https://www.jmir.org/2023/1/e47608", url="http://www.ncbi.nlm.nih.gov/pubmed/37792467" } @Article{info:doi/10.2196/46318, author="Xu, Stanley and Hong, Vennis and Sy, S. Lina and Bruxvoort, J. Katia and Lewin, Bruno and Han, Bing and Holmquist, J. Kimberly and Qian, Lei", title="Risk Factors for Not Completing a 2-Dose Primary Series of Messenger RNA COVID-19 Vaccination in a Large Health Care System in Southern California: Retrospective Cohort Study", journal="JMIR Public Health Surveill", year="2023", month="Oct", day="4", volume="9", pages="e46318", keywords="mRNA COVID-19 vaccines", keywords="2-dose primary series", keywords="vaccines", keywords="SARS-CoV-2", keywords="coronavirus", keywords="respiratory", keywords="infectious", keywords="communicable", keywords="immunization", keywords="immunize", keywords="noncompletion", keywords="risk factors", keywords="multiple Poisson regression model", keywords="COVID-19", keywords="vaccination", keywords="vaccine", keywords="dose", keywords="dosing", keywords="regression", keywords="risk", keywords="risks", keywords="health outcome", keywords="health outcomes", keywords="retrospective", keywords="cohort", keywords="dosage", keywords="United States", keywords="community", keywords="inoculation", abstract="Background: COVID-19 vaccination is crucial in combating the COVID-19 pandemic. Messenger RNA COVID-19 vaccines were initially authorized as a 2-dose primary series and have been widely used in the United States; completing the 2-dose primary series offers protection against infection, severe illness, and death. Understanding the risk factors for not completing the 2-dose primary series is critical to evaluate COVID-19 vaccination programs and promote completion of the 2-dose primary series. Objective: This study examined potential risk factors for not completing a 2-dose primary series of mRNA COVID-19 vaccination. Methods: We conducted a retrospective cohort study among members aged ?18 years from a large integrated health care system, Kaiser Permanente Southern California, from December 14, 2020, to June 30, 2022. Noncompletion of the 2-dose primary series was defined as not completing the second dose within 6 months after receipt of the first dose. Crude noncompletion rates were estimated overall and by demographic characteristics, health care use patterns, comorbidity, and community-level socioeconomic factors. A Poisson regression model was fit to examine associations of individual-level and community-level risk factors with noncompletion of the 2-dose primary series. Results: Among 2.5 million recipients of ?1 dose of mRNA COVID-19 vaccines, 3.3\% (n=81,202) did not complete the second dose within 6 months. Members aged 25-44 years, 65-74 years, and ?75 years were less likely to not complete the 2-dose primary series than those aged 18-24 years, while members aged 45-64 years were more likely to not complete the 2-dose primary series (adjusted risk ratio [aRR] 1.13, 95\% CI 1.10-1.15). Male sex was associated with a higher risk of noncompletion (aRR 1.17, 95\% CI 1.15-1.19). Hispanic and non-Hispanic Black race/ethnicity were associated with a lower risk of noncompletion (range aRR 0.78-0.91). Having Medicaid and prior influenza vaccination were associated with a higher risk of noncompletion. Having SARS-CoV-2 infection, experiencing an adverse event, or having an inpatient and emergency department visit during the minimum recommended dose intervals were associated with a higher risk of not completing the 2-dose primary series (aRR 1.98, 95\% CI 1.85-2.12; 1.99, 95\% CI 1.43-2.76; and 1.85, 95\% CI 1.77-1.93, respectively). Those who received the first dose after June 30, 2021, were more likely to not complete the 2-dose primary series within 6 months of receipt of the first dose. Conclusions: Despite limitations such as being a single-site study and the inability to consider social factors such as employment and vaccine attitudes, our study identified several risk factors for not completing a 2-dose primary series of mRNA vaccination, including being male; having Medicaid coverage; and experiencing SARS-CoV-2 infection, adverse events, or inpatient and emergency department visits during the minimum recommended dose intervals. These findings can inform future efforts in developing effective strategies to enhance vaccination coverage and improve the completion rate of necessary doses. ", doi="10.2196/46318", url="https://publichealth.jmir.org/2023/1/e46318", url="http://www.ncbi.nlm.nih.gov/pubmed/37792452" } @Article{info:doi/10.2196/46951, author="Chen, Chia-Chen Angela and Kim, Wonsun Sunny and Ou, Lihong and Todd, Michael and Larkey, Linda", title="Digital Storytelling Intervention to Promote Human Papillomavirus Vaccination Among At-Risk Asian Immigrant Populations: Pilot Intervention Study", journal="JMIR Form Res", year="2023", month="Oct", day="4", volume="7", pages="e46951", keywords="digital storytelling", keywords="human papillomavirus", keywords="immigrants", keywords="Korean", keywords="Vietnamese", keywords="vaccination", abstract="Background: The high morbidity, mortality, and economic burden attributed to cancer-causing human papillomavirus (HPV) calls for researchers to address this public health concern through HPV vaccination. Despite disparities in HPV-associated cancers in Korean Americans and Vietnamese Americans, their vaccination rates remain low. Evidence points to the importance of developing culturally and linguistically congruent interventions to improve HPV vaccination rates. Digital storytelling (a specific form of cultural narrative) shows promise as an effective culture-centric health promotion strategy. Objective: The aim of this quasi-experimental single-group study was to assess the feasibility, acceptability, and preliminary effects of a culturally and linguistically congruent digital storytelling intervention on Korean American and Vietnamese American mothers' attitudes and intention in vaccinating their children against HPV. We also examined if the association between attitudes and intention differed by their child's sex (boy vs girl) and by ethnicity (Korean American vs Vietnamese American). Methods: Participants were recruited via multiple avenues (eg, ethnic minority community organizations, social media, and flyers posted in local Asian supermarkets and nail salons). Web-based, valid, and reliable measures were administered to collect data preintervention and postintervention. Descriptive statistics, paired and independent sample t tests, the chi-square test, and the McNemar test were used to describe the distributions of variables and to examine the differences between subgroups and changes in key variables over time. Logistic regression models were used to examine associations of mothers' HPV- and vaccine-related attitudes with vaccination intention and to explore if the association between attitudes and vaccination intention differed by the target children's sex or ethnicity. Results: In our sample of 50 Korean American mothers (mean age 42.8, SD 4.8 years) and 114 Vietnamese American mothers (mean age 41.5, SD 5.4 years), 36\% (18/50) of Korean American and 51\% (58/114) of Vietnamese American mothers reported that their children received free or reduced-price lunches at school. After the intervention, mothers' attitudes toward HPV and the vaccine (t163=2.49, P=.01) and intention to vaccinate their children improved significantly (X21=18.38, P<.001). The measure of mothers' negative attitudes toward HPV and the vaccine was significantly associated with higher vaccination intention (odds ratio 0.27, 95\% CI 0.14-0.51; P<.001), adjusting for background variables (sociodemographic characteristics) and other HPV-related variables (family cancer history, prior HPV education, and HPV communication with health care providers). Findings did not suggest that a child's sex or ethnicity moderated the association between attitudes and vaccination intention. Conclusions: This remotely delivered intervention using digital stories was feasible and acceptable, and showed preliminary effects on promoting Korean American and Vietnamese American mothers' intention to vaccinate their children against HPV. Future research that uses a randomized controlled trial design with a larger and more diverse sample and includes children's vaccination status will help understand the effect of the intervention. ", doi="10.2196/46951", url="https://formative.jmir.org/2023/1/e46951", url="http://www.ncbi.nlm.nih.gov/pubmed/36877658" } @Article{info:doi/10.2196/44211, author="Song, Han In and Lee, Hyuk Jin and Shin, Soo Jee", title="Firearm Possession Rates in Home Countries and Firearm Suicide Rates Among US- and Foreign-Born Suicide Decedents in the United States: Analysis of Combined Data from the National Violent Death Reporting System and the Small Arms Survey", journal="JMIR Public Health Surveill", year="2023", month="Sep", day="29", volume="9", pages="e44211", keywords="firearm suicide", keywords="US born", keywords="foreign born", keywords="means of suicide", keywords="firearm possession rate", keywords="suicide decedents", abstract="Background: Suicide by firearms is a serious public health issue in the United States. However, little research has been conducted on the relationship between cultural backgrounds and suicide by firearms, specifically in those born and raised in the United States compared to those who have immigrated to the United States. Objective: To better understand the relationship between cultural backgrounds and suicide, this study aimed to examine firearm suicide rates among US- and foreign-born suicide decedents based on the firearm possession rate in the decedent's home country. Methods: Multivariate logistic regression was performed to analyze data of 28,895 suicide decedents from 37 states obtained from the 2017 National Violent Death Reporting System data set. The firearm possession rate in the home countries of foreign-born suicide decedents was obtained from the 2017 Small Arms Survey. Results: The firearm suicide rate was about twice as high among US-born suicide decedents compared to their foreign-born counterparts. Meanwhile, suicide by hanging was about 75\% higher among foreign-born compared to US-born suicide decedents. Those from countries with a low-to-medium firearm possession rate were significantly less likely to use firearms compared to US-born suicide decedents (adjusted odds ratio [AOR]=0.45, 95\% CI 0.31-0.65, and AOR=0.46, 95\% CI 0.39-0.53, respectively). Meanwhile, firearm suicide rates were not different between US- and foreign-born suicide decedents from countries with a similarly high firearm possession rate. Conclusions: The results suggest that there is an association between using firearms as a means of suicide and the firearm possession rate in the decedent's home country. Suicide by firearms in the United States needs to be understood in the sociocultural context related to firearm possession. ", doi="10.2196/44211", url="https://publichealth.jmir.org/2023/1/e44211", url="http://www.ncbi.nlm.nih.gov/pubmed/37773604" } @Article{info:doi/10.2196/48177, author="Brown, A. Lily and Webster, L. Jessica and Tran, T. Jennifer and Wolfe, R. James and Golinkoff, Jesse and Patel, Esha and Arcomano, C. Amanda and Ben Nathan, Jennifer and Azat O'Connor, Alexander and Zhu, Yiqin and Oquendo, Maria and Brown, K. Gregory and Mandell, David and Mowery, Danielle and Bauermeister, A. Jos{\'e}", title="A Suicide Prevention Intervention for Emerging Adult Sexual and Gender Minority Groups: Protocol for a Pilot Hybrid Effectiveness Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Sep", day="29", volume="12", pages="e48177", keywords="lesbian, gay, bisexual, transgender, queer, plus", keywords="LGBTQ+ health", keywords="suicide", keywords="peer navigator", keywords="emerging adults", keywords="life skills", keywords="mobile phone", abstract="Background: Suicide attempts and suicide death disproportionately affect sexual and gender minority emerging adults (age 18-24 years). However, suicide prevention strategies tailored for emerging adult sexual and gender minority (EA-SGM) groups are not widely available. The Safety Planning Intervention (SPI) has strong evidence for reducing the risk for suicide in the general population, but it is unclear how best to support EA-SGM groups in their use of a safety plan. Our intervention (Supporting Transitions to Adulthood and Reducing Suicide [STARS]) builds on content from an existing life skills mobile app for adolescent men who have sex with men (iREACH) and seeks to target core risk factors for suicide among EA-SGM groups, namely, positive affect, discrimination, and social disconnection. The mobile app is delivered to participants randomized to STARS alongside 6 peer mentoring sessions to support the use of the safety plan and other life skills from the app to ultimately reduce suicide risk. Objective: We will pilot-test the combination of peer mentoring alongside an app-based intervention (STARS) designed to reduce suicidal ideation and behaviors. STARS will include suicide prevention content and will target positive affect, discrimination, and social support. After an in-person SPI with a clinician, STARS users can access content and activities to increase their intention to use SPI and overcome obstacles to its use. EA-SGM groups will be randomized to receive either SPI alone or STARS and will be assessed for 6 months. Methods: Guided by the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework, we will recruit and enroll a racially and ethnically diverse sample of 60 EA-SGM individuals reporting past-month suicidal ideation. Using a type-1 effectiveness-implementation hybrid design, participants will be randomized to receive SPI (control arm) or to receive SPI alongside STARS (intervention arm). We will follow the participants for 6 months, with evaluations at 2, 4, and 6 months. Preliminary effectiveness outcomes (suicidal ideation and behavior) and hypothesized mechanisms of change (positive affect, coping with discrimination, and social support) will serve as our primary outcomes. Secondary outcomes include key implementation indicators, including participants' willingness and adoption of SPI and STARS and staff's experiences with delivering the program. Results: Study activities began in September 2021 and are ongoing. The study was approved by the institutional review board of the University of Pennsylvania (protocol number 849500). Study recruitment began on October 14, 2022. Conclusions: This project will be among the first tailored, mobile-based interventions for EA-SGM groups at risk for suicide. This project is responsive to the documented gaps for this population: approaches that address chosen family, focus on a life-course perspective, web approaches, and focus on health equity and provision of additional services relevant to sexual and gender minority youth. Trial Registration: ClinicalTrials.gov NCT05018143; https://classic.clinicaltrials.gov/ct2/show/NCT05018143 International Registered Report Identifier (IRRID): DERR1-10.2196/48177 ", doi="10.2196/48177", url="https://www.researchprotocols.org/2023/1/e48177", url="http://www.ncbi.nlm.nih.gov/pubmed/37773618" } @Article{info:doi/10.2196/47202, author="Cornell, Samuel and Brander, Robert and Peden, Amy", title="Selfie-Related Incidents: Narrative Review and Media Content Analysis", journal="J Med Internet Res", year="2023", month="Sep", day="27", volume="25", pages="e47202", keywords="selfie", keywords="aquatic locations", keywords="death", keywords="injury", keywords="risk", keywords="communication", keywords="social media", keywords="drowning", keywords="mobile phone", abstract="Background: Selfie-related injury has become a public health concern amid the near ubiquitous use of smartphones and social media apps. Of particular concern are selfie-related deaths at aquatic locations; areas often frequented because of their photogenic allure. Unfortunately, such places exhibit hazards inherent with their environment. Objective: This study aimed to ascertain current evidence regarding selfie-related injuries and recommended risk treatment measures in the academic literature as well as how selfie-related injuries and deaths were being reported by the media, allowing us to identify key challenges facing land managers and public health practitioners in mitigating selfie-related injuries and deaths. Methods: Between October and December 2022, we performed a narrative review of peer-reviewed literature published since January 2011. Literature was screened to identify causal factors implicated in selfie-related deaths and injuries, as well as risk treatments recommended. Furthermore, we used an environmental scan methodology to search for media reports of selfie-related injuries and deaths at aquatic locations in Australia and the United States. Individual cases of selfie-related aquatic injuries and deaths sourced from news reports were analyzed to assess epidemiological characteristics, and a thematic content analysis was conducted to identify key themes of news reporting on selfie-related deaths and injuries. Results: In total, 5 peer-reviewed studies were included. Four studies identified falls from height as the most common injury mechanism in selfie incidents. Drowning was the second most common cause of death. Recommended risk treatments were limited but included the adoption of ``no selfie zones,'' physical barriers, signage, and provision of information on dangerous locations to social media users. In total, 12 cases were identified from media reports (4 injuries and 8 fatalities; 7 in Australia and 5 in the United States). The mean age of the reported victims was 22.1 (SD 6.93) years with victims more likely to be female tourists. Content analysis revealed 3 key themes from media reports: ``blame,'' ``warning,'' and ``prevention and education.'' Few media reports (n=8) provided safety recommendations. Conclusions: The selfie-related incident phenomenon should be viewed as a public health problem that requires a public health risk communication response. To date, little attention has been paid to averting selfie-related incidents through behavior change methodologies or direct messaging to users, including through social media apps. Although previous research has recommended ``no selfie zones,'' barriers, and signage as ways to prevent selfie incidents, our results suggest this may not be enough, and it may be prudent to also engage in direct safety messaging to social media users. Media reporting of selfie incidents should focus on preventive messaging rather than blame or warning. ", doi="10.2196/47202", url="https://www.jmir.org/2023/1/e47202", url="http://www.ncbi.nlm.nih.gov/pubmed/37756044" } @Article{info:doi/10.2196/44402, author="Oladele, Ayoola David and Iwelunmor, Juliet and Gbajabiamila, Titilola and Obiezu-Umeh, Chisom and Okwuzu, Ogoamaka Jane and Nwaozuru, Ucheoma and Musa, Zaidat Adesola and Tahlil, Kadija and Idigbe, Ifeoma and Ong, Jason and Tang, Weiming and Tucker, Joseph and Ezechi, Oliver", title="An Unstructured Supplementary Service Data System to Verify HIV Self-Testing Among Nigerian Youths: Mixed Methods Analysis of Usability and Feasibility", journal="JMIR Form Res", year="2023", month="Sep", day="25", volume="7", pages="e44402", keywords="adolescent", keywords="adolescents and young adults", keywords="Africa", keywords="AYA", keywords="development", keywords="feasibility", keywords="HIV self-testing", keywords="HIV", keywords="HIVST", keywords="information system", keywords="Nigeria", keywords="platform", keywords="testing", keywords="think aloud", keywords="unstructured supplementary service data", keywords="usability", keywords="user-centered", keywords="USSD", keywords="young adult", keywords="youth", abstract="Background: Mobile health (mHealth) interventions among adolescents and young adults (AYAs) are increasingly available in African low- and middle-income countries (LMICs). For example, the unstructured supplementary service data (USSD) could be used to verify HIV self-testing (HIVST) among AYAs with poor bandwidth. Objective: The aim of this study is to describe the creation of an USSD platform and determine its feasibility and usability to promote the verification of HIVST results among AYAs in Nigeria. Methods: We developed and evaluated a USSD platform to verify HIVST results using a user-centered approach. The USSD platform guided AYAs in performing HIVST, interpreting the result, and providing linkage to care after the test. Following the usability assessment, the USSD platform was piloted. We used a mixed methods study to assess the platform's usability through a process of quantitative heuristic assessment, a qualitative think-aloud method, and an exit interview. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were organized. Results: A total of 19 AYAs participated in the usability test, with a median age of 19 (IQR 16-23) years. There were 11 females, 8 males, and 0 nonbinary individuals. All individuals were out-of-school AYAs. Seven of the 10 Nielsen usability heuristics assessed yielded positive results. The participants found the USSD platform easy to use, preferred the simplicity of the system, felt no need for a major improvement in the design of the platform, and were happy the system provided linkage to care following the interpretation of the HIVST results. The pilot field test of the platform enrolled 164 out-of-school AYAs, mostly young girls and women (101, 61.6\%). The mean age was 17.5 (SD 3.18) years, and 92.1\% (151/164) of the participants reported that they were heterosexual, while 7.9\% (13/164) reported that they were gay. All the participants in the pilot study were able to conduct HIVST, interpret their results, and use the linkage to care feature of the USSD platform without any challenge. A total of 7.9\% (13/164) of the AYAs had positive HIV results (reactive to the OraQuick kit). Conclusions: This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone apps to verify HIVST results among Nigerian youth without smartphone access. Therefore, the use of a USSD platform has implications for the verification of HIVST in areas with low internet bandwidth. Further pragmatic trials are needed to scale up this approach. ", doi="10.2196/44402", url="https://formative.jmir.org/2023/1/e44402", url="http://www.ncbi.nlm.nih.gov/pubmed/37747780" } @Article{info:doi/10.2196/42857, author="Kang-Auger, Sarit and Lewin, Antoine and Ayoub, Aimina and Bilodeau-Bertrand, Marianne and Marcoux, Sophie and Auger, Nathalie", title="Social Media and Selfie-Related Mortality Amid COVID-19: Interrupted Time Series Analysis", journal="JMIR Form Res", year="2023", month="Sep", day="25", volume="7", pages="e42857", keywords="COVID-19", keywords="injury", keywords="mortality", keywords="mortality rate", keywords="web-based news", keywords="selfie", keywords="social media", keywords="time series regression", abstract="Background: COVID-19 had a considerable impact on mortality, but its effect on behaviors associated with social media remains unclear. As travel decreased due to lockdowns during the pandemic, selfie-related mortality may have decreased, as fewer individuals were taking smartphone photographs in risky locations. Objective: In this study, we examined the effect of the COVID-19 pandemic on trends in selfie-related mortality. Methods: We identified fatal selfie-related injuries reported in web-based news reports worldwide between March 2014 and April 2021, including the deaths of individuals attempting a selfie photograph or anyone else present during the incident. The main outcome measure was the total number of selfie-related deaths per month. We used interrupted time series regression to estimate the monthly change in the number of selfie-related deaths over time, comparing the period before the pandemic (March 2014 to February 2020) with the period during the pandemic (March 2020 to April 2021). Results: The study included a total of 332 selfie-related deaths occurring between March 2014 and April 2021, with 18 (5.4\%) deaths during the pandemic. Most selfie-related deaths occurred in India (n=153, 46.1\%) and involved men (n=221, 66.6\%) and young individuals (n=296, 89.2\%). During the pandemic, two-thirds of selfie-related deaths were due to falls, whereas a greater proportion of selfie-related deaths before the pandemic were due to drowning. Based on interrupted time series regression, there was an average of 1.3 selfie-related deaths per month during the pandemic, compared with 4.3 deaths per month before the pandemic. The number of selfie-related deaths decreased by 2.6 in the first month of the pandemic alone and continued to decrease thereafter. Conclusions: Our findings indicate that the COVID-19 pandemic led to a marked decrease in selfie-related mortality, suggesting that lockdowns and travel restrictions likely prevented hazardous selfie-taking. The decrease in selfie-related mortality occurred despite a potential increase in social media use during the pandemic. ", doi="10.2196/42857", url="https://formative.jmir.org/2023/1/e42857", url="http://www.ncbi.nlm.nih.gov/pubmed/37747765" } @Article{info:doi/10.2196/45019, author="Li, Ziyu and Wu, Xiaoqian and Xu, Lin and Liu, Ming and Huang, Cheng", title="Hot Topic Recognition of Health Rumors Based on Anti-Rumor Articles on the WeChat Official Account Platform: Topic Modeling", journal="J Med Internet Res", year="2023", month="Sep", day="21", volume="25", pages="e45019", keywords="topic model", keywords="health rumors", keywords="social media", keywords="WeChat official account", keywords="content analysis", keywords="public health", keywords="machine learning", keywords="Twitter", keywords="social network", keywords="misinformation", keywords="users", keywords="disease", keywords="diet", abstract="Background: Social networks have become one of the main channels for obtaining health information. However, they have also become a source of health-related misinformation, which seriously threatens the public's physical and mental health. Governance of health-related misinformation can be implemented through topic identification of rumors on social networks. However, little attention has been paid to studying the types and routes of dissemination of health rumors on the internet, especially rumors regarding health-related information in Chinese social media. Objective: This study aims to explore the types of health-related misinformation favored by WeChat public platform users and their prevalence trends and to analyze the modeling results of the text by using the Latent Dirichlet Allocation model. Methods: We used a web crawler tool to capture health rumor--dispelling articles on WeChat rumor-dispelling public accounts. We collected information from health-debunking articles posted between January 1, 2016, and August 31, 2022. Following word segmentation of the collected text, a document topic generation model called Latent Dirichlet Allocation was used to identify and generalize the most common topics. The proportion distribution of the themes was calculated, and the negative impact of various health rumors in different periods was analyzed. Additionally, the prevalence of health rumors was analyzed by the number of health rumors generated at each time point. Results: We collected 9366 rumor-refuting articles from January 1, 2016, to August 31, 2022, from WeChat official accounts. Through topic modeling, we divided the health rumors into 8 topics, that is, rumors on prevention and treatment of infectious diseases (1284/9366, 13.71\%), disease therapy and its effects (1037/9366, 11.07\%), food safety (1243/9366, 13.27\%), cancer and its causes (946/9366, 10.10\%), regimen and disease (1540/9366, 16.44\%), transmission (914/9366, 9.76\%), healthy diet (1068/9366, 11.40\%), and nutrition and health (1334/9366, 14.24\%). Furthermore, we summarized the 8 topics under 4 themes, that is, public health, disease, diet and health, and spread of rumors. Conclusions: Our study shows that topic modeling can provide analysis and insights into health rumor governance. The rumor development trends showed that most rumors were on public health, disease, and diet and health problems. Governments still need to implement relevant and comprehensive rumor management strategies based on the rumors prevalent in their countries and formulate appropriate policies. Apart from regulating the content disseminated on social media platforms, the national quality of health education should also be improved. Governance of social networks should be clearly implemented, as these rapidly developed platforms come with privacy issues. Both disseminators and receivers of information should ensure a realistic attitude and disseminate health information correctly. In addition, we recommend that sentiment analysis--related studies be conducted to verify the impact of health rumor--related topics. ", doi="10.2196/45019", url="https://www.jmir.org/2023/1/e45019", url="http://www.ncbi.nlm.nih.gov/pubmed/37733396" } @Article{info:doi/10.2196/43630, author="Fisher, Andrew and Young, Maclaren Matthew and Payer, Doris and Pacheco, Karen and Dubeau, Chad and Mago, Vijay", title="Automating Detection of Drug-Related Harms on Social Media: Machine Learning Framework", journal="J Med Internet Res", year="2023", month="Sep", day="19", volume="25", pages="e43630", keywords="early warning system", keywords="social media", keywords="law enforcement", keywords="public health", keywords="new psychoactive substances", keywords="development", keywords="drug", keywords="dosage", keywords="Canada", keywords="Twitter", keywords="poisoning", keywords="monitoring", keywords="community", keywords="public safety", keywords="machine learning", keywords="Fleiss", keywords="tweet", keywords="tweet annotations", keywords="pharmacology", keywords="addiction", abstract="Background: A hallmark of unregulated drug markets is their unpredictability and constant evolution with newly introduced substances. People who use drugs and the public health workforce are often unaware of the appearance of new drugs on the unregulated market and their type, safe dosage, and potential adverse effects. This increases risks to people who use drugs, including the risk of unknown consumption and unintentional drug poisoning. Early warning systems (EWSs) can help monitor the landscape of emerging drugs in a given community by collecting and tracking up-to-date information and determining trends. However, there are currently few ways to systematically monitor the appearance and harms of new drugs on the unregulated market in Canada. Objective: The goal of this work is to examine how artificial intelligence can assist in identifying patterns of drug-related risks and harms, by monitoring the social media activity of public health and law enforcement groups. This information is beneficial in the form of an EWS as it can be used to identify new and emerging drug trends in various communities. Methods: To collect data for this study, 145 relevant Twitter accounts throughout Quebec (n=33), Ontario (n=78), and British Columbia (n=34) were manually identified. Tweets posted between August 23 and December 21, 2021, were collected via the application programming interface developed by Twitter for a total of 40,393 tweets. Next, subject matter experts (1) developed keyword filters that reduced the data set to 3746 tweets and (2) manually identified relevant tweets for monitoring and early warning efforts for a total of 464 tweets. Using this information, a zero-shot classifier was applied to tweets from step 1 with a set of keep (drug arrest, drug discovery, and drug report) and not-keep (drug addiction support, public safety report, and others) labels to see how accurately it could extract the tweets identified in step 2. Results: When looking at the accuracy in identifying relevant posts, the system extracted a total of 584 tweets and had an overlap of 392 out of 477 (specificity of {\textasciitilde}84.5\%) with the subject matter experts. Conversely, the system identified a total of 3162 irrelevant tweets and had an overlap of 3090 (sensitivity of {\textasciitilde}94.1\%) with the subject matter experts. Conclusions: This study demonstrates the benefits of using artificial intelligence to assist in finding relevant tweets for an EWS. The results showed that it can be quite accurate in filtering out irrelevant information, which greatly reduces the amount of manual work required. Although the accuracy in retaining relevant information was observed to be lower, an analysis showed that the label definitions can impact the results significantly and would therefore be suitable for future work to refine. Nonetheless, the performance is promising and demonstrates the usefulness of artificial intelligence in this domain. ", doi="10.2196/43630", url="https://www.jmir.org/2023/1/e43630", url="http://www.ncbi.nlm.nih.gov/pubmed/37725410" } @Article{info:doi/10.2196/48739, author="Caldwell, Sylvia and Flickinger, Tabor and Hodges, Jacqueline and Waldman, D. Ava Lena and Garofalini, Chloe and Cohn, Wendy and Dillingham, Rebecca and Castel, Amanda and Ingersoll, Karen", title="An mHealth Platform for People With HIV Receiving Care in Washington, District of Columbia: Qualitative Analysis of Stakeholder Feedback", journal="JMIR Form Res", year="2023", month="Sep", day="19", volume="7", pages="e48739", keywords="HIV", keywords="mobile health", keywords="mHealth", keywords="cluster randomized controlled trial", keywords="formative", keywords="adaptation", keywords="qualitative methods", keywords="smartphone", keywords="mobile phone", abstract="Background: HIV viral suppression and retention in care continue to be challenging goals for people with HIV in Washington, District of Columbia (DC). The PositiveLinks mobile app is associated with increased retention in care and viral load suppression in nonurban settings. The app includes features such as daily medication reminders, mood and stress check-ins, an anonymized community board for peer-to-peer social support, secure messaging to care teams, and resources for general and clinic-specific information, among other features. PositiveLinks has not been tailored or tested for this distinct urban population of people with HIV. Objective: This study aimed to inform the tailoring of a mobile health app to the needs of people with HIV and their providers in Washington, DC. Methods: We conducted a 3-part formative study to guide the tailoring of PositiveLinks for patients in the DC Cohort, a longitudinal cohort of >12,000 people with HIV receiving care in Washington, DC. The study included in-depth interviews with providers (n=28) at study clinics, focus groups with people with HIV enrolled in the DC Cohort (n=32), and a focus group with members of the DC Regional Planning Commission on Health and HIV (COHAH; n=35). Qualitative analysis used a constant comparison iterative approach; thematic saturation and intercoder agreement were achieved. Emerging themes were identified and grouped to inform an adaptation of PositiveLinks tailored for patients and providers. Results: Emerging themes for patients, clinic providers, and COHAH providers included population needs and concerns, facilitators and barriers to engagement in care and viral suppression, technology use, anticipated benefits, questions and concerns, and suggestions. DC Cohort clinic and COHAH provider interviews generated an additional theme: clinic processes. For patients, the most commonly discussed potential benefits included improved health knowledge and literacy (mentioned n=10 times), self-monitoring (n=7 times), and connection to peers (n=6 times). For providers, the most common anticipated benefits were improved communication with the clinic team (n=21), connection to peers (n=14), and facilitation of self-monitoring (n=11). Following data review, site principal investigators selected core PositiveLinks features, including daily medication adherence, mood and stress check-ins, resources, frequently asked questions, and the community board. Principal investigators wanted English and Spanish versions depending on the site. Two additional app features (messaging and documents) were selected as optional for each clinic site. Overall, 3 features were not deployed as not all participating clinics supported them. Conclusions: Patient and provider perspectives of PositiveLinks had some overlap, but some themes were unique to each group. Beta testing of the tailored app was conducted (August 2022). This formative work prepared the team for a cluster randomized controlled trial of PositiveLinks' efficacy. Randomization of clinics to PositiveLinks or usual care occurred in August 2022, and the randomized controlled trial launched in November 2022. International Registered Report Identifier (IRRID): RR2-10.2196/37748 ", doi="10.2196/48739", url="https://formative.jmir.org/2023/1/e48739", url="http://www.ncbi.nlm.nih.gov/pubmed/37725419" } @Article{info:doi/10.2196/46814, author="Silva, Martha and Anaba, Udochisom and Jani Tulsani, Nrupa and Sripad, Pooja and Walker, Jonathan and Aisiri, Adolor", title="Gender-Based Violence Narratives in Internet-Based Conversations in Nigeria: Social Listening Study", journal="J Med Internet Res", year="2023", month="Sep", day="15", volume="25", pages="e46814", keywords="gender-based violence", keywords="social listening", keywords="sexual health", keywords="consent", keywords="social media", keywords="Twitter", keywords="Nigeria", keywords="gender inequalities", keywords="discrimination", keywords="natural language processing", keywords="sexual consent", abstract="Background: Overcoming gender inequities is a global priority recognized as essential for improved health and human development. Gender-based violence (GBV) is an extreme manifestation of gender inequities enacted in real-world and internet-based environments. In Nigeria, GBV has come to the forefront of attention since 2020, when a state of emergency was declared due to increased reporting of sexual violence. Understanding GBV-related social narratives is important to design public health interventions. Objective: We explore how gender-related internet-based conversations in Nigeria specifically related to sexual consent (actively agreeing to sexual behavior), lack of consent, and slut-shaming (stigmatization in the form of insults based on actual or perceived sexuality and behaviors) manifest themselves and whether they changed between 2017 and 2022. Additionally, we explore what role events or social movements have in shaping gender-related narratives in Nigeria. Methods: Social listening was carried out on 12,031 social media posts (Twitter, Facebook, forums, and blogs) and almost 2 million public searches (Google and Yahoo search engines) between April 2017 and May 2022. The data were analyzed using natural language processing to determine the most salient conversation thematic clusters, qualitatively analyze time trends in discourse, and compare data against selected key events. Results: Between 2017 and 2022, internet-based conversation about sexual consent increased 72,633\%, from an average 3 to 2182 posts per month, while slut-shaming conversation (perpetrating or condemning) shrunk by 9\%, from an average 3560 to 3253 posts per month. Thematic analysis shows conversation revolves around the objectification of women, poor comprehension of elements of sexual consent, and advocacy for public education about sexual consent. Additionally, posters created space for sexual empowerment and expressions of sex positivity, pushing back against others who weaponize posts in support of slut-shaming narrative. Time trend analysis shows a greater sense of empowerment in advocating for education around the legal age of consent for sexual activity, calling out double standards, and rejecting slut-shaming. However, analysis of emotions in social media posts shows anger was most prominent in sexual consent (n=1213, 73\%) and slut-shaming (n=226, 64\%) posts. Organic social movements and key events (\#ArewaMeToo and \#ChurchToo, the \#SexforGrades scandal, and the \#BBNaija television program) played a notable role in sparking discourse related to sexual consent and slut-shaming. Conclusions: Social media narratives are significantly impacted by popular culture events, mass media programs, social movements, and micro influencers speaking out against GBV. Hashtags, media clips, and other content can be leveraged effectively to spread awareness and spark conversation around evolving gender norms. Public health practitioners and other stakeholders including policymakers, researchers, and social advocates should be prepared to capitalize on social media events and discourse to help shape the conversation in support of a normative environment that rejects GBV in all its forms. ", doi="10.2196/46814", url="https://www.jmir.org/2023/1/e46814", url="http://www.ncbi.nlm.nih.gov/pubmed/37713260" } @Article{info:doi/10.2196/42712, author="Chandler, Rasheeta and Farinu, O. Oluyemi T. and Guillaume, Dominique and Francis, Sherilyn and Parker, G. Andrea and Shah, Kewal and Hernandez, D. Natalie and ", title="Digital Health App to Address Disparate HIV Outcomes Among Black Women Living in Metro-Atlanta: Protocol for a Multiphase, Mixed Methods Pilot Feasibility Study", journal="JMIR Res Protoc", year="2023", month="Sep", day="15", volume="12", pages="e42712", keywords="Black women", keywords="CBPR", keywords="community-based participatory research", keywords="HIV", keywords="human centered design", keywords="mhealth", keywords="pilot usability study", abstract="Background: Cisgender Black women in the southern United States are at heightened risk for HIV and adverse sexual and reproductive health outcomes. Mobile health interventions that target HIV risk while being adapted to the needs and lived experiences of Black women are remarkably limited. Objective: The study aims to refine SavvyHER, a mobile app for HIV prevention, with Black women residing in high HIV incidence areas of Georgia and evaluate the feasibility, acceptability, and usability of SavvyHER. This paper describes the procedures implemented to conduct this research. Methods: Community-based participatory research tenets guide this multiphase study to finalize the development of what we hypothesize will be an effective, sustainable, and culturally relevant HIV prevention and optimal sexual health and reproductive wellness app for Black women. This multiphased, mixed methods study consists of 3 phases. The first phase entails focus groups with Black women to understand their preferences for the functionality and design of a beta prototype version of SavvyHER. In the second phase, an app usability pretest (N=10) will be used to refine and optimize the SavvyHER app. The final phase will entail a pilot randomized controlled trial (N=60) to evaluate the app's feasibility and usability in preparation for a larger trial. Results: Findings from preliminary focus groups revealed educational content, app aesthetics, privacy considerations, and marketing preferred by Black women, thus informing the first functional SavvyHER prototype. As we adapt and test the feasibility of SavvyHER, we hypothesize that the app will be an effective, sustainable, and culturally relevant HIV prevention, sexual health, and reproductive wellness tool for Black women. Conclusions: The findings from this research substantiate the importance of developing health interventions curated for and by Black women to address critical HIV disparities. The knowledge gained from this research can reduce HIV disparities among Black women through a targeted intervention that centers on their health needs and priorities. International Registered Report Identifier (IRRID): DERR1-10.2196/42712 ", doi="10.2196/42712", url="https://www.researchprotocols.org/2023/1/e42712", url="http://www.ncbi.nlm.nih.gov/pubmed/37713259" } @Article{info:doi/10.2196/46153, author="Llanes, D. Karla and Ling, M. Pamela and Guillory, Jamie and Vogel, A. Erin", title="Young Adults' Perceptions of and Intentions to Use Nicotine and Cannabis Vaporizers in Response to e-Cigarette or Vaping-Associated Lung Injury Instagram Posts: Experimental Study", journal="J Med Internet Res", year="2023", month="Sep", day="14", volume="25", pages="e46153", keywords="EVALI", keywords="risk perception, nicotine", keywords="cannabis", keywords="e-cigarettes", keywords="young adult", keywords="vaping", keywords="social media", keywords="Instagram", keywords="harmful effect", abstract="Background: Inhaling aerosolized nicotine and cannabis (colloquially called ``vaping'') is prevalent among young adults. Instagram influencers often promote both nicotine and cannabis vaporizer products. However, Instagram posts discouraging the use of both products received national media attention during the 2019 outbreak of e-cigarette or vaping-associated lung injury (EVALI). Objective: This experiment tested the impact of viewing Instagram posts about EVALI, varying in image and text valence, on young adults' perceived harmfulness of nicotine and cannabis products, perceived risk of nicotine and cannabis vaporizer use, and intentions to use nicotine and cannabis vaporizers in the future. Methods: Participants (N=1229) aged 18-25 (mean 21.40, SD 2.22) years were recruited through Qualtrics Research Services, oversampling for ever-use of nicotine or cannabis vaporizers (618/1229, 50.3\%). Participants were randomly assigned to view Instagram posts from young people portraying their experiences of EVALI in a 2 (image valence: positive or negative) {\texttimes} 2 (text valence: positive or negative) between-subjects experiment. Positive images were attractive and aesthetically pleasing selfies. The positive text was supportive and uplifting regarding quitting the use of vaporized products. Negative images and text were graphic and fear inducing. After viewing 3 posts, participants reported the perceived harmfulness of nicotine and cannabis products, the perceived risk of nicotine and cannabis vaporizer use, and intentions to use nicotine and cannabis vaporizers in the future. Ordinal logistic regression models assessed the main effects and interactions of image and text valence on perceived harmfulness and risk. Binary logistic regression models assessed the main effects and interactions of image and text valence on intentions to use nicotine and cannabis vaporizers. Analyses were adjusted for product use history. Results: Compared to viewing positive images, viewing negative images resulted in significantly greater perceived harm of nicotine (P=.02 for disposable pod-based vaporizers and P=.04 for other e-cigarette ``mods'' devices) and cannabis vaporized products (P=.01), greater perceived risk of nicotine vaporizers (P<.01), and lower odds of intentions to use nicotine (P=.02) but not cannabis (P=.43) vaporizers in the future. There were no significant main effects of text valence on perceived harm, perceived risk, and intentions to use nicotine and cannabis vaporized products. No significant interaction effects of image and text valence were found. Conclusions: Negative imagery in Instagram posts about EVALI may convey the risks of vaporized product use and discourage young adults from this behavior, regardless of the valence of the post's text. Public health messaging regarding EVALI on Instagram should emphasize the risk of cannabis vaporizer use, as young adults may otherwise believe that only nicotine vaporizer use increases their risk for EVALI. ", doi="10.2196/46153", url="https://www.jmir.org/2023/1/e46153", url="http://www.ncbi.nlm.nih.gov/pubmed/37552552" } @Article{info:doi/10.2196/44461, author="L{\"o}sch, Lea and Zuiderent-Jerak, Teun and Kunneman, Florian and Syurina, Elena and Bongers, Marloes and Stein, L. Mart and Chan, Michelle and Willems, Willemine and Timen, Aura", title="Capturing Emerging Experiential Knowledge for Vaccination Guidelines Through Natural Language Processing: Proof-of-Concept Study", journal="J Med Internet Res", year="2023", month="Sep", day="14", volume="25", pages="e44461", keywords="guidelines as topic", keywords="COVID-19", keywords="public health", keywords="natural language processing", keywords="NLP", keywords="social media", keywords="stakeholder engagement", keywords="vaccine", keywords="vaccination", keywords="health policy", keywords="coronavirus", keywords="SARS-CoV-2", abstract="Background: Experience-based knowledge and value considerations of health professionals, citizens, and patients are essential to formulate public health and clinical guidelines that are relevant and applicable to medical practice. Conventional methods for incorporating such knowledge into guideline development often involve a limited number of representatives and are considered to be time-consuming. Including experiential knowledge can be crucial during rapid guidance production in response to a pandemic but it is difficult to accomplish. Objective: This proof-of-concept study explored the potential of artificial intelligence (AI)--based methods to capture experiential knowledge and value considerations from existing data channels to make these insights available for public health guideline development. Methods: We developed and examined AI-based methods in relation to the COVID-19 vaccination guideline development in the Netherlands. We analyzed Dutch messages shared between December 2020 and June 2021 on social media and on 2 databases from the Dutch National Institute for Public Health and the Environment (RIVM), where experiences and questions regarding COVID-19 vaccination are reported. First, natural language processing (NLP) filtering techniques and an initial supervised machine learning model were developed to identify this type of knowledge in a large data set. Subsequently, structural topic modeling was performed to discern thematic patterns related to experiences with COVID-19 vaccination. Results: NLP methods proved to be able to identify and analyze experience-based knowledge and value considerations in large data sets. They provide insights into a variety of experiential knowledge that is difficult to obtain otherwise for rapid guideline development. Some topics addressed by citizens, patients, and professionals can serve as direct feedback to recommendations in the guideline. For example, a topic pointed out that although travel was not considered as a reason warranting prioritization for vaccination in the national vaccination campaign, there was a considerable need for vaccines for indispensable travel, such as cross-border informal caregiving, work or study, or accessing specialized care abroad. Another example is the ambiguity regarding the definition of medical risk groups prioritized for vaccination, with many citizens not meeting the formal priority criteria while being equally at risk. Such experiential knowledge may help the early identification of problems with the guideline's application and point to frequently occurring exceptions that might initiate a revision of the guideline text. Conclusions: This proof-of-concept study presents NLP methods as viable tools to access and use experience-based knowledge and value considerations, possibly contributing to robust, equitable, and applicable guidelines. They offer a way for guideline developers to gain insights into health professionals, citizens, and patients' experience-based knowledge, especially when conventional methods are difficult to implement. AI-based methods can thus broaden the evidence and knowledge base available for rapid guideline development and may therefore be considered as an important addition to the toolbox of pandemic preparedness. ", doi="10.2196/44461", url="https://www.jmir.org/2023/1/e44461", url="http://www.ncbi.nlm.nih.gov/pubmed/37610972" } @Article{info:doi/10.2196/38481, author="Inomata, Takenori and Sung, Jaemyoung and Nakamura, Masahiro and Iwagami, Masao and Akasaki, Yasutsugu and Fujio, Kenta and Ebihara, Nobuyuki and Ide, Takuma and Nagao, Masashi and Okumura, Yuichi and Nagino, Ken and Fujimoto, Keiichi and Eguchi, Atsuko and Hirosawa, Kunihiko and Midorikawa-Inomata, Akie and Muto, Kaori and Fujisawa, Kumiko and Kikuchi, Yota and Nojiri, Shuko and Murakami, Akira", title="Using the AllerSearch Smartphone App to Assess the Association Between Dry Eye and Hay Fever: mHealth-Based Cross-Sectional Study", journal="J Med Internet Res", year="2023", month="Sep", day="12", volume="25", pages="e38481", keywords="dry eye", keywords="hay fever", keywords="mobile health", keywords="personalized medicine", keywords="smartphone", keywords="pollinosis", keywords="rhinitis", keywords="allergic conjunctivitis", keywords="nasal symptom score", keywords="nonnasal symptom score", keywords="Ocular Surface Disease Index", keywords="Japanese Allergic Conjunctival Disease Standard Quality of Life Questionnaire", keywords="mobile phone", abstract="Background: Dry eye (DE) and hay fever (HF) show synergistic exacerbation of each other's pathology through inflammatory pathways. Objective: This study aimed to investigate the association between DE and HF comorbidity and the related risk factors. Methods: A cross-sectional observational study was conducted using crowdsourced multidimensional data from individuals who downloaded the AllerSearch smartphone app in Japan between February 2018 and May 2020. AllerSearch collected the demographics, medical history, lifestyle and residential information, HF status, DE symptoms, and HF-related quality of life. HF symptoms were evaluated using the nasal symptom score (0-15 points) and nonnasal symptom score (0-12 points). HF was defined by the participants' responses to the questionnaire as HF, non-HF, or unknown. Symptomatic DE was defined as an Ocular Surface Disease Index total score (0-100 points), with a threshold score of 13 points. HF-related quality of life was assessed using the Japanese Allergic Conjunctival Disease Standard Quality of Life Questionnaire (0-68 points). We conducted a multivariable linear regression analysis to examine the association between the severity of DE and HF symptoms. We subsequently conducted a multivariable logistic regression analysis to identify the factors associated with symptomatic DE (vs nonsymptomatic DE) among individuals with HF. Dimension reduction via Uniform Manifold Approximation and Projection stratified the comorbid DE and HF symptoms. The symptom profiles in each cluster were identified using hierarchical heat maps. Results: This study included 11,284 participants, classified into experiencing HF (9041 participants), non-HF (720 participants), and unknown (1523 participants) groups. The prevalence of symptomatic DE among individuals with HF was 49.99\% (4429/9041). Severe DE symptoms were significantly associated with severe HF symptoms: coefficient 1.33 (95\% CI 1.10-1.57; P<.001) for mild DE, coefficient 2.16 (95\% CI 1.84-2.48; P<.001) for moderate DE, and coefficient 3.80 (95\% CI 3.50-4.11; P<.001) for severe DE. The risk factors for comorbid symptomatic DE among individuals with HF were identified as female sex; lower BMI; medicated hypertension; history of hematologic, collagen, heart, liver, respiratory, or atopic disease; tomato allergy; current and previous mental illness; pet ownership; living room and bedrooms furnished with materials other than hardwood, carpet, tatami, and vinyl; discontinuation of contact lens use during the HF season; current contact lens use; smoking habits; and sleep duration of <6 hours per day. Uniform Manifold Approximation and Projection stratified the heterogeneous comorbid DE and HF symptoms into 14 clusters. In the hierarchical heat map, cluster 9 was comorbid with the most severe HF and DE symptoms, and cluster 1 showed severe HF symptoms with minimal DE-related symptoms. Conclusions: This crowdsourced study suggested a significant association between severe DE and HF symptoms. Detecting DE among individuals with HF could allow effective prevention and interventions through concurrent treatment for ocular surface management along with HF treatment. ", doi="10.2196/38481", url="https://www.jmir.org/2023/1/e38481", url="http://www.ncbi.nlm.nih.gov/pubmed/37698897" } @Article{info:doi/10.2196/41364, author="Lin, Li-Yin and Lin, Chun-Ji and Kuan, Chen-I and Chiou, Hung-Yi", title="Potential Determinants Contributing to COVID-19 Vaccine Acceptance and Hesitancy in Taiwan: Rapid Qualitative Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Sep", day="12", volume="7", pages="e41364", keywords="COVID-19", keywords="vaccine acceptance", keywords="vaccine hesitancy", keywords="google trends", keywords="public health", keywords="vaccination", keywords="health promotion", keywords="thematic analysis", keywords="infoveillance", abstract="Background: Although vaccination has been shown to be one of the most important interventions, COVID-19 vaccine hesitancy remains one of the top 10 global public health challenges worldwide. Objective: The objective of this study is to investigate (1) major determinants of vaccine hesitancy, (2) changes in the determinants of vaccine hesitancy at different time periods, and (3) the potential factors affecting vaccine acceptance. Methods: This study applied a mixed methods approach to explore the potential determinants contributing to vaccine hesitancy among the Taiwanese population. The quantitative design of this study involved using Google Trends search query data. We chose the search term ``??`` (vaccine), selected ''??'' (Taiwan) as the location, and selected the period between December 18, 2020, and July 31, 2021. The rising keywords related to vaccine acceptance and hesitancy were collected. Based on the responses obtained from the qualitative study and the rising keywords obtained in Google Trends, the 3 most popular keywords related to vaccine hesitancy were identified and used as search queries in Google Trends between December 18, 2020, and July 31, 2021, to generate relative search volumes (RSVs). Lastly, autoregressive integrated moving average modeling was used to forecast the RSVs for the 3 keywords between May 29 and July 31, 2021. The estimated RSVs were compared to the observed RSVs in Google Trends within the same time frame. Results: The 4 prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy were doubts about the government and manufacturers, side effects, deaths associated with vaccination, and efficacy of vaccination. During the vaccine observation period, ``political role'' was the overarching consideration leading to vaccine hesitancy. During the peak of the pandemic, side effects, death, and vaccine protection were the main factors contributing to vaccine hesitancy. The popularity of the 3 frequently searched keywords ``side effects,'' ``vaccine associated deaths,'' and ``vaccine protection'' continued to rise throughout the pandemic outbreak. Lastly, the highest Google search queries related to COVID-19 vaccines emerged as ``side effects'' prior to vaccination, deaths associated with vaccines during the period when single vaccines were available, and ``side effects'' and ``vaccine protection'' during the period when multiple vaccines were available. Conclusions: Investigating the key factors influencing COVID-19 vaccine hesitancy appears to be a fundamental task that needs to be undertaken to ensure effective implementation of COVID-19 vaccination. Google Trends may be used as a complementary infoveillance tool by government agencies for future vaccine policy implementation and communication. ", doi="10.2196/41364", url="https://formative.jmir.org/2023/1/e41364", url="http://www.ncbi.nlm.nih.gov/pubmed/37698904" } @Article{info:doi/10.2196/48670, author="Edwards, Abagail and Nu{\~n}o, Aries and Kemp, Christopher and Tillett, Emily and Armington, Gretchen and Fink, Rachel and Hamill, M. Matthew and Manabe, C. Yukari", title="A Web-Based, Mail-Order Sexually Transmitted Infection Testing Program: Qualitative Analysis of User Feedback", journal="JMIR Form Res", year="2023", month="Sep", day="11", volume="7", pages="e48670", keywords="sexually transmitted infection", keywords="STI", keywords="HIV", keywords="direct-to-consumer screening and testing", keywords="web-based systems", keywords="feedback", keywords="web-based", keywords="user", keywords="testing program", abstract="Background: The incidence of sexually transmitted infections (STIs) is increasing in the United States. The COVID-19 pandemic resulted in significant reductions in access to health care services, including STI testing and treatment, leading to underreporting of STI cases and a need for alternatives to clinic-based testing. Moreover, concerns around confidentiality, accessibility, and stigma continue to limit access to clinic-based STI testing, particularly for high-priority populations. IWantTheKit (IWTK) is a web-based platform that mails free, confidential, self-administered sample collection kits for testing for gonorrhea, chlamydia (both genital and extragenital sites), and vaginal trichomonas. Individuals visiting the IWTK website may select genital, pharyngeal, and rectal samples for chlamydia and gonorrhea testing. Vaginal samples are tested for trichomoniasis. Self-collected samples are processed in a College of American Pathologists--accredited laboratory, and results are posted to an individual's secure digital account. Objective: This study aimed to (1) describe users' experience with the IWTK service through analysis of routine data and (2) optimize retention among current users and expand reach among high-priority populations by responding to user needs through programmatic and functional changes to the IWTK service. Methods: Free-text entries were submitted by IWTK users via a confidential ``Contact Us'' page on the IWTK website from May 17, 2021, to January 31, 2022. All entries were deidentified prior to analysis. Two independent analysts coded these entries using a predefined codebook developed inductively for thematic analysis. Results: A total of 254 free-text entries were analyzed after removing duplicates and nonsensical entries. Themes emerged regarding the functionality of the website and personal experiences using IWTK's services. Users' submissions included requests related to order status, address changes, replacement of old kits, clinical information (eg, treatment options and symptom reports), and reported risk behaviors. Conclusions: This analysis demonstrates how routine data can be used to propose potential programmatic improvements. IWTK implemented innovations on the website based on the study results to improve users' experience, including a tracking system for orders, address verification for each order, a physical drop box, additional textual information, direct linkage to care navigation, and printable results. Web-based, mail-order STI testing programs can leverage user feedback to optimize implementation and retention among current users and potentially expand reach among high-priority populations. This analysis is supported by other data that demonstrate how comprehensive support and follow-up care for individuals testing positive are critical components of any self-testing service. Additional formal assessments of the IWTK user experience and efforts to optimize posttesting linkage to care may be needed. ", doi="10.2196/48670", url="https://formative.jmir.org/2023/1/e48670", url="http://www.ncbi.nlm.nih.gov/pubmed/37695644" } @Article{info:doi/10.2196/48998, author="Goodman, S. Rachel and Mittal, Lavanya and Parker, Rawlings Eva", title="Public Health Risks, Dermatological Manifestations, and Environmental Justice Associated With Vinyl Chloride Exposure: Narrative Review", journal="JMIR Dermatol", year="2023", month="Sep", day="7", volume="6", pages="e48998", keywords="vinyl chloride", keywords="cutaneous manifestations", keywords="dermatology", keywords="industrial accident", keywords="climate advocacy", keywords="public health", keywords="environmental toxins", keywords="environmental health", keywords="acute", keywords="chronic", keywords="utilization", keywords="malignancy", keywords="community", keywords="socioeconomic", keywords="hazardous chemicals", keywords="toxicology", abstract="Background: Environmental vinyl chloride (VC) exposure may result in serious acute and chronic dermatological conditions. Because existing literature largely focuses on exposures in occupational settings, a gap persists in our understanding of the medical consequences of large-scale chemical spills. Objective: This study aims to examine the potential dermatological manifestations of VC exposure in the context of industrial spills and other environmental disasters and to highlight the public health and justice implications of such releases. Methods: In this narrative review, relevant evidence-based, peer-reviewed scientific sources, gray literature, and media reports were identified via searches of search PubMed and Google using predetermined keyword search terms related to VC, VC spills and releases, train derailment, cutaneous disease, public health, and vulnerable and marginalized populations. Results: Contact dermatitis and frostbite may arise acutely, highlighting the importance of swift decontamination. Long-term manifestations from chronic VC exposure due to persistence in environmental reservoirs include Raynaud disease, sclerodermatous skin changes, acro-osteolysis, and cutaneous malignancies. The clinical severity of cutaneous manifestations is influenced by individual susceptibility as well as duration, intensity, and route of exposure. Additionally, chemical releases of VC more frequently impact Communities of Color and those of lower socioeconomic status, resulting in greater rates of exposure-related disease. Conclusions: With environmental release events of hazardous chemicals becoming increasingly common and because the skin has increased contact with environmental toxins relative to other organs, an urgent need exists for a greater understanding of the overall short- and long-term health impacts of large-scale, toxic exposures, underscoring the need for ongoing clinical vigilance. Dermatologists and public health officials should also aim to better understand the ways in which the disproportionate impacts of hazardous chemical exposures on lower-income and minority populations may exacerbate existing health disparities. Herein, we describe the health implications of toxic releases with particular consideration paid to marginalized and vulnerable populations. In addition to legal and regulatory frameworks, we advocate for improved public health measures, to not only mitigate the risk of environmental catastrophes in the future, but also ensure timely and effective responses to them. ", doi="10.2196/48998", url="https://derma.jmir.org/2023/1/e48998", url="http://www.ncbi.nlm.nih.gov/pubmed/37676716" } @Article{info:doi/10.2196/41682, author="Delmonaco, Daniel and Li, Shannon and Paneda, Christian and Popoff, Elliot and Hughson, Luna and Jadwin-Cakmak, Laura and Alferio, Jack and Stephenson, Christian and Henry, Angelique and Powdhar, Kiandra and Gierlinger, Isabella and Harper, W. Gary and Haimson, L. Oliver", title="Community-Engaged Participatory Methods to Address Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Young People's Health Information Needs With a Resource Website: Participatory Design and Development Study", journal="JMIR Form Res", year="2023", month="Sep", day="7", volume="7", pages="e41682", keywords="lesbian, gay, bisexual, transgender, and queer health", keywords="LGBTQ+ health", keywords="information seeking", keywords="participatory design", keywords="community-based research", keywords="web-based health resources", keywords="lesbian, gay, bisexual, transgender, and queer young people", keywords="LGBTQ+ young people", keywords="mobile phone", abstract="Background: Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) young people (aged 15 to 25 years) face unique health challenges and often lack resources to adequately address their health information needs related to gender and sexuality. Beyond information access issues, LGBTQ+ young people may need information resources to be designed and organized differently compared with their cisgender and heterosexual peers and, because of identity exploration, may have different information needs related to gender and sexuality than older people. Objective: The objective of our study was to work with a community partner to develop an inclusive and comprehensive new website to address LGBTQ+ young people's health information needs. To design this resource website using a community-engaged approach, our objective required working with and incorporating content and design recommendations from young LGBTQ+ participants. Methods: We conducted interviews (n=17) and participatory design sessions (n=11; total individual participants: n=25) with LGBTQ+ young people to understand their health information needs and elicit design recommendations for the new website. We involved our community partner in all aspects of the research and design process. Results: We present participants' desired resources, health topics, and technical website features that can facilitate information seeking for LGBTQ+ young people exploring their sexuality and gender and looking for health resources. We describe how filters can allow people to find information related to intersecting marginalized identities and how dark mode can be a privacy measure to avoid unwanted identity disclosure. We reflect on our design process and situate the website development in previous critical reflections on participatory research with marginalized communities. We suggest recommendations for future LGBTQ+ health websites based on our research and design experiences and final website design, which can enable LGBTQ+ young people to access information, find the right information, and navigate identity disclosure concerns. These design recommendations include filters, a reduced number of links, conscientious choice of graphics, dark mode, and resources tailored to intersecting identities. Conclusions: Meaningful collaboration with community partners throughout the design process is vital for developing technological resources that meet community needs. We argue for community partner leadership rather than just involvement in community-based research endeavors at the intersection of human-computer interaction and health. ", doi="10.2196/41682", url="https://formative.jmir.org/2023/1/e41682", url="http://www.ncbi.nlm.nih.gov/pubmed/37676709" } @Article{info:doi/10.2196/48630, author="Park, Albert and Sayed, Fatima and Robinson, Patrick and Elopre, Latesha and Ge, Yaorong and Li, Shaoyu and Grov, Christian and Sullivan, Sean Patrick", title="Health Information on Pre-Exposure Prophylaxis From Search Engines and Twitter: Readability Analysis", journal="JMIR Public Health Surveill", year="2023", month="Sep", day="4", volume="9", pages="e48630", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="health literacy", keywords="health education materials", keywords="readability", keywords="prophylaxis", keywords="health information", keywords="electronic health education", keywords="HIV", keywords="infection", keywords="Twitter", abstract="Background: Pre-exposure prophylaxis (PrEP) is proven to prevent HIV infection. However, PrEP uptake to date has been limited and inequitable. Analyzing the readability of existing PrEP-related information is important to understand the potential impact of available PrEP information on PrEP uptake and identify opportunities to improve PrEP-related education and communication. Objective: We examined the readability of web-based PrEP information identified using search engines and on Twitter. We investigated the readability of web-based PrEP documents, stratified by how the PrEP document was obtained on the web, information source, document format and communication method, PrEP modality, and intended audience. Methods: Web-based PrEP information in English was systematically identified using search engines and the Twitter API. We manually verified and categorized results and described the method used to obtain information, information source, document format and communication method, PrEP modality, and intended audience. Documents were converted to plain text for the analysis and readability of the collected documents was assessed using 4 readability indices. We conducted pairwise comparisons of readability based on how the PrEP document was obtained on the web, information source, document format, communication method, PrEP modality, and intended audience, then adjusted for multiple comparisons. Results: A total of 463 documents were identified. Overall, the readability of web-based PrEP information was at a higher level (10.2-grade reading level) than what is recommended for health information provided to the general public (ninth-grade reading level, as suggested by the Department of Health and Human Services). Brochures (n=33, 7\% of all identified resources) were the only type of PrEP materials that achieved the target of ninth-grade reading level. Conclusions: Web-based PrEP information is often written at a complex level for potential and current PrEP users to understand. This may hinder PrEP uptake for some people who would benefit from it. The readability of PrEP-related information found on the web should be improved to align more closely with health communication guidelines for reading level to improve access to this important health information, facilitate informed decisions by those with a need for PrEP, and realize national prevention goals for PrEP uptake and reducing new HIV infections in the United States. ", doi="10.2196/48630", url="https://publichealth.jmir.org/2023/1/e48630", url="http://www.ncbi.nlm.nih.gov/pubmed/37665621" } @Article{info:doi/10.2196/46701, author="Saha, Amit and Andrewartha, Kelly and Badman, G. Steven and Tangey, Annie and Smith, S. Kirsty and Sandler, Sergio and Ramsay, Stuart and Braund, Wilton and Manoj-Margison, Stuart and Matthews, Susan and Shephard, S. Mark D. and Guy, Rebecca and Causer, Louise", title="Flexible and Innovative Connectivity Solution to Support National Decentralized Infectious Diseases Point-of-Care Testing Programs in Primary Health Services: Descriptive Evaluation Study", journal="J Med Internet Res", year="2023", month="Sep", day="1", volume="25", pages="e46701", keywords="infectious disease", keywords="diagnostics", keywords="POC testing", keywords="point-of-care", keywords="connectivity", keywords="digital health", keywords="disease surveillance", keywords="GeneXpert", abstract="Background: Molecular point-of-care (POC) testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) has been available in regional and remote primary health services in Australia as part of a decentralized POC testing program since 2016 and for SARS-CoV-2 from 2020. As there was no suitable existing connectivity infrastructure to capture and deliver POC test results to a range of end users, a new system needed to be established. Objective: The aim of the study is to design, implement, and optimize a connectivity system to meet clinical management, analytical quality management, and public health surveillance needs. Methods: We used commercially available e-messaging technology coupled with adapted proprietary software to integrate a decentralized molecular POC testing platform (GeneXpert) in primary health services and interface with end-user databases. This connectivity infrastructure was designed to overcome key barriers to the implementation, integration, and monitoring of these large multijurisdictional infectious disease POC testing networks. Test result messages were tailored to meet end-user needs. Using centrally captured deidentified data, we evaluated the time to receipt of test results and completeness of accompanying demographic data. Results: From January 2016 to April 2020, we operationalized the system at 31 health services across 4 jurisdictions and integrated with 5 different patient management systems to support the real-time delivery of 29,356 CT/NG and TV test results to designated recipients (patient management system and local clinical and central program databases). In 2019, 12,105 CT/NG and TV results were delivered, and the median time to receipt of results was 3.2 (IQR 2.2-4.6) hours, inclusive of test runtime. From May 2020 to August 2022, we optimized the system to support rapid scale-up of SARS-CoV-2 testing (105 services; 6 jurisdictions; 71,823 tests) and additional sexually transmissible infection testing (16,232 tests), including the electronic disease-specific notifications to jurisdictional health departments and alerts for connectivity disruption and positive results. In 2022, 19,355 results were delivered with an overall median transmission time of 2.3 (IQR 1.4-3.1) hours, 2.2 (IQR 1.2-2.3) hours for SARS-CoV-2 (n=16,066), 3.0 (IQR 2.0-4.0) hours for CT/NG (n=1843), and 2.6 (IQR 1.5-3.8) hours for TV (n=1446). Demographic data (age, sex, and ethnicity) were completed for 99.5\% of test results in 2022. Conclusions: This innovative connectivity system designed to meet end-user needs has proven to be sustainable, flexible, and scalable. It represents the first such system in Australia established independent of traditional pathology providers to support POC testing in geographically dispersed remote primary health services. The system has been optimized to deliver real-time test results and has proven critical for clinical, public health, and quality management. The system has significantly supported equitable access to rapid diagnostics for infectious diseases across Australia, and its design is suitable for onboarding other POC tests and testing platforms in the future. ", doi="10.2196/46701", url="https://www.jmir.org/2023/1/e46701", url="http://www.ncbi.nlm.nih.gov/pubmed/37656506" } @Article{info:doi/10.2196/45262, author="Luo, Qianqian and Wu, Zunyou and Mi, Guodong and Xu, Jie and Scott, Robbins Sarah", title="Using HIV Risk Self-Assessment Tools to Increase HIV Testing in Men Who Have Sex With Men in Beijing, China: App-Based Randomized Controlled Trial", journal="J Med Internet Res", year="2023", month="Sep", day="1", volume="25", pages="e45262", keywords="app", keywords="China", keywords="HIV testing", keywords="men who have sex with men", keywords="risk assessment", abstract="Background: Men who have sex with men (MSM) in China hold a low-risk perception of acquiring HIV. This has resulted in an inadequate HIV testing rate. Objective: This study aims to investigate whether administering HIV risk self-assessments with tailored feedback on a gay geosocial networking (GSN) app could improve HIV testing rates and reduce sexual risk behaviors in Chinese MSM. Methods: We recruited MSM from Beijing, China, who used the GSN platform Blued in October 2017 in this 12-month double-blinded randomized controlled trial. From October 2017 to September 2018, eligible participants were randomly assigned to use a self-reported HIV risk assessment tool that provided tailored feedback according to transmission risk (group 1), access to the same HIV risk assessment without feedback (group 2), or government-recommended HIV education materials (control). All interventions were remotely delivered through the mobile phone--based app Blued, and participants were followed up at 1, 3, 6, and 12 months from baseline. The number of HIV tests over the 12-month study was the primary outcome and was assessed using an intention-to-treat analysis with an incident rate ratio (IRR). Unprotected anal intercourse (UAI) over 6 months was assessed by a modified intention-to-treat analysis and was the secondary outcome. All statistical analyses were conducted in SAS 9.3 (SAS Institute, Inc.), and a P value <.05 was considered statistically significant. Results: In total, 9280 MSM were recruited from baseline and were randomly assigned to group 1 (n=3028), group 2 (n=3065), or controls (n=3187). After follow-up, 1034 (34.1\%), 993 (32.4\%), and 1103 (34.6\%) remained in each group, respectively. Over 12 months, group 1 took 391 tests (mean of 2.51 tests per person), group 2 took 352 tests (mean of 2.01 tests per person), and controls took 295 tests (mean of 1.72 tests per person). Group 1 had significantly more HIV testing than the control group (IRR 1.32, 95\% CI 1.09-4.58; P=.01), while group 2 did not differ significantly from the controls (IRR 1.06, 95\% CI 0.86-1.30; P=.60). The proportion of UAI was not statistically different among different groups, but all 3 groups had UAI, which declined from baseline. Conclusions: Repeated HIV risk assessments coupled with tailored feedback through GSN apps improved HIV testing. Such interventions should be considered a simple way of improving HIV testing among MSM in China and increasing awareness of HIV status. Trial Registration: ClinicalTrials.gov NCT03320239; https://clinicaltrials.gov/study/NCT03320239 ", doi="10.2196/45262", url="https://www.jmir.org/2023/1/e45262", url="http://www.ncbi.nlm.nih.gov/pubmed/37656500" } @Article{info:doi/10.2196/46644, author="Leal Neto, Onicio and Paolotti, Daniela and Dalton, Craig and Carlson, Sandra and Susumpow, Patipat and Parker, Matt and Phetra, Polowat and Lau, Y. Eric H. and Colizza, Vittoria and Jan van Hoek, Albert and Kjels{\o}, Charlotte and Brownstein, S. John and Smolinski, S. Mark", title="Enabling Multicentric Participatory Disease Surveillance for Global Health Enhancement: Viewpoint on Global Flu View", journal="JMIR Public Health Surveill", year="2023", month="Sep", day="1", volume="9", pages="e46644", keywords="participatory surveillance", keywords="digital epidemiology", keywords="influenza-like illness", keywords="data transfer", keywords="surveillance", keywords="digital platform", keywords="Global Flu View", keywords="program", keywords="data sharing", keywords="public health", keywords="innovative", keywords="flu", doi="10.2196/46644", url="https://publichealth.jmir.org/2023/1/e46644", url="http://www.ncbi.nlm.nih.gov/pubmed/37490846" } @Article{info:doi/10.2196/44950, author="Kreslake, M. Jennifer and Aarvig, Kathleen and Muller-Tabanera, Hope and Vallone, M. Donna and Hair, C. Elizabeth", title="Checkpoint Travel Numbers as a Proxy Variable in Population-Based Studies During the COVID-19 Pandemic: Validation Study", journal="JMIR Public Health Surveill", year="2023", month="Aug", day="29", volume="9", pages="e44950", keywords="research methods", keywords="public health", keywords="data quality", keywords="psychosocial factors", keywords="history", keywords="COVID-19", keywords="social", keywords="behavioral", keywords="validation", keywords="social distancing", keywords="tracking survey", keywords="survey", keywords="pandemic", abstract="Background: The COVID-19 pandemic had wide-ranging systemic impacts, with implications for social and behavioral factors in human health. The pandemic may introduce history bias in population-level research studies of other health topics during the COVID-19 period. Objective: We sought to identify and validate an accessible, flexible measure to serve as a covariate in research spanning the COVID-19 pandemic period. Methods: Transportation Security Administration checkpoint travel numbers were used to calculate a weekly sum of daily passengers and validated against two measures with strong face validity: (1) a self-reported item on social distancing practices drawn from a continuous tracking survey among a national sample of youths and young adults (15-24 years) in the United States (N=45,080, approximately 280 unique respondents each week); and (2) Google's Community Mobility Reports, which calculate daily values at the national level to represent rates of change in visits and length of stays to public spaces. For the self-reported survey data, an aggregated week-level variable was calculated as the proportion of respondents who did not practice social distancing that week (January 1, 2019, to May 31, 2022). For the community mobility data, a weekly estimate of change was calculated using daily values compared to a 5-week prepandemic baseline period (January 3, 2020, to February 6, 2020). Spearman rank correlation coefficients were calculated for each comparison. Results: Checkpoint travel data ranged from 668,719 travelers in the week of April 8, 2020, to nearly 15.5 million travelers in the week of May 18, 2022. The weekly proportion of survey respondents who did not practice social distancing ranged from 18.1\% (n=42; week of April 15, 2020) to 70.9\% (n=213; week of May 25, 2022). The measures were strongly correlated from January 2019 to May 2022 ($\rho$=0.90, P<.001) and March 2020 to May 2022 ($\rho$=0.87, P<.001). Strong correlations were observed when analyses were restricted to age groups (15-17 years: $\rho$=0.90; P<.001; 18-20 years: $\rho$=0.87; P<.001; 21-24 years: $\rho$=0.88; P<.001), racial or ethnic minorities ($\rho$=0.86, P<.001), and respondents with lower socioeconomic status ($\rho$=0.88, P<.001). There were also strong correlations between the weekly change from the baseline period for checkpoint travel data and community mobility data for transit stations ($\rho$=0.92, P<.001) and retail and recreation ($\rho$=0.89, P<.001), and moderate significant correlations for grocery and pharmacy ($\rho$=0.68, P<.001) and parks ($\rho$=0.62, P<.001). A strong negative correlation was observed for places of residence ($\rho$=?0.78, P<.001), and a weak but significant positive correlation was found for workplaces ($\rho$=0.24, P<.001). Conclusions: The Transportation Security Administration's travel checkpoint data provide a publicly available flexible time-varying metric to control for history bias introduced by the pandemic in research studies spanning the COVID-19 period in the United States. ", doi="10.2196/44950", url="https://publichealth.jmir.org/2023/1/e44950", url="http://www.ncbi.nlm.nih.gov/pubmed/37191643" } @Article{info:doi/10.2196/44657, author="Keck, W. James and Lindner, Jess and Liversedge, Matthew and Mijatovic, Blazan and Olsson, Cullen and Strike, William and Noble, Anni and Adatorwovor, Reuben and Lacy, Parker and Smith, Ted and Berry, M. Scott", title="Wastewater Surveillance for SARS-CoV-2 at Long-Term Care Facilities: Mixed Methods Evaluation", journal="JMIR Public Health Surveill", year="2023", month="Aug", day="29", volume="9", pages="e44657", keywords="wastewater surveillance", keywords="wastewater-based epidemiology", keywords="evaluation", keywords="long-term care facility", keywords="COVID-19", keywords="SARS-CoV-2", abstract="Background: Wastewater surveillance provided early indication of COVID-19 in US municipalities. Residents of long-term care facilities (LTCFs) experienced disproportionate morbidity and mortality early in the COVID-19 pandemic. We implemented LTCF building-level wastewater surveillance for SARS-CoV-2 at 6 facilities in Kentucky to provide early warning of SARS-CoV-2 in populations considered vulnerable. Objective: This study aims to evaluate the performance of wastewater surveillance for SARS-CoV-2 at LTCFs in Kentucky. Methods: We conducted a mixed methods evaluation of wastewater surveillance following Centers for Disease Control and Prevention (CDC) guidelines for evaluating public health surveillance systems. Evaluation steps in the CDC guidelines were engaging stakeholders, describing the surveillance system, focusing the evaluation design, gathering credible evidence, and generating conclusions and recommendations. We purposively recruited stakeholders for semistructured interviews and undertook thematic content analysis of interview data. We integrated wastewater, clinical testing, and process data to characterize or calculate 7 surveillance system performance attributes (simplicity, flexibility, data quality, sensitivity and positive predictive value [PPV], timeliness, representativeness, and stability). Results: We conducted 8 stakeholder interviews. The surveillance system collected wastewater samples (N=811) 2 to 4 times weekly at 6 LTCFs in Kentucky from March 2021 to February 2022. Synthesis of credible evidence indicated variable surveillance performance. Regarding simplicity, surveillance implementation required moderate human resource and technical capacity. Regarding flexibility, the system efficiently adjusted surveillance frequency and demonstrated the ability to detect additional pathogens of interest. Regarding data quality, software identified errors in wastewater sample metadata entry (110/3120, 3.53\% of fields), technicians identified polymerase chain reaction data issues (140/7734, 1.81\% of reactions), and staff entered all data corrections into a log. Regarding sensitivity and PPV, using routine LTCF SARS-CoV-2 clinical testing results as the gold standard, a wastewater SARS-CoV-2 signal of >0 RNA copies/mL was 30.6\% (95\% CI 24.4\%-36.8\%) sensitive and 79.7\% (95\% CI 76.4\%-82.9\%) specific for a positive clinical test at the LTCF. The PPV of the wastewater signal was 34.8\% (95\% CI 27.9\%-41.7\%) at >0 RNA copies/mL and increased to 75\% (95\% CI 60\%-90\%) at >250 copies/mL. Regarding timeliness, stakeholders received surveillance data 24 to 72 hours after sample collection, with delayed reporting because of the lack of weekend laboratory staff. Regarding representativeness, stakeholders identified challenges delineating the population contributing to LTCF wastewater because of visitors, unknown staff toileting habits, and the use of adult briefs by some residents preventing their waste from entering the sewer system. Regarding stability, the reoccurring cost to conduct 1 day of wastewater surveillance at 1 facility was approximately US \$144.50, which included transportation, labor, and materials expenses. Conclusions: The LTCF wastewater surveillance system demonstrated mixed performance per CDC criteria. Stakeholders found surveillance feasible and expressed optimism regarding its potential while also recognizing challenges in interpreting and acting on surveillance data. ", doi="10.2196/44657", url="https://publichealth.jmir.org/2023/1/e44657" } @Article{info:doi/10.2196/40227, author="Alhaboby, A. Zhraa and Evans, Hala and Barnes, James and Short, Emma", title="The Impact of Cybervictimization on the Self-Management of Chronic Conditions: Lived Experiences", journal="J Med Internet Res", year="2023", month="Aug", day="25", volume="25", pages="e40227", keywords="chronic diseases", keywords="biographical disruption", keywords="long-term conditions", keywords="self-management", keywords="cybervictimization", keywords="cyber abuse", keywords="cyberbullying", keywords="cyber harassment", keywords="disability discrimination", keywords="discrimination", keywords="awareness", abstract="Background: Cybervictimization of people with long-term conditions is a disturbing phenomenon with a documented impact on health and well-being. These experiences are primarily examined using quantitative methods, focusing on children and young people. However, research centered on the cybervictimization of adults with chronic conditions is scarce, with limited qualitative input from the victims as experts in their own experiences. Objective: This study aims to understand the impact of cybervictimization on the self-management of long-term conditions among adults with chronic conditions and disabilities in the United Kingdom. Methods: This paper reports the findings from the qualitative phase of a phenomenologically informed mixed methods study. The biographical disruption concept was used to conceptualize the study. In-depth semistructured interviews were conducted with 13 participants with chronic conditions who experienced cybervictimization. A codebook was developed, and a zigzag approach to thematic analysis was used to define and refine themes. Ethical considerations and risk assessment were ongoing during the research process because of the sensitivity of the topic and cases of harassment. Results: Cybervictimization has direct and indirect impacts on the self-management of chronic conditions. This impact was verified across 6 overarching themes that emerged from this study. First, biomedical events included overall health deterioration because of existing conditions, new diagnoses, and subjective physical complaints. Second, the impact on mental health was perceived through psychological consequences and psychiatric disorders that developed after or during this traumatic experience. Third, the multilevel impact theme focused on disrupting the strategies for coping with health conditions and involved unplanned changes to victims' health management priorities. Fourth, the impact of complexity reflected the perceived uniqueness in each case, intersectionality, struggle to obtain formal support, and subsequent health complications. Fifth, social network involvement comprised the effects of social isolation, victim blaming, and deception. Finally, the disability discrimination theme focused on prejudice, issues on inclusion, and hostility in society, with subsequent effects on well-being. Conclusions: People with long-term conditions experienced different forms of cybervictimization, all disruptive with various effects on health. Disability discrimination was a prominent finding to be further investigated. This paper reports the impact as themes to guide further research and practice, with the recognition that long-term conditions and impairments are not a homogeneous group. Despite the devastating consequences, there are positive points that strengthen potential interventions. Awareness-raising campaigns, training of support channels, and multidisciplinary research are recommended to tackle this issue and initiate change. ", doi="10.2196/40227", url="https://www.jmir.org/2023/1/e40227", url="http://www.ncbi.nlm.nih.gov/pubmed/37624637" } @Article{info:doi/10.2196/45583, author="Jones, M. Christopher and Diethei, Daniel and Sch{\"o}ning, Johannes and Shrestha, Rehana and Jahnel, Tina and Sch{\"u}z, Benjamin", title="Impact of Social Reference Cues on Misinformation Sharing on Social Media: Series of Experimental Studies", journal="J Med Internet Res", year="2023", month="Aug", day="24", volume="25", pages="e45583", keywords="misinformation", keywords="social media", keywords="health literacy", keywords="COVID-19", keywords="fake news", keywords="Twitter", keywords="tweet", keywords="infodemiology", keywords="information behavior", keywords="information sharing", keywords="sharing behavior", keywords="behavior change", keywords="social cue", keywords="social reference", keywords="flag", abstract="Background: Health-related misinformation on social media is a key challenge to effective and timely public health responses. Existing mitigation measures include flagging misinformation or providing links to correct information, but they have not yet targeted social processes. Current approaches focus on increasing scrutiny, providing corrections to misinformation (debunking), or alerting users prospectively about future misinformation (prebunking and inoculation). Here, we provide a test of a complementary strategy that focuses on the social processes inherent in social media use, in particular, social reinforcement, social identity, and injunctive norms. Objective: This study aimed to examine whether providing balanced social reference cues (ie, cues that provide information on users sharing and, more importantly, not sharing specific content) in addition to flagging COVID-19--related misinformation leads to reductions in sharing behavior and improvement in overall sharing quality. Methods: A total of 3 field experiments were conducted on Twitter's native social media feed (via a newly developed browser extension). Participants' feed was augmented to include misleading and control information, resulting in 4 groups: no-information control, Twitter's own misinformation warning (misinformation flag), social cue only, and combined misinformation flag and social cue. We tracked the content shared or liked by participants. Participants were provided with social information by referencing either their personal network on Twitter or all Twitter users. Results: A total of 1424 Twitter users participated in 3 studies (n=824, n=322, and n=278). Across all 3 studies, we found that social cues that reference users' personal network combined with a misinformation flag reduced the sharing of misleading but not control information and improved overall sharing quality. We show that this improvement could be driven by a change in injunctive social norms (study 2) but not social identity (study 3). Conclusions: Social reference cues combined with misinformation flags can significantly and meaningfully reduce the amount of COVID-19--related misinformation shared and improve overall sharing quality. They are a feasible and scalable way to effectively curb the sharing of COVID-19--related misinformation on social media. ", doi="10.2196/45583", url="https://www.jmir.org/2023/1/e45583", url="http://www.ncbi.nlm.nih.gov/pubmed/37616030" } @Article{info:doi/10.2196/43790, author="Maxwell, P. Sarah and Brooks, Chris and Kim, Dohyeong and McNeely, L. Connie and Cho, Seonga and Thomas, C. Kevin", title="Improving Surveillance of Human Tick-Borne Disease Risks: Spatial Analysis Using Multimodal Databases", journal="JMIR Public Health Surveill", year="2023", month="Aug", day="23", volume="9", pages="e43790", keywords="tick-borne disease surveillance", keywords="Lyme disease", keywords="tick bite encounter", keywords="One Health model", keywords="triangulation", keywords="entomology", keywords="entomological", keywords="tick", keywords="thematic mapping", keywords="spatial", keywords="risk", keywords="surveillance", keywords="vector", abstract="Background: The extent of tick-borne disease (TBD) risk in the United States is generally unknown. Active surveillance using entomological measures, such as presence and density of infected nymphal Ixodes scapularis ticks, have served as indicators for assessing human risk, but results have been inconsistent and passive surveillance via public health systems suggests TBDs are underreported. Objective: Research using various data sources and collection methods (eg, Google Trends, apps, and tick bite encounters [TBEs] reports) has shown promise for assessing human TBD risk. In that vein, and engaging a One Health perspective, this study used multimodal databases, geographically overlaying patient survey data on TBEs and concomitant reports of TBDs with data drawn from other sources, such as canine serological reports, to glean insights and to determine and assess the use of various indicators as proxies for human TBD risk. Methods: This study used a mixed methods research strategy, relying on triangulation techniques and drawing on multiple data sources to provide insights into various aspects of human disease risk from TBEs and TBDs in the United States. A web-based survey was conducted over a 15-month period beginning in December 2020 to collect data on TBEs. To maximize the value of the covariate data, related analyses included TBE reports that occurred in the United States between January 1, 2000, and March 31, 2021. TBEs among patients diagnosed with Lyme disease were analyzed at the county level and compared to I scapularis and I pacificus tick presence, human cases identified by the Centers for Disease Control and Prevention (CDC), and canine serological data. Spatial analyses employed multilayer thematic mapping and other techniques. Results: After cleaning, survey results showed a total of 249 (75.7\%) TBEs spread across 148 respondents (61.9\% of all respondents, 81.7\% of TBE-positive respondents); 144 (4.7\%) counties in 30 states (60\%) remained eligible for analysis, with an average of 1.68 (SD 1.00) and median of 1 (IQR 1) TBEs per respondent. Analysis revealed significant spatial matching at the county level among patient survey reports of TBEs and disease risk indicators from the CDC and other official sources. Thematic mapping results included one-for-one county-level matching of reported TBEs with at least 1 designated source of human disease risk (ie, positive canine serological tests, CDC-reported Lyme disease, or known tick presence). Conclusions: Use of triangulation methods to integrate patient data on TBE recall with established canine serological reports, tick presence, and official human TBD information offers more granular, county-level information regarding TBD risk to inform clinicians and public health officials. Such data may supplement public health sources to offer improved surveillance and provide bases for developing robust proxies for TBD risk among humans. ", doi="10.2196/43790", url="https://publichealth.jmir.org/2023/1/e43790", url="http://www.ncbi.nlm.nih.gov/pubmed/37610812" } @Article{info:doi/10.2196/44031, author="Du, Min and Yan, Wenxin and Zhu, Lin and Liang, Wannian and Liu, Min and Liu, Jue", title="Trends in the Baidu Index in Search Activity Related to Mpox at Geographical and Economic Levels and Associated Factors in China: National Longitudinal Analysis", journal="JMIR Form Res", year="2023", month="Aug", day="23", volume="7", pages="e44031", keywords="mpox", keywords="internet attention", keywords="emergency", keywords="disparities", keywords="China", abstract="Background: Research assessing trends in online search activity related to mpox in China is scarce. Objective: We aimed to provide evidence for an overview of online information searching during an infectious disease outbreak by analyzing trends in online search activity related to mpox at geographical and economic levels in China and explore influencing factors. Methods: We used the Baidu index to present online search activity related to mpox from May 19 to September 19, 2022. Segmented interrupted time-series analysis was used to estimate trends in online search activity. Factors influencing these trends were analyzed using a general linear regression (GLM) model. We calculated the concentration index to measure economic-related inequality in online search activity and related trends. Results: Online search activity was highest on the day the first imported case of mpox appeared in Chongqing compared to 3 other cutoff time points. After the day of the first imported mpox case in Taiwan, the declaration of a public health emergency of international concern, the first imported mpox case in Hong Kong, and the first imported mpox case in Chongqing, national online search activity increased by 0.642\%, 1.035\%, 1.199\%, and 2.023\%, respectively. The eastern regions had higher increases than the central and western regions. Across 31 provinces, municipalities, and autonomous regions, the top 3 areas with higher increases were Beijing, Shanghai, and Tianjin at 3 time points, with the exception of the day of the first imported mpox case in Chongqing (Chongqing replaced Tianjin on that day). When AIDS incidence increased by 1 per 100,000 people, there was an increase after the day of the first imported mpox case in Chongqing of 36.22\% (95\% CI 3.29\%-69.15\%; P=.04) after controlling for other covariates. Online search activity (concentration index=0.18; P<.001) was more concentrated among populations with a higher economic status. Unlike the central area, the eastern (concentration index=0.234; P<.001) and western areas (concentration index=0.047; P=.04) had significant economic-related disparities (P for difference <.001) in online search activity. The overall concentration index of changes in online search activity became lower over time. Conclusions: Regions with a higher economic level showed more interest in mpox, especially Beijing and Shanghai. After the day of the first imported mpox case in Chongqing, changes in online search activity were affected by AIDS incidence rate. Economic-related disparities in changes in online search activity became lower over time. It would be desirable to construct a reliable information source in regions with a higher economic level and higher AIDS incidence rate and promote public knowledge in regions with a lower economic level in China, especially after important public events. ", doi="10.2196/44031", url="https://formative.jmir.org/2023/1/e44031", url="http://www.ncbi.nlm.nih.gov/pubmed/37610816" } @Article{info:doi/10.2196/43703, author="Sigalo, Nekabari and Awasthi, Naman and Abrar, Mohammad Saad and Frias-Martinez, Vanessa", title="Using COVID-19 Vaccine Attitudes on Twitter to Improve Vaccine Uptake Forecast Models in the United States: Infodemiology Study of Tweets", journal="JMIR Infodemiology", year="2023", month="Aug", day="21", volume="3", pages="e43703", keywords="social media", keywords="Twitter", keywords="COVID-19", keywords="vaccine", keywords="surveys", keywords="SARS-CoV-2", keywords="vaccinations", keywords="hesitancy", keywords="vaccine hesitancy", keywords="forecast model", keywords="vaccine uptake", keywords="health promotion", keywords="infodemiology", keywords="health information", keywords="misinformation", abstract="Background: Since the onset of the COVID-19 pandemic, there has been a global effort to develop vaccines that protect against COVID-19. Individuals who are fully vaccinated are far less likely to contract and therefore transmit the virus to others. Researchers have found that the internet and social media both play a role in shaping personal choices about vaccinations. Objective: This study aims to determine whether supplementing COVID-19 vaccine uptake forecast models with the attitudes found in tweets improves over baseline models that only use historical vaccination data. Methods: Daily COVID-19 vaccination data at the county level was collected for the January 2021 to May 2021 study period. Twitter's streaming application programming interface was used to collect COVID-19 vaccine tweets during this same period. Several autoregressive integrated moving average models were executed to predict the vaccine uptake rate using only historical data (baseline autoregressive integrated moving average) and individual Twitter-derived features (autoregressive integrated moving average exogenous variable model). Results: In this study, we found that supplementing baseline forecast models with both historical vaccination data and COVID-19 vaccine attitudes found in tweets reduced root mean square error by as much as 83\%. Conclusions: Developing a predictive tool for vaccination uptake in the United States will empower public health researchers and decisionmakers to design targeted vaccination campaigns in hopes of achieving the vaccination threshold required for the United States to reach widespread population protection. ", doi="10.2196/43703", url="https://infodemiology.jmir.org/2023/1/e43703", url="http://www.ncbi.nlm.nih.gov/pubmed/37390402" } @Article{info:doi/10.2196/47530, author="Quijote, Llew Kirk and Casta{\~n}eda, Therese Arielle Marie and Guevara, Edgar Bryan and Tangtatco, Aileen Jennifer", title="A Descriptive Analysis of Dermatology Content and Creators on Social Media in the Philippines", journal="JMIR Dermatol", year="2023", month="Aug", day="21", volume="6", pages="e47530", keywords="social media", keywords="dermatology", keywords="dermatologist", keywords="creator", keywords="content", keywords="impact", keywords="Philippines", keywords="Facebook", keywords="Instagram", keywords="Twitter", keywords="TikTok", keywords="YouTube", doi="10.2196/47530", url="https://derma.jmir.org/2023/1/e47530", url="http://www.ncbi.nlm.nih.gov/pubmed/37603392" } @Article{info:doi/10.2196/45717, author="Lee, Frank and Jain, Payaal Jennifer and Duthely, M. Lunthita and Ikeda, Janet and Santos, Glenn-Milo", title="Stimulant Use Associated With Psychosocial Factors, HIV Risk, and Concurrent Hazardous Alcohol Use Among US Adults: Exploratory Cross-Sectional Questionnaire Study", journal="JMIR Form Res", year="2023", month="Aug", day="17", volume="7", pages="e45717", keywords="Amazon Mechanical Turk", keywords="stimulant use", keywords="alcohol use", keywords="craving", keywords="men who have sex with men", keywords="MSM", keywords="depression", keywords="affect", keywords="HIV", keywords="public health", keywords="gender minority", keywords="psychosocial", keywords="addiction", abstract="Background: Stimulant use is a major public health problem that contributes to morbidity and mortality among men who have sex with men (MSM) in the United States. To reduce the harms associated with stimulant use, there is a need to identify the factors associated with stimulant use to inform interventions. Additionally, there is a need to use large crowdsourcing platforms like Amazon Mechanical Turk (MTurk) to engage more individuals who use substances across the United States. Objective: We identified the correlates of stimulant use among people who use alcohol or stimulants in the United States recruited using MTurk. Methods: Participants who were aged ?18 years in the United States and reported alcohol or stimulant (ie, cocaine, crack cocaine, and methamphetamine) use were deemed eligible and recruited via the web platform MTurk. Participants completed a baseline survey, which assessed sociodemographics, psychosocial (ie, depression, affect, self-esteem, and stress) factors, substance use, and sexual behaviors. Data were collected and analyzed with STATA (version 17; StataCorp). Stratifying by MSM status, bivariate and multivariable logistic regression models were built in STATA to examine the correlates of stimulant use. Multivariable models controlled for age, race, health insurance, and relationship status. Results: Of 272 participants, 201 (73.9\%) identified as male, 134 (49.2\%) were MSM, 52 (19.1\%) were from racial and ethnic minoritized communities, and 158 (58\%) were in a relationship. The mean age was 36.10 (SD 10.3) years. A total of 40 (14.7\%) participants reported stimulant use in the past 6 months. Factors significantly associated with stimulant use were being MSM (adjusted odds ratio [aOR]\thinspace4.61, 95\% CI 1.97-10.81), a higher Alcohol Use Disorders Identification Test-Concise score (aOR 1.24, 95\% CI 1.08-1.42), more intense cravings for alcohol in the past 24 hours (aOR 1.03, 95\% CI 1.01-1.04), a higher depression score (aOR 1.06, 95\% CI 1.01-1.12), a greater number of male partners in the last 6 months (aOR 1.32, 95\% CI 1.08-1.61), a greater number of female partners in the last 6 months (aOR 1.42, 95\% CI 1.04-1.92), and being diagnosed with a sexually transmitted infection (eg, syphilis, gonorrhea, chlamydia, herpes simplex virus, human papillomavirus, and other) in the last 6 months (aOR 14.61, 95\% CI 3.45-61.87). Additionally, there was a significant additive interaction between MSM status and negative affect, such that the impact of negative affect on stimulant use was significantly greater among MSM compared with non-MSM (relative excess risk due to interaction 0.085, 95\% CI 0.037-0.13). Conclusions: Interventions that address stimulant use should use evidence-based approaches that reduce negative affect, depression, and cravings for alcohol. Additionally, interventions should be customized for MSM populations. ", doi="10.2196/45717", url="https://formative.jmir.org/2023/1/e45717", url="http://www.ncbi.nlm.nih.gov/pubmed/37590045" } @Article{info:doi/10.2196/48308, author="Xu, Huan Richard and Shi, Lushaobo and Shi, Zengping and Li, Ting and Wang, Dong", title="Investigating Individuals' Preferences in Determining the Functions of Smartphone Apps for Fighting Pandemics: Best-Worst Scaling Survey Study", journal="J Med Internet Res", year="2023", month="Aug", day="15", volume="25", pages="e48308", keywords="best-worst scaling", keywords="BWS", keywords="smartphone app", keywords="app", keywords="pandemic", keywords="preference", keywords="health care", keywords="survey", abstract="Background: Smartphone apps have been beneficial in controlling and preventing the COVID-19 pandemic. However, there is a gap in research surrounding the importance of smartphone app functions from a user's perspective. Although the insights and opinions of different stakeholders, such as policymakers and medical professionals, can influence the success of a public health policy, any strategy will face difficulty in achieving the expected effect if it is not based on a method that users can accept. Objective: This study aimed to assess the importance of a hypothetical smartphone app's functions for managing health during a pandemic based on the perspective of user preferences. Methods: A cross-sectional and web-based survey using the best-worst scaling (BWS) method was used to investigate the general population's preferences for important smartphone app functions. Participants were recruited from a professional surveying company's web-based surveying panel. The attributes of the BWS questionnaire were developed based on a robust process, including literature review, interviews, and expert discussion. A balanced incomplete block design was used to construct the choice task to ensure the effectiveness of the research design. Count analysis, conditional logit model analysis, and mixed logit analysis were used to estimate preference heterogeneity among respondents. Results: The responses of 2153 participants were eligible for analysis. Nearly 55\% (1192/2153) were female, and the mean age was 31.4 years. Most participants (1765/2153, 81.9\%) had completed tertiary or higher education, and approximately 70\% (1523/2153) were urban residents. The 3 most vital functions according to their selection were ``surveillance and monitoring of infected cases,'' ``quick self-screening,'' and ``early detection of infected cases.'' The mixed logit regression model identified significant heterogeneity in preferences among respondents, and stratified analysis showed that some heterogeneities varied in respondents by demographics and COVID-19--related characteristics. Participants who preferred to use the app were more likely to assign a high weight to the preventive functions than those who did not prefer to use it. Conversely, participants who showed lower willingness to use the app tended to indicate a higher preference for supportive functions than those who preferred to use it. Conclusions: This study ranks the importance of smartphone app features that provide health care services during a pandemic based on the general population's preferences in China. It provides empirical evidence for decision-makers to develop eHealth policies and strategies that address future public health crises from a person-centered care perspective. Continued use of apps and smart investment in digital health can help improve health outcomes and reduce the burden of disease on individuals and communities. ", doi="10.2196/48308", url="https://www.jmir.org/2023/1/e48308", url="http://www.ncbi.nlm.nih.gov/pubmed/37581916" } @Article{info:doi/10.2196/44760, author="Goodman, L. Kimberly and Kamke, Kristyn and Mullin, M. Tara", title="Online Help-Seeking Among Youth Victims of Sexual Violence Before and During COVID-19 (2016-2021): Analysis of Hotline Use Trends", journal="JMIR Public Health Surveill", year="2023", month="Aug", day="11", volume="9", pages="e44760", keywords="child sexual abuse", keywords="hotlines", keywords="COVID-19", keywords="help-seeking", keywords="online services", keywords="child abuse", keywords="mental health well-being", keywords="child support", keywords="sexual abuse", keywords="mental health service", keywords="sexual violence", abstract="Background: Three years since the onset of COVID-19, pandemic-related trends in child sexual abuse (CSA) remain poorly understood. Common administrative surveillance metrics may have underestimated abuse during the pandemic, given youths' limited access to mandatory reporters. Research using anonymous service-use data showed increased violence-related online help-seeking but overlooked youth-specific help-seeking for CSA during COVID-19. Understanding pandemic-related trends in CSA can inform abuse detection practices and mental health service provision for youth victims. Objective: The purpose of this study was to harness anonymous help-seeking data from the National Sexual Assault Online Hotline (NSAOH) to glean insights about CSA occurrence in the United States during the COVID-19 pandemic. Methods: We used an archival sample of victims who contacted NSAOH from 2016 to 2021 (n=41,561). We examined differences in the proportion of youth and adult victims contacting NSAOH during the first COVID-19 year (March 2020 to February 2021) compared to the prior year (March 2019 to February 2020; n=11,719). Further, we compared key characteristics of hotline interactions among youth victims during the first COVID-19 year to the prior year (n=5913). Using joinpoint regression analysis, we examined linear trends in the number of monthly sampled youth and adult victims (excluding victims of unknown age) from 2016 to 2021 who discussed any victimization event (n=26,904) and who discussed recent events (ie, events occurring during the pandemic; n=9932). Results: Most youth victims were abused by family members prior to (1013/1677, 60.4\%) and after (2658/3661, 72.6\%) the onset of COVID-19. The number of youth victims contacting NSAOH spiked in March 2020 and peaked in November 2020 for all youth (slope=28.2, 95\% CI 18.7-37.7) and those discussing recent events (slope=17.4, 95\% CI 11.1-23.6). We observed a decline in youth victims into spring 2021 for all youth (slope=--56.9, 95\% CI --91.4 to --22.3) and those discussing recent events (slope=--33.7, 95\% 47.3 to -20.0). The number of adult victims discussing any victimization event increased steadily from January 2018 through May 2021 (slope=3.6; 95\% CI 2.9-4.2) and then declined (slope=--13.8, 95\% CI --22.8 to --4.7). Trends were stable for adults discussing recent events. Conclusions: This study extends the use of hotline data to understand the implications of the pandemic on CSA. We observed increased youth help-seeking through the NSAOH coinciding with the onset of COVID-19. Trends persisted when limiting analyses to recent victimization events, suggesting increased help-seeking reflected increased CSA during COVID-19. These findings underscore the utility of anonymous online services for youth currently experiencing abuse. Further, the findings support calls for increased youth mental health services and efforts to incorporate online chat into youth-targeted services. ", doi="10.2196/44760", url="https://publichealth.jmir.org/2023/1/e44760", url="http://www.ncbi.nlm.nih.gov/pubmed/37566446" } @Article{info:doi/10.2196/47798, author="Mitsuhashi, Toshiharu", title="Assessing Vulnerability to Surges in Suicide-Related Tweets Using Japan Census Data: Case-Only Study", journal="JMIR Form Res", year="2023", month="Aug", day="10", volume="7", pages="e47798", keywords="case-only approach", keywords="mass media", keywords="public health", keywords="social media", keywords="suicidal risk", keywords="suicide prevention", keywords="suicide", keywords="suicide-related tweets", keywords="Twitter", abstract="Background: As the use of social media becomes more widespread, its impact on health cannot be ignored. However, limited research has been conducted on the relationship between social media and suicide. Little is known about individuals' vulnerable to suicide, especially when social media suicide information is extremely prevalent. Objective: This study aims to identify the characteristics underlying individuals' vulnerability to suicide brought about by an increase in suicide-related tweets, thereby contributing to public health. Methods: A case-only design was used to investigate vulnerability to suicide using individual data of people who died by suicide and tweet data from January 1, 2011, through December 31, 2014. Mortality data were obtained from Japanese government statistics, and tweet data were provided by a commercial service. Tweet data identified the days when suicide-related tweets surged, and the date-keyed merging was performed by considering 3 and 7 lag days. For the merged data set for analysis, the logistic regression model was fitted with one of the personal characteristics of interest as a dependent variable and the dichotomous exposure variable. This analysis was performed to estimate the interaction between the surges in suicide-related tweets and personal characteristics of the suicide victims as case-only odds ratios (ORs) with 95\% CIs. For the sensitivity analysis, unexpected deaths other than suicide were considered. Results: During the study period, there were 159,490 suicides and 115,072 unexpected deaths, and the number of suicide-related tweets was 2,804,999. Following the 3-day lag of a highly tweeted day, there were significant interactions for those who were aged 40 years or younger (OR 1.09, 95\% CI 1.03-1.15), male (OR 1.12, 95\% CI 1.07-1.18), divorced (OR 1.11, 95\% CI 1.03 1.19), unemployed (OR 1.12, 95\% CI 1.02-1.22), and living in urban areas (OR 1.26, 95\% CI 1.17 1.35). By contrast, widowed individuals had significantly lower interactions (OR 0.83, 95\% CI 0.77-0.89). Except for unemployment, significant relationships were also observed for the 7-day lag. For the sensitivity analysis, no significant interactions were observed for other unexpected deaths in the 3-day lag, and only the widowed had a significantly larger interaction than those who were married (OR 1.08, 95\% CI 1.02-1.15) in the 7-day lag. Conclusions: This study revealed the interactions of personal characteristics associated with susceptibility to suicide-related tweets. In addition, a few significant relationships were observed in the sensitivity analysis, suggesting that such an interaction is specific to suicide deaths. In other words, individuals with these characteristics, such as being young, male, unemployed, and divorced, may be vulnerable to surges in suicide-related tweets. Thus, minimizing public health strain by identifying people who are vulnerable and susceptible to a surge in suicide-related information on the internet is necessary. ", doi="10.2196/47798", url="https://formative.jmir.org/2023/1/e47798", url="http://www.ncbi.nlm.nih.gov/pubmed/37561553" } @Article{info:doi/10.2196/47018, author="Ngah, Emerencia Yayah and Raoufi, Ghazal and Amirkhani, Maral and Esmaeili, Ashkan and Nikooifard, Rasa and Ghaemi Mood, Shidrokh and Rahmanian, Ava and Boltena, Tadesse Minyahil and Aga, Eresso and Neogi, Ujjwal and Ikomey Mondinde, George and El-Khatib, Ziad", title="Testing the Impact of Phone Texting Reminders for Children's Immunization Appointments in Rural Cameroon: Protocol for a Nonrandomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Aug", day="9", volume="12", pages="e47018", keywords="immunization", keywords="children", keywords="Cameroon", keywords="digital health", keywords="global health", keywords="nonrandomized controlled trial", keywords="child vaccination", abstract="Background: Globally, over 20 million children are unvaccinated and over 25 million missed their follow-up doses during the COVID-19 pandemic; thus, they face vaccine-preventable diseases and unnecessary deaths. This is especially the case for those with HIV or living in vulnerable settings. Using cell phones to send reminders to parents has been shown to improve vaccination rates. Objective: We aim to determine whether implementation of an automated SMS reminder will improve child vaccination rates in a turbulent, semiurban/semirural setting in a low-income country. Methods: This will be a nonrandomized controlled trial that will be conducted at Azire Integrated Health Centre, Bamenda, Cameroon. Results: A total of 200 parents per study group (aged over 18 years) who are registered at the clinic at least one month prior to the study will be recruited. The intervention group will receive 2 reminders: 1 week and 2 days prior to the scheduled vaccination. For those who miss their appointments, a reminder will be sent 1 week after their missed appointment. The control group will receive the regular care provided at the clinic. Baseline information, clinical visit data, and vaccination records will be collected for both groups. Descriptive statistics will be used to summarize baseline characteristics between and within clusters and groups. The Fisher exact test will be used to compare parent-child units who return for follow-up visits (as a percentage) and children vaccinated as scheduled (as a percentage) between the study groups. Finally, we will compare how many members of both study groups return for 1 follow-up visit using Kaplan-Meier survival analysis. Conclusions: Due to limited effective child vaccination interventions in unstable settings, this study will be of high importance for suggesting a holistic approach to improve child vaccination and public health. International Registered Report Identifier (IRRID): DERR1-10.2196/47018 ", doi="10.2196/47018", url="https://www.researchprotocols.org/2023/1/e47018", url="http://www.ncbi.nlm.nih.gov/pubmed/37556178" } @Article{info:doi/10.2196/41959, author="Scharnetzki, Elizabeth and Waterston, Leo and Scherer, M. Aaron and Thorpe, Alistair and Fagerlin, Angela and Han, J. Paul K.", title="Effects of Prosocial and Hope-Promoting Communication Strategies on COVID-19 Worry and Intentions for Risk-Reducing Behaviors and Vaccination: Experimental Study", journal="JMIR Form Res", year="2023", month="Aug", day="1", volume="7", pages="e41959", keywords="COVID-19", keywords="communication", keywords="hope", keywords="prosocial", keywords="vaccination", keywords="risk", keywords="behavior", keywords="vaccine", keywords="effect", keywords="effectiveness", keywords="social", keywords="messages", keywords="public", keywords="web-based", keywords="survey", abstract="Background: The COVID-19 pandemic has engendered widespread fear and skepticism about recommended risk-reducing behaviors including vaccination. Health agencies are faced with the need to communicate to the public in ways that both provide reassurance and promote risk-reducing behaviors. Communication strategies that promote prosocial (PS) values and hope are being widely used; however, the existing research on the persuasiveness of these strategies has offered mixed evidence. There is also very little research examining the comparative effectiveness of PS and hope-promoting (HP) strategies. Objective: The aim of this study is to evaluate the comparative effectiveness of PS and HP messages in reassuring the public and motivating COVID-19 risk--reducing behaviors. Methods: A web-based factorial experiment was conducted in which a diverse sample of the US public was randomized to read messages which adapted existing COVID-19 information from a public website produced by a state government public health department to include alternative framing language: PS, HP, or no additional framing (control). Participants then completed surveys measuring COVID-19 worry and intentions for COVID-19 risk--reducing behaviors and vaccination. Results: COVID-19 worry was unexpectedly higher in the HP than in the control and PS conditions. Intentions for COVID-19 risk--reducing behaviors did not differ between groups; however, intentions for COVID-19 vaccination were higher in the HP than in the control condition, and this effect was mediated by COVID-19 worry. Conclusions: It appears that HP communication strategies may be more effective than PS strategies in motivating risk-reducing behaviors in some contexts but with the paradoxical cost of promoting worry. ", doi="10.2196/41959", url="https://formative.jmir.org/2023/1/e41959", url="http://www.ncbi.nlm.nih.gov/pubmed/37379364" } @Article{info:doi/10.2196/48405, author="Parker, A. Maria and Valdez, Danny and Rao, K. Varun and Eddens, S. Katherine and Agley, Jon", title="Results and Methodological Implications of the Digital Epidemiology of Prescription Drug References Among Twitter Users: Latent Dirichlet Allocation (LDA) Analyses", journal="J Med Internet Res", year="2023", month="Jul", day="28", volume="25", pages="e48405", keywords="Twitter", keywords="LDA", keywords="drug use", keywords="digital epidemiology", keywords="unsupervised analysis", keywords="tweet", keywords="tweets", keywords="social media", keywords="epidemiology", keywords="epidemiological", keywords="machine learning", keywords="text mining", keywords="data mining", keywords="pharmacy", keywords="pharmaceutic", keywords="pharmaceutical", keywords="pharmaceuticals", keywords="drug", keywords="prescription", keywords="NLP", keywords="natural language processing", abstract="Background: Social media is an important information source for a growing subset of the population and can likely be leveraged to provide insight into the evolving drug overdose epidemic. Twitter can provide valuable insight into trends, colloquial information available to potential users, and how networks and interactivity might influence what people are exposed to and how they engage in communication around drug use. Objective: This exploratory study was designed to investigate the ways in which unsupervised machine learning analyses using natural language processing could identify coherent themes for tweets containing substance names. Methods: This study involved harnessing data from Twitter, including large-scale collection of brand name (N=262,607) and street name (N=204,068) prescription drug--related tweets and use of unsupervised machine learning analyses (ie, natural language processing) of collected data with data visualization to identify pertinent tweet themes. Latent Dirichlet allocation (LDA) with coherence score calculations was performed to compare brand (eg, OxyContin) and street (eg, oxys) name tweets. Results: We found people discussed drug use differently depending on whether a brand name or street name was used. Brand name categories often contained political talking points (eg, border, crime, and political handling of ongoing drug mitigation strategies). In contrast, categories containing street names occasionally referenced drug misuse, though multiple social uses for a term (eg, Sonata) muddled topic clarity. Conclusions: Content in the brand name corpus reflected discussion about the drug itself and less often reflected personal use. However, content in the street name corpus was notably more diverse and resisted simple LDA categorization. We speculate this may reflect effective use of slang terminology to clandestinely discuss drug-related activity. If so, straightforward analyses of digital drug-related communication may be more difficult than previously assumed. This work has the potential to be used for surveillance and detection of harmful drug use information. It also might be used for appropriate education and dissemination of information to persons engaged in drug use content on Twitter. ", doi="10.2196/48405", url="https://www.jmir.org/2023/1/e48405", url="http://www.ncbi.nlm.nih.gov/pubmed/37505795" } @Article{info:doi/10.2196/43493, author="Dai, Zhen and Mi, Guodong and Yu, Fei and Chen, Guodong and Wang, Xiaodong and He, Qinying", title="Using a Geosocial Networking App to Investigate New HIV Infections and Related Risk Factors Among Student and Nonstudent Men Who Have Sex With Men in Chengdu, China: Open Cohort Study", journal="J Med Internet Res", year="2023", month="Jul", day="28", volume="25", pages="e43493", keywords="geosocial networking app", keywords="GSN app", keywords="young men who have sex with men", keywords="MSM", keywords="HIV", keywords="incidence", keywords="risk factors", keywords="cohort study", keywords="smartphone", keywords="mobile phone", abstract="Background: In China, condomless sex among men who have sex with men (MSM) is the primary route of HIV infection in young people. Chengdu is a hotspot for reported HIV cases among young people nationwide. Extensive use of geosocial networking (GSN) smartphone apps has dramatically changed the pattern of sexual behavior among young MSM (YMSM). However, data on HIV incidence and the risk behavior of YMSM using the GSN app are still obscure. Objective: This study aims to analyze and understand the HIV incidence and its risk factors among YMSM using GSN apps in Chengdu, China. Methods: An open cohort study was conducted among YMSM aged 18-24 years through a gay GSN smartphone app in Chengdu, China, from July 2018 to December 2020. Every participant completed a web-based questionnaire on sociodemographic characteristics, sexual behaviors, and other related statuses; made a reservation for a web-based HIV testing; and then voluntarily got tested at the designated testing site. At least one additional HIV test was taken via the app during the study period, and participants were evaluated at the end of the study or at the time of HIV seroconversion. By dividing the sum of the observed HIV seroconversions by the observed person-years, HIV incidence was calculated and compared between the student and nonstudent MSM. Univariate and multivariate (Cox proportional hazards regression) analyses were used to discuss the risk factors for new HIV infections. Results: In the study cohort, 24 seroconversions occurred among 625 YMSM who took at least two HIV tests through the app during the study period, contributing to 505 observed person-years. The HIV incidence rate per 100 person-years was 4.75 (95\% CI 2.89-6.61) among all MSM, 3.60 (95\% CI 1.27-5.93) among student MSM, and 5.88 (95\% CI 2.97-8.79) among nonstudent MSM. In addition, the HIV incidence per 100 person-years was 11.11 (95\% CI 4.49-17.73) among those who had resided in the area for 6 months or less and 7.14 (95\% CI 1.52-12.77) among those with senior high school or less education. Two or more sexual partners (adjusted hazards ratio [HR] 3.63, 95\% CI 1.08-12.23) in the preceding 6 months was a risk factor for new HIV infections. Consistent condom use for anal sex (adjusted HR 0.38, 95\% CI 0.16-0.88) and insertive anal sex only (adjusted HR 0.10, 95\% CI 0.01-0.75) in the preceding 6 months were protective factors for new HIV infections. Conclusions: The rate of new HIV infections among YMSM who actively used GSN smartphone apps was high, especially among migrant nonstudent MSM. Targeted interventions on GSN smartphone apps should be implemented to provide demand-adapted prevention and services to reduce the threat of HIV. ", doi="10.2196/43493", url="https://www.jmir.org/2023/1/e43493", url="http://www.ncbi.nlm.nih.gov/pubmed/37505891" } @Article{info:doi/10.2196/45713, author="Tang, Mitchell and Sharma, Yashoda and Goldsack, C. Jennifer and Stern, Dora Ariel", title="Building the Business Case for an Inclusive Approach to Digital Health Measurement With a Web App (Market Opportunity Calculator): Instrument Development Study", journal="JMIR Form Res", year="2023", month="Jul", day="26", volume="7", pages="e45713", keywords="inclusion", keywords="digital health", keywords="digital product development", keywords="health equity", keywords="public health", keywords="Digital Health Measurement Collaborative Community", keywords="DATAcc", abstract="Background: The use of digital health measurement tools has grown substantially in recent years. However, there are concerns that the promised benefits from these products will not be shared equitably. Underserved populations, such as those with lower education and income, racial and ethnic minorities, and those with disabilities, may find such tools poorly suited for their needs. Because underserved populations shoulder a disproportionate share of the US disease burden, they also represent a substantial share of digital health companies' target markets. Incorporating inclusive principles into the product development process can help ensure that the resulting tools are broadly accessible and effective. In this context, inclusivity not only maximizes societal benefit but also leads to greater commercial success. Objective: A critical element in fostering inclusive product development is building the business case for why it is worthwhile. The Digital Health Measurement Collaborative Community (DATAcc) Market Opportunity Calculator was developed as an open-access resource to enable digital health measurement product developers to build a business case for incorporating inclusive practices into their research and development processes. Methods: The DATAcc Market Opportunity Calculator combines data on population demographics and disease prevalence and health status from the US Census Bureau and the US Centers for Disease Control and Prevention (CDC). Together, these data are used to calculate the share of US adults with specific conditions (eg, diabetes) falling into various population segments along key ``inclusion vectors'' (eg, race and ethnicity). Results: A free and open resource, the DATAcc Market Opportunity Calculator can be accessed from the DATAcc website. Users first select the target health condition addressed by their product, and then an inclusion vector to segment the patient population. The calculator displays each segment as a share of the overall US adult population and its share specifically among adults with the target condition, quantifying the importance of underserved patient segments to the target market. The calculator also estimates the value of improvements to product inclusivity by modeling the downstream impact on the accessible market size. For example, simplifying prompts on a hypertension-focused product to make it more accessible for adults with lower educational attainment is shown by the calculator to increase the target market by 2 million people and the total addressable market opportunity by US \$200 million. Conclusions: Digital health measurement is still in its infancy. Now is the time to establish a precedent for inclusive product development to maximize societal benefit and build sustainable commercial returns. The Market Opportunity Calculator can help build the business case for ``why''---showing how inclusivity can translate to financial opportunity. Once the decision has been made to pursue inclusive design, other components of the broader DATAcc toolkit for inclusive product development can support the ``how.'' ", doi="10.2196/45713", url="https://formative.jmir.org/2023/1/e45713", url="http://www.ncbi.nlm.nih.gov/pubmed/37494108" } @Article{info:doi/10.2196/43628, author="Jin, Qiang and Raza, Hassan Syed and Yousaf, Muhammad and Zaman, Umer and Ogadimma, C. Emenyeonu and Shah, Ali Amjad and Core, Rachel and Malik, Aqdas", title="Assessing How Risk Communication Surveillance Prompts COVID-19 Vaccine Acceptance Among Internet Users by Applying the Situational Theory of Problem Solving: Cross-Sectional Study", journal="JMIR Form Res", year="2023", month="Jul", day="26", volume="7", pages="e43628", keywords="COVID-19", keywords="vaccine safety", keywords="risk communication", keywords="digital interventions", keywords="health communication", keywords="Situational Theory of Problem Solving", abstract="Background: The World Health Organization has recently raised concerns regarding the low number of people fully vaccinated against COVID-19. The low ratio of fully vaccinated people and the emergence of renewed infectious variants correspond to worsening public health. Global health managers have highlighted COVID-19 vaccine--related infodemics as a significant risk perception factor hindering mass vaccination campaigns. Objective: Given the ambiguous digital communication environment that has fostered infodemics, resource-limited nations struggle to boost public willingness to encourage people to fully vaccinate. Authorities have launched some risk communication--laden digital interventions in response to infodemics. However, the value of the risk communication strategies used to tackle infodemics needs to be evaluated. The current research using the tenets of the Situational Theory of Problem Solving is novel, as it explores the impending effects of risk communication strategies. The relationship between infodemic-induced risk perception of COVID-19 vaccine safety and risk communication actions to intensify willingness to be fully vaccinated was examined. Methods: This study used a cross-sectional research design vis-{\`a}-vis a nationally representative web-based survey. We collected data from 1946 internet users across Pakistan. Participants voluntarily participated in this research after completing the consent form and reading ethical permissions. Responses were received over 3 months, from May 2022 to July 2022. Results: The results delineated that infodemics positively affected risk perception. This realization pushed the public to engage in risky communicative actions through reliance on and searches for accurate information. Therefore, the prospect of managing infodemics through risk information exposure (eg, digital interventions) using the situational context could predict robust willingness to be fully vaccinated against COVID-19. Conclusions: These pioneering results offer strategic considerations for health authorities to effectively manage the descending spiral of optimal protection against COVID-19. This research concludes that the likelihood of managing infodemics using situational context through exposure to relevant information could improve one's knowledge of forfending and selection, which can lead to robust protection against COVID-19. Hence, more situation-specific information about the underlying problem (ie, the selection of an appropriate vaccine) can be made accessible through several official digital sources to achieve a more active public health response. ", doi="10.2196/43628", url="https://formative.jmir.org/2023/1/e43628", url="http://www.ncbi.nlm.nih.gov/pubmed/37315198" } @Article{info:doi/10.2196/43516, author="Kopsco, L. Heather and Krell, K. Rayda and Mather, N. Thomas and Connally, P. Neeta", title="Identifying Trusted Sources of Lyme Disease Prevention Information Among Internet Users Connected to Academic Public Health Resources: Internet-Based Survey Study", journal="JMIR Form Res", year="2023", month="Jul", day="26", volume="7", pages="e43516", keywords="communication", keywords="consumer health information", keywords="disease", keywords="internet", keywords="Lyme disease", keywords="online", keywords="pathogen", keywords="prevention", keywords="public health", keywords="resources", keywords="social media", keywords="survey", keywords="tickborne disease", keywords="ticks", abstract="Background: Misinformation about Lyme disease and other tick-transmitted pathogens circulates frequently on the internet and can compete with, or even overshadow, science-based guidance on tick-borne disease (TBD) prevention. Objective: We surveyed internet users connected to academic tick-related resources to identify trusted sources of Lyme disease prevention information, explore confidence in tick bite prevention information, and examine associations of these responses with answers to commonly disputed issues. Methods: The survey was conducted through social media and website pages for Western Connecticut State University Tickborne Disease Prevention Laboratory and the University of Rhode Island TickEncounter Resource Center. Results: Respondents (N=1190) were predominantly female (903/1190, 76.3\%), middle-aged (574/1182, 48.6\%), and resided in New England states (663/1190, 55.7\%). In total 984 of 1186 (83\%) respondents identified conventional experts (eg, the Centers for Disease Control [CDC] or other government health agencies, physicians who follow Infectious Diseases Society of America guidelines for Lyme disease treatment guidelines, and academics) as trustworthy TBD prevention resources. However, nearly one-fourth of respondents would first consult personal contacts and web-based communities regarding prevention information before consulting conventional expert sources. The opinions of public health experts and physicians were rated among the top motivators underlying personal prevention decisions; yet, more than 50\% of participants revealed distrustful attitudes toward, or were uncertain about, CDC-supported statements related to time to transmission of Lyme disease (708/1190, 59.5\%), the safety of diethyltoluamide-based repellents for children (604/1183, 51.1\%), and recommended use of antibiotic prophylaxis (773/1181, 65.4\%). Multimodal regression models revealed that participants from high-Lyme-disease-incidence states were more likely to first seek TBD prevention information from personal networks and nontraditional sources before approaching conventional sources of TBD prevention information. We found that those reporting high rates of social media usage were more than twice as likely to first seek traditional expert sources of prevention information but were overall more likely to reject CDC-promoted Lyme disease information, in particular the established time to transmission of Lyme disease bacteria. Models also predicted that those participants who disagreed with the conventional scientific view on the antibiotic prophylaxis prevention statement were less likely to be confident in their ability to protect themselves from a tick bite. Overall, uncertainty in one's ability to protect oneself against tick bites was strongly associated with uncertainty about beliefs in CDC-promoted TBD prevention information. Self-reported trust in experts and frequency of social media use suggest that these platforms may provide opportunities to engage directly with the public about TBD prevention practices. Conclusions: Using strategies to improve public trust and provide information where the public engages on social media may improve prevention communication and adoption of best practices. ", doi="10.2196/43516", url="https://formative.jmir.org/2023/1/e43516", url="http://www.ncbi.nlm.nih.gov/pubmed/37494089" } @Article{info:doi/10.2196/46026, author="Schooley, L. Benjamin and Ahmed, Abdulaziz and Maxwell, Justine and Feldman, S. Sue", title="Predictors of COVID-19 From a Statewide Digital Symptom and Risk Assessment Tool: Cross-Sectional Study", journal="J Med Internet Res", year="2023", month="Jul", day="25", volume="25", pages="e46026", keywords="COVID-19", keywords="risk assessment", keywords="symptom tracker", keywords="passport application", keywords="surveillance", keywords="mobile app", keywords="multiple linear regression", keywords="healthcheck", keywords="public health informatics", keywords="decision support system", keywords="health information technology", abstract="Background: Some of the most vexing issues with the COVID-19 pandemic were the inability of facilities and events, such as schools and work areas, to track symptoms to mitigate the spread of the disease. To combat these challenges, many turned to the implementation of technology. Technology solutions to mitigate repercussions of the COVID-19 pandemic include tools that provide guidelines and interfaces to influence behavior, reduce exposure to the disease, and enable policy-driven avenues to return to a sense of normalcy. This paper presents the implementation and early evaluation of a return-to-work COVID-19 symptom and risk assessment tool. The system was implemented across 34 institutions of health and education in Alabama, including more than 174,000 users with over 4 million total uses and more than 86,000 reports of exposure risk between July 2020 and April 2021. Objective: This study aimed to explore the usage of technology, specifically a COVID-19 symptom and risk assessment tool, to mitigate exposure to COVID-19 within public spaces. More specifically, the objective was to assess the relationship between user-reported symptoms and exposure via a mobile health app, with confirmed COVID-19 cases reported by the Alabama Department of Public Health (ADPH). Methods: This cross-sectional study evaluated the relationship between confirmed COVID-19 cases and user-reported COVID-19 symptoms and exposure reported through the Healthcheck web-based mobile application. A dependent variable for confirmed COVID-19 cases in Alabama was obtained from ADPH. Independent variables (ie, health symptoms and exposure) were collected through Healthcheck survey data and included measures assessing COVID-19--related risk levels and symptoms. Multiple linear regression was used to examine the relationship between ADPH-confirmed diagnosis of COVID-19 and self-reported health symptoms and exposure via Healthcheck that were analyzed across the state population but not connected at the individual patient level. Results: Regression analysis showed that the self-reported information collected by Healthcheck significantly affects the number of COVID-19--confirmed cases. The results demonstrate that the average number of confirmed COVID-19 cases increased by 5 (high risk: $\beta$=5.10; P=.001), decreased by 24 (sore throat: $\beta$=?24.03; P=.001), and increased by 21 (nausea or vomiting: $\beta$=21.67; P=.02) per day for every additional self-report of symptoms by Healthcheck survey respondents. Congestion or runny nose was the most frequently reported symptom. Sore throat, low risk, high risk, nausea, or vomiting were all statistically significant factors. Conclusions: The use of technology allowed organizations to remotely track a population as it is related to COVID-19. Healthcheck was a platform that aided in symptom tracking, risk assessment, and evaluation of status for admitting individuals into public spaces for people in the Alabama area. The confirmed relationship between symptom and exposure self-reporting using an app and population-wide confirmed cases suggests that further investigation is needed to determine the opportunity for such apps to mitigate disease spread at a community and individual level. ", doi="10.2196/46026", url="https://www.jmir.org/2023/1/e46026", url="http://www.ncbi.nlm.nih.gov/pubmed/37490320" } @Article{info:doi/10.2196/41806, author="Darien, Kaja and Lee, Susan and Knowles, Kayla and Wood, Sarah and Langer, D. Miriam and Lazar, Nellie and Dowshen, Nadia", title="Health Information From Web Search Engines and Virtual Assistants About Pre-Exposure Prophylaxis for HIV Prevention in Adolescents and Young Adults: Content Analysis", journal="JMIR Pediatr Parent", year="2023", month="Jul", day="18", volume="6", pages="e41806", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="prophylaxis", keywords="internet use", keywords="search engine", keywords="adolescent", keywords="youth", keywords="pediatric", keywords="adolescence", keywords="young adult", keywords="readability", keywords="human immunodeficiency virus", keywords="HIV", keywords="virtual assistant", keywords="health information", keywords="information quality", keywords="accuracy", keywords="credibility", keywords="patient education", keywords="comprehension", keywords="comprehensible", keywords="web-based", keywords="online information", keywords="sexual health", keywords="reading level", abstract="Background: Adolescents and young adults are disproportionately affected by HIV, suggesting that HIV prevention methods such as pre-exposure prophylaxis (PrEP) should focus on this group as a priority. As digital natives, youth likely turn to internet resources regarding health topics they may not feel comfortable discussing with their medical providers. To optimize informed decision-making by adolescents and young adults most impacted by HIV, the information from internet searches should be educational, accurate, and readable. Objective: The aims of this study were to compare the accuracy of web-based PrEP information found using web search engines and virtual assistants, and to assess the readability of the resulting information. Methods: Adolescent HIV prevention clinical experts developed a list of 23 prevention-related questions that were posed to search engines (Ask.com, Bing, Google, and Yahoo) and virtual assistants (Amazon Alexa, Microsoft Cortana, Google Assistant, and Apple Siri). The first three results from search engines and virtual assistant web references, as well as virtual assistant verbal responses, were recorded and coded using a six-tier scale to assess the quality of information produced. The results were also entered in a web-based tool determining readability using the Flesch-Kincaid Grade Level scale. Results: Google web search engine and Google Assistant more frequently produced PrEP information of higher quality than the other search engines and virtual assistants with scores ranging from 3.4 to 3.7 and 2.8 to 3.3, respectively. Additionally, the resulting information generally was presented in language at a seventh and 10th grade reading level according to the Flesch-Kincaid Grade Level scale. Conclusions: Adolescents and young adults are large consumers of technology and may experience discomfort discussing their sexual health with providers. It is important that efforts are made to ensure the information they receive about HIV prevention methods, and PrEP in particular, is comprehensive, comprehensible, and widely available. ", doi="10.2196/41806", url="https://pediatrics.jmir.org/2023/1/e41806", url="http://www.ncbi.nlm.nih.gov/pubmed/37463044" } @Article{info:doi/10.2196/46345, author="Kite, James and Chan, Lilian and MacKay, Kathryn and Corbett, Lucy and Reyes-Marcelino, Gillian and Nguyen, Binh and Bellew, William and Freeman, Becky", title="A Model of Social Media Effects in Public Health Communication Campaigns: Systematic Review", journal="J Med Internet Res", year="2023", month="Jul", day="14", volume="25", pages="e46345", keywords="awareness", keywords="behavior change", keywords="campaign development", keywords="campaign evaluation", keywords="engagement", keywords="hierarchy of effects", keywords="social media", keywords="systematic review", abstract="Background: Social media platforms are frequently used in health communication campaigns. Common understandings of campaign effects posit a sequential and linear series of steps from exposure to behavior change, commonly known as the hierarchy of effects model (HOE). These concepts need to be reevaluated in the age of social media, which are interactional and communal. Objective: This review aims to update the traditional HOE for health communication campaigns in the context of social media, including identifying indicators of effectiveness and how these are conceptualized to lead to health-related outcomes. Methods: We conducted a systematic review of studies following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines reporting on the use of social media as part of health communication campaigns, extracting campaign information such as objectives, platforms used, and measures of campaign performance. We used these data, combined with our understanding of the HOE, to develop an updated conceptual model of social media campaign effects. Results: We identified 99 eligible studies reporting on 93 campaigns, published between 2012 and 2022. The campaigns were conducted in over 20 countries, but nearly half (n=42) were conducted in the United States. Campaigns targeted a variety of health issues and predominantly used Facebook, Twitter, Instagram, and YouTube. Most campaigns (n=81) set objectives targeting awareness or individual behavior change. Process measures (n=68; eg, reach and impressions) and engagement measures (n=73; eg, likes and retweets) were reported most frequently, while two-fifths (n=42) did not report any outcomes beyond engagement, such as changes in knowledge, behavior, or social norms. Most campaigns (n=55) collected measures that did not allow them to determine if the campaign objective had been met; that is, they were process evaluations only. Based on our review, our updated model suggests that campaign exposure can lead to individual behavior change and improved health outcomes, either through a direct or indirect pathway. Indirect pathways include exposure through social and policy changes. ``Engagement'' is positioned as critical to success, replacing awareness in the traditional HOE, and all types of engagement are treated as equal and good. No consideration is being given to potential negative engagement, such as the distribution of misinformation. Additionally, the process is no longer linear and sequential, with circular pathways evident, such as engagement not only influencing behavior change but also generating additional exposure to campaign messages. Conclusions: Our review has highlighted a change in conventional understandings of how campaigns can influence health outcomes in the age of social media. The updated model we propose provides social media campaigners with a starting point to develop and tailor campaign messages and allows evaluators to identify critical assumptions to test, including the role and value of ``engagement.'' Trial Registration: PROSPERO CRD42021287257; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=287257 ", doi="10.2196/46345", url="https://www.jmir.org/2023/1/e46345", url="http://www.ncbi.nlm.nih.gov/pubmed/37450325" } @Article{info:doi/10.2196/46563, author="Pihlajam{\"a}ki, Mika and Wickstr{\"o}m, Sara and Puranen, Kaija and Helve, Otto and Yrttiaho, Aleksi and Siira, Lotta", title="Implementing and Maintaining a SARS-CoV-2 Exposure Notification Application for Mobile Phones: The Finnish Experience", journal="JMIR Public Health Surveill", year="2023", month="Jul", day="13", volume="9", pages="e46563", keywords="digital proximity tracing", keywords="DPT", keywords="exposure notification application", keywords="ENA", keywords="COVID-19", keywords="Finland", keywords="digital health", keywords="mobile health", keywords="mHealth", keywords="contact tracing", keywords="user", keywords="data privacy", keywords="effectiveness", keywords="mobile app", keywords="technology", keywords="public health", doi="10.2196/46563", url="https://publichealth.jmir.org/2023/1/e46563", url="http://www.ncbi.nlm.nih.gov/pubmed/37440286" } @Article{info:doi/10.2196/45338, author="Arakawa, Yuki and Inoue, Kosuke and Nishioka, Daisuke and Nakagomi, Atsushi and Tabuchi, Takahiro and Kondo, Naoki", title="Remote Communication and Loneliness During the COVID-19 Pandemic: Cross-Sectional Study", journal="J Med Internet Res", year="2023", month="Jul", day="11", volume="25", pages="e45338", keywords="loneliness", keywords="remote communication", keywords="social isolation", keywords="information and communications technology", keywords="ICT", keywords="COVID-19", keywords="restrictions", keywords="communication tool", keywords="age", keywords="gender", keywords="text message", abstract="Background: Although remote communication technologies have been widely used to maintain connections with others against interpersonal contact restrictions and exacerbated loneliness during the COVID-19 pandemic, it is unclear whether and what types of remote communication technologies are effective in mitigating loneliness. Objective: This study aimed to investigate the association between remote communication and loneliness when face-to-face meetings with others were strongly prohibited and whether this association varied across types of communication tools, age, and gender. Methods: We used cross-sectional data from the Japan COVID-19 and Society Internet Survey conducted from August to September 2020. From registered panelists of the research agency, 28,000 randomly sampled participants completed the survey on the website. We created 2 study cohorts who stopped meeting with family members living apart and friends during the pandemic. We categorized whether participants had technology-based remote communication (voice calling, text messaging, and video calling) with family and friends. Loneliness was assessed using the 3-item University of California, Los Angeles Loneliness Scale. We used a modified Poisson regression model to investigate the association between loneliness and remote communication with family members living apart or friends. We also conducted subgroup analyses based on age and gender. Results: A total of 4483 participants stopped meeting with family members living apart, and 6783 participants stopped meeting with friends during the COVID-19 pandemic. Remote communication with family members living apart did not show an association with loneliness, whereas remote communication with friends was associated with a low prevalence of loneliness (family: adjusted prevalence ratio [aPR]=0.89, 95\% CI 0.74-1.08; P=.24 and friends: aPR=0.82, 95\% CI 0.73-0.91; P<.001). From analyses by tools, voice calling was associated with low loneliness (family: aPR=0.88, 95\% CI 0.78-0.98; P=.03 and friends: aPR=0.87, 95\% CI 0.80-0.95; P=.003). Similarly, text messaging was associated with low loneliness (family: aPR=0.82, 95\% CI 0.69-0.97; P=.02 and friends: aPR=0.81, 95\% CI 0.73-0.89; P<.001). However, we did not find an association between video calling and loneliness (family: aPR=0.88, 95\% CI 0.75-1.02; P=.09 and friends: aPR=0.94, 95\% CI 0.85-1.04; P=.25). Text messaging with friends was associated with low loneliness regardless of age, whereas voice calling with family or friends was associated with low loneliness only among participants aged ?65 years. An association between remote communication with friends and low loneliness was found regardless of the type of remote communication tool among men, whereas it was found only for text messaging with friends among women. Conclusions: In this cross-sectional study of adults in Japan, remote communication, especially via voice calling and text messaging, was associated with low loneliness. Promoting remote communication may reduce loneliness when face-to-face contact is restricted, which should be the subject of future research. ", doi="10.2196/45338", url="https://www.jmir.org/2023/1/e45338", url="http://www.ncbi.nlm.nih.gov/pubmed/37432730" } @Article{info:doi/10.2196/34387, author="Taramasco, Carla and Rimassa, Carla", title="Architecture Assessment of the Chilean Epidemiological Surveillance System for Notifiable Diseases (EPIVIGILA): Qualitative Study", journal="JMIR Form Res", year="2023", month="Jul", day="7", volume="7", pages="e34387", keywords="eHealth", keywords="surveillance", keywords="mandatory reporting of infectious diseases", keywords="public health", keywords="data mining", abstract="Background: To fulfill their epidemiological vigilance function, authorities require valid, complete, timely, precise, and reliable information. Advancements in new technologies have facilitated public health control through vigilance systems for notifiable diseases; these systems can gather large numbers of simultaneous notifications, process a wide array of data, and deliver updated information in real time to relevant decision-makers. A large worldwide deployment of new information technologies was seen during the COVID-19 pandemic; these technologies proved to be efficient, resourceful tools . Platform developers should seek self-evaluation strategies to optimize functionality or improve the capacity of national vigilance systems. These tools exist in the Latin American region at various development stages, although publications reporting architectural characteristics of these tools are scarce. International publications are more abundant a nd serve as a basis for comparing the standards that need to be met. Objective: This study aimed to assess the architecture of the Chilean epidemiological surveillance system for notifiable diseases (EPIVIGILA), as compared to that of the international systems reported in scientific publications. Methods: A search for scientific publications was conducted to identify systematic reviews that documented the architectural characteristics of disease notification and vigilance systems. EPIVIGILA was compared to other systems from countries in Africa, the Americas, Asia, Europe, and Oceania. Results: The following aspects of the architecture were identified: (1) notification provenance, (2) minimum data set, (3) database users, and (4) data quality control. The notifying organizations, including hospitals, clinics, laboratories, and medical consultation offices, were similar among the 13 countries analyzed; this contrasted with Chile, where the reporting agent is the physician who can belong to an organization. The minimum data set include patient identification, disease data, and general codifications. EPIVIGILA includes all these elements, in addition to symptomatology, hospitalization data, type of medicine and treatment result, and laboratory test types. The database users or data analyzers include public health organizations, research organizations, epidemiological organizations, health organizations or departments, and the Centers for Disease Control and Prevention. Finally, for data quality control, the criteria most often used were completeness, consistency, validity, timeliness, accuracy, and competencies. Conclusions: An efficient notification and vigilance system must be capable of promptly identifying probable risks as well as incidence and prevalence of the diseases under surveillance. EPIVIGILA has been shown to comply with high quality and functionality standards, at the level of developed countries, by achieving total national coverage and by providing timely, trustworthy, and complete information at high-security levels, thus obtaining positive assessment from national and international authorities. ", doi="10.2196/34387", url="https://formative.jmir.org/2023/1/e34387", url="http://www.ncbi.nlm.nih.gov/pubmed/37418297" } @Article{info:doi/10.2196/47343, author="Qin, Lang and Zheng, Ming and Schwebel, C. David and Li, Li and Cheng, Peixia and Rao, Zhenzhen and Peng, Ruisha and Ning, Peishan and Hu, Guoqing", title="Content Quality of Web-Based Short-Form Videos for Fire and Burn Prevention in China: Content Analysis", journal="J Med Internet Res", year="2023", month="Jun", day="30", volume="25", pages="e47343", keywords="fire", keywords="burn", keywords="prevention", keywords="first aid", keywords="short video", keywords="content quality", keywords="public impact", keywords="China", abstract="Background: Web-based short-form videos are increasingly popular for disseminating fire and burn prevention information, but their content quality is unknown. Objective: We aimed to systematically assess the characteristics, content quality, and public impact of web-based short-form videos offering primary and secondary (first aid) prevention recommendations for fires and burns in China between 2018 and 2021. Methods: We retrieved short-form videos offering both primary and secondary (first aid) information to prevent fire and burn injuries published on the 3 most popular web-based short-form video platforms in China: TikTok, Kwai, and Bilibili. To assess video content quality, we calculated the proportion of short-form videos that included information on each of the 15 recommendations for burn prevention education from the World Health Organization (WHO; P1) and that correctly disseminated each recommendation (P2). High P1 and P2 indicated better content quality. To assess their public impact, we calculated the median (IQR) of 3 indicators: the number of comments, likes, and saves as a favorite by viewers. Chi-square test, trend chi-square test, and Kruskal-Wallis H test examined differences in indicators across the 3 platforms, years, content, and time duration of videos and between videos disseminating correct versus incorrect information. Results: Overall, 1459 eligible short-form videos were included. The number of short-form videos increased by 16 times between 2018 and 2021. Of them, 93.97\% (n=1371) were about secondary prevention (first aid) and 86.02\% (n=1255) lasted <2 minutes. The proportion of short-form videos including each of the 15 WHO recommendations ranged from 0\% to 77.86\% (n=1136). Recommendations 8, 13, and 11 had the highest proportions (n=1136, 77.86\%; n=827, 56.68\%; and n=801, 54.9\%, respectively), whereas recommendations 3 and 5 were never mentioned. Among the short-form videos that included the WHO recommendations, recommendations 1, 2, 4, 6, 9, and 12 were always disseminated correctly, but the other 9 recommendations were correctly disseminated in 59.11\% (120/203) to 98.68\% (1121/1136) of videos. The proportion of short-form videos including and correctly disseminating the WHO recommendations varied across platforms and years. The public impact of short videos varied greatly across videos, with a median (IQR) of 5 (0-34) comments, 62 (7-841) likes, and 4 (0-27) saves as a favorite. Short-form videos disseminating correct recommendations had larger public impact than those disseminating either partially correct or incorrect knowledge (median 5 vs 4 comments, 68 vs 51 likes, and 5 vs 3 saves as a favorite, respectively; all P<.05). Conclusions: Despite the rapid increase in the number of web-based short-form videos about fire and burn prevention available in China, their content quality and public impact were generally low. Systematic efforts are recommended to improve the content quality and public impact of short-form videos on injury prevention topics such as fire and burn prevention. ", doi="10.2196/47343", url="https://www.jmir.org/2023/1/e47343", url="http://www.ncbi.nlm.nih.gov/pubmed/37389906" } @Article{info:doi/10.2196/45600, author="Ar{\'e}valo-Baeza, Marta and Viuda-Serrano, Alejandro and Juan-Llamas, Carmen and Sotoca-Orgaz, Pablo and As{\'i}n-Izquierdo, Iv{\'a}n", title="Impact of a Serious Game (\#RedPing{\"u}iNO) to Reduce Facial Self-Touches and Prevent Exposure to Pathogens Transmitted via Hands: Quasi-Experimental Intervention", journal="JMIR Serious Games", year="2023", month="Jun", day="30", volume="11", pages="e45600", keywords="self-touching", keywords="face", keywords="serious game", keywords="health", keywords="pathogen transmission", keywords="hazard scenarios", keywords="body language", abstract="Background: After the COVID-19 pandemic, society has become more aware of the importance of some basic hygienic habits to avoid exposure to pathogens transmitted via hands. Given that a high frequency of touching mucous membranes can lead to a high risk of infection, it is essential to establish strategies to reduce this behavior as a preventive measure against contagion. This risk can be extrapolated to a multitude of health scenarios and transmission of many infectious diseases. \#RedPing{\"u}iNO was designed as an intervention to prevent the transmission of SARS-CoV-2 and other pathogens through the reduction of facial self-touches by thoughtfully engaging participants in a serious game. Objective: Facial self-touches should be understood as behaviors of limited control and awareness, used to regulate situations of cognitive and emotional demands, or as part of nonverbal communication. The objective of this study was to ensure that participants become aware of and reduce these behaviors through a game of self-perception. Methods: The quasi-experimental intervention was applied to 103 healthy university students selected by convenience sampling and put into practice for 2 weeks, with 1 control group (n=24, 23.3\%) and 2 experimental groups (experimental group with no additional social reinforcement interventions: n=36, 35\%; experimental group with additional social reinforcement interventions: n=43, 41.7\%). The objective was to improve knowledge and perception and reduce facial self-touches to prevent exposure to pathogens transmitted via hands not only in health multihazard scenarios but also in ordinary circumstances. The ad hoc instrument used to analyze the experience consisted of 43 items and was valid and reliable for the purpose of this study. The items were divided into 5 blocks extracted from the theoretical framework: sociological issues (1-5); hygiene habits (6-13); risk awareness (14-19); strategies for not touching the face (20-26); and questions after the intervention (27-42), designed as a postintervention tool assessing the game experience. Validation of the content was achieved through assessment by 12 expert referees. External validation was performed using a test-retest procedure, and reliability was verified using the Spearman correlation. Results: The results of the ad hoc questionnaire, which were analyzed using the Wilcoxon signed-rank test and McNemar index to identify significant differences between test and retest for a 95\% CI, showed that facial self-touches were reduced (item 20, P<.001; item 26, P=.04), and awareness of this spontaneous behavior and its triggers increased (item 15; P=.007). The results were reinforced by qualitative findings from the daily logs. Conclusions: The intervention exhibited a greater effect from sharing the game, with interactions between people; however, in both cases, it was helpful in reducing facial self-touches. In summary, this game is suitable for reducing facial self-touches, and owing to its free availability and design, it can be adapted to various contexts. ", doi="10.2196/45600", url="https://games.jmir.org/2023/1/e45600", url="http://www.ncbi.nlm.nih.gov/pubmed/37389910" } @Article{info:doi/10.2196/39576, author="Wynn, S. Chelsea and Fiks, G. Alexander and Localio, Russell and Shults, Justine and Nekrasova, Ekaterina and Shone, P. Laura and Torres, Alessandra and Griffith, Miranda and Unger, Rebecca and Ware, Ann Leigh and Kelly, Kate Mary and Stockwell, S. Melissa", title="Examination of Text Message Plans and Baseline Usage of Families Enrolled in a Text Message Influenza Vaccine Reminder Trial: Survey Study", journal="JMIR Form Res", year="2023", month="Jun", day="30", volume="7", pages="e39576", keywords="influenza vaccine", keywords="mHealth", keywords="mobile phone", keywords="pediatric", keywords="primary care", keywords="PROS", keywords="reminders", keywords="text message", abstract="Background: Mobile health (mHealth) is quickly expanding as a method of health promotion, but some interventions may not be familiar or comfortable for potential users. SMS text messaging has been investigated as a low-cost, accessible way to provide vaccine reminders. Most (97\%) US adults own a cellphone and of those adults most use SMS text messaging. However, understanding patterns of SMS text message plan type and use in diverse primary care populations needs more investigation. Objective: We sought to use a survey to examine baseline SMS text messaging and data plan patterns among families willing to accept SMS text message vaccine reminders. Methods: As part of a National Institutes of Health (NIH)--funded national study (Flu2Text) conducted during the 2017-2018 and 2018-2019 influenza seasons, families of children needing a second seasonal influenza vaccine dose were recruited in pediatric primary care offices at the time of their first dose. Practices were from the American Academy of Pediatrics' (AAP) Pediatric Research in Office Settings (PROS) research network, the Children's Hospital of Philadelphia, and Columbia University. A survey was administered via telephone (Season 1) or electronically (Season 2) at enrollment. Standardized (adjusted) proportions for SMS text message plan type and texting frequency were calculated using logistic regression that was adjusted for child and caregiver demographics. Results: Responses were collected from 1439 participants (69\% of enrolled). The mean caregiver age was 32 (SD 6) years, and most children (n=1355, 94.2\%) were aged 6-23 months. Most (n=1357, 94.3\%) families were English-speaking. Most (n=1331, 92.8\%) but not all participants had an unlimited SMS text messaging plan and sent or received texts at least once daily (n=1313, 91.5\%). SMS text messaging plan type and use at baseline was uniform across most but not all subgroups. However, there were some differences in the study population's SMS text messaging plan type and usage. Caregivers who wanted Spanish SMS text messages were less likely than those who chose English to have an unlimited SMS text messaging plan (n=61, 86.7\% vs n=1270, 94\%; risk difference --7.2\%, 95\% CI --27.1 to --1.8). There were no significant differences in having an unlimited plan associated with child's race, ethnicity, age, health status, insurance type, or caregiver education level. SMS text messaging use at baseline was not uniform across all subgroups. Nearly three-quarters (n=1030, 71.9\%) of participants had received some form of SMS text message from their doctor's office; most common were appointment reminders (n=1014, 98.4\%), prescription (n=300, 29.1\%), and laboratory notifications (n=117, 11.4\%). Even the majority (n=64, 61.5\%) of those who did not have unlimited plans and who texted less than daily (n=72, 59\%) reported receipt of these SMS text messages. Conclusions: In this study, most participants had access to unlimited SMS text messaging plans and texted at least once daily. However, infrequent texting and lack of access to an unlimited SMS text messaging plan did not preclude enrolling to receive SMS text message reminders in pediatric primary care settings. ", doi="10.2196/39576", url="https://formative.jmir.org/2023/1/e39576", url="http://www.ncbi.nlm.nih.gov/pubmed/37389945" } @Article{info:doi/10.2196/46810, author="Katapally, Reddy Tarun and Ibrahim, Tolulope Sheriff", title="Digital Health Dashboards for Decision-Making to Enable Rapid Responses During Public Health Crises: Replicable and Scalable Methodology", journal="JMIR Res Protoc", year="2023", month="Jun", day="30", volume="12", pages="e46810", keywords="big data", keywords="COVID-19", keywords="digital citizen science", keywords="digital dashboards", keywords="digital epidemiology", keywords="digital health", keywords="digital health platforms", keywords="eHealth", keywords="health equity", keywords="mHealth", keywords="pandemics", keywords="public health surveillance", keywords="virtual health care", keywords="mobile phone", abstract="Background: The COVID-19 pandemic has reiterated the need for cohesive, collective, and deliberate societal efforts to address inherent inefficiencies in our health systems and overcome decision-making gaps using real-time data analytics. To achieve this, decision makers need independent and secure digital health platforms that engage citizens ethically to obtain big data, analyze and convert big data into real-time evidence, and finally, visualize this evidence to inform rapid decision-making. Objective: The objective of this study is to develop replicable and scalable jurisdiction-specific digital health dashboards for rapid decision-making to ethically monitor, mitigate, and manage public health crises via systems integration beyond health care. Methods: The primary approach in the development of the digital health dashboard was the use of global digital citizen science to tackle pandemics like COVID-19. The first step in the development process was to establish an 8-member Citizen Scientist Advisory Council via Digital Epidemiology and Population Health Laboratory's community partnerships. Based on the consultation with the council, three critical needs of citizens were prioritized: (1) management of household risk of COVID-19, (2) facilitation of food security, and (3) understanding citizen accessibility of public services. Thereafter, a progressive web application (PWA) was developed to provide daily services that address these needs. The big data generated from citizen access to these PWA services are set up to be anonymized, aggregated, and linked to the digital health dashboard for decision-making, that is, the dashboard displays anonymized and aggregated data obtained from citizen devices via the PWA. The digital health dashboard and the PWA are hosted on the Amazon Elastic Compute Cloud server. The digital health dashboard's interactive statistical navigation was designed using the Microsoft Power Business Intelligence tool, which creates a secure connection with the Amazon Relational Database server to regularly update the visualization of jurisdiction-specific, anonymized, and aggregated data. Results: The development process resulted in a replicable and scalable digital health dashboard for decision-making. The big data relayed to the dashboard in real time reflect usage of the PWA that provides households the ability to manage their risk of COVID-19, request food when in need, and report difficulties and issues in accessing public services. The dashboard also provides (1) delegated community alert system to manage risks in real time, (2) bidirectional engagement system that allows decision makers to respond to citizen queries, and (3) delegated access that provides enhanced dashboard security. Conclusions: Digital health dashboards for decision-making can transform public health policy by prioritizing the needs of citizens as well as decision makers to enable rapid decision-making. Digital health dashboards provide decision makers the ability to directly communicate with citizens to mitigate and manage existing and emerging public health crises, a paradigm-changing approach, that is, inverting innovation by prioritizing community needs, and advancing digital health for equity. International Registered Report Identifier (IRRID): RR1-10.2196/46810 ", doi="10.2196/46810", url="https://www.researchprotocols.org/2023/1/e46810", url="http://www.ncbi.nlm.nih.gov/pubmed/37389905" } @Article{info:doi/10.2196/46328, author="Park, Woo Han and Yoon, Young Ho", title="Global COVID-19 Policy Engagement With Scientific Research Information: Altmetric Data Study", journal="J Med Internet Res", year="2023", month="Jun", day="29", volume="25", pages="e46328", keywords="altmetrics", keywords="government policy report", keywords="citation analysis", keywords="COVID-19", keywords="World Health Organization", keywords="WHO", keywords="COVID-19 research", keywords="online citation network", keywords="policy domains", abstract="Background: Previous studies on COVID-19 scholarly articles have primarily focused on bibliometric characteristics, neglecting the identification of institutional actors that cite recent scientific contributions related to COVID-19 in the policy domain, and their locations. Objective: The purpose of this study was to assess the online citation network and knowledge structure of COVID-19 research across policy domains over 2 years from January 2020 to January 2022, with a particular emphasis on geographical frequency. Two research questions were addressed. The first question was related to who has been the most active in policy engagement with science and research information sharing during the COVID-19 pandemic, particularly in terms of countries and organization types. The second question was related to whether there are significant differences in the types of coronavirus research shared among countries and continents. Methods: The Altmetric database was used to collect policy report citations of scientific articles for 3 topic terms (COVID-19, COVID-19 vaccine, and COVID-19 variants). Altmetric provides the URLs of policy agencies that have cited COVID-19 research. The scientific articles used for Altmetric citations are extracted from journals indexed by PubMed. The numbers of COVID-19, COVID-19 vaccine, and COVID-19 variant research outputs between January 1, 2020, and January 31, 2022, were 216,787, 16,748, and 2777, respectively. The study examined the frequency of citations based on policy institutional domains, such as intergovernmental organizations, national and domestic governmental organizations, and nongovernmental organizations (think tanks and academic institutions). Results: The World Health Organization (WHO) stood out as the most notable institution citing COVID-19--related research outputs. The WHO actively sought and disseminated information regarding the COVID-19 pandemic. The COVID-19 vaccine citation network exhibited the most extensive connections in terms of degree centrality, 2-local eigenvector centrality, and eigenvector centrality among the 3 key terms. The Netherlands, the United States, the United Kingdom, and Australia were the countries that sought and shared the most information on COVID-19 vaccines, likely due to their high numbers of COVID-19 cases. Developing nations, although gaining quicker access to COVID-19 vaccine information, appeared to be relatively isolated from the enriched COVID-19 pandemic content in the global network. Conclusions: The global scientific network ecology during the COVID-19 pandemic revealed distinct types of links primarily centered around the WHO. Western countries demonstrated effective networking practices in constructing these networks. The prominent position of the key term ``COVID-19 vaccine'' demonstrates that nation-states align with global authority regardless of their national contexts. In summary, the citation networking practices of policy agencies have the potential to uncover the global knowledge distribution structure as a proxy for the networking strategy employed during a pandemic. ", doi="10.2196/46328", url="https://www.jmir.org/2023/1/e46328", url="http://www.ncbi.nlm.nih.gov/pubmed/37384384" } @Article{info:doi/10.2196/40477, author="Yeung, Anna and Lisk, Ryan and Rana, Jayoti and Guiang, B. Charlie and Bacon, Jean and Brunetta, Jason and Gilbert, Mark and Gesink, Dionne and Grewal, Ramandip and Kwag, Michael and Logie, H. Carmen and Mitterni, Leo and Shahin, Rita and Tan, HS Darrell and Burchell, N. Ann", title="Community and Health Care Provider Preferences for Bacterial Sexually Transmitted Infection Testing Interventions for Gay, Bisexual, and Other Men Who Have Sex With Men: e-Delphi Study", journal="J Med Internet Res", year="2023", month="Jun", day="29", volume="25", pages="e40477", keywords="sexual and gender minorities", keywords="sexually transmitted diseases", keywords="community-based research", keywords="mass screening", keywords="patient acceptance of health care", abstract="Background: Canadian clinical guidelines recommend at least annual and up to quarterly bacterial sexually transmitted infection (STI) testing among sexually active gay, bisexual, and other men who have sex with men (GBM). However, testing rates are suboptimal. Innovative solutions are needed to close the gap because there is currently limited knowledge on how best to approach this issue. Objective: Our aim was to build consensus regarding interventions with the greatest potential for improving local STI testing services for GBM communities in Toronto, Ontario, Canada, using a web-based e-Delphi process. Methods: The e-Delphi method involves using a panel format to conduct successive rounds of prioritization, with feedback between rounds, to determine priorities among groups. We recruited experts separately from the community (GBM who sought or underwent STI testing in the preceding 18 months; conducted between October 2019 and November 2019) and health care providers (those who offered STI testing to GBM in the past 12 months; conducted between February 2020 and May 2020). The experts prioritized 6 to 8 potential interventions on a 7-point Likert scale ranging from definitely not a priority to definitely a priority over 3 survey rounds and ranked their top 3 interventions. Consensus was defined as ?60\% within a {\textpm}1 response point. Summaries of responses were provided in successive rounds. We reported the percentage of a priority (encompassing somewhat a priority, a priority, and definitely a priority responses) at the end of the final round of the survey. Results: Of the community experts (CEs), 84\% (43/51) completed all rounds; 19\% (8/43) were living with HIV; 37\% (16/43) were HIV negative and on pre-exposure prophylaxis; and 42\% (18/43) were HIV negative and not on pre-exposure prophylaxis. We reached consensus on 6 interventions: client reminders (41/43, 95\%), express testing (38/43, 88\%), routine testing (36/43, 84\%), an online booking app (36/43, 84\%), online-based testing (33/43, 77\%), and nurse-led testing (31/43, 72\%). The CEs favored convenient interventions that also maintain a relationship with their provider. Of the provider experts (PEs), 77\% (37/48) completed all rounds; 59\% (22/37) were physicians. Consensus was reached on the same 6 interventions (range 25/37, 68\%, to 39/39, 100\%) but not for provider alerts (7/37, 19\%) and provider audit and feedback (6/37, 16\%). Express testing, online-based testing, and nurse-led testing were prioritized by >95\% (>37/39) of the PEs by the end of round 2 because of streamlined processes and decreased need to see a provider. Conclusions: Both panels were enthusiastic about innovations that make STI testing more efficient, with express testing rating highly in both the prioritizations and top 3 rankings. However, CEs preferred convenient interventions that involved their provider, whereas PEs favored interventions that prioritized patient independence and reduced patient-provider time. International Registered Report Identifier (IRRID): RR2-10.2196/13801 ", doi="10.2196/40477", url="https://www.jmir.org/2023/1/e40477", url="http://www.ncbi.nlm.nih.gov/pubmed/37384393" } @Article{info:doi/10.2196/40441, author="Bonner, Carissa and Batcup, Carys and Cvejic, Erin and Ayre, Julie and Pickles, Kristen and Copp, Tessa and Cornell, Samuel and Nickel, Brooke and Dhahir, Mustafa and McCaffery, Kirsten", title="Addressing Behavioral Barriers to COVID-19 Testing With Health Literacy--Sensitive eHealth Interventions: Results From 2 National Surveys and 2 Randomized Experiments", journal="JMIR Public Health Surveill", year="2023", month="Jun", day="29", volume="9", pages="e40441", keywords="behavior change", keywords="health literacy", keywords="COVID-19", keywords="testing", keywords="infectious disease", keywords="public health", abstract="Background: Polymerase chain reaction (PCR) testing for COVID-19 was crucial in Australia's prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact with cases, travel, and certain professions. However, several months into the pandemic, half of Australians were still not getting tested for respiratory symptoms, and little was known about the drivers of and barriers to COVID-19 PCR testing as a novel behavior at that time. Objective: We aimed to identify and address COVID-19 testing barriers, and test the effectiveness of multiple eHealth interventions on knowledge for people with varying health literacy levels. Methods: The intervention was developed in 4 phases. Phase 1 was a national survey conducted in June 2020 (n=1369), in which testing barriers were coded using the capability-opportunity-motivation-behavior framework. Phase 2 was a national survey conducted in November 2020 (n=2034) to estimate the prevalence of testing barriers and health literacy disparities. Phase 3 was a randomized experiment testing health literacy--sensitive written information for a wide range of barriers between February and March 2021 (n=1314), in which participants chose their top 3 barriers to testing to view a tailored intervention. Phase 4 was a randomized experiment testing 2 audio-visual interventions addressing common testing barriers for people with lower health literacy in November 2021, targeting young adults as a key group endorsing misinformation (n=1527). Results: In phase 1, barriers were identified in all 3 categories: capability (eg, understanding which symptoms to test for), opportunity (eg, not being able to access a PCR test), and motivation (eg, not believing the symptoms are those of COVID-19). Phase 2 identified knowledge gaps for people with lower versus higher health literacy. Phase 3 found no differences between the intervention (health literacy--sensitive text for top 3 barriers) and control groups. Phase 4 showed that a fact-based animation or a TikTok-style video presenting the same facts in a humorous style increased knowledge about COVID-19 testing compared with government information. However, no differences were found for COVID-19 testing intentions. Conclusions: This study identified a wide range of barriers to a novel testing behavior, PCR testing for COVID-19. These barriers were prevalent even in a health system where COVID-19 testing was free and widely available. We showed that key capability barriers, such as knowledge gaps, can be improved with simple videos targeting people with lower health literacy. Additional behavior change strategies are required to address motivational issues to support testing uptake. Future research will explore health literacy strategies in the current context of self-administered rapid antigen tests. The findings may inform planning for future COVID-19 variant outbreaks and new public health emergencies where novel testing behaviors are required. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000876897, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382318?; Australian New Zealand Clinical Trials Registry ACTRN12620001355965, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380916\&isReview=true ", doi="10.2196/40441", url="https://publichealth.jmir.org/2023/1/e40441", url="http://www.ncbi.nlm.nih.gov/pubmed/37172319" } @Article{info:doi/10.2196/45112, author="Haltaufderheide, Joschka and Viero, Davide and Kr{\"a}mer, Dennis", title="Cultural Implications Regarding Privacy in Digital Contact Tracing Algorithms: Method Development and Empirical Ethics Analysis of a German and a Japanese Approach to Contact Tracing", journal="J Med Internet Res", year="2023", month="Jun", day="28", volume="25", pages="e45112", keywords="digital contact tracing", keywords="algorithms", keywords="methodology", keywords="empirical ethics", keywords="privacy", keywords="culture-sensitive ethics", keywords="mobile phone", abstract="Background: Digital contact tracing algorithms (DCTAs) have emerged as a means of supporting pandemic containment strategies and protecting populations from the adverse effects of COVID-19. However, the impact of DCTAs on users' privacy and autonomy has been heavily debated. Although privacy is often viewed as the ability to control access to information, recent approaches consider it as a norm that structures social life. In this regard, cultural factors are crucial in evaluating the appropriateness of information flows in DCTAs. Hence, an important part of ethical evaluations of DCTAs is to develop an understanding of their information flow and their contextual situatedness to be able to adequately evaluate questions about privacy. However, only limited studies and conceptual approaches are currently available in this regard. Objective: This study aimed to develop a case study methodology to include contextual cultural factors in ethical analysis and present exemplary results of a subsequent analysis of 2 different DCTAs following this approach. Methods: We conducted a comparative qualitative case study of the algorithm of the Google Apple Exposure Notification Framework as exemplified in the German Corona Warn App and the Japanese approach of Computation of Infection Risk via Confidential Locational Entries (CIRCLE) method. The methodology was based on a postphenomenological perspective, combined with empirical investigations of the technological artifacts within their context of use. An ethics of disclosure approach was used to focus on the social ontologies created by the algorithms and highlight their connection to the question about privacy. Results: Both algorithms use the idea of representing a social encounter of 2 subjects. These subjects gain significance in terms of risk against the background of a representation of their temporal and spatial properties. However, the comparative analysis reveals 2 major differences. Google Apple Exposure Notification Framework prioritizes temporality over spatiality. In contrast, the representation of spatiality is reduced to distance without any direction or orientation. However, the CIRCLE framework prioritizes spatiality over temporality. These different concepts and prioritizations can be seen to align with important cultural differences in considering basic concepts such as subject, time, and space in Eastern and Western thought. Conclusions: The differences noted in this study essentially lead to 2 different ethical questions about privacy that are raised against the respective backgrounds. These findings have important implications for the ethical evaluation of DCTAs, suggesting that a culture-sensitive assessment is required to ensure that technologies fit into their context and create less concern regarding their ethical acceptability. Methodologically, our study provides a basis for an intercultural approach to the ethics of disclosure, allowing for cross-cultural dialogue that can overcome mutual implicit biases and blind spots based on cultural differences. ", doi="10.2196/45112", url="https://www.jmir.org/2023/1/e45112", url="http://www.ncbi.nlm.nih.gov/pubmed/37379062" } @Article{info:doi/10.2196/42187, author="de Batlle, Jordi and Ben{\'i}tez, D. Ivan and Moncus{\'i}-Moix, Anna and Androutsos, Odysseas and Angles Barbastro, Rosana and Antonini, Alessio and Arana, Eunate and Cabrera-Umpierrez, Fernanda Maria and Cea, Gloria and Dafoulas, $\Epsilon$ George and Folkvord, Frans and Fullaondo, Ane and Giuliani, Francesco and Huang, Hsiao-Ling and Innominato, F. Pasquale and Kardas, Przemyslaw and Lou, Q. Vivian W. and Manios, Yannis and Matsangidou, Maria and Mercalli, Franco and Mokhtari, Mounir and Pagliara, Silvio and Schellong, Julia and Stieler, Lisa and Votis, Konstantinos and Curr{\'a}s, Paula and Arredondo, Teresa Maria and Posada, Jorge and Guill{\'e}n, Sergio and Pecchia, Leandro and Barb{\'e}, Ferran and Torres, Gerard and Fico, Giuseppe and ", title="GATEKEEPER's Strategy for the Multinational Large-Scale Piloting of an eHealth Platform: Tutorial on How to Identify Relevant Settings and Use Cases", journal="J Med Internet Res", year="2023", month="Jun", day="28", volume="25", pages="e42187", keywords="big data", keywords="chronic diseases", keywords="eHealth", keywords="healthy aging", keywords="integrated care", keywords="large-scale pilots", abstract="Background: The World Health Organization's strategy toward healthy aging fosters person-centered integrated care sustained by eHealth systems. However, there is a need for standardized frameworks or platforms accommodating and interconnecting multiple of these systems while ensuring secure, relevant, fair, trust-based data sharing and use. The H2020 project GATEKEEPER aims to implement and test an open-source, European, standard-based, interoperable, and secure framework serving broad populations of aging citizens with heterogeneous health needs. Objective: We aim to describe the rationale for the selection of an optimal group of settings for the multinational large-scale piloting of the GATEKEEPER platform. Methods: The selection of implementation sites and reference use cases (RUCs) was based on the adoption of a double stratification pyramid reflecting the overall health of target populations and the intensity of proposed interventions; the identification of a principles guiding implementation site selection; and the elaboration of guidelines for RUC selection, ensuring clinical relevance and scientific excellence while covering the whole spectrum of citizen complexities and intervention intensities. Results: Seven European countries were selected, covering Europe's geographical and socioeconomic heterogeneity: Cyprus, Germany, Greece, Italy, Poland, Spain, and the United Kingdom. These were complemented by the following 3 Asian pilots: Hong Kong, Singapore, and Taiwan. Implementation sites consisted of local ecosystems, including health care organizations and partners from industry, civil society, academia, and government, prioritizing the highly rated European Innovation Partnership on Active and Healthy Aging reference sites. RUCs covered the whole spectrum of chronic diseases, citizen complexities, and intervention intensities while privileging clinical relevance and scientific rigor. These included lifestyle-related early detection and interventions, using artificial intelligence--based digital coaches to promote healthy lifestyle and delay the onset or worsening of chronic diseases in healthy citizens; chronic obstructive pulmonary disease and heart failure decompensations management, proposing integrated care management based on advanced wearable monitoring and machine learning (ML) to predict decompensations; management of glycemic status in diabetes mellitus, based on beat to beat monitoring and short-term ML-based prediction of glycemic dynamics; treatment decision support systems for Parkinson disease, continuously monitoring motor and nonmotor complications to trigger enhanced treatment strategies; primary and secondary stroke prevention, using a coaching app and educational simulations with virtual and augmented reality; management of multimorbid older patients or patients with cancer, exploring novel chronic care models based on digital coaching, and advanced monitoring and ML; high blood pressure management, with ML-based predictions based on different intensities of monitoring through self-managed apps; and COVID-19 management, with integrated management tools limiting physical contact among actors. Conclusions: This paper provides a methodology for selecting adequate settings for the large-scale piloting of eHealth frameworks and exemplifies with the decisions taken in GATEKEEPER the current views of the WHO and European Commission while moving forward toward a European Data Space. ", doi="10.2196/42187", url="https://www.jmir.org/2023/1/e42187", url="http://www.ncbi.nlm.nih.gov/pubmed/37379060" } @Article{info:doi/10.2196/43776, author="Salazar, Alejandro and Moreno-Pulido, Soledad and Prego-Meleiro, Pablo and Henares-Montiel, Jes{\'u}s and Pulido, Jos{\'e} and Donat, Marta and Sotres-Fernandez, Gabriel and Sordo, Luis", title="Correlation Between Opioid Drug Prescription and Opioid-Related Mortality in Spain as a Surveillance Tool: Ecological Study", journal="JMIR Public Health Surveill", year="2023", month="Jun", day="28", volume="9", pages="e43776", keywords="opioid", keywords="overdose", keywords="drug overdose", keywords="opioid-related deaths", keywords="mortality", keywords="tramadol", keywords="fentanyl", keywords="substance use", keywords="substance misuse", keywords="substance abuse", keywords="ecological study", keywords="death", abstract="Background: Opioid drug prescription (ODP) and opioid-related mortality (ORM) have increased in Spain. However, their relationship is complex, as ORM is registered without considering the type of opioid (legal or illegal). Objective: This ecological study aimed to examine the correlation between ODP and ORM in Spain and discuss their usefulness as a surveillance tool. Methods: This was an ecological descriptive study using retrospective annual data (2000-2019) from the Spanish general population. Data were collected from people of all ages. Information on ODP was obtained from the Spanish Medicines Agency in daily doses per 1000 inhabitants per day (DHD) for total ODP, total ODP excluding those with better safety protocols (codeine and tramadol), and each opioid drug separately. Rates of ORM (per 1,000,000 inhabitants) were calculated based on deaths registered (International Classification of Diseases, 10th Revision codes) as opioid poisoning by the National Statistics Institute, derived from the drug data recorded by medical examiners in death certificates. Opioid-related deaths were considered to be those that indicated opioid consumption (accidental, infringed, or self-inflicted) as the main cause of death: death due to accidental poisoning (X40-X44), intentional self-inflicted poisoning (X60-X64), drug-induced aggression (X85), and poisoning of undetermined intention (Y10-Y14). A descriptive analysis was carried out, and correlations between the annual rates of ORM and DHD of the prescribed opioid drugs globally, excluding medications of the least potential risk of overdose and lowest treatment tier, were analyzed using Pearson linear correlation coefficient. Their temporal evolution was analyzed using cross-correlations with 24 lags and the cross-correlation function. The analyses were carried out using Stata and StatGraphics Centurion 19. Results: The rate of ORM (2000-2019) ranged between 14 and 23 deaths per 1,000,000 inhabitants, with a minimum in 2006 and an increasing trend starting in 2010. The ODP ranged between 1.51 to 19.94 DHD. The rates of ORM were directly correlated with the DHD of total ODP (r=0.597; P=.006), total ODP without codeine and tramadol (r=0.934; P<.001), and every prescribed opioid except buprenorphine (P=.47). In the time analysis, correlations between DHD and ORM were observed in the same year, although not statistically significant (all P?.05). Conclusions: There is a correlation between greater availability of prescribed opioid drugs and an increase in opioid-related deaths. The correlation between ODP and ORM may be a useful tool in monitoring legal opiates and possible disturbances in the illegal market. The role of tramadol (an easily prescribed opioid) is important in this correlation, as is that of fentanyl (the strongest opioid). Measures stronger than recommendations need to be taken to reduce off-label prescribing. This study shows that not only is opioid use directly related to the prescribing of opioid drugs above what is desirable but also an increase in deaths. ", doi="10.2196/43776", url="https://publichealth.jmir.org/2023/1/e43776", url="http://www.ncbi.nlm.nih.gov/pubmed/37379061" } @Article{info:doi/10.2196/42149, author="Tai, Shu-Yu and Chi, Ying-Chen and Chien, Yu-Wen and Kawachi, Ichiro and Lu, Tsung-Hsueh", title="Dashboard With Bump Charts to Visualize the Changes in the Rankings of Leading Causes of Death According to Two Lists: National Population-Based Time-Series Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2023", month="Jun", day="27", volume="9", pages="e42149", keywords="COVID-19", keywords="dashboard", keywords="data visualization", keywords="leading causes of death", keywords="mortality/trend", keywords="ranking", keywords="surveillance", keywords="cause of mortality", keywords="cause of death", keywords="monitoring", keywords="surveillance indicator", keywords="health statistics", keywords="mortality data", abstract="Background: Health advocates and the media often use the rankings of the leading causes of death (CODs) to draw attention to health issues with relatively high mortality burdens in a population. The National Center for Health Statistics (NCHS) publishes ``Deaths: leading causes'' annually. The ranking list used by the NCHS and statistical offices in several countries includes broad categories such as cancer, heart disease, and accidents. However, the list used by the World Health Organization (WHO) subdivides broad categories (17 for cancer, 8 for heart disease, and 6 for accidents) and classifies Alzheimer disease and related dementias and hypertensive diseases more comprehensively compared to the NCHS list. Regarding the data visualization of the rankings of leading CODs, the bar chart is the most commonly used graph; nevertheless, bar charts may not effectively reveal the changes in the rankings over time. Objective: The aim of this study is to use a dashboard with bump charts to visualize the changes in the rankings of the leading CODs in the United States by sex and age from 1999 to 2021, according to 2 lists (NCHS vs WHO). Methods: Data on the number of deaths in each category from each list for each year were obtained from the Wide-ranging Online Data for Epidemiologic Research system, maintained by the Center for Disease Control and Prevention. Rankings were based on the absolute number of deaths. The dashboard enables users to filter by list (NCHS or WHO) and demographic characteristics (sex and age) and highlight a particular COD. Results: Several CODs that were only on the WHO list, including brain, breast, colon, hematopoietic, lung, pancreas, prostate, and uterus cancer (all classified as cancer on the NCHS list); unintentional transport injury; poisoning; drowning; and falls (all classified as accidents on the NCHS list), were among the 10 leading CODs in several sex and age subgroups. In contrast, several CODs that appeared among the 10 leading CODs according to the NCHS list, such as pneumonia, kidney disease, cirrhosis, and sepsis, were excluded from the 10 leading CODs if the WHO list was used. The rank of Alzheimer disease and related dementias and hypertensive diseases according to the WHO list was higher than their ranks according to the NCHS list. A marked increase in the ranking of unintentional poisoning among men aged 45-64 years was noted from 2008 to 2021. Conclusions: A dashboard with bump charts can be used to improve the visualization of the changes in the rankings of leading CODs according to the WHO and NCHS lists as well as demographic characteristics; the visualization can help users make informed decisions regarding the most appropriate ranking list for their needs. ", doi="10.2196/42149", url="https://publichealth.jmir.org/2023/1/e42149", url="http://www.ncbi.nlm.nih.gov/pubmed/37368475" } @Article{info:doi/10.2196/46357, author="Latorre, Eligado Angelica Anne and Nakamura, Keiko and Seino, Kaoruko and Hasegawa, Takanori", title="Vector Autoregression for Forecasting the Number of COVID-19 Cases and Analyzing Behavioral Indicators in the Philippines: Ecologic Time-Trend Study", journal="JMIR Form Res", year="2023", month="Jun", day="27", volume="7", pages="e46357", keywords="COVID-19", keywords="forecasting", keywords="interest by the general public", keywords="mobility", keywords="surveillance", keywords="vector autoregression", abstract="Background: Traditional surveillance systems rely on routine collection of data. The inherent delay in retrieval and analysis of data leads to reactionary rather than preventive measures. Forecasting and analysis of behavior-related data can supplement the information from traditional surveillance systems. Objective: We assessed the use of behavioral indicators, such as the general public's interest in the risk of contracting SARS-CoV-2 and changes in their mobility, in building a vector autoregression model for forecasting and analysis of the relationships of these indicators with the number of COVID-19 cases in the National Capital Region. Methods: An etiologic, time-trend, ecologic study design was used to forecast the daily number of cases in 3 periods during the resurgence of COVID-19. We determined the lag length by combining knowledge on the epidemiology of SARS-CoV-2 and information criteria measures. We fitted 2 models to the training data set and computed their out-of-sample forecasts. Model 1 contains changes in mobility and number of cases with a dummy variable for the day of the week, while model 2 also includes the general public's interest. The forecast accuracy of the models was compared using mean absolute percentage error. Granger causality test was performed to determine whether changes in mobility and public's interest improved the prediction of cases. We tested the assumptions of the model through the Augmented Dickey-Fuller test, Lagrange multiplier test, and assessment of the moduli of eigenvalues. Results: A vector autoregression (8) model was fitted to the training data as the information criteria measures suggest the appropriateness of 8. Both models generated forecasts with similar trends to the actual number of cases during the forecast period of August 11-18 and September 15-22. However, the difference in the performance of the 2 models became substantial from January 28 to February 4, as the accuracy of model 2 remained within reasonable limits (mean absolute percentage error [MAPE]=21.4\%) while model 1 became inaccurate (MAPE=74.2\%). The results of the Granger causality test suggest that the relationship of public interest with number of cases changed over time. During the forecast period of August 11-18, only change in mobility (P=.002) improved the forecasting of cases, while public interest was also found to Granger-cause the number of cases during September 15-22 (P=.001) and January 28 to February 4 (P=.003). Conclusions: To the best of our knowledge, this is the first study that forecasted the number of COVID-19 cases and explored the relationship of behavioral indicators with the number of COVID-19 cases in the Philippines. The resemblance of the forecasts from model 2 with the actual data suggests its potential in providing information about future contingencies. Granger causality also implies the importance of examining changes in mobility and public interest for surveillance purposes. ", doi="10.2196/46357", url="https://formative.jmir.org/2023/1/e46357", url="http://www.ncbi.nlm.nih.gov/pubmed/37368473" } @Article{info:doi/10.2196/42678, author="Amicosante, Vincenza Anna Maria and Rosso, Annalisa and Bernardini, Fabio and Guglielmi, Elisa and Eugeni, Erica and Da Re, Filippo and Baglio, Giovanni", title="COVID-19 Contact Tracing Strategies During the First Wave of the Pandemic: Systematic Review of Published Studies", journal="JMIR Public Health Surveill", year="2023", month="Jun", day="23", volume="9", pages="e42678", keywords="COVID-19", keywords="SARS-CoV-2", keywords="contact tracing", keywords="public health", keywords="infectious disease", keywords="disease control", keywords="community engagement", keywords="digital tool", abstract="Background: Contact tracing (CT) represented one of the core activities for the prevention and control of COVID-19 in the early phase of the pandemic. Several guidance documents were developed by international public health agencies and national authorities on the organization of COVID-19 CT activities. While most research on CT focused on the use digital tools or relied on modelling techniques to estimate the efficacy of interventions, poor evidence is available on the real-world implementation of CT strategies and on the organizational models adopted during the initial phase of the emergency to set up CT activities. Objective: We aimed to provide a comprehensive picture of the organizational aspects of CT activities during the first wave of the pandemic through the systematic identification and description of CT strategies used in different settings during the period from March to June 2020. Methods: A systematic review of published studies describing organizational models of COVID-19 CT strategies developed in real-world settings was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, Embase, and Cochrane Library were searched. Studies not providing a description of the organizational aspects of CT strategies and studies reporting or modelling theoretical strategies or focusing on the description of digital technologies' properties were excluded. Quality of reporting was assessed by using the Template for Intervention Description and Replication Checklist for Population Health and Policy. We developed a narrative synthesis, using a conceptual framework to map the extracted studies broken down by target population. Results: We retrieved a total of 1638 studies, of which 17 were included in the narrative synthesis; 7 studies targeted the general population and 10 studies described CT activities carried out in specific population subgroups. Our review identified some common elements across studies used to develop CT activities, including decentralization of CT activities, involvement of trained nonpublic health resources (eg, university students or civil servants), use of informatics tools for CT management, interagency collaboration, and community engagement. CT strategies implemented in the workplace envisaged a strong collaboration with occupational health services. Outreach activities were shown to increase CT efficiency in susceptible groups, such as people experiencing homelessness. Data on the effectiveness of CT strategies are scarce, with only few studies reporting on key performance indicators. Conclusions: Despite the lack of systematically collected data on CT effectiveness, our findings can provide some indication for the future planning and development of CT strategies for infectious disease control, mainly in terms of coordination mechanisms and the use of human and technical resources needed for the rapid development of CT activities. Further research on the organizational models of CT strategies during the COVID-19 pandemic would be required to contribute to a more robust evidence-making process. ", doi="10.2196/42678", url="https://publichealth.jmir.org/2023/1/e42678", url="http://www.ncbi.nlm.nih.gov/pubmed/37351939" } @Article{info:doi/10.2196/44900, author="Zheng, Feiyang and Wang, Kang and Wang, Qianning and Yu, Tiantian and Wang, Lu and Zhang, Xinping and Wu, Xiang and Zhou, Qian and Tan, Li", title="Factors Influencing Clinicians' Use of Hospital Information Systems for Infection Prevention and Control: Cross-Sectional Study Based on the Extended DeLone and McLean Model", journal="J Med Internet Res", year="2023", month="Jun", day="22", volume="25", pages="e44900", keywords="hospital infection prevention and control", keywords="information system", keywords="information systems success model", abstract="Background: Healthcare-associated infections have become a serious public health problem. Various types of information systems have begun to be applied in hospital infection prevention and control (IPC) practice. Clinicians are the key users of these systems, but few studies have assessed the use of infection prevention and control information systems (IPCISs) from their perspective. Objective: This study aimed to (1) apply the extended DeLone and McLean Information Systems Success model (D\&M model) that incorporates IPC culture to examine how technical factors like information quality, system quality, and service quality, as well as organizational culture factors affect clinicians' use intention, satisfaction, and perceived net benefits, and (2) identify which factors are the most important for clinicians' use intention. Methods: A total of 12,317 clinicians from secondary and tertiary hospitals were surveyed online. Data were analyzed using partial least squares-structural equation modeling and the importance-performance matrix analysis. Results: Among the technical factors, system quality ($\beta$=.089-.252; P<.001), information quality ($\beta$=.294-.102; P<.001), and service quality ($\beta$=.126-.411; P<.001) were significantly related to user satisfaction (R2=0.833), use intention (R2=0.821), and perceived net benefits (communication benefits [R2=0.676], decision-making benefits [R2=0.624], and organizational benefits [R2=0.656]). IPC culture had an effect on use intention ($\beta$=.059; P<.001), and it also indirectly affected perceived net benefits ($\beta$=.461-.474; P<.001). In the importance-performance matrix analysis, the attributes of service quality (providing user training) and information quality (readability) were present in the fourth quadrant, indicating their high importance and low performance. Conclusions: This study provides valuable insights into IPCIS usage among clinicians from the perspectives of technology and organization culture factors. It found that technical factors (system quality, information quality, and service quality) and hospital IPC culture have an impact on the successful use of IPCISs after evaluating the application of IPCISs based on the extended D\&M model. Furthermore, service quality and information quality showed higher importance and lower performance for use intention. These findings provide empirical evidence and specific practical directions for further improving the construction of IPCISs. ", doi="10.2196/44900", url="https://www.jmir.org/2023/1/e44900", url="http://www.ncbi.nlm.nih.gov/pubmed/37347523" } @Article{info:doi/10.2196/41902, author="Te, Vannarath and Chhim, Srean and Buffel, Veerle and Van Damme, Wim and van Olmen, Josefien and Ir, Por and Wouters, Edwin", title="Evaluation of Diabetes Care Performance in Cambodia Through the Cascade-of-Care Framework: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2023", month="Jun", day="22", volume="9", pages="e41902", keywords="diabetes", keywords="cascade of care", keywords="implementation research", keywords="population-based survey", keywords="care continuum", keywords="mobile phone", abstract="Background: Cambodia has seen an increase in the prevalence of type 2 diabetes (T2D) over the last 10 years. Three main care initiatives for T2D are being scaled up in the public health care system across the country: hospital-based care, health center--based care, and community-based care. To date, no empirical study has systematically assessed the performance of these care initiatives across the T2D care continuum in Cambodia. Objective: This study aimed to assess the performance of the 3 care initiatives---individually or in coexistence---and determine the factors associated with the failure to diagnose T2D in Cambodia. Methods: We used a cascade-of-care framework to assess the T2D care continuum. The cascades were generated using primary data from a cross-sectional population-based survey conducted in 2020 with 5072 individuals aged ?40 years. The survey was conducted in 5 operational districts (ODs) selected based on the availability of the care initiatives. Multiple logistic regression analysis was used to identify the factors associated with the failure to diagnose T2D. The significance level of P<.05 was used as a cutoff point. Results: Of the 5072 individuals, 560 (11.04\%) met the definition of a T2D diagnosis (fasting blood glucose level ?126 mg/dL and glycated hemoglobin level ?6.5\%). Using the 560 individuals as the fixed denominator, the cascade displayed substantial drops at the testing and control stages. Only 63\% (353/560) of the participants had ever tested their blood glucose level in the last 3 years, and only 10.7\% (60/560) achieved blood glucose level control with the cutoff point of glycated hemoglobin level <8\%. The OD hosting the coexistence of care displayed the worst cascade across all bars, whereas the OD with hospital-based care had the best cascade among the 5 ODs. Being aged 40 to 49 years, male, and in the poorest category of the wealth quintile were factors associated with the undiagnosed status. Conclusions: The unmet needs for T2D care in Cambodia were large, particularly in the testing and control stages, indicating the need to substantially improve early detection and management of T2D in the country. Rapid scale-up of T2D care components at public health facilities to increase the chances of the population with T2D of being tested, diagnosed, retained in care, and treated, as well as of achieving blood glucose level control, is vital in the health system. Specific population groups susceptible to being undiagnosed should be especially targeted for screening through active community outreach activities. Future research should incorporate digital health interventions to evaluate the effectiveness of the T2D care initiatives longitudinally with more diverse population groups from various settings based on routine data vital for integrated care. Trial Registration: International Standard Randomized Controlled Trials Number (ISRCTN) ISRCTN41932064; https://www.isrctn.com/ISRCTN41932064 International Registered Report Identifier (IRRID): RR2-10.2196/36747 ", doi="10.2196/41902", url="https://publichealth.jmir.org/2023/1/e41902", url="http://www.ncbi.nlm.nih.gov/pubmed/37347529" } @Article{info:doi/10.2196/45188, author="Reid, C. Sean and Wang, Vania and Assaf, D. Ryan and Kaloper, Sofia and Murray, T. Alan and Shoptaw, Steven and Gorbach, Pamina and Cassels, Susan", title="Novel Location-Based Survey Using Cognitive Interviews to Assess Geographic Networks and Hotspots of Sex and Drug Use: Implementation and Validation Study", journal="JMIR Form Res", year="2023", month="Jun", day="22", volume="7", pages="e45188", keywords="networks", keywords="sexual network geography", keywords="activity space", keywords="HIV", keywords="survey design", keywords="risk hotspots", keywords="cognitive interviews", keywords="health interventions", keywords="mobile phone", abstract="Background: The Ending the HIV Epidemic initiative in the United States relies on HIV hotspots to identify where to geographically target new resources, expertise, and technology. However, interventions targeted at places with high HIV transmission and infection risk, not just places with high HIV incidence, may be more effective at reducing HIV incidence and achieving health equity. Objective: We described the implementation and validation of a web-based activity space survey on HIV risk behaviors. The survey was intended to collect geographic information that will be used to map risk behavior hotspots as well as the geography of sexual networks in Los Angeles County. Methods: The survey design team developed a series of geospatial questions that follow a 3-level structure that becomes more geographically precise as participants move through the levels. The survey was validated through 9 cognitive interviews and iteratively updated based on participant feedback until the saturation of topics and technical issues was reached. Results: In total, 4 themes were identified through the cognitive interviews: functionality of geospatial questions, representation and accessibility, privacy, and length and understanding of the survey. The ease of use for the geospatial questions was critical as many participants were not familiar with mapping software. The inclusion of well-known places, landmarks, and road networks was critical for ease of use. The addition of a Google Maps interface, which was familiar to many participants, aided in collecting accurate and precise location information. The geospatial questions increased the length of the survey and warranted the inclusion of features to simplify it and speed it up. Using nicknames to refer to previously entered geographic locations limited the number of geospatial questions that appeared in the survey and reduced the time taken to complete it. The long-standing relationship between participants and the research team improved comfort to disclose sensitive geographic information related to drug use and sex. Participants in the cognitive interviews highlighted how trust and inclusive and validating language in the survey alleviated concerns related to privacy and representation. Conclusions: This study provides promising results regarding the feasibility of using a web-based mapping survey to collect sensitive location information relevant to ending the HIV epidemic. Data collection at several geographic levels will allow for insights into spatial recall of behaviors as well as future sensitivity analysis of the spatial scale of hotspots and network characteristics. This design also promotes the privacy and comfort of participants who provide location information for sensitive topics. Key considerations for implementing this type of survey include trust from participants, community partners, or research teams to overcome concerns related to privacy and comfort. The implementation of similar surveys should consider local characteristics and knowledge when crafting the geospatial components. ", doi="10.2196/45188", url="https://formative.jmir.org/2023/1/e45188", url="http://www.ncbi.nlm.nih.gov/pubmed/37347520" } @Article{info:doi/10.2196/44586, author="Lotto, Matheus and Zakir Hussain, Irfhana and Kaur, Jasleen and Butt, Ahmad Zahid and Cruvinel, Thiago and Morita, P. Plinio", title="Analysis of Fluoride-Free Content on Twitter: Topic Modeling Study", journal="J Med Internet Res", year="2023", month="Jun", day="20", volume="25", pages="e44586", keywords="fluoride", keywords="health information", keywords="infodemiology", keywords="infoveillance", keywords="misinformation", keywords="social media", keywords="Twitter", keywords="oral care", keywords="healthy lifestyle", keywords="hygiene", abstract="Background: Although social media has the potential to spread misinformation, it can also be a valuable tool for elucidating the social factors that contribute to the onset of negative beliefs. As a result, data mining has become a widely used technique in infodemiology and infoveillance research to combat misinformation effects. On the other hand, there is a lack of studies that specifically aim to investigate misinformation about fluoride on Twitter. Web-based individual concerns on the side effects of fluoridated oral care products and tap water stimulate the emergence and propagation of convictions that boost antifluoridation activism. In this sense, a previous content analysis--driven study demonstrated that the term fluoride-free was frequently associated with antifluoridation interests. Objective: This study aimed to analyze ``fluoride-free'' tweets regarding their topics and frequency of publication over time. Methods: A total of 21,169 tweets published in English between May 2016 and May 2022 that included the keyword ``fluoride-free'' were retrieved by the Twitter application programming interface. Latent Dirichlet allocation (LDA) topic modeling was applied to identify the salient terms and topics. The similarity between topics was calculated through an intertopic distance map. Moreover, an investigator manually assessed a sample of tweets depicting each of the most representative word groups that determined specific issues. Lastly, additional data visualization was performed regarding the total count of each topic of fluoride-free record and its relevance over time, using Elastic Stack software. Results: We identified 3 issues by applying the LDA topic modeling: ``healthy lifestyle'' (topic 1), ``consumption of natural/organic oral care products'' (topic 2), and ``recommendations for using fluoride-free products/measures'' (topic 3). Topic 1 was related to users' concerns about leading a healthier lifestyle and the potential impacts of fluoride consumption, including its hypothetical toxicity. Complementarily, topic 2 was associated with users' personal interests and perceptions of consuming natural and organic fluoride-free oral care products, whereas topic 3 was linked to users' recommendations for using fluoride-free products (eg, switching from fluoridated toothpaste to fluoride-free alternatives) and measures (eg, consuming unfluoridated bottled water instead of fluoridated tap water), comprising the propaganda of dental products. Additionally, the count of tweets on fluoride-free content decreased between 2016 and 2019 but increased again from 2020 onward. Conclusions: Public concerns toward a healthy lifestyle, including the adoption of natural and organic cosmetics, seem to be the main motivation of the recent increase of ``fluoride-free'' tweets, which can be boosted by the propagation of fluoride falsehoods on the web. Therefore, public health authorities, health professionals, and legislators should be aware of the spread of fluoride-free content on social media to create and implement strategies against their potential health damage for the population. ", doi="10.2196/44586", url="https://www.jmir.org/2023/1/e44586", url="http://www.ncbi.nlm.nih.gov/pubmed/37338975" } @Article{info:doi/10.2196/41479, author="Hengst, M. Tessi and Lechner, Lilian and van der Laan, Nynke Laura and Hommersom, Arjen and Dohmen, Daan and Hooft, Lotty and Metting, Esther and Ebbers, Wolfgang and Bolman, W. Catherine A.", title="The Adoption of a COVID-19 Contact-Tracing App: Cluster Analysis", journal="JMIR Form Res", year="2023", month="Jun", day="20", volume="7", pages="e41479", keywords="contact-tracing app", keywords="CTA", keywords="CoronaMelder", keywords="intention", keywords="adoption", keywords="cluster analysis", keywords="application", keywords="psychosocial", keywords="data", keywords="risk", keywords="societal", keywords="social norm", keywords="norm", keywords="COVID-19", keywords="adaptation", keywords="acceptance", keywords="mHealth", keywords="mobile health", abstract="Background: During the COVID-19 pandemic, there was limited adoption of contact-tracing apps (CTAs). Adoption was particularly low among vulnerable people (eg, people with a low socioeconomic position or of older age), while this part of the population tends to have lesser access to information and communication technology and is more vulnerable to the COVID-19 virus. Objective: This study aims to understand the cause of this lagged adoption of CTAs in order to facilitate adoption and find indications to make public health apps more accessible and reduce health disparities. Methods: Because several psychosocial variables were found to be predictive of CTA adoption, data from the Dutch CTA CoronaMelder (CM) were analyzed using cluster analysis. We examined whether subgroups could be formed based on 6 psychosocial perceptions (ie, trust in the government, beliefs about personal data, social norms, perceived personal and societal benefits, risk perceptions, and self-efficacy) of (non)users concerning CM in order to examine how these clusters differ from each other and what factors are predictive of the intention to use a CTA and the adoption of a CTA. The intention to use and the adoption of CM were examined based on longitudinal data consisting of 2 time frames in October/November 2020 (N=1900) and December 2020 (N=1594). The clusters were described by demographics, intention, and adoption accordingly. Moreover, we examined whether the clusters and the variables that were found to influence the adoption of CTAs, such as health literacy, were predictive of the intention to use and the adoption of the CM app. Results: The final 5-cluster solution based on the data of wave 1 contained significantly different clusters. In wave 1, respondents in the clusters with positive perceptions (ie, beneficial psychosocial variables for adoption of a CTA) about the CM app were older (P<.001), had a higher education level (P<.001), and had higher intention (P<.001) and adoption (P<.001) rates than those in the clusters with negative perceptions. In wave 2, the intention to use and adoption were predicted by the clusters. The intention to use CM in wave 2 was also predicted using the adoption measured in wave 1 (P<.001, $\beta$=--2.904). Adoption in wave 2 was predicted by age (P=.022, exp(B)=1.171), the intention to use in wave 1 (P<.001, exp(B)=1.770), and adoption in wave 1 (P<.001, exp(B)=0.043). Conclusions: The 5 clusters, as well as age and previous behavior, were predictive of the intention to use and the adoption of the CM app. Through the distinguishable clusters, insight was gained into the profiles of CM (non)intenders and (non)adopters. Trial Registration: OSF Registries osf.io/cq742; https://osf.io/cq742 ", doi="10.2196/41479", url="https://formative.jmir.org/2023/1/e41479", url="http://www.ncbi.nlm.nih.gov/pubmed/37338969" } @Article{info:doi/10.2196/38388, author="Lee, Yun Hee and Xiong, Serena and Sur, Aparajita and Khang, Tounhia and Vue, Bai and Culhane-Pera, A. Kathleen and Pergament, Shannon and Torres, Beatriz M. and Koopmeiners, S. Joseph and Desai, Jay", title="Evaluating Human Papillomavirus eHealth in Hmong Adolescents to Promote Vaccinations: Pilot Feasibility Study", journal="JMIR Form Res", year="2023", month="Jun", day="20", volume="7", pages="e38388", keywords="human papillomavirus", keywords="HPV", keywords="HPV vaccine", keywords="community-based participatory action research", keywords="CBPAR", keywords="eHealth", keywords="website", keywords="social cognitive theory", keywords="Hmong", keywords="mobile phone", abstract="Background: Human papillomavirus (HPV) is a common sexually transmitted infection, causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished by HPV vaccination. Unfortunately, vaccination rates among Hmong Americans are substantially lower than those among other racial and ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally appropriate educational interventions to improve HPV vaccine rates in Hmong Americans. Objective: We aimed to develop and evaluate the effectiveness and usability of an innovative web-based eHealth educational website, the Hmong Promoting Vaccines website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations. Methods: Through social cognitive theory and community-based participatory action research process, we created a theory-driven and culturally and linguistically appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website's effectiveness and usability. Overall, 30 Hmong-American parent and adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at preintervention, 1 week after intervention, and at the 5-week follow-up. Participants responded to survey questions about website content and processes at 1 and 5 weeks, and a subset of 20 dyad participants participated in telephone interviews 6 weeks later. We used paired t tests (2-tailed) to measure the change in knowledge, self-efficacy, and decision-making processes, and used template analysis to identify a priori themes for website usability. Results: Participants' HPV and HPV vaccine knowledge improved significantly from pre- to postintervention stage and follow-up. Knowledge scores increased from preintervention to 1 week after intervention for both parents (HPV knowledge, P=.01; vaccine knowledge, P=.01) and children (HPV knowledge, P=.01; vaccine knowledge, P<.001), which were sustained at the 5-week follow-up. Parents' average self-efficacy score increased from 21.6 at baseline to 23.9 (P=.007) at post intervention and 23.5 (P=.054) at follow-up. Similar improvements were observed in the teenagers' self-efficacy scores (from 30.3 at baseline to 35.6, P=.009, at post intervention and 35.9, P=.006, at follow-up). Collaborative decision-making between parents and adolescents improved immediately after using the website (P=.002) and at follow-up (P=.02). The interview data also revealed that the website's content was informative and engaging; in particular, participants enjoyed the web-based quizzes and vaccine reminders. Conclusions: This theory-driven, community-based participatory action research--designed and culturally and linguistically appropriate educational website was well received. It improved Hmong parents' and adolescents' knowledge, self-efficacy, and decision-making processes regarding HPV vaccination. Future studies should examine the website's impact on HPV vaccine uptake and its potential for broader use across various settings (eg, clinics and schools). ", doi="10.2196/38388", url="https://formative.jmir.org/2023/1/e38388", url="http://www.ncbi.nlm.nih.gov/pubmed/37338961" } @Article{info:doi/10.2196/46938, author="Hoang, Uy and Williams, Alice and Smylie, Jessica and Aspden, Carole and Button, Elizabeth and Macartney, Jack and Okusi, Cecilia and Byford, Rachel and Ferreira, Filipa and Leston, Meredith and Xie, Xuan Charis and Joy, Mark and Marsden, Gemma and Clark, Tristan and de Lusignan, Simon", title="The Impact of Point-of-Care Testing for Influenza on Antimicrobial Stewardship (PIAMS) in UK Primary Care: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2023", month="Jun", day="16", volume="12", pages="e46938", keywords="medical records systems, computerized", keywords="influenza point-of-care systems", keywords="general practice", keywords="RSV", keywords="implementation", keywords="outcome assessment", keywords="health care", keywords="antimicrobial stewardship", keywords="acute respiratory infection", keywords="antimicrobial", keywords="influenza", keywords="primary care", keywords="respiratory symptom", abstract="Background: Molecular point-of-care testing (POCT) used in primary care can inform whether a patient presenting with an acute respiratory infection has influenza. A confirmed clinical diagnosis, particularly early in the disease, could inform better antimicrobial stewardship. Social distancing and lockdowns during the COVID-19 pandemic have disturbed previous patterns of influenza infections in 2021. However, data from samples taken in the last quarter of 2022 suggest that influenza represents 36\% of sentinel network positive virology, compared with 24\% for respiratory syncytial virus. Problems with integration into the clinical workflow is a known barrier to incorporating technology into routine care. Objective: This study aims to report the impact of POCT for influenza on antimicrobial prescribing in primary care. We will additionally describe severe outcomes of infection (hospitalization and mortality) and how POCT is integrated into primary care workflows. Methods: The impact of POCT for influenza on antimicrobial stewardship (PIAMS) in UK primary care is an observational study being conducted between December 2022 and May 2023 and involving 10 practices that contribute data to the English sentinel network. Up to 1000 people who present to participating practices with respiratory symptoms will be swabbed and tested with a rapid molecular POCT analyzer in the practice. Antimicrobial prescribing and other study outcomes will be collected by linking information from the POCT analyzer with data from the patient's computerized medical record. We will collect data on how POCT is incorporated into practice using data flow diagrams, unified modeling language use case diagrams, and Business Process Modeling Notation. Results: We will present the crude and adjusted odds of antimicrobial prescribing (all antibiotics and antivirals) given a POCT diagnosis of influenza, stratifying by whether individuals have a respiratory or other relevant diagnosis (eg, bronchiectasis). We will also present the rates of hospital referrals and deaths related to influenza infection in PIAMS study practices compared with a set of matched practices in the sentinel network and the rest of the network. We will describe any difference in implementation models in terms of staff involved and workflow. Conclusions: This study will generate data on the impact of POCT testing for influenza in primary care as well as help to inform about the feasibility of incorporating POCT into primary care workflows. It will inform the design of future larger studies about the effectiveness and cost-effectiveness of POCT to improve antimicrobial stewardship and any impact on severe outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/46938 ", doi="10.2196/46938", url="https://www.researchprotocols.org/2023/1/e46938", url="http://www.ncbi.nlm.nih.gov/pubmed/37327029" } @Article{info:doi/10.2196/46793, author="Li, Ju-Shuang and Gu, Yu-Zhou and Hou, Feng-Su and Lu, Yong-Heng and Fan, Xiao-Ru and Qiu, Jia-Ling and Yang, Qing-Ling and Gu, Jing and Li, Jing-Hua and Xu, Roman Dong and Hao, Chun", title="Delivery of WeChat-Based HIV Result e-Reports in Social Networks for Recruitment of High-Risk Population: Baseline Data From a Cluster Randomized Controlled Trial", journal="J Med Internet Res", year="2023", month="Jun", day="15", volume="25", pages="e46793", keywords="social network strategy", keywords="HIV result e-report", keywords="recruitment", keywords="MSM", abstract="Background: Disclosure of infectious disease status to social network peers can facilitate reaching and early detection among high-risk populations. In this era of social media, globally, HIV/AIDS represents a high burden of infectious disease. Thus, delivery of an HIV result e-report via social media presents a new approach that has the potential to improve contact with and enrollment of the high-risk population in research studies and routine practice. Objective: This study explores the effectiveness and associated factors of a recruitment strategy (ie, WeChat-based HIV e-report delivery in social networks) on the enrollment of men who have sex with men (MSM) for an HIV testing intervention study. Methods: This was an enrollment result analysis of an ongoing cluster randomized controlled trial (RCT) aiming to promote HIV testing among MSM. Recruitment of potential participants was based on the unit of an egocentric social network, which includes 1 core member (an offline tested ego as the recruiter) and several network members (online alters as network associates). Alters' enrollment and alters' transformation to ego-recruiters (alter-ego) were measured as outcomes. Recruitment outcomes were compared between the exchangeable and regular e-report groups of the RCT. Associated factors of both outcomes were also investigated, including sociodemographic characteristics, health behaviors, social network characteristics, e-report types, and online delivery information. Binary outcomes were modeled using logistic models, with Firth correction for rare events. Qualitative interviews were conducted to understand facilitators and barriers in detail for alter-ego as the subsequent wave's recruiter. Results: The e-report of 1157 egos who tested offline were delivered to 5165 alters in 3 recruitment waves; eventually, 1162 eligible alters enrolled in this RCT (response rate: 22.5\%). In the exchangeable e-report group, 544 egos recruited 467 alters, of which 35 alters transformed to alter-egos (7.5\%), whereas in the regular e-report group, 613 egos recruited 695 alters, of which 40 alters transformed to alter-egos (5.8\%). Alters' enrollment at first wave was associated with a higher number of e-reports being forwarded by the egos. Alters' transformation to alter-egos for the subsequent wave was associated with the exchangeable e-report, higher income, being a Guangzhou resident, unprotected anal intercourse, preferring self-testing, and viewing senders' e-reports frequently. Qualitative interviews revealed that the lack of awareness of e-reports' function and inadequate access to e-reports at offline testing facilities were major barriers to alters' transformation to offline ego-recruiters. Conclusions: The delivery of e-report was feasible in MSM social network, and the success and sustainability of online recruitment depended on high levels of familiarity among MSM with the digital tool. The HIV e-report exchange mechanism might promote MSM to test HIV offline to get their own e-report for exchange in the community. The e-report provides an innovative recruitment method with great potential to trace direct contacts for infectious diseases studies. ", doi="10.2196/46793", url="https://www.jmir.org/2023/1/e46793", url="http://www.ncbi.nlm.nih.gov/pubmed/37318850" } @Article{info:doi/10.2196/44966, author="Louw, Candice", title="Digital Public Health Solutions in Response to the COVID-19 Pandemic: Comparative Analysis of Contact Tracing Solutions Deployed in Japan and Germany", journal="J Med Internet Res", year="2023", month="Jun", day="14", volume="25", pages="e44966", keywords="contact tracing", keywords="COVID-19", keywords="digital health", keywords="digitalization", keywords="open-source software", keywords="pandemic preparedness", keywords="pandemic technologies", abstract="Background: In response to the COVID-19 pandemic, numerous countries, including the likes of Japan and Germany, initiated, developed, and deployed digital contact tracing solutions in an effort to detect and interrupt COVID-19 transmission chains. These initiatives indicated the willingness of both the Japanese and German governments to support eHealth solution development for public health; however, end user acceptance, trust, and willingness to make use of the solutions delivered through these initiatives are critical to their success. Through a case-based analysis of contact tracing solutions deployed in Japan and Germany during the COVID-19 pandemic we may gain valuable perspectives on the transnational role of digital technologies in crises, while also projecting possible directions for future pandemic technologies. Objective: In this study, we investigate (1) which types of digital contact tracing solutions were developed and deployed by the Japanese and German governments in response to the COVID-19 pandemic and (2) how many of these solutions are open-source software (OSS) solutions. Our objective is to establish not only the type of applications that may be needed in response to a pandemic from the perspective of 2 geographically diverse, world-leading economies but also how prevalent OSS pandemic technology development has been in this context. Methods: We analyze the official government websites of Japan and Germany to identify digital solutions that are developed and deployed for contact tracing purposes (for any length of time) during the timeframe January-December 2021, specifically in response to the COVID-19 pandemic. We subsequently perform a case-oriented comparative analysis, also identifying which solutions are published as open-source. Results: In Japan, a proximity tracing tool (COVID-19 Contact-Confirming Application [COCOA]) and an outbreak management tool (Health Center Real-time Information-sharing System on COVID-19 [HER-SYS]) with an integrated symptom tracking tool (My HER-SYS) were developed. In Germany, a proximity tracing tool (Corona-Warn-App) and an outbreak management tool (Surveillance Outbreak Response Management and Analysis System [SORMAS]) were developed. From these identified solutions, COCOA, Corona-Warn-App, and SORMAS were published as open-source, indicating support by both the Japanese and German governments for OSS pandemic technology development in the context of public health. Conclusions: Japan and Germany showed support for developing and deploying not only digital contact tracing solutions but also OSS digital contact tracing solutions in response to the COVID-19 pandemic. Despite the open nature of such OSS solutions' source code, software solutions (both OSS and non-OSS) are only as transparent as the live or production environment where their processed data is hosted or stored. Software development and live software hosting are thus 2 sides of the same coin. It is nonetheless arguable that OSS pandemic technology solutions for public health are a step in the right direction for enhanced transparency in the interest of the greater public good. ", doi="10.2196/44966", url="https://www.jmir.org/2023/1/e44966", url="http://www.ncbi.nlm.nih.gov/pubmed/37314852" } @Article{info:doi/10.2196/45897, author="Mao, Lingchao and Chu, Emily and Gu, Jinghong and Hu, Tao and Weiner, J. Bryan and Su, Yanfang", title="A 4D Theoretical Framework for Measuring Topic-Specific Influence on Twitter: Development and Usability Study on Dietary Sodium Tweets", journal="J Med Internet Res", year="2023", month="Jun", day="13", volume="25", pages="e45897", keywords="social media", keywords="health education", keywords="health promotion", keywords="dissemination strategy", keywords="influence", keywords="Twitter", keywords="activity", keywords="priority", keywords="originality", keywords="popularity", abstract="Background: Social media has emerged as a prominent approach for health education and promotion. However, it is challenging to understand how to best promote health-related information on social media platforms such as Twitter. Despite commercial tools and prior studies attempting to analyze influence, there is a gap to fill in developing a publicly accessible and consolidated framework to measure influence and analyze dissemination strategies. Objective: We aimed to develop a theoretical framework to measure topic-specific user influence on Twitter and to examine its usability by analyzing dietary sodium tweets to support public health agencies in improving their dissemination strategies. Methods: We designed a consolidated framework for measuring influence that can capture topic-specific tweeting behaviors. The core of the framework is a summary indicator of influence decomposable into 4 dimensions: activity, priority, originality, and popularity. These measures can be easily visualized and efficiently computed for any Twitter account without the need for private access. We demonstrated the proposed methods by using a case study on dietary sodium tweets with sampled stakeholders and then compared the framework with a traditional measure of influence. Results: More than half a million dietary sodium tweets from 2006 to 2022 were retrieved for 16 US domestic and international stakeholders in 4 categories, that is, public agencies, academic institutions, professional associations, and experts. We discovered that World Health Organization, American Heart Association, Food and Agriculture Organization of the United Nations (UN-FAO), and World Action on Salt (WASH) were the top 4 sodium influencers in the sample. Each had different strengths and weaknesses in their dissemination strategies, and 2 stakeholders with similar overall influence, that is, UN-FAO and WASH, could have significantly different tweeting patterns. In addition, we identified exemplars in each dimension of influence. Regarding tweeting activity, a dedicated expert published more sodium tweets than any organization in the sample in the past 16 years. In terms of priority, WASH had more than half of its tweets dedicated to sodium. UN-FAO had both the highest proportion of original sodium tweets and posted the most popular sodium tweets among all sampled stakeholders. Regardless of excellence in 1 dimension, the 4 most influential stakeholders excelled in at least 2 out of 4 dimensions of influence. Conclusions: Our findings demonstrate that our method not only aligned with a traditional measure of influence but also advanced influence analysis by analyzing the 4 dimensions that contribute to topic-specific influence. This consolidated framework provides quantifiable measures for public health entities to understand their bottleneck of influence and refine their social media campaign strategies. Our framework can be applied to improve the dissemination of other health topics as well as assist policy makers and public campaign experts to maximize population impact. ", doi="10.2196/45897", url="https://www.jmir.org/2023/1/e45897", url="http://www.ncbi.nlm.nih.gov/pubmed/37310774" } @Article{info:doi/10.2196/42363, author="Kim, Hyunuk and Proctor, R. Chris and Walker, Dylan and McCarthy, R. Ronan", title="Understanding the Consumption of Antimicrobial Resistance--Related Content on Social Media: Twitter Analysis", journal="J Med Internet Res", year="2023", month="Jun", day="12", volume="25", pages="e42363", keywords="antimicrobial resistance", keywords="AMR", keywords="social media", keywords="Twitter", keywords="engagement", keywords="antimicrobial", keywords="effective", keywords="public health", keywords="awareness", keywords="disease", keywords="microbiology", keywords="pathogen", keywords="development", abstract="Background: Antimicrobial resistance (AMR) is one of the most pressing concerns in our society. Today, social media can function as an important channel to disseminate information about AMR. The way in which this information is engaged with depends on a number of factors, including the target audience and the content of the social media post. Objective: The aim of this study is to better understand how AMR-related content is consumed on the social media platform Twitter and to understand some of the drivers of engagement. This is essential to designing effective public health strategies, raising awareness about antimicrobial stewardship, and enabling academics to effectively promote their research on social media. Methods: We took advantage of unrestricted access to the metrics associated with the Twitter bot @AntibioticResis, which has over 13,900 followers. This bot posts the latest AMR research in the format of a title and a URL link to the PubMed page for an article. The tweets do not contain other attributes such as author, affiliation, or journal. Therefore, engagement with the tweets is only affected by the words used in the titles. Using negative binomial regression models, we measured the impact of pathogen names in paper titles, academic attention inferred from publication counts, and general attention estimated from Twitter on URL clicks to AMR research papers. Results: Followers of @AntibioticResis consisted primarily of health care professionals and academic researchers whose interests comprised mainly AMR, infectious diseases, microbiology, and public health. Three World Health Organization (WHO) critical priority pathogens---Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacteriaceae---were positively associated with URL clicks. Papers with shorter titles tended to have more engagements. We also described some key linguistic characteristics that should be considered when a researcher is trying to maximize engagement with their publication. Conclusions: Our finding suggests that specific pathogens gain more attention on Twitter than others and that the levels of attention do not necessarily correspond to their status on the WHO priority pathogen list. This suggests that more targeted public health strategies may be needed to raise awareness about AMR among specific pathogens. Analysis of follower data suggests that in the busy schedules of health care professionals, social media offers a fast and accessible gateway to staying abreast of the latest developments in this field. ", doi="10.2196/42363", url="https://www.jmir.org/2023/1/e42363", url="http://www.ncbi.nlm.nih.gov/pubmed/37307042" } @Article{info:doi/10.2196/39484, author="Lane, M. Jamil and Habib, Daniel and Curtis, Brenda", title="Linguistic Methodologies to Surveil the Leading Causes of Mortality: Scoping Review of Twitter for Public Health Data", journal="J Med Internet Res", year="2023", month="Jun", day="12", volume="25", pages="e39484", keywords="Twitter", keywords="public health interventions", keywords="surveillance data", keywords="health communication", keywords="natural language processing", abstract="Background: Twitter has become a dominant source of public health data and a widely used method to investigate and understand public health--related issues internationally. By leveraging big data methodologies to mine Twitter for health-related data at the individual and community levels, scientists can use the data as a rapid and less expensive source for both epidemiological surveillance and studies on human behavior. However, limited reviews have focused on novel applications of language analyses that examine human health and behavior and the surveillance of several emerging diseases, chronic conditions, and risky behaviors. Objective: The primary focus of this scoping review was to provide a comprehensive overview of relevant studies that have used Twitter as a data source in public health research to analyze users' tweets to identify and understand physical and mental health conditions and remotely monitor the leading causes of mortality related to emerging disease epidemics, chronic diseases, and risk behaviors. Methods: A literature search strategy following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extended guidelines for scoping reviews was used to search specific keywords on Twitter and public health on 5 databases: Web of Science, PubMed, CINAHL, PsycINFO, and Google Scholar. We reviewed the literature comprising peer-reviewed empirical research articles that included original research published in English-language journals between 2008 and 2021. Key information on Twitter data being leveraged for analyzing user language to study physical and mental health and public health surveillance was extracted. Results: A total of 38 articles that focused primarily on Twitter as a data source met the inclusion criteria for review. In total, two themes emerged from the literature: (1) language analysis to identify health threats and physical and mental health understandings about people and societies and (2) public health surveillance related to leading causes of mortality, primarily representing 3 categories (ie, respiratory infections, cardiovascular disease, and COVID-19). The findings suggest that Twitter language data can be mined to detect mental health conditions, disease surveillance, and death rates; identify heart-related content; show how health-related information is shared and discussed; and provide access to users' opinions and feelings. Conclusions: Twitter analysis shows promise in the field of public health communication and surveillance. It may be essential to use Twitter to supplement more conventional public health surveillance approaches. Twitter can potentially fortify researchers' ability to collect data in a timely way and improve the early identification of potential health threats. Twitter can also help identify subtle signals in language for understanding physical and mental health conditions. ", doi="10.2196/39484", url="https://www.jmir.org/2023/1/e39484", url="http://www.ncbi.nlm.nih.gov/pubmed/37307062" } @Article{info:doi/10.2196/44356, author="Morita, Pelegrini Plinio and Zakir Hussain, Irfhana and Kaur, Jasleen and Lotto, Matheus and Butt, Ahmad Zahid", title="Tweeting for Health Using Real-time Mining and Artificial Intelligence--Based Analytics: Design and Development of a Big Data Ecosystem for Detecting and Analyzing Misinformation on Twitter", journal="J Med Internet Res", year="2023", month="Jun", day="9", volume="25", pages="e44356", keywords="big data", keywords="deep learning", keywords="infodemics", keywords="misinformation", keywords="social media", keywords="infoveillance", abstract="Background: Digital misinformation, primarily on social media, has led to harmful and costly beliefs in the general population. Notably, these beliefs have resulted in public health crises to the detriment of governments worldwide and their citizens. However, public health officials need access to a comprehensive system capable of mining and analyzing large volumes of social media data in real time. Objective: This study aimed to design and develop a big data pipeline and ecosystem (UbiLab Misinformation Analysis System [U-MAS]) to identify and analyze false or misleading information disseminated via social media on a certain topic or set of related topics. Methods: U-MAS is a platform-independent ecosystem developed in Python that leverages the Twitter V2 application programming interface and the Elastic Stack. The U-MAS expert system has 5 major components: data extraction framework, latent Dirichlet allocation (LDA) topic model, sentiment analyzer, misinformation classification model, and Elastic Cloud deployment (indexing of data and visualizations). The data extraction framework queries the data through the Twitter V2 application programming interface, with queries identified by public health experts. The LDA topic model, sentiment analyzer, and misinformation classification model are independently trained using a small, expert-validated subset of the extracted data. These models are then incorporated into U-MAS to analyze and classify the remaining data. Finally, the analyzed data are loaded into an index in the Elastic Cloud deployment and can then be presented on dashboards with advanced visualizations and analytics pertinent to infodemiology and infoveillance analysis. Results: U-MAS performed efficiently and accurately. Independent investigators have successfully used the system to extract significant insights into a fluoride-related health misinformation use case (2016 to 2021). The system is currently used for a vaccine hesitancy use case (2007 to 2022) and a heat wave--related illnesses use case (2011 to 2022). Each component in the system for the fluoride misinformation use case performed as expected. The data extraction framework handles large amounts of data within short periods. The LDA topic models achieved relatively high coherence values (0.54), and the predicted topics were accurate and befitting to the data. The sentiment analyzer performed at a correlation coefficient of 0.72 but could be improved in further iterations. The misinformation classifier attained a satisfactory correlation coefficient of 0.82 against expert-validated data. Moreover, the output dashboard and analytics hosted on the Elastic Cloud deployment are intuitive for researchers without a technical background and comprehensive in their visualization and analytics capabilities. In fact, the investigators of the fluoride misinformation use case have successfully used the system to extract interesting and important insights into public health, which have been published separately. Conclusions: The novel U-MAS pipeline has the potential to detect and analyze misleading information related to a particular topic or set of related topics. ", doi="10.2196/44356", url="https://www.jmir.org/2023/1/e44356", url="http://www.ncbi.nlm.nih.gov/pubmed/37294603" } @Article{info:doi/10.2196/38342, author="Bell, Lauren and Garnett, Claire and Bao, Yihan and Cheng, Zhaoxi and Qian, Tianchen and Perski, Olga and Potts, W. Henry W. and Williamson, Elizabeth", title="How Notifications Affect Engagement With a Behavior Change App: Results From a Micro-Randomized Trial", journal="JMIR Mhealth Uhealth", year="2023", month="Jun", day="9", volume="11", pages="e38342", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="behavior change", keywords="digital behavior change", keywords="engagement", keywords="micro-randomized trial", keywords="randomized trial", keywords="randomization", keywords="just-in-time adaptive intervention", keywords="adaptive intervention", keywords="push notification", keywords="notification", keywords="excessive alcohol consumption", keywords="smartphone app", keywords="alcohol", keywords="drinking", keywords="drinker", keywords="mobile phone", abstract="Background: Drink Less is a behavior change app to help higher-risk drinkers in the United Kingdom reduce their alcohol consumption. The app includes a daily notification asking users to ``Please complete your drinks and mood diary,'' yet we did not understand the causal effect of the notification on engagement nor how to improve this component of Drink Less. We developed a new bank of 30 new messages to increase users' reflective motivation to engage with Drink Less. This study aimed to determine how standard and new notifications affect engagement. Objective: Our objective was to estimate the causal effect of the notification on near-term engagement, to explore whether this effect changed over time, and to create an evidence base to further inform the optimization of the notification policy. Methods: We conducted a micro-randomized trial (MRT) with 2 additional parallel arms. Inclusion criteria were Drink Less users who consented to participate in the trial, self-reported a baseline Alcohol Use Disorders Identification Test score of ?8, resided in the United Kingdom, were aged ?18 years, and reported interest in drinking less alcohol. Our MRT randomized 350 new users to test whether receiving a notification, compared with receiving no notification, increased the probability of opening the app in the subsequent hour, over the first 30 days since downloading Drink Less. Each day at 8 PM, users were randomized with a 30\% probability of receiving the standard message, a 30\% probability of receiving a new message, or a 40\% probability of receiving no message. We additionally explored time to disengagement, with the allocation of 60\% of eligible users randomized to the MRT (n=350) and 40\% of eligible users randomized in equal number to the 2 parallel arms, either receiving the no notification policy (n=98) or the standard notification policy (n=121). Ancillary analyses explored effect moderation by recent states of habituation and engagement. Results: Receiving a notification, compared with not receiving a notification, increased the probability of opening the app in the next hour by 3.5-fold (95\% CI 2.91-4.25). Both types of messages were similarly effective. The effect of the notification did not change significantly over time. A user being in a state of already engaged lowered the new notification effect by 0.80 (95\% CI 0.55-1.16), although not significantly. Across the 3 arms, time to disengagement was not significantly different. Conclusions: We found a strong near-term effect of engagement on the notification, but no overall difference in time to disengagement between users receiving the standard fixed notification, no notification at all, or the random sequence of notifications within the MRT. The strong near-term effect of the notification presents an opportunity to target notifications to increase ``in-the-moment'' engagement. Further optimization is required to improve the long-term engagement. International Registered Report Identifier (IRRID): RR2-10.2196/18690 ", doi="10.2196/38342", url="https://mhealth.jmir.org/2023/1/e38342", url="http://www.ncbi.nlm.nih.gov/pubmed/37294612" } @Article{info:doi/10.2196/45705, author="Yang, Hee Sou", title="The Implications of Using Digital Technologies in the Management of COVID-19: Comparative Study of Japan and South Korea", journal="J Med Internet Res", year="2023", month="Jun", day="6", volume="25", pages="e45705", keywords="comparative study", keywords="technology", keywords="health care technology", keywords="digital technology", keywords="COVID-19", keywords="mobile phone", abstract="Background: Technology can assist in providing effective infectious disease management, but it can also become a source of social injustice and inequality. To control the rapidly increasing SARS-CoV-2 infections and promote effective vaccine administration, both South Korea and Japan have been using several technology-based systems and mobile apps. However, their different approaches to technology use have yielded contrasting social implications. Objective: Through comparative studies of the use of digital technologies for pandemic management and its social implications in Japan and South Korea, this study aimed to discuss whether the active and optimal use of technology for pandemic management can occur without subverting or compromising important social values, such as privacy and equality. Methods: This study compared the social implications of Japan's and South Korea's contrasting approaches to technology implementation for COVID-19 pandemic management in early 2022. Results: Digital technologies have been actively and comprehensively used in South Korea, enabling effective COVID-19 management, but have raised serious concerns about privacy and social equality. In Japan, technologies have been more carefully implemented, thereby not causing similar social concerns, but their effectiveness in supporting COVID-19 regulations has been criticized. Conclusions: Potential social implications such as equality concerns, the balance between public interest and individual rights, and legal implications must be carefully assessed in conjunction with effective and optimal infectious disease control to achieve sustainable use of digital health technologies for infectious disease management in the future. ", doi="10.2196/45705", url="https://www.jmir.org/2023/1/e45705", url="http://www.ncbi.nlm.nih.gov/pubmed/37279042" } @Article{info:doi/10.2196/43841, author="Edinger, Andy and Valdez, Danny and Walsh-Buhi, Eric and Trueblood, S. Jennifer and Lorenzo-Luaces, Lorenzo and Rutter, A. Lauren and Bollen, Johan", title="Misinformation and Public Health Messaging in the Early Stages of the Mpox Outbreak: Mapping the Twitter Narrative With Deep Learning", journal="J Med Internet Res", year="2023", month="Jun", day="6", volume="25", pages="e43841", keywords="COVID-19", keywords="deep learning", keywords="misinformation", keywords="monkeypox", keywords="mpox", keywords="outbreak", keywords="public health", keywords="social media", keywords="Twitter", abstract="Background: Shortly after the worst of the COVID-19 pandemic, an outbreak of mpox introduced another critical public health emergency. Like the COVID-19 pandemic, the mpox outbreak was characterized by a rising prevalence of public health misinformation on social media, through which many US adults receive and engage with news. Digital misinformation continues to challenge the efforts of public health officials in providing accurate and timely information to the public. We examine the evolving topic distributions of social media narratives during the mpox outbreak to map the tension between rapidly diffusing misinformation and public health communication. Objective: This study aims to observe topical themes occurring in a large-scale collection of tweets about mpox using deep learning. Methods: We leveraged a data set comprised of all mpox-related tweets that were posted between May 7, 2022, and July 23, 2022. We then applied Sentence Bidirectional Encoder Representations From Transformers (S-BERT) to the content of each tweet to generate a representation of its content in high-dimensional vector space, where semantically similar tweets will be located closely together. We projected the set of tweet embeddings to a 2D map by applying principal component analysis and Uniform Manifold Approximation Projection (UMAP). Finally, we group these data points into 7 topical clusters using k-means clustering and analyze each cluster to determine its dominant topics. We analyze the prevalence of each cluster over time to evaluate longitudinal thematic changes. Results: Our deep-learning pipeline revealed 7 distinct clusters of content: (1) cynicism, (2) exasperation, (3) COVID-19, (4) men who have sex with men, (5) case reports, (6) vaccination, and (7) World Health Organization (WHO). Clusters that largely communicated erroneous or irrelevant information began earlier and grew faster, reaching a wider audience than later communications by official instances and health officials. Conclusions: Within a few weeks of the first reported mpox cases, an avalanche of mostly false, misleading, irrelevant, or damaging information started to circulate on social media. Official institutions, including the WHO, acted promptly, providing case reports and accurate information within weeks, but were overshadowed by rapidly spreading social media chatter. Our results point to the need for real-time monitoring of social media content to optimize responses to public health emergencies. ", doi="10.2196/43841", url="https://www.jmir.org/2023/1/e43841", url="http://www.ncbi.nlm.nih.gov/pubmed/37163694" } @Article{info:doi/10.2196/47225, author="Wang, Siqin and Ning, Huan and Huang, Xiao and Xiao, Yunyu and Zhang, Mengxi and Yang, Fan Ellie and Sadahiro, Yukio and Liu, Yan and Li, Zhenlong and Hu, Tao and Fu, Xiaokang and Li, Zi and Zeng, Ye", title="Public Surveillance of Social Media for Suicide Using Advanced Deep Learning Models in Japan: Time Series Study From 2012 to 2022", journal="J Med Internet Res", year="2023", month="Jun", day="2", volume="25", pages="e47225", keywords="suicide", keywords="suicidal ideation", keywords="suicide-risk identification", keywords="natural language processing", keywords="social media", keywords="Japan", abstract="Background: Social media platforms have been increasingly used to express suicidal thoughts, feelings, and acts, raising public concerns over time. A large body of literature has explored the suicide risks identified by people's expressions on social media. However, there is not enough evidence to conclude that social media provides public surveillance for suicide without aligning suicide risks detected on social media with actual suicidal behaviors. Corroborating this alignment is a crucial foundation for suicide prevention and intervention through social media and for estimating and predicting suicide in countries with no reliable suicide statistics. Objective: This study aimed to corroborate whether the suicide risks identified on social media align with actual suicidal behaviors. This aim was achieved by tracking suicide risks detected by 62 million tweets posted in Japan over a 10-year period and assessing the locational and temporal alignment of such suicide risks with actual suicide behaviors recorded in national suicide statistics. Methods: This study used a human-in-the-loop approach to identify suicide-risk tweets posted in Japan from January 2013 to December 2022. This approach involved keyword-filtered data mining, data scanning by human efforts, and data refinement via an advanced natural language processing model termed Bidirectional Encoder Representations from Transformers. The tweet-identified suicide risks were then compared with actual suicide records in both temporal and spatial dimensions to validate if they were statistically correlated. Results: Twitter-identified suicide risks and actual suicide records were temporally correlated by month in the 10 years from 2013 to 2022 (correlation coefficient=0.533; P<.001); this correlation coefficient is higher at 0.652 when we advanced the Twitter-identified suicide risks 1 month earlier to compare with the actual suicide records. These 2 indicators were also spatially correlated by city with a correlation coefficient of 0.699 (P<.001) for the 10-year period. Among the 267 cities with the top quintile of suicide risks identified from both tweets and actual suicide records, 73.5\% (n=196) of cities overlapped. In addition, Twitter-identified suicide risks were at a relatively lower level after midnight compared to a higher level in the afternoon, as well as a higher level on Sundays and Saturdays compared to weekdays. Conclusions: Social media platforms provide an anonymous space where people express their suicidal thoughts, ideation, and acts. Such expressions can serve as an alternative source to estimating and predicting suicide in countries without reliable suicide statistics. It can also provide real-time tracking of suicide risks, serving as an early warning for suicide. The identification of areas where suicide risks are highly concentrated is crucial for location-based mental health planning, enabling suicide prevention and intervention through social media in a spatially and temporally explicit manner. ", doi="10.2196/47225", url="https://www.jmir.org/2023/1/e47225", url="http://www.ncbi.nlm.nih.gov/pubmed/37267022" } @Article{info:doi/10.2196/45360, author="Li, He and Teng, Yi and Yan, Xinxin and Cao, Maomao and Yang, Fan and He, Siyi and Zhang, Shaoli and Li, Qianru and Xia, Changfa and Li, Kai and Chen, Wanqing", title="Profiles and Findings of Population-Based Esophageal Cancer Screening With Endoscopy in China: Systematic Review and Meta-analysis", journal="JMIR Public Health Surveill", year="2023", month="Jun", day="1", volume="9", pages="e45360", keywords="esophageal cancer", keywords="screening", keywords="high-risk individuals", keywords="detection rates", keywords="China", abstract="Background: Population-based esophageal cancer (EC) screening trials and programs have been conducted in China for decades; however, screening strategies have been adopted in different regions and screening profiles are unclear. Objective: We performed a meta-analysis to profile EC screening in China by positivity rate, compliance rate, and endoscopy findings, aiming to provide explicit evidence and recommendations for EC screening programs. Methods: English (PubMed, Embase) and Chinese (China National Knowledge Infrastructure, Wanfang) language databases were systematically searched for population-based EC screening studies in the Chinese population until December 31, 2022. A meta-analysis was performed by standard methodology using a random-effects model. Pooled prevalence rates were calculated for three groups: high-risk areas with a universal endoscopy strategy, rural China with a risk-stratified endoscopic screening (RSES) strategy, and urban China with an RSES strategy. Positive cases included lesions of severe dysplasia, carcinoma in situ, intramucosal carcinoma, submucosal carcinoma, and invasive carcinoma. Results: The pooled positivity rate of the high-risk population was higher in rural China (44.12\%) than in urban China (23.11\%). The compliance rate of endoscopic examinations was the highest in rural China (52.40\%), followed by high-risk areas (50.11\%), and was the lowest in urban China (23.67\%). The pooled detection rate of positive cases decreased from 1.03\% (95\% CI 0.82\%-1.30\%) in high-risk areas to 0.48\% (95\% CI 0.25\%-0.93\%) in rural China and 0.12\% (95\% CI 0.07\%-0.21\%) in urban China. The pooled detection rate of low-grade intraepithelial neoplasia (LGIN) was also in the same order, being the highest in high-risk areas (3.99\%, 95\% CI 2.78\%-5.69\%), followed by rural China (2.55\%, 95\% CI 1.03\%-6.19\%) and urban China (0.34\%, 95\% CI 0.14\%-0.81\%). Higher detection rates of positive cases and LGIN were observed among males than among females and at older ages. The pooled early detection rate was 81.90\% (95\% CI 75.58\%-86.88\%), which was similar to the rates in high-risk areas (82.09\%), in rural China (80.76\%), and in urban China (80.08\%). Conclusions: Under the current screening framework, a higher screening benefit was observed in high-risk areas than in other regions. To promote EC screening and reduce the current inequality of screening in China, more focus should be given to optimizing strategies of high-risk individual assessment and surveillance management to improve compliance with endoscopic examination. Trial Registration: PROSPERO CRD42022375720; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=375720 ", doi="10.2196/45360", url="https://publichealth.jmir.org/2023/1/e45360", url="http://www.ncbi.nlm.nih.gov/pubmed/37261899" } @Article{info:doi/10.2196/43646, author="Boender, Sonia T. and Schneider, Helene Paula and Houareau, Claudia and Wehrli, Silvan and Purnat, D. Tina and Ishizumi, Atsuyoshi and Wilhelm, Elisabeth and Voegeli, Christopher and Wieler, H. Lothar and Leuker, Christina", title="Establishing Infodemic Management in Germany: A Framework for Social Listening and Integrated Analysis to Report Infodemic Insights at the National Public Health Institute", journal="JMIR Infodemiology", year="2023", month="Jun", day="1", volume="3", pages="e43646", keywords="infodemic", keywords="social listening", keywords="communication", keywords="infodemiology", keywords="public health", keywords="health promotion", keywords="misinformation", keywords="integrated analysis", keywords="infodemic insights", abstract="Background: To respond to the need to establish infodemic management functions at the national public health institute in Germany (Robert Koch Institute, RKI), we explored and assessed available data sources, developed a social listening and integrated analysis framework, and defined when infodemic management functions should be activated during emergencies. Objective: We aimed to establish a framework for social listening and integrated analysis for public health in the German context using international examples and technical guidance documents for infodemic management. Methods: This study completed the following objectives: identified (potentially) available data sources for social listening and integrated analysis; assessed these data sources for their suitability and usefulness for integrated analysis in addition to an assessment of their risk using the RKI's standardized data protection requirements; developed a framework and workflow to combine social listening and integrated analysis to report back actionable infodemic insights for public health communications by the RKI and stakeholders; and defined criteria for activating integrated analysis structures in the context of a specific health event or health emergency. Results: We included and classified 38\% (16/42) of the identified and assessed data sources for social listening and integrated analysis at the RKI into 3 categories: social media and web-based listening data, RKI-specific data, and infodemic insights. Most data sources can be analyzed weekly to detect current trends and narratives and to inform a timely response by reporting insights that include a risk assessment and scalar judgments of different narratives and themes. Conclusions: This study identified, assessed, and prioritized a wide range of data sources for social listening and integrated analysis to report actionable infodemic insights, ensuring a valuable first step in establishing and operationalizing infodemic management at the RKI. This case study also serves as a roadmap for others. Ultimately, once operational, these activities will inform better and targeted public health communication at the RKI and beyond. ", doi="10.2196/43646", url="https://infodemiology.jmir.org/2023/1/e43646", url="http://www.ncbi.nlm.nih.gov/pubmed/37261891" } @Article{info:doi/10.2196/43132, author="Rocha, Paulo and Pinheiro, Diego and de Paula Monteiro, Rodrigo and Tubert, Ela and Romero, Erick and Bastos-Filho, Carmelo and Nuno, Miriam and Cadeiras, Martin", title="Adaptive Content Tuning of Social Network Digital Health Interventions Using Control Systems Engineering for Precision Public Health: Cluster Randomized Controlled Trial", journal="J Med Internet Res", year="2023", month="May", day="31", volume="25", pages="e43132", keywords="psychosocial intervention", keywords="social network", keywords="SNI", keywords="social network intervention", keywords="precision medicine", keywords="precision public health", keywords="organ donation", keywords="organ procurement", keywords="public awareness", keywords="social media", keywords="systems analysis", keywords="tissue and organ procurement", keywords="adaptive clinical trial", keywords="proportional integral derivative", keywords="patient education", keywords="digital health", abstract="Background: Social media has emerged as an effective tool to mitigate preventable and costly health issues with social network interventions (SNIs), but a precision public health approach is still lacking to improve health equity and account for population disparities. Objective: This study aimed to (1) develop an SNI framework for precision public health using control systems engineering to improve the delivery of digital educational interventions for health behavior change and (2) validate the SNI framework to increase organ donation awareness in California, taking into account underlying population disparities. Methods: This study developed and tested an SNI framework that uses publicly available data at the ZIP Code Tabulation Area (ZCTA) level to uncover demographic environments using clustering analysis, which is then used to guide digital health interventions using the Meta business platform. The SNI delivered 5 tailored organ donation--related educational contents through Facebook to 4 distinct demographic environments uncovered in California with and without an Adaptive Content Tuning (ACT) mechanism, a novel application of the Proportional Integral Derivative (PID) method, in a cluster randomized trial (CRT) over a 3-month period. The daily number of impressions (ie, exposure to educational content) and clicks (ie, engagement) were measured as a surrogate marker of awareness. A stratified analysis per demographic environment was conducted. Results: Four main clusters with distinctive sociodemographic characteristics were identified for the state of California. The ACT mechanism significantly increased the overall click rate per 1000 impressions ($\beta$=.2187; P<.001), with the highest effect on cluster 1 ($\beta$=.3683; P<.001) and the lowest effect on cluster 4 ($\beta$=.0936; P=.053). Cluster 1 is mainly composed of a population that is more likely to be rural, White, and have a higher rate of Medicare beneficiaries, while cluster 4 is more likely to be urban, Hispanic, and African American, with a high employment rate without high income and a higher proportion of Medicaid beneficiaries. Conclusions: The proposed SNI framework, with its ACT mechanism, learns and delivers, in real time, for each distinct subpopulation, the most tailored educational content and establishes a new standard for precision public health to design novel health interventions with the use of social media, automation, and machine learning in a form that is efficient and equitable. Trial Registration: ClinicalTrials.gov NTC04850287; https://clinicaltrials.gov/ct2/show/NCT04850287 ", doi="10.2196/43132", url="https://www.jmir.org/2023/1/e43132", url="http://www.ncbi.nlm.nih.gov/pubmed/37256680" } @Article{info:doi/10.2196/45908, author="Teshome, Berhanu Getenesh and Haileslassie, Abebe Hiwot and Shand, Phyllis and Lin, Yun and Lieffers, L. Jessica R. and Henry, Carol", title="Pulse-Based Nutrition Education Intervention Among High School Students to Enhance Knowledge, Attitudes, and Practices: Pilot for a Formative Survey Study", journal="JMIR Form Res", year="2023", month="May", day="31", volume="7", pages="e45908", keywords="adolescents", keywords="food literacy", keywords="high school", keywords="macronutrients", keywords="micronutrients", keywords="pulses", keywords="dietary pattern", keywords="diet", keywords="eating habits", keywords="nutrition", keywords="students", keywords="school-based interventions", abstract="Background: Promoting pulse consumption in schools could improve students' healthy food choices. Pulses, described as legumes, are rich in protein and micronutrients and are an important food choice for health and well-being. However, most Canadians consume very little pulse-based food. Objective: This pilot study sought to investigate outcomes of a teacher-led, school-based food literacy intervention focused on the Pulses Make Perfect Sense (PMPS) program in 2 high schools in Saskatoon, Saskatchewan. Methods: Both high schools were selected using a convenience sampling technique and have similar sociodemographic characteristics. The mean age of students was 16 years. The intervention comprised 7 key themes focused on pulses, which included defining pulses; health and nutritional benefits of pulses; incorporating pulses into meals; the role of pulses in reducing environmental stressors, food insecurity, and malnutrition; product development; taste testing and sensory analysis; and pulses around the world. A self-administered questionnaire was used to assess knowledge, attitudes, practices, and barriers regarding pulse consumption in students at baseline and study end. Teachers were interviewed at the end of the intervention. Descriptive statistics and the nonparametric Mann-Whitney U test were used for analysis. Results: In total, 41 and 32 students participated in the baseline and study-end assessments, respectively. At baseline, the median knowledge score was 9, attitude score was 6, and barrier score was 0. At study end, the median knowledge score was 10, attitude score was 7, and barrier score was 1. A lower score for barriers indicated fewer barriers to pulse consumption. There was a significant difference between baseline and study-end scores in knowledge (P<.05). Barriers to pulse consumption included parents not cooking or consuming pulses at home, participants not liking the taste of pulses, and participants often preferring other food choices over pulses. The teachers indicated that the pulse food-literacy teaching resources were informative, locally available, and easy to use. Conclusions: Despite the improvements in knowledge, attitude, and practice, pulse consumption did not change significantly at the end of the intervention. Future studies with larger samples are needed to determine the impact of PMPS on knowledge, attitude, and practice of high school students. ", doi="10.2196/45908", url="https://formative.jmir.org/2023/1/e45908", url="http://www.ncbi.nlm.nih.gov/pubmed/37256666" } @Article{info:doi/10.2196/43308, author="Niesen, Sydney and Ramon, Daniel and Spencer-Hwang, Rhonda and Sinclair, Ryan", title="The Relationship Between Face Mask Use and Face-Touching Frequency in Public Areas: Naturalistic Study", journal="Interact J Med Res", year="2023", month="May", day="29", volume="12", pages="e43308", keywords="COVID-19", keywords="mask wearing", keywords="face-touching", keywords="self-inoculation", keywords="public health", keywords="digital surveillance", keywords="webcam video", keywords="prevention", keywords="health risk", keywords="health", keywords="risk", keywords="mask", keywords="surveillance", keywords="transmission", keywords="behavior", abstract="Background: Throughout the COVID-19 pandemic in the United States, a major public health goal has been reducing the spread of the virus, with particular emphasis on reducing transmission from person to person. Frequent face touching can transmit viral particles from one infected person and subsequently infect others in a public area. This raises an important concern about the use of face masks and their relationship with face-touching behaviors. One concern discussed during the pandemic is that wearing a mask, and different types of masks, could increase face touching because there is a need to remove the mask to smoke, drink, eat, etc. To date, there have been few studies that have assessed this relationship between mask wearing and the frequency of face touching relative to face-touching behaviors. Objective: This study aimed to compare the frequency of face touching in people wearing a mask versus not wearing a mask in high--foot traffic urban outdoor areas. The purpose of this study was to assess if mask wearing was associated with increased face touching. Methods: Public webcam videos from 4 different cities in New York, New Jersey, Louisiana, and Florida were used to collect data. Face touches were recorded as pedestrians passed under the webcam. Adult pedestrians wearing masks were compared to those not wearing masks. Quantitative measures of frequency, duration, site of touch, and oral activities were recorded. Linear regression analysis was used to assess the association between mask use and face touching. Results: Of the 490 observed subjects, 241 (49.2\%) were wearing a mask properly and 249 (50.8\%) were not. In the unmasked group, 33.7\% (84/249) were wearing it improperly, covering the mouth only. Face touching occurred in 11.4\% (56/490) of the masked group and 17.6\% (88/490) in the unmasked group. Of those who touched their face, 61.1\% (88/144) of people were not wearing a mask. The most common site of face touching was the perioral region in both groups. Both the masked and unmasked group had a frequency of face touching for 0.03 touches/s. Oral activities such as eating or smoking increased face touching in the unmasked group. Conclusions: Contrary to expectations, non--mask-wearing subjects touched their face more frequently than those who were wearing a mask. This finding is substantial because wearing a face mask had a negative association with face touching. When wearing a mask, individuals are less likely to be spreading and ingesting viral particles. Therefore, wearing a mask is more effective in preventing the spread of viral particles. ", doi="10.2196/43308", url="https://www.i-jmr.org/2023/1/e43308", url="http://www.ncbi.nlm.nih.gov/pubmed/37094229" } @Article{info:doi/10.2196/41944, author="Lord, Z. Asta Y. and Pan, Wen-Harn", title="Effects of WAKE.TAIWAN Healthy Lifestyle Web-Based Promotion Programs on Adults' Awareness of Self-perceived Weight Status and Their Healthy Lifestyle Stages: Retrospective Analysis", journal="JMIR Form Res", year="2023", month="May", day="25", volume="7", pages="e41944", keywords="healthy eating", keywords="active living", keywords="obese", keywords="weight", keywords="social media", keywords="website", keywords="web based", keywords="health behavior", keywords="online health promotion", keywords="obesity", keywords="chronic disease", keywords="healthy lifestyle", keywords="lifestyle", keywords="health promotion", keywords="health education", keywords="online health information", keywords="quasi-experimental", keywords="questionnaire", keywords="survey research", keywords="applied method", keywords="nutrition", keywords="food", keywords="eat", keywords="confidence interval", keywords="generalized linear model", abstract="Background: Obesity is a major risk factor of many chronic diseases. However, current obesity control policies and actions are not sufficient to halt the pandemic. It has been documented that more than half of all adults are not able to interpret their own weight status, not to mention to practice healthy lifestyles. Social media and interactive websites can reach people on a long-term basis, which may be used as intervention vehicles to build up cognition for weight control and to promote healthy behavior practices. Objective: WAKE.TAIWAN is an ongoing web-based multifaceted healthy lifestyle promotion program with social media and interactive websites as the intervention vehicle. This study aimed to examine whether adults reached by our program would have increased awareness to their own anthropometric measures, correctly judge their body weight status, and practice healthy behaviors over time. Methods: This study adopted a quasi-experimental design with web-based questionnaire surveys. The experimental group consisted of WAKE.TAIWAN Facebook group members aged 20-65 years who have used the interactive website health education resources (n=177). The group was further stratified into 2 subgroups based on their duration of participation (E1 group: duration <1 year; E2 group: duration ?1 year). The control group consisted of other Facebook users (n=545) in the same age range who had not been exposed to the health education materials of this project. A total of 722 people (male: n=267, 37\%; and female: n=455, 63\%) participated in our survey in 2019. Data were analyzed to evaluate program effectiveness using a generalized linear model. Results: The proportion of people correctly interpreting their own weight status in the experimental group was greater than that of the control group (control group: 320/545, 58.7\%; group E1: 53/88, 60\%; and group E2: 64/89, 72\%). The E2 experimental group was significantly better than the control group in paying attention to weight-related measures and in correctly interpreting their own weight status (odds ratio 1.73, 95\% CI 1.04-2.89; P=.04). With respect to the behavioral stages of practicing healthy eating and active living, both experimental groups, E1 and E2, performed significantly better than the control group (group E1: P=.003 and P=.02; and group E2: P=.004 and P<.001, respectively). Conclusions: This study demonstrates that the longer the participants were exposed to our social media--based programs, the higher the proportion of them that would have the correct judgement on their weight status and fall in the higher stages of healthy lifestyle behaviors. A longitudinal follow-up survey is in place to verify these findings. ", doi="10.2196/41944", url="https://formative.jmir.org/2023/1/e41944", url="http://www.ncbi.nlm.nih.gov/pubmed/37227770" } @Article{info:doi/10.2196/46537, author="Lee, Hocheol and Koh, Baek Sang and Jo, Sug Heui and Lee, Ho Tae and Nam, Kweun Hae and Zhao, Bo and Lim, Subeen and Lim, Aeh Joo and Lee, Hee Ho and Hwang, Seong Yu and Kim, Hyun Dong and Nam, Woo Eun", title="Global Trends in Social Prescribing: Web-Based Crawling Approach", journal="J Med Internet Res", year="2023", month="May", day="22", volume="25", pages="e46537", keywords="social prescribing", keywords="social loneliness", keywords="National Health Service", keywords="aging population", keywords="web crawling", keywords="sustainable model", keywords="Google Trend", keywords="web-based data", keywords="NPI", keywords="health care model", keywords="primary care", keywords="digital health intervention", keywords="implementation", keywords="health care professional", abstract="Background: Social loneliness is a prevalent issue in industrialized countries that can lead to adverse health outcomes, including a 26\% increased risk of premature mortality, coronary heart disease, stroke, depression, cognitive impairment, and Alzheimer disease. The United Kingdom has implemented a strategy to address loneliness, including social prescribing---a health care model where physicians prescribe nonpharmacological interventions to tackle social loneliness. However, there is a need for evidence-based plans for global social prescribing dissemination. Objective: This study aims to identify global trends in social prescribing from 2018. To this end, we intend to collect and analyze words related to social prescribing worldwide and evaluate various trends of related words by classifying the core areas of social prescribing. Methods: Google's searchable data were collected to analyze web-based data related to social prescribing. With the help of web crawling, 3796 news items were collected for the 5-year period from 2018 to 2022. Key topics were selected to identify keywords for each major topic related to social prescribing. The topics were grouped into 4 categories, namely Healthy, Program, Governance, and Target, and keywords for each topic were selected thereafter. Text mining was used to determine the importance of words collected from new data. Results: Word clouds were generated for words related to social prescribing, which collected 3796 words from Google News databases, including 128 in 2018, 432 in 2019, 566 in 2020, 748 in 2021, and 1922 in 2022, increasing nearly 15-fold between 2018 and 2022 (5 years). Words such as health, prescribing, and GPs (general practitioners) were the highest in terms of frequency in the list for all the years. Between 2020 and 2021, COVID, gardening, and UK were found to be highly related words. In 2022, NHS (National Health Service) and UK ranked high. This dissertation examines social prescribing--related term frequency and classification (2018-2022) in Healthy, Program, Governance, and Target categories. Key findings include increased ``Healthy'' terms from 2020, ``gardening'' prominence in ``Program,'' ``community'' growth across categories, and ``Target'' term spikes in 2021. Conclusions: This study's discussion highlights four key aspects: (1) the ``Healthy'' category trends emphasize mental health, cancer, and sleep; (2) the ``Program'' category prioritizes gardening, community, home-schooling, and digital initiatives; (3) ``Governance'' underscores the significance of community resources in social prescribing implementation; and (4) ``Target'' focuses on 4 main groups: individuals with long-term conditions, low-level mental health issues, social isolation, or complex social needs impacting well-being. Social prescribing is gaining global acceptance and is becoming a global national policy, as the world is witnessing a sharp rise in the aging population, noncontagious diseases, and mental health problems. A successful and sustainable model of social prescribing can be achieved by introducing social prescribing schemes based on the understanding of roles and the impact of multisectoral partnerships. ", doi="10.2196/46537", url="https://www.jmir.org/2023/1/e46537", url="http://www.ncbi.nlm.nih.gov/pubmed/37086427" } @Article{info:doi/10.2196/44649, author="Maddah, Noha and Verma, Arpana and Almashmoum, Maryam and Ainsworth, John", title="Effectiveness of Public Health Digital Surveillance Systems for Infectious Disease Prevention and Control at Mass Gatherings: Systematic Review", journal="J Med Internet Res", year="2023", month="May", day="19", volume="25", pages="e44649", keywords="public health", keywords="digital surveillance system", keywords="infectious disease prevention and control", keywords="mass gathering event", keywords="systematic review", abstract="Background: Mass gatherings (MGs; eg, religious, sporting, musical, sociocultural, and other occasions that draw large crowds) pose public health challenges and concerns related to global health. A leading global concern regarding MGs is the possible importation and exportation of infectious diseases as they spread from the attendees to the general population, resulting in epidemic outbreaks. Governments and health authorities use technological interventions to support public health surveillance and prevent and control infectious diseases. Objective: This study aims to review the evidence on the effectiveness of public health digital surveillance systems for infectious disease prevention and control at MG events. Methods: A systematic literature search was conducted in January 2022 using the Ovid MEDLINE, Embase, CINAHL, and Scopus databases to examine relevant articles published in English up to January 2022. Interventional studies describing or evaluating the effectiveness of public health digital surveillance systems for infectious disease prevention and control at MGs were included in the analysis. Owing to the lack of appraisal tools for interventional studies describing and evaluating public health digital surveillance systems at MGs, a critical appraisal tool was developed and used to assess the quality of the included studies. Results: In total, 8 articles were included in the review, and 3 types of MGs were identified: religious (the Hajj and Prayagraj Kumbh), sporting (the Olympic and Paralympic Games, the Federation International Football Association World Cup, and the Micronesian Games), and cultural (the Festival of Pacific Arts) events. In total, 88\% (7/8) of the studies described surveillance systems implemented at MG events, and 12\% (1/8) of the studies described and evaluated an enhanced surveillance system that was implemented for an event. In total, 4 studies reported the implementation of a surveillance system: 2 (50\%) described the enhancement of the system that was implemented for an event, 1 (25\%) reported a pilot implementation of a surveillance system, and 1 (25\%) reported an evaluation of an enhanced system. The types of systems investigated were 2 syndromic, 1 participatory, 1 syndromic and event-based, 1 indicator- and event-based, and 1 event-based surveillance system. In total, 62\% (5/8) of the studies reported timeliness as an outcome generated after implementing or enhancing the system without measuring its effectiveness. Only 12\% (1/8) of the studies followed the Centers for Disease Control and Prevention guidelines for evaluating public health surveillance systems and the outcomes of enhanced systems based on the systems' attributes to measure their effectiveness. Conclusions: On the basis of the review of the literature and the analysis of the included studies, there is limited evidence of the effectiveness of public health digital surveillance systems for infectious disease prevention and control at MGs because of the absence of evaluation studies. ", doi="10.2196/44649", url="https://www.jmir.org/2023/1/e44649", url="http://www.ncbi.nlm.nih.gov/pubmed/37204833" } @Article{info:doi/10.2196/42729, author="Shan, Duo and Xue, Hui and Yu, Fei and Zan, Xingkai and Liu, Hui and Liu, Jiaye and Han, Mengjie and Zhang, Dapeng", title="Understanding the Uptake and Outcomes of Non-occupational Postexposure Prophylaxis Use Through an Online Medical Platform in China: Web-Based Cross-sectional Study", journal="J Med Internet Res", year="2023", month="May", day="19", volume="25", pages="e42729", keywords="online medical platform", keywords="men who have sex with men", keywords="postexposure prophylaxis", keywords="preexposure prophylaxis", keywords="PrEP", keywords="sexual behaviors", keywords="HIV", keywords="risk", keywords="prevention", abstract="Background: To date, non-occupational postexposure prophylaxis (PEP) has been widely accepted as a safe and effective intervention for HIV in many countries, yet it remains an underutilized prevention strategy in China. Evidence indicated a high demand for PEP among Chinese men who have sex with men, but the uptake and access to PEP service remain limited. In an era of rapid development of web-based technology, online medical platforms in China hold great promise in facilitating PEP provision and delivery by addressing problems such as accessibility, convenience, privacy protection, and antidiscrimination by integrating online and offline resources. However, there is a paucity of data concerning the uptake and outcomes of online PEP in China. Objective: The aim of this study is to explore online PEP service provision and understand PEP uptake and outcome through a web-based cross-sectional study. Methods: From January 2020 to June 2021, we conducted a retrospective web-based survey among those seeking online PEP services via the internet medical platform ``HeHealth'' using a structured questionnaire. Participants were surveyed on sociodemographic characteristics, sexual and drug-related behaviors, history of preexposure prophylaxis (PrEP) usage, and PEP uptake. Statistical analysis included descriptive analysis, chi-square test, and multivariable logistic regression. P values <.05 were deemed statistically significant. Results: No HIV seroconversions were observed among 539 PEP users. Our sample demonstrated that most participants seeking online PEP services were gay (397/539, 73.7\%), single (470/539, 87.2\%), having an education of more than 12 years (493/539, 91.5\%), and with an average monthly income of 7000 RMB (1 RMB=US \$0.14) or more (274/539, 50.8\%). Sexual exposures accounted for 86.8\% (468/539) of the cases, with anal sex being the most common indication (389/539, 72.2\%) for seeking PEP use. Among 539 participants, 60.7\% (327/539) sought online PEP for relatively low-risk exposures, whereas 39.3\% (212/539) were considered high-risk exposures. Nearly all (537/539, 99.6\%) initiated PEP within 72 hours and 68.6\% (370/539) within 24 hours of exposure. All users (539/539) were prescribed a 3-drug regimen, with most comprising 3TC/TDF+DTG (lamivudine, tenofovir disoproxil fumarate, and dolutegravir; 293/539, 54.4\%), followed by FTC/TDF+DTG (emtricitabine, tenofovir disoproxil fumarate, and dolutegravir; 158/539, 29.3\%). The adjusted model showed that greater odds of PrEP usage were associated with an age of 35 years or older versus the age group of 25-34 years (adjusted odds ratio [AOR] 2.04, 95\% CI 1.24-3.37), having an education of 17 years or more versus an education of 12 years or less (AOR 3.14, 95\% CI 1.29-7.62), average monthly income of 20,000 RMB or more versus less than 3000 RMB (AOR 2.60, 95\% CI 1.09-6.23), and having high-risk sexual behavior during PEP treatment (AOR 2.20, 95\% CI 1.05, 3.69). Conclusions: The 0\% infection rate in this study demonstrated that online PEP could be a valuable risk-reduction option to improve HIV prevention service within China. However, further research is needed to better facilitate PrEP transition among online PEP users. ", doi="10.2196/42729", url="https://www.jmir.org/2023/1/e42729", url="http://www.ncbi.nlm.nih.gov/pubmed/37204828" } @Article{info:doi/10.2196/42304, author="Cernadas Ramos, Andr{\'e}s and Fern{\'a}ndez Da Silva, {\'A}ngela and Barral Buceta, Bran and Bouzas-Lorenzo, Ram{\'o}n", title="Offerings and User Demands of eHealth Services in Spain: National Survey", journal="J Med Internet Res", year="2023", month="May", day="18", volume="25", pages="e42304", keywords="Spanish eHealth", keywords="health policies", keywords="digital health", keywords="COVID-19", keywords="eHealth offers", keywords="eHealth demands", abstract="Background: The accelerated development of information and communication technologies has made health care one of the pioneering fields in the incorporation of these tools. As new technologies have been applied, existing technologies have been sophisticated and improved and the concept of eHealth has expanded. However, these advances and expansion of eHealth do not seem to have served to adapt the supply of services to users' demands; rather, supply seems to be governed by other variables. Objective: The main objective of this work was to review the existing differences between user demands and the supply of eHealth services in Spain and their causes. The aim is to provide information on the level of use of the services and the causes of the variation in demand for these services, which can be useful in correcting existing differences and adapting them to the needs of users. Methods: A survey, ``Use and Attitudes Toward eHealth in Spain,'' was applied by telephone to a sample of 1695 people aged 18 years and over, taking into account sociodemographic profile characteristics (sex, age, habitat, educational level). The confidence level was set at 95\% and the margin of error was {\textpm}2.45 for the whole sample. Results: The survey results showed that the online doctor's appointment service is the most frequently used eHealth service by users: 72.48\% of respondents used this service at some point and 21.28\% stated that they use it regularly. The other services showed significantly lower percentages of use, including ``managing health cards'' (28.04\%), ``consulting medical history'' (20.37\%), ``managing test results'' (20.22\%), ``communicating with health professionals'' (17.80\%), and ``requesting a change of doctor'' (13.76\%). Despite this low usage, a large majority of respondents (80.00\%) attach great importance to all the services offered. Overall, 16.52\% of the users surveyed were willing to make new service requests to the regional websites, with 9.33\% of them highlighting services such as ``the availability of a complaints and claims mailbox,'' ``the possibility of consulting medical records,'' and ``the availability of more detailed information on medical centers (location, medical directory, waiting lists, etc).'' Other outstanding requests (8.00\%) were to simplify the procedures for using certain existing services. Conclusions: The data from the survey show that eHealth services are widely known and highly valued by users, but not all services are used with the same frequency or intensity. It appears that users find it difficult to suggest new services that might be useful to them in terms of demand for new services that do not currently exist. It would be useful to use qualitative studies to gain a deeper understanding of currently unmet needs and the possibilities of eHealth. The lack of access to and use of these services and the unmet needs particularly affect more vulnerable populations who have the greatest difficulty in meeting their needs through alternative means to eHealth. ", doi="10.2196/42304", url="https://www.jmir.org/2023/1/e42304", url="http://www.ncbi.nlm.nih.gov/pubmed/37200072" } @Article{info:doi/10.2196/43897, author="Link, Elena and Baumann, Eva", title="A Comparison of Women's and Men's Web-Based Information-Seeking Behaviors About Gender-Related Health Information: Web-Based Survey Study of a Stratified German Sample", journal="J Med Internet Res", year="2023", month="May", day="17", volume="25", pages="e43897", keywords="health information-seeking behavior", keywords="HISB", keywords="gender", keywords="sex", keywords="planned risk information seeking model", keywords="subjective norms", keywords="risk perceptions", keywords="affective risk responses", keywords="attitudes toward seeking", keywords="perceived seeking control", abstract="Background: Gender-sensitive approaches to health communication aim to integrate gender perspectives at all levels of communication, as an individual's biological sex and socially assigned gender identity have an impact on whether and how one acquires what type of health information. Due to the fast and low-cost opportunity to search for a wide range of information, the internet seems to be a particularly suitable place for gender-related health information about diseases of sex-specific organs and diseases where biological differences are associated with different health risks. Objective: This study aims to inform gender-related information provision and acquisition in 2 ways. The first objective was to provide a theory-driven analysis of web-based health information--seeking behavior (HISB) regarding gender-related issues. Therefore, the Planned Risk Information Seeking Model (PRISM), which is one of the most integrative models of HISB, was adapted and applied. Second, we asked for gender-specific motivational determinants of gender-related web-based HISB comparing the predictors in the groups of women and men. Methods: Data from a stratified web-based survey of the German population (N=3000) explained gender-related web-based HISB and influencing patterns comparing women and men. The applicability of PRISM to gender-related web-based HISB was tested using structural equation modeling and a multigroup comparison. Results: The results revealed PRISM as an effective framework for explaining gender-related web-based HISB. The model accounted for 28.8\% of the variance in gender-related web-based HISB. Gender-related subjective norms provided the most crucial explanatory power, followed by perceived seeking control. The multigroup comparison revealed differences in the model's explanatory power and the relevance of predictors of gender-related web-based HISB. The share of explained variances of web-based HISB is higher in men than in women. For men, norms were a more relevant promoting factor, whereas web-based HISB of women was more strongly associated with perceived seeking control. Conclusions: The results are crucial for gender-sensitive targeting strategies and suggest gender-related health information interventions that address gender-related subjective norms. Furthermore, programs (eg, web-based learning units) should be developed and offered to improve individuals' (perceived) abilities to perform web-based searches for health information, as those with higher control beliefs are more likely to access web-based information. ", doi="10.2196/43897", url="https://www.jmir.org/2023/1/e43897", url="http://www.ncbi.nlm.nih.gov/pubmed/37195743" } @Article{info:doi/10.2196/39933, author="Alhaboby, A. Zhraa and Barnes, James and Evans, Hala and Short, Emma", title="Cybervictimization of Adults With Long-term Conditions: Cross-sectional Study", journal="J Med Internet Res", year="2023", month="May", day="17", volume="25", pages="e39933", keywords="cyberharassment", keywords="chronic conditions", keywords="disability", keywords="social media", keywords="cyberbullying", keywords="web-based hate", abstract="Background: People living with chronic conditions and disabilities experience harassment both offline and on the web. Cybervictimization is an umbrella term for negative web-based experiences. It has distressing consequences on physical health, mental well-being, and social relationships. These experiences have mostly been documented among children and adolescents. However, the scope of such experiences is not well documented among adults with long-term conditions, and the potential impact has not been examined from a public health perspective. Objective: This study aimed to examine the scope of cybervictimization among adults living with long-term conditions in the United Kingdom and the perceived impact on self-management of chronic conditions. Methods: This paper reports the findings of the quantitative phase of a mixed methods study in the United Kingdom. This cross-sectional study targeted adults aged ?18 years with long-term conditions. Using a web-based link, the survey was shared on the web via 55 victim support groups, health support organizations, and social media accounts of nongovernmental organizations and activists such as journalists and disability campaigners. People with long-term conditions were asked about their health conditions, comorbidities, self-management, negative web-based experiences, their impact on them, and support sought to mitigate the experiences. The perceived impact of cybervictimization was measured using a set of questions on a Likert scale, frequency tables, and the Stanford Self-Efficacy for Managing Chronic Diseases Scale. Demographic data and the impact on self-management were cross-tabulated to identify the demographic characteristics of the targeted individuals and potential conditions with complications and highlight directions for future research. Results: Data from 152 participants showed that almost 1 in every 2 adults with chronic conditions was cybervictimized (69/152, 45.4\%). Most victims (53/69, 77\%) had disabilities; the relationship between cybervictimization and disability was statistically significant (P=.03). The most common means of contacting the victims was Facebook (43/68, 63\%), followed by personal email or SMS text messaging, each accounting for 40\% (27/68). Some participants (9/68, 13\%) were victimized in web-based health forums. Furthermore, 61\% (33/54) of victims reported that experiencing cybervictimization had affected their health condition self-management plan. The highest impact was on lifestyle changes such as exercise, diet, avoiding triggers, and avoiding excessive smoking and alcohol consumption. This was followed by changes to medications and follow-ups with health care professionals. Most victims (38/55, 69\%) perceived a worsened self-efficacy on the Self-Efficacy for Managing Chronic Diseases Scale. Formal support was generally rated as poor, with only 25\% (13/53) of victims having disclosed this experience to their physicians. Conclusions: Cybervictimization of people with chronic conditions is a public health issue with worrying consequences. This triggered considerable fear and negatively influenced the self-management of different health conditions. Further context- and condition-specific research is needed. Global collaborations to address inconsistencies in research are recommended. ", doi="10.2196/39933", url="https://www.jmir.org/2023/1/e39933", url="http://www.ncbi.nlm.nih.gov/pubmed/37195761" } @Article{info:doi/10.2196/45493, author="Wang, Yingcheng and Fekadu, Ginenus and You, Hoi-sze Joyce", title="Cost-Effectiveness Analyses of Digital Health Technology for Improving the Uptake of Vaccination Programs: Systematic Review", journal="J Med Internet Res", year="2023", month="May", day="15", volume="25", pages="e45493", keywords="cost-effectiveness analyses", keywords="digital health technology", keywords="vaccination coverage", keywords="vaccine", keywords="systematic review", abstract="Background: Vaccination is the most effective strategy to prevent infectious diseases, yet vaccination coverage has not reached the target level. To promote vaccination uptake, digital health interventions (DHIs) have been used in various vaccination programs. Objective: This study aimed to perform a systematic review of the cost-effectiveness analyses of DHIs for the improvement of the uptake of vaccination programs. Methods: A literature review was conducted in MEDLINE (Ovid), Embase (Ovid), APA PsycINFO (Ovid), Web of Science, Scopus, CINAHL Ultimate (EBSCOhost), Center for Review and Dissemination, and Institute for IEEE Xplore up to October 2022. Health economic evaluations that met the following inclusion criteria were included: (1) adult or pediatric vaccination programs; (2) interventions delivered through digital technology; (3) full-scale health economic analyses including cost-effectiveness, cost-utility, cost-benefit, or cost-consequence analyses; and (4) evaluations conducted by model-based or trial-based analyses. The quality of each included study was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Results: The systematic review included 7 studies. Four of the cost-effectiveness studies were conducted by model-based analyses, and 3 were trial-based analyses. One study reported the additional cost per quality-adjusted life years (QALYs) gained, whereas 6 studies reported the additional cost per individual vaccinated (or return case). The vaccines targeted the human papillomavirus (HPV) vaccine, influenza vaccination, measles-mumps-rubella (MMR) vaccine, and children immunization at different ages. The DHIs were delivered by television campaign, web-based decision aid, SMS text message, telephone, and computer-generated recall letters. The studies were classified as very good (n=5) and good (n=2) qualities. One study concluded that the DHI was cost-saving, and 6 studies concluded that the DHI was cost-effective. Conclusions: This study is the first systematic review on cost-effectiveness analyses of DHIs to improve vaccination uptake. All included studies have good to very good quality on study assessment and reported the DHIs to be cost-saving or cost-effective in the improvement of vaccination uptake. ", doi="10.2196/45493", url="https://www.jmir.org/2023/1/e45493", url="http://www.ncbi.nlm.nih.gov/pubmed/37184916" } @Article{info:doi/10.2196/39854, author="Lorthe, Elsa and Santos, Carolina and Ornelas, Pedro Jos{\'e} and Doetsch, Nadine Julia and Marques, S. Sandra C. and Teixeira, Raquel and Santos, Cristina Ana and Rodrigues, Carina and Gon{\c{c}}alves, Gon{\c{c}}alo and Ferreira Sousa, Pedro and Correia Lopes, Jo{\~a}o and Rocha, Artur and Barros, Henrique", title="Using Digital Tools to Study the Health of Adults Born Preterm at a Large Scale: e-Cohort Pilot Study", journal="J Med Internet Res", year="2023", month="May", day="15", volume="25", pages="e39854", keywords="e-cohort", keywords="prematurity", keywords="preterm birth", keywords="life course epidemiology", keywords="participant involvement", keywords="citizen science", keywords="Research on European Children and Adults born Preterm", keywords="RECAP Preterm", keywords="premature", keywords="preterm", keywords="cohort study", keywords="epidemiology", keywords="observational study", keywords="global health", keywords="global burden", keywords="survey", keywords="questionnaire", keywords="health outcome", keywords="mobile phone", abstract="Background: Preterm birth is a global health concern. Its adverse consequences may persist throughout the life course, exerting a potentially heavy burden on families, health systems, and societies. In high-income countries, the first children who benefited from improved care are now adults entering middle age. However, there is a clear gap in the knowledge regarding the long-term outcomes of individuals born preterm. Objective: This study aimed to assess the feasibility of recruiting and following up an e-cohort of adults born preterm worldwide and provide estimations of participation, characteristics of participants, the acceptability of questions, and the quality of data collected. Methods: We implemented a prospective, open, observational, and international e-cohort pilot study (Health of Adult People Born Preterm---an e-Cohort Pilot Study [HAPP-e]). Inclusion criteria were being an adult (aged ?18 years), born preterm (<37 weeks of gestation), having internet access and an email address, and understanding at least 1 of the available languages. A large, multifaceted, and multilingual communication strategy was established. Between December 2019 and June 2021, inclusion and repeated data collection were performed using a secured web platform. We provided descriptive statistics regarding participation in the e-cohort, namely, the number of persons who registered on the platform, signed the consent form, initiated and completed the baseline questionnaire, and initiated and completed the follow-up questionnaire. We also described the main characteristics of the HAPP-e participants and provided an assessment of the quality of the data and the acceptability of sensitive questions. Results: As of December 31, 2020, a total of 1004 persons had registered on the platform, leading to 527 accounts with a confirmed email and 333 signed consent forms. A total of 333 participants initiated the baseline questionnaire. All participants were invited to follow-up, and 35.7\% (119/333) consented to participate, of whom 97.5\% (116/119) initiated the follow-up questionnaire. Completion rates were very high both at baseline (296/333, 88.9\%) and at follow-up (112/116, 96.6\%). This sample of adults born preterm in 34 countries covered a wide range of sociodemographic and health characteristics. The gestational age at birth ranged from 23+6 to 36+6 weeks (median 32, IQR 29-35 weeks). Only 2.1\% (7/333) of the participants had previously participated in a cohort of individuals born preterm. Women (252/333, 75.7\%) and highly educated participants (235/327, 71.9\%) were also overrepresented. Good quality data were collected thanks to validation controls implemented on the web platform. The acceptability of potentially sensitive questions was excellent, as very few participants chose the ``I prefer not to say'' option when available. Conclusions: Although we identified room for improvement in specific procedures, this pilot study confirmed the great potential for recruiting a large and diverse sample of adults born preterm worldwide, thereby advancing research on adults born preterm. ", doi="10.2196/39854", url="https://www.jmir.org/2023/1/e39854", url="http://www.ncbi.nlm.nih.gov/pubmed/37184902" } @Article{info:doi/10.2196/43046, author="Li, Xuan and Tang, Kun", title="The Effects of Online Health Information--Seeking Behavior on Sexually Transmitted Disease in China: Infodemiology Study of the Internet Search Queries", journal="J Med Internet Res", year="2023", month="May", day="12", volume="25", pages="e43046", keywords="sexually transmitted infections", keywords="Baidu search index", keywords="Baidu search rate", keywords="online health information-seeking behavior", keywords="long-term effect", keywords="effect", keywords="disease", keywords="internet", keywords="prevention", keywords="data", keywords="treatment", keywords="surveillance", abstract="Background: Sexually transmitted diseases (STDs) are a serious issue worldwide. With the popularity of the internet, online health information-seeking behavior (OHISB) has been widely adopted to improve health and prevent disease. Objective: This study aimed to investigate the short-term and long-term effects of different types of OHISBs on STDs, including syphilis, gonorrhea, and AIDS due to HIV, based on the Baidu index. Methods: Multisource big data were collected, including case numbers of STDs, search queries based on the Baidu index, provincial total population, male-female ratio, the proportion of the population older than 65 years, gross regional domestic product (GRDP), and health institution number data in 2011-2018 in mainland China. We categorized OHISBs into 4 types: concept, symptoms, treatment, and prevention. Before and after controlling for socioeconomic and medical conditions, we applied multiple linear regression to analyze associations between the Baidu search index (BSI) and Baidu search rate (BSR) and STD case numbers. In addition, we compared the effects of 4 types of OHISBs and performed time lag cross-correlation analyses to investigate the long-term effect of OHISB. Results: The distributions of both STD case numbers and OHISBs presented variability. For case number, syphilis, and gonorrhea, cases were mainly distributed in southeastern and northwestern areas of China, while HIV/AIDS cases were mostly distributed in southwestern areas. For the search query, the eastern region had the highest BSI and BSR, while the western region had the lowest ones. For 4 types of OHISB for 3 diseases, the BSI was positively related to the case number, while the BSR was significantly negatively related to the case number (P<.05). Different categories of OHISB have different effects on STD case numbers. Searches for prevention tended to have a larger impact, while searches for treatment tended to have a smaller impact. Besides, due to the time lag effect, those impacts would increase over time. Conclusions: Our study validated the significant associations between 4 types of OHISBs and STD case numbers, and the impact of OHISBs on STDs became stronger over time. It may provide insights into how to use internet big data to better achieve disease surveillance and prevention goals. ", doi="10.2196/43046", url="https://www.jmir.org/2023/1/e43046", url="http://www.ncbi.nlm.nih.gov/pubmed/37171864" } @Article{info:doi/10.2196/40669, author="Alaqra, Sarah Ala and Khumalo, C. Akhona", title="Handling Public Well-being During the COVID-19 Crisis: Empirical Study With Representatives From Municipalities in Sweden", journal="JMIR Form Res", year="2023", month="May", day="12", volume="7", pages="e40669", keywords="COVID-19", keywords="Sweden", keywords="government", keywords="well-being", keywords="public health", keywords="information and communications technology", keywords="recreational activities", abstract="Background: COVID-19 has had a significant impact on the public's health and well-being due to infections and restrictions imposed during the crisis. Recreational activities are important for the public's well-being; however, the public's safety from the COVID-19 virus is the top priority. Sweden, a country with a decentralized public health and welfare system, relied on less stringent approaches for handling the crisis. The limited restrictions in Sweden allowed recreational activities to take place despite the pandemic, which could be attributed to considerations for the public's well-being. Objective: The objective of this study was to investigate municipal approaches for handling and supporting recreational activities during the COVID-19 crisis. Methods: We conducted an empirical study (qualitative and quantitative), using an online survey for data collection, with 23 participants. They were representatives holding mostly managerial roles in 18 distinct municipalities (18 counties). A thematic analysis was conducted to analyze open-ended responses, and descriptive statistics were used to summarize the closed-ended responses. Results: In this study, we report on the status of municipalities during the COVID-19 pandemic. The highlighted results showed a significant impact on the municipalities as a result of COVID-19, where 78\% (18/23) of participants stated significant changes due to the pandemic. Moreover, 91\% (21/23) indicated efforts and approaches for supporting recreational activities during COVID-19. Following national guidelines for the public's health and safety was indicated by 78\% (18/23) of participants. Information and communications technology (ICT) was considered significant for dealing with COVID-19 according to 87\% (20/23) of participants. Our qualitative results further showed details of the public's health and safety considerations, the efforts to support recreational activities particularly for youth, and the role and requirements of ICT. Challenges relating to the usability of ICT were also highlighted. Conclusions: Despite the critique of Sweden's lenient strategy for handling the COVID-19 crisis, our results showed significant considerations for the public's safety and well-being by the municipalities (regional and local levels) in this study. The Swedish approach to handling the crisis involved trusting the public with safety guidelines in addition to efforts for the public's safety, supporting the public's well-being with approaches for maintaining recreational activities, and giving special care to the youth. Despite having technological solutions in place, challenges in using digital solutions and requirements for future development were noted. ", doi="10.2196/40669", url="https://formative.jmir.org/2023/1/e40669", url="http://www.ncbi.nlm.nih.gov/pubmed/37053098" } @Article{info:doi/10.2196/45440, author="Sbaffi, Laura and Zamani, Efpraxia and Kalua, Khumbo", title="Promoting Well-being Among Informal Caregivers of People With HIV/AIDS in Rural Malawi: Community-Based Participatory Research Approach", journal="J Med Internet Res", year="2023", month="May", day="11", volume="25", pages="e45440", keywords="informal caregivers", keywords="HIV/AIDS", keywords="rural Malawi", keywords="health advisory messages", keywords="mobile phone", abstract="Background: People living with HIV/AIDS and their informal caregivers (usually family members) in Malawi do not have adequate access to patient-centered care, particularly in remote rural areas of the country because of the high burden of HIV/AIDS, coupled with a fragmented and patchy health care system. Chronic conditions require self-care strategies, which are now promoted in both developed and developing contexts but are still only emerging in sub-Saharan African countries. Objective: This study aims to explore the effects of the implementation of a short-term intervention aimed at supporting informal caregivers of people living with HIV/AIDS in Malawi in their caring role and improving their well-being. The intervention includes the dissemination of 6 health advisory messages on topics related to the management of HIV/AIDS over a period of 6 months, via the WhatsApp audio function to 94 caregivers attending peer support groups in the rural area of Namwera. Methods: We adopted a community-based participatory research approach, whereby the health advisory messages were designed and formulated in collaboration with informal caregivers, local medical physicians, social care workers, and community chiefs and informed by prior discussions with informal caregivers. Feedback on the quality, relevance, and applicability of the messages was gathered via individual interviews with the caregivers. Results: The results showed that the messages were widely disseminated beyond the support groups via word of mouth and highlighted a very high level of adoption of the advice contained in the messages by caregivers, who reported immediate (short-term) and long-term self-assessed benefits for themselves, their families, and their local communities. Conclusions: This study offers a novel perspective on how to combine community-based participatory research with a cost-effective, health-oriented informational intervention that can be implemented to support effective HIV/AIDS self-care and facilitate informal caregivers' role. ", doi="10.2196/45440", url="https://www.jmir.org/2023/1/e45440", url="http://www.ncbi.nlm.nih.gov/pubmed/37166971" } @Article{info:doi/10.2196/43596, author="Keddem, Shimrit and Agha, Aneeza and Morawej, Sabrina and Buck, Amy and Cronholm, Peter and Sonalkar, Sarita and Kearney, Matthew", title="Characterizing Twitter Content About HIV Pre-exposure Prophylaxis (PrEP) for Women: Qualitative Content Analysis", journal="J Med Internet Res", year="2023", month="May", day="11", volume="25", pages="e43596", keywords="HIV pre-exposure prophylaxis", keywords="women", keywords="Twitter", keywords="social media", keywords="health communication", keywords="communication", keywords="HIV", keywords="barrier", keywords="awareness", keywords="tweets", keywords="application", keywords="prevention", abstract="Background: HIV remains a persistent health problem in the United States, especially among women. Approved in 2012, HIV pre-exposure prophylaxis (PrEP) is a daily pill or bimonthly injection that can be taken by individuals at increased risk of contracting HIV to reduce their risk of new infection. Women who are at risk of HIV face numerous barriers to HIV services and information, underscoring the critical need for strategies to increase awareness of evidence-based HIV prevention methods, such as HIV PrEP, among women. Objective: We aimed to identify historical trends in the use of Twitter hashtags specific to women and HIV PrEP and explore content about women and PrEP shared through Twitter. Methods: This was a qualitative descriptive study using a purposive sample of tweets containing hashtags related to women and HIV PrEP from 2009 to 2022. Tweets were collected via Twitter's API. Each Twitter user profile, tweet, and related links were coded using content analysis, guided by the framework of the Health Belief Model (HBM) to generate results. We used a factor analysis to identify salient clusters of tweets. Results: A total of 1256 tweets from 396 unique users were relevant to our study focus of content about PrEP specifically for women (1256/2908, 43.2\% of eligible tweets). We found that this sample of tweets was posted mostly by organizations. The 2 largest groups of individual users were activists and advocates (61/396, 15.4\%) and personal users (54/396, 13.6\%). Among individual users, most were female (100/166, 60\%) and American (256/396, 64.6\%). The earliest relevant tweet in our sample was posted in mid-2014 and the number of tweets significantly decreased after 2018. We found that 61\% (496/820) of relevant tweets contained links to informational websites intended to provide guidance and resources or promote access to PrEP. Most tweets specifically targeted people of color, including through the use of imagery and symbolism. In addition to inclusive imagery, our factor analysis indicated that more than a third of tweets were intended to share information and promote PrEP to people of color. Less than half of tweets contained any HBM concepts, and only a few contained cues to action. Lastly, while our sample included only tweets relevant to women, we found that the tweets directed to lesbian, gay, bisexual, transgender, queer (LGBTQ) audiences received the highest levels of audience engagement. Conclusions: These findings point to several areas for improvement in future social media campaigns directed at women about PrEP. First, future posts would benefit from including more theoretical constructs, such as self-efficacy and cues to action. Second, organizations posting on Twitter should continue to broaden their audience and followers to reach more people. Lastly, tweets should leverage the momentum and strategies used by the LGBTQ community to reach broader audiences and destigmatize PrEP use across all communities. ", doi="10.2196/43596", url="https://www.jmir.org/2023/1/e43596", url="http://www.ncbi.nlm.nih.gov/pubmed/37166954" } @Article{info:doi/10.2196/43645, author="Newby, Katie and Kwah, Kayleigh and Schumacher, Lauren and Crutzen, Rik and Bailey, V. Julia and Jackson, J. Louise and Bremner, Stephen and Brown, E. Katherine", title="An Intervention to Increase Condom Use Among Users of Sexually Transmitted Infection Self-sampling Websites (Wrapped): Protocol for a Randomized Controlled Feasibility Trial", journal="JMIR Res Protoc", year="2023", month="May", day="11", volume="12", pages="e43645", keywords="adolescent", keywords="condom use", keywords="digital health", keywords="eHealth", keywords="feasibility randomized controlled trial", keywords="sexual health", keywords="sexually transmitted infections", keywords="STIs", keywords="self-testing", keywords="young people", abstract="Background: Reducing the rates of sexually transmitted infections (STIs) among young people is a public health priority. The best way to avoid STIs from penetrative sex is to use a condom, but young people report inconsistent use. A missed opportunity to intervene to increase condom use is when young people access self-sampling kits for STIs through the internet. The potential of this opportunity is enhanced by the increasing numbers of young people being tested through this route every year in England. Hence, in a cocreation by young people, stakeholders, and researchers, Wrapped was developed----a fully automated, multicomponent, and interactive digital behavior change intervention developed for users of STI self-sampling websites, who are aged 16-24 years. Objective: This paper is a protocol for a feasibility randomized controlled trial (fRCT). The fRCT seeks to establish whether it is feasible to run a randomized controlled trial to test the effectiveness and cost-effectiveness of Wrapped. Wrapped aims to reduce the incidence of STIs through increasing correct and consistent use of condoms among users of STI self-sampling websites, who are aged 16-24 years. Methods: A 2-arm parallel-group randomized fRCT of Wrapped plus usual care, compared to usual care only (basic information on STIs and condom use), with a nested qualitative study. A minimum of 230 participants (aged 16-24 years) are recruited from an existing chlamydia self-sampling website. Participants are randomized into 1 of 2 parallel groups (1:1 allocation). Primary outcomes are the percentage of users recruited to the fRCT and the percentage of randomized participants who return a chlamydia self-sampling kit at month 12. Additionally, besides chlamydia positivity based on biological samples, surveys at baseline, month 3, month 6, and month 12, are used to assess condom use attitude, behavioral capability, self-efficacy, and intention, along with details of any partnered sexual activity and condom use, and health economic data. Nested qualitative interviews with trial participants are used to gain insight into the factors affecting recruitment and attrition. Results: Recruitment to the fRCT began in March 2021 and was completed in October 2021. Data collection was completed in December 2022. Conclusions: This feasibility study will provide data to inform the design of a future-definitive trial. This work is timely given a rapid rise in the use of internet testing for STIs and the sustained high levels of STIs among young people. Trial Registration: ISRCTN Registry ISRCTN17478654; http://www.isrctn.com/ISRCTN17478654 International Registered Report Identifier (IRRID): DERR1-10.2196/43645 ", doi="10.2196/43645", url="https://www.researchprotocols.org/2023/1/e43645", url="http://www.ncbi.nlm.nih.gov/pubmed/37166958" } @Article{info:doi/10.2196/42417, author="Wilson, A. Lindsay and Gandhi, Preet", title="Opioid Agonist Therapies and Pregnancy Outcomes for Pregnant People With Opioid Use Disorder: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2023", month="May", day="10", volume="12", pages="e42417", keywords="opioid agonist therapies", keywords="opioid use disorder", keywords="pregnancy", keywords="opioid", keywords="drug", keywords="symptoms", keywords="treatment", keywords="screening", keywords="data", keywords="risk", keywords="clinical", keywords="policy makers", keywords="community", abstract="Background: Opioid use disorder (OUD) during pregnancy presents a significant risk to maternal, fetal, and neonatal health, increasing the likelihood of adverse events, such as maternal overdose, pregnancy loss, stillbirth, preterm birth, low birth weight, and neonatal abstinence syndrome. In order to reduce the risk of these outcomes, the standard of care for OUD during pregnancy in many jurisdictions within the United States and Canada is opioid agonist therapy (OAT). OAT refers to prescription medications that alleviate or eliminate opioid withdrawal symptoms, so that opioid use can be managed more safely. Although OAT has been recognized as a safe option for pregnant people with OUD, many jurisdictions do not have treatment guidelines regarding pharmacological options, dosing recommendations, side effect management, and individual preferences. There is currently a lack of systematic evidence on the impacts of different OAT regimens on pregnancy outcomes. Objective: We aim to evaluate the impacts of specific OAT agents on pregnancy outcomes and inform recommendations for practitioners treating pregnant people with OUD. Methods: The MEDLINE, Embase, CINAHL, and PsycINFO databases will be searched for published quantitative studies assessing pregnancy outcomes for individuals on OAT. Given the substantially increased risk of preterm birth, low birth weight, small for gestational age, and stillbirth among pregnant people with OUD, these four end points will comprise our primary outcomes. Database searches will not be restricted by date, and conference abstracts will be restricted to the past 2 years. Titles, abstracts, and full-text articles will be independently screened by 2 reviewers. Data will be extracted independently and in duplicate, using a data extraction form to reduce the risk of reviewer bias. The risk of bias within individual studies will be assessed by using the appropriate CASP (Critical Appraisal Skills Programme) checklists. For studies that consider the same research questions, interventions, or outcomes, meta-analyses will be conducted to synthesize the pooled effect size. In the event that studies cannot be compared directly, results will be synthesized in a narrative account. Between-study heterogeneity will be measured by using the $\tau$2 statistic. If more than 10 studies are available for pooling, publication bias will be evaluated by using the Egger regression test. Results: As of January 2023, a total of 3266 abstracts have been identified for screening. Data extraction is expected to commence in February 2023. Conclusions: The topic of OAT and its effect on pregnancy is an understudied area that has the potential to improve health outcomes, clinical practice, education, and community advocacy. The results of our review will be used to inform clinical practice guidelines and improve health outcomes for pregnant people. Findings will be disseminated to diverse groups of stakeholders, including policy makers, clinicians, community partners, and individuals with lived experience of drug use. Trial Registration: PROSPERO CRD42022332082; https://tinyurl.com/2p94pkx5 International Registered Report Identifier (IRRID): DERR1-10.2196/42417 ", doi="10.2196/42417", url="https://www.researchprotocols.org/2023/1/e42417", url="http://www.ncbi.nlm.nih.gov/pubmed/37163329" } @Article{info:doi/10.2196/37306, author="Kochuthakidiyel Suresh, Praveenkumar and Sekar, Gnanasoundari and Mallady, Kavya and Wan Ab Rahman, Suriana Wan and Shima Shahidan, Nazatul Wan and Venkatesan, Gokulakannan", title="The Identification of Potential Drugs for Dengue Hemorrhagic Fever: Network-Based Drug Reprofiling Study", journal="JMIR Bioinform Biotech", year="2023", month="May", day="9", volume="4", pages="e37306", keywords="dengue hemorrhagic fever", keywords="drug reprofiling", keywords="network pharmacology", keywords="network medicine", keywords="DHF", keywords="repurposable drugs", keywords="viral fevers", keywords="drug repurposing", abstract="Background: Dengue fever can progress to dengue hemorrhagic fever (DHF), a more serious and occasionally fatal form of the disease. Indicators of serious disease arise about the time the fever begins to reduce (typically 3 to 7 days following symptom onset). There are currently no effective antivirals available. Drug repurposing is an emerging drug discovery process for rapidly developing effective DHF therapies. Through network pharmacology modeling, several US Food and Drug Administration (FDA)-approved medications have already been researched for various viral outbreaks. Objective: We aimed to identify potentially repurposable drugs for DHF among existing FDA-approved drugs for viral attacks, symptoms of viral fevers, and DHF. Methods: Using target identification databases (GeneCards and DrugBank), we identified human--DHF virus interacting genes and drug targets against these genes. We determined hub genes and potential drugs with a network-based analysis. We performed functional enrichment and network analyses to identify pathways, protein-protein interactions, tissues where the gene expression was high, and disease-gene associations. Results: Analyzing virus-host interactions and therapeutic targets in the human genome network revealed 45 repurposable medicines. Hub network analysis of host-virus-drug associations suggested that aspirin, captopril, and rilonacept might efficiently treat DHF. Gene enrichment analysis supported these findings. According to a Mayo Clinic report, using aspirin in the treatment of dengue fever may increase the risk of bleeding complications, but several studies from around the world suggest that thrombosis is associated with DHF. The human interactome contains the genes prostaglandin-endoperoxide synthase 2 (PTGS2), angiotensin converting enzyme (ACE), and coagulation factor II, thrombin (F2), which have been documented to have a role in the pathogenesis of disease progression in DHF, and our analysis of most of the drugs targeting these genes showed that the hub gene module (human-virus-drug) was highly enriched in tissues associated with the immune system (P=7.29 {\texttimes} 10--24) and human umbilical vein endothelial cells (P=1.83 {\texttimes} 10--20); this group of tissues acts as an anticoagulant barrier between the vessel walls and blood. Kegg analysis showed an association with genes linked to cancer (P=1.13 {\texttimes} 10--14) and the advanced glycation end products--receptor for advanced glycation end products signaling pathway in diabetic complications (P=3.52 {\texttimes} 10--14), which indicates that DHF patients with diabetes and cancer are at risk of higher pathogenicity. Thus, gene-targeting medications may play a significant part in limiting or worsening the condition of DHF patients. Conclusions: Aspirin is not usually prescribed for dengue fever because of bleeding complications, but it has been reported that using aspirin in lower doses is beneficial in the management of diseases with thrombosis. Drug repurposing is an emerging field in which clinical validation and dosage identification are required before the drug is prescribed. Further retrospective and collaborative international trials are essential for understanding the pathogenesis of this condition. ", doi="10.2196/37306", url="https://bioinform.jmir.org/2023/1/e37306" } @Article{info:doi/10.2196/39700, author="Bota, Brianne A. and Bettinger, A. Julie and Sarfo-Mensah, Shirley and Lopez, Jimmy and Smith, P. David and Atkinson, M. Katherine and Bell, Cameron and Marty, Kim and Serhan, Mohamed and Zhu, T. David and McCarthy, E. Anne and Wilson, Kumanan", title="Comparing the Use of a Mobile App and a Web-Based Notification Platform for Surveillance of Adverse Events Following Influenza Immunization: Randomized Controlled Trial", journal="JMIR Public Health Surveill", year="2023", month="May", day="8", volume="9", pages="e39700", keywords="active participant--centered reporting", keywords="health technology", keywords="adverse event reporting", keywords="mobile apps", keywords="immunization", keywords="vaccine", keywords="safety", keywords="influenza", keywords="campaign", keywords="apps", keywords="mobile", keywords="surveillance", keywords="pharmacovigilance", abstract="Background: Vaccine safety surveillance is a core component of?vaccine pharmacovigilance. In Canada, active, participant-centered vaccine surveillance is available for influenza vaccines and has been used for COVID-19 vaccines. Objective: The objective of this study is to evaluate the effectiveness and feasibility of using a mobile app for reporting participant-centered seasonal influenza adverse events following immunization (AEFIs) compared to a web-based notification system. Methods: Participants were randomized to influenza vaccine safety reporting via a mobile app or a web-based notification platform. All participants were invited to complete a user experience survey. Results: Among the 2408 randomized participants, 1319 (54\%) completed their safety survey 1 week after vaccination, with a higher completion rate among the web-based notification platform users (767/1196, 64\%) than among mobile app users (552/1212, 45\%; P<.001). Ease-of-use ratings were high for the web-based notification platform users (99\% strongly agree or agree) and 88.8\% of them strongly agreed or agreed that the system made reporting AEFIs easier. Web-based notification platform users supported the statement that a web-based notification-only approach would make it easier for public health professionals to detect vaccine safety signals (91.4\%, agreed or strongly agreed). Conclusions: Participants in this study were significantly more likely to respond to a web-based safety survey rather than within a mobile app. These results suggest that mobile apps present an additional barrier for use compared to the web-based notification--only approach. Trial Registration: ClinicalTrials.gov NCT05794113; https://clinicaltrials.gov/show/NCT05794113 ", doi="10.2196/39700", url="https://publichealth.jmir.org/2023/1/e39700", url="http://www.ncbi.nlm.nih.gov/pubmed/37155240" } @Article{info:doi/10.2196/43961, author="Alatorre, Selenne and Schwarz, G. Aviva and Egan, A. Kelsey and Feldman, R. Amanda and Rosa, Marielis and Wang, L. Monica", title="Exploring Social Media Preferences for Healthy Weight Management Interventions Among Adolescents of Color: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2023", month="May", day="8", volume="6", pages="e43961", keywords="social media", keywords="adolescents of color", keywords="obesity disparities", keywords="disparity", keywords="disparities", keywords="healthy weight management", keywords="health education", keywords="child health", keywords="mHealth", keywords="mobile health", keywords="weight", keywords="obese", keywords="obesity", keywords="child", keywords="pediatric", keywords="adolescent", keywords="adolescence", keywords="preference", keywords="health behavior", keywords="mobile phone", abstract="Background: Social media holds promise as an intervention platform to engage youths in healthy weight management and target racial inequities in obesity. Objective: This mixed methods study aimed to examine social media habits, preferences, and obesity-related behaviors (eg, diet and physical activity) among adolescents of color and understand preferences for healthy weight management interventions delivered via social media. Methods: This mixed methods study is comprised of a cross-sectional web-based survey and a series of digital focus groups. Study participants (English-speaking youths of color ages 14-18 years) were recruited from high schools and youth-based community settings in Massachusetts and California. For surveys, participants were invited to complete an anonymous web-based survey assessing self-reported sociodemographics, social media habits and preferences, health behaviors (diet, physical activity, sleep, and screen time), and height and weight. For focus groups, participants were invited to participate in 45- to 60-minute web-based group discussions assessing social media habits, preferred social media platforms, and preferences for physical activity and nutrition intervention content and delivery. Survey data were analyzed descriptively; focus group transcripts were analyzed using a directed content analysis approach. Results: A total of 101 adolescents completed the survey and 20 adolescents participated in a total of 3 focus groups. Participants reported most frequently using TikTok, followed by Instagram, Snapchat, and Twitter; preference for platform varied by purpose of use (eg, content consumption, connection, or communication). TikTok emerged as the platform of choice as an engaging way to learn about various topics, including desired health information on physical fitness and diet. Conclusions: Findings from this study suggest that social media platforms can be an engaging way to reach adolescents of color. Data will inform future social media--based interventions to engage adolescents of color in healthy weight management content. ", doi="10.2196/43961", url="https://pediatrics.jmir.org/2023/1/e43961", url="http://www.ncbi.nlm.nih.gov/pubmed/37155230" } @Article{info:doi/10.2196/43873, author="Williams, J. Christopher and Kranzler, C. Elissa and Luchman, N. Joseph and Denison, Benjamin and Fischer, Sean and Wonder, Thomas and Ostby, Ronne and Vines, Monica and Weinberg, Jessica and Petrun Sayers, L. Elizabeth and Kurti, N. Allison and Trigger, Sarah and Hoffman, Leah and Peck, A. Joshua F.", title="The Initial Relationship Between the United States Department of Health and Human Services' Digital COVID-19 Public Education Campaign and Vaccine Uptake: Campaign Effectiveness Evaluation", journal="J Med Internet Res", year="2023", month="May", day="3", volume="25", pages="e43873", keywords="communication campaign", keywords="COVID-19", keywords="COVID-19 pandemic", keywords="COVID-19 vaccination", keywords="public education campaign", keywords="public health campaign", keywords="social marketing", keywords="marketing", keywords="campaign", keywords="vaccination", keywords="patient education", keywords="United States", keywords="vaccine", keywords="digital impression", keywords="public education", abstract="Background: Over 1 million people in the United States have died of COVID-19. In response to this public health crisis, the US Department of Health and Human Services launched the We Can Do This public education campaign in April 2021 to increase vaccine confidence. The campaign uses a mix of digital, television, print, radio, and out-of-home channels to reach target audiences. However, the impact of this campaign on vaccine uptake has not yet been assessed. Objective: We aimed to address this gap by assessing the association between the We Can Do This COVID-19 public education campaign's digital impressions and the likelihood of first-dose COVID-19 vaccination among US adults. Methods: A nationally representative sample of 3642 adults recruited from a US probability panel was surveyed over 3 waves (wave 1: January to February 2021; wave 2: May to June 2021; and wave 3: September to November 2021) regarding COVID-19 vaccination, vaccine confidence, and sociodemographics. Survey data were merged with weekly paid digital campaign impressions delivered to each respondent's media market (designated market area [DMA]) during that period. The unit of analysis was the survey respondent--broadcast week, with respondents nested by DMA. Data were analyzed using a multilevel logit model with varying intercepts by DMA and time-fixed effects. Results: The We Can Do This digital campaign was successful in encouraging first-dose COVID-19 vaccination. The findings were robust to multiple modeling specifications, with the independent effect of the change in the campaign's digital dose remaining practically unchanged across all models. Increases in DMA-level paid digital campaign impressions in a given week from --30,000 to 30,000 increased the likelihood of first-dose COVID-19 vaccination by 125\%. Conclusions: Results from this study provide initial evidence of the We Can Do This campaign's digital impact on vaccine uptake. The size and length of the Department of Health and Human Services We Can Do This public education campaign make it uniquely situated to examine the impact of a digital campaign on COVID-19 vaccination, which may help inform future vaccine communication efforts and broader public education efforts. These findings suggest that campaign digital dose is positively associated with COVID-19 vaccination uptake among US adults; future research assessing campaign impact on reduced COVID-19--attributed morbidity and mortality and other benefits is recommended. This study indicates that digital channels have played an important role in the COVID-19 pandemic response. Digital outreach may be integral in addressing future pandemics and could even play a role in addressing nonpandemic public health crises. ", doi="10.2196/43873", url="https://www.jmir.org/2023/1/e43873", url="http://www.ncbi.nlm.nih.gov/pubmed/36939670" } @Article{info:doi/10.2196/42721, author="Li, Jiayu and He, Zhiyu and Zhang, Min and Ma, Weizhi and Jin, Ye and Zhang, Lei and Zhang, Shuyang and Liu, Yiqun and Ma, Shaoping", title="Estimating Rare Disease Incidences With Large-scale Internet Search Data: Development and Evaluation of a Two-step Machine Learning Method", journal="JMIR Infodemiology", year="2023", month="Apr", day="28", volume="3", pages="e42721", keywords="disease incidence estimation", keywords="rare disease", keywords="internet search engine", keywords="infoveillance", keywords="deep learning", keywords="public health", abstract="Background: As rare diseases (RDs) receive increasing attention, obtaining accurate RD incidence estimates has become an essential concern in public health. Since RDs are difficult to diagnose, include diverse types, and have scarce cases, traditional epidemiological methods are costly in RD registries. With the development of the internet, users have become accustomed to searching for disease-related information through search engines before seeking medical treatment. Therefore, online search data provide a new source for estimating RD incidences. Objective: The aim of this study was to estimate the incidences of multiple RDs in distinct regions of China with online search data. Methods: Our research scale included 15 RDs in China from 2016 to 2019. The online search data were obtained from Sogou, one of the top 3 commercial search engines in China. By matching to multilevel keywords related to 15 RDs during the 4 years, we retrieved keyword-matched RD-related queries. The queries used before and after the keyword-matched queries formed the basis of the RD-related search sessions. A two-step method was developed to estimate RD incidences with users' intents conveyed by the sessions. In the first step, a combination of long short-term memory and multilayer perceptron algorithms was used to predict whether the intents of search sessions were RD-concerned, news-concerned, or others. The second step utilized a linear regression (LR) model to estimate the incidences of multiple RDs in distinct regions based on the RD- and news-concerned session numbers. For evaluation, the estimated incidences were compared with RD incidences collected from China's national multicenter clinical database of RDs. The root mean square error (RMSE) and relative error rate (RER) were used as the evaluation metrics. Results: The RD-related online data included 2,749,257 queries and 1,769,986 sessions from 1,380,186 users from 2016 to 2019. The best LR model with sessions as the input estimated the RD incidences with an RMSE of 0.017 (95\% CI 0.016-0.017) and an RER of 0.365 (95\% CI 0.341-0.388). The best LR model with queries as input had an RMSE of 0.023 (95\% CI 0.017-0.029) and an RER of 0.511 (95\% CI 0.377-0.645). Compared with queries, using session intents achieved an error decrease of 28.57\% in terms of the RER (P=.01). Analysis of different RDs and regions showed that session input was more suitable for estimating the incidences of most diseases (14 of 15 RDs). Moreover, examples focusing on two RDs showed that news-concerned session intents reflected news of an outbreak and helped correct the overestimation of incidences. Experiments on RD types further indicated that type had no significant influence on the RD estimation task. Conclusions: This work sheds light on a novel method for rapid estimation of RD incidences in the internet era, and demonstrates that search session intents were especially helpful for the estimation. The proposed two-step estimation method could be a valuable supplement to the traditional registry for understanding RDs, planning policies, and allocating medical resources. The utilization of search sessions in disease detection and estimation could be transferred to infoveillance of large-scale epidemics or chronic diseases. ", doi="10.2196/42721", url="https://infodemiology.jmir.org/2023/1/e42721" } @Article{info:doi/10.2196/46514, author="Kwan, Ho Tsz and Chan, Chung Denise Pui and Wong, Yeung-shan Samuel and Lee, Shan Shui", title="Implementation Cascade of a Social Network--Based HIV Self-testing Approach for Men Who Have Sex With Men: Cross-sectional Study", journal="J Med Internet Res", year="2023", month="Apr", day="26", volume="25", pages="e46514", keywords="community-based testing service", keywords="cross-sectional study", keywords="HIV self-test", keywords="HIV testing", keywords="HIV", keywords="implementation cascade", keywords="men who have sex with men", keywords="social network", keywords="virus transmission", abstract="Background: HIV testing is the cornerstone of strategies for achieving the fast-track target to end the AIDS epidemic by 2030. Self-testing has been proven to be an effective health intervention for men who have sex with men (MSM). While social network--based approaches for distributing HIV self-tests are recommended by the World Health Organization, their implementation consists of multiple steps that need to be properly evaluated. Objective: This study aimed to assess the implementation cascade of a social network--based HIV self-test approach for reaching MSM who had never undergone testing in Hong Kong. Methods: This is a cross-sectional study. Seed MSM participants were recruited through different web-based channels, who in turn invited their peers to participate in this study. A web-based platform was set up to support the recruitment and referral process. Participants could request for an oral fluid or a finger-prick HIV self-test, with or without real-time support, after completing a self-administered questionnaire. Referrals could be made upon uploading the test result and passing the web-based training. Characteristics of participants completing each of these steps and their preferences for the type of HIV self-test were evaluated. Results: A total of 463 MSM were recruited, including 150 seeds. Participants recruited by seeds were less likely to have previously been tested for HIV (odds ratio [OR] 1.80, 95\% CI 1.06-3.04, P=.03) and have lower confidence in performing self-tests (OR 0.66, 95\% CI 0.45-0.99, P=.045). Almost all (434/442, 98\%) MSM who completed the questionnaire requested a self-test, of whom 82\% (354/434) had uploaded their test results. Participants requesting support were new to self-testing (OR 3.65, 95\% CI 2.10-6.35, P<.001) and less confident in carrying out the self-test correctly (OR 0.35, 95\% CI 0.22-0.56, P<.001). More than half (216/354, 61\%) of the eligible participants initiated the referral process by attempting the web-based training with a passing rate of 93\% (200/216). They were more likely to have sought sex partners (OR 2.20, 95\% CI 1.14-4.25, P=.02), especially through location-based networking apps (OR 2.13, 95\% CI 1.31-3.49, P=.002). They also gave higher usability scores along the implementation cascade (median 81 vs 75, P=.003). Conclusions: The social network approach was effective in diffusing HIV self-tests in the MSM community and reaching nontesters. Support and option to choose a preferable type of self-test are essential to address users' individual needs when delivering HIV self-tests. A positive user experience throughout the processes along the implementation cascade is vital to transform a tester into a promoter. Trial Registration: ClinicalTrials.gov NCT04379206; https://clinicaltrials.gov/ct2/show/NCT04379206 ", doi="10.2196/46514", url="https://www.jmir.org/2023/1/e46514", url="http://www.ncbi.nlm.nih.gov/pubmed/37099364" } @Article{info:doi/10.2196/40176, author="Fan, Xiaoyan and Ning, Ke and Liu, Cong and Zhong, Haidan and Lau, F. Joseph T. and Hao, Chun and Hao, Yuantao and Li, Jinghua and Li, Linghua and Gu, Jing", title="Uptake of an App-Based Case Management Service for HIV-Positive Men Who Have Sex With Men in China: Process Evaluation Study", journal="J Med Internet Res", year="2023", month="Apr", day="26", volume="25", pages="e40176", keywords="process evaluation", keywords="mobile health", keywords="mHealth", keywords="HIV", keywords="men who have sex with men", keywords="MSM", keywords="antiretroviral treatment", keywords="ART", keywords="case management", abstract="Background: Men who have sex with men (MSM) in China are disproportionately affected by the HIV epidemic, and medication adherence to antiretroviral treatment in this vulnerable population is suboptimal. To address this issue, we developed an app-based case management service with multiple components, informed by the Information Motivation Behavioral skills model. Objective: We aimed to conduct a process evaluation for the implementation of an innovative app-based intervention guided by the Linnan and Steckler framework. Methods: Process evaluation was performed alongside a randomized controlled trial in the largest HIV clinic in Guangzhou, China. Eligible participants were HIV-positive MSM aged ?18 years planning to initiate treatment on the day of recruitment. The app-based intervention had 4 components: web-based communication with case managers, educational articles, supportive service information (eg, information on mental health care and rehabilitation service), and hospital visit reminders. Process evaluation indicators of the intervention include dose delivered, dose received, fidelity, and satisfaction. The behavioral outcome was adherence to antiretroviral treatment at month 1, and Information Motivation Behavioral skills model scores were the intermediate outcome. Logistic and linear regression was used to investigate the association between intervention uptake and outcomes, controlling for potential confounders. Results: A total of 344 MSM were recruited from March 19, 2019, to January 13, 2020, and 172 were randomized to the intervention group. At month 1 follow-up, there was no significant difference in the proportion of adherent participants between the intervention and control groups (66/144, 45.8\% vs 57/134, 42.5\%; P=.28). In the intervention group, 120 participants engaged in web-based communication with case managers and 158 accessed at least 1 of the delivered articles. The primary concern captured in the web-based conversation was the side effects of the medication (114/374, 30.5\%), which was also one of the most popular educational articles topics. The majority (124/144, 86.1\%) of participants that completed the month 1 survey rated the intervention as ``very helpful'' or ``helpful.'' The number of educational articles accessed was associated with adequate adherence in the intervention group (odds ratio 1.08, 95\% CI 1.02-1.15; P=.009). The intervention also improved the motivation score after adjusting for baseline values ($\beta$=2.34, 95\% CI 0.77-3.91; P=.004). However, the number of web-based conversations, regardless of conversation features, was associated with lower motivation scores in the intervention group. Conclusions: The intervention was well-received. Delivering educational resources of interest may enhance medication adherence. The uptake of the web-based communication component could serve as an indicator of real-life difficulties and could be used by case managers to identify potential inadequate adherence. Trial Registration: Clinicaltrial.gov NCT03860116; https://clinicaltrials.gov/ct2/show/NCT03860116 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-020-8171-5 ", doi="10.2196/40176", url="https://www.jmir.org/2023/1/e40176", url="http://www.ncbi.nlm.nih.gov/pubmed/37099367" } @Article{info:doi/10.2196/44010, author="Jiang, Zheng and Yang, Xin and Chen, Fei and Liu, Jun", title="Critical Analysis and Cross-Comparison Between English and Chinese Websites Providing Online Medical Information for Patients With Adenoid Hypertrophy: Cross-sectional Study", journal="JMIR Form Res", year="2023", month="Apr", day="24", volume="7", pages="e44010", keywords="adenoid hypertrophy", keywords="website quality", keywords="critical analysis", keywords="English and Chinese", keywords="English", keywords="Chinese", keywords="patient", keywords="internet", keywords="online", keywords="decisions", keywords="medical issues", keywords="airway obstruction", keywords="airway", keywords="accessibility", keywords="quality", abstract="Background: In the information era, patients can easily be misled by inaccurate internet content, thus making not well-informed decisions about medical issues. Adenoid hypertrophy, one of the most common causes of chronic upper airway obstruction in children and adolescents, may lead to serious complications, including sleep apnea and craniofacial change. There have been no critical studies about the quality of websites on adenoid hypertrophy, posing a challenge for users without a medical background to determine which website offers more reliable information. Moreover, the blockage of access to internet search tools such as Google, Yahoo, and others has created an isolated internet environment for the enormous user population in mainland China. Differences in internet legislation, the commercial environment, and culture are also likely to result in varied quality of online health information inside and outside mainland China. To date, no study has compared the quality difference between mainland Chinese and English websites. Objective: The aims of this study were to (1) analyze the quality of websites about adenoid hypertrophy accessible by patients, (2) investigate the quality differences between Chinese and English websites, (3) determine which type of website (eg, government-sponsored, health care provider) is more reliable in terms of medical information, and (4) determine whether the blockage of foreign websites is hindering users' accessibility to better-quality websites in mainland China. Methods: The first 100 websites (excluding advertisements) displayed on the top three search engines worldwide and in mainland China for the key search term ``enlarged adenoids'' were collected as the data source. The websites were evaluated based on accessibility, accountability, interactivity, structure, and content quality (accuracy, content coverage, and objectivity). Cohen $\kappa$ was calculated, and one-way ANOVA and the Kruskal-Wallis test were performed to compare the results between groups and subgroups. Results: The mean score for the content quality of English websites was significantly higher than that of Chinese websites (6.16 vs 4.94, P=.03 for Google, Bing, and Yahoo; 6.16 vs 4.16, P<.001 for Baidu, Sougou, and Bing China). Chinese users who are not influenced by the Internet Censorship System are more likely to access higher-quality online medical information (4.94 vs 4.16, P=.02). In within-group Student-Newman-Keuls q posthoc analysis, professional organization and government-sponsored websites were generally of better quality than other websites for both Chinese and English websites (P<.05). Conclusions: Generally, the English websites on adenoid hypertrophy are of better quality than Chinese websites; thus, Chinese users residing outside of the Chinese mainland are less influenced by inaccurate online medical information. ", doi="10.2196/44010", url="https://formative.jmir.org/2023/1/e44010", url="http://www.ncbi.nlm.nih.gov/pubmed/37093621" } @Article{info:doi/10.2196/39891, author="Van Heel, Lou Kasi and Nelson, Anna and Handysides, Daniel and Shah, Huma", title="The Factors Associated With Confidence in Using the Internet to Access Health Information: Cross-sectional Data Analysis", journal="JMIR Form Res", year="2023", month="Apr", day="11", volume="7", pages="e39891", keywords="confidence", keywords="health information access", keywords="health information seeking", keywords="health information sources", keywords="internet", keywords="health information", abstract="Background: Confidence in health information access is a measure of the perceived ability to obtain health information. One's beliefs or perceived ability to access health information is particularly important in understanding trends in health care access. Previous literature has found that access to health information is lowest among society's most vulnerable population groups. These groups include older, less educated, and low-income populations. While health confidence has previously been used as a scale to measure health outcomes, additional research is needed describing the demographic factors associated with users' confidence in health information access. This may be a key component of health information seeking that affects beneficial health outcomes such as prevention and treatment. Objective: This study examines the demographic factors associated with the levels of confidence in using the internet to access health information for adults 18 years and older in the United States. Methods: Using a cross-sectional design, secondary data from the Health Information National Trends Survey (HINTS) 5, Cycle 3 (2019) were analyzed (N=5374). An ordinal regression stratified by internet use was used to determine the association between demographic characteristics and level of confidence in health information access. Results: When the internet is the primary source for health information, high school graduates (adjusted odds ratio [AOR] 0.58, 95\% CI 0.37-0.89) compared to those with a college degree or more had significantly lower odds of being confident in obtaining health information. In addition, non-Hispanic Asian participants (AOR 0.44, 95\% CI 0.24-0.82) compared to non-Hispanic White participants, male participants (AOR 0.72, 95\% CI 0.54-0.97) compared to female participants, and those who made between US \$20,000-\$35,000 annually (AOR 0.55, 95\% CI 0.31-0.98) compared to those who made US \$75,000 or more annually had significantly lower odds of being confident in obtaining health information via the internet. Moreover, when the internet is the primary source for health information, those with health insurance had significantly higher odds of being confident in obtaining health information (AOR 2.91, 95\% CI 1.58-5.34) compared to those who do not have health insurance. Lastly, a significant association was observed between confidence in health information access and primary health information source and frequency of visiting a health care provider. Conclusions: Confidence in accessing health information can differ by individual demographics. Accessing health-related information from the internet has become increasingly more common and can provide insight into health information-seeking behaviors. Further exploration of these factors can inform the science of health education by providing deeper insight into improving access to health information for vulnerable populations. ", doi="10.2196/39891", url="https://formative.jmir.org/2023/1/e39891", url="http://www.ncbi.nlm.nih.gov/pubmed/37040161" } @Article{info:doi/10.2196/39765, author="Li, Dan and Shelby, Tyler and Brault, Marie and Manohar, Rajit and Vermund, Sten and Hagaman, Ashley and Forastiere, Laura and Caruthers, Tyler and Egger, Emilie and Wang, Yizhou and Manohar, Nathan and Manohar, Peter and Davis, Lucian J. and Zhou, Xin", title="Implementation of a Hardware-Assisted Bluetooth-Based COVID-19 Tracking Device in a High School: Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Apr", day="7", volume="7", pages="e39765", keywords="contact tracing", keywords="COVID-19", keywords="digital contact tracing", keywords="Bluetooth device", keywords="school health", keywords="secondary school", keywords="implementation science", keywords="mixed methods", abstract="Background: Contact tracing is a vital public health tool used to prevent the spread of infectious diseases. However, traditional interview-format contact tracing (TCT) is labor-intensive and time-consuming and may be unsustainable for large-scale pandemics such as COVID-19. Objective: In this study, we aimed to address the limitations of TCT. The Yale School of Engineering developed a Hardware-Assisted Bluetooth-based Infection Tracking (HABIT) device. Following the successful implementation of HABIT in a university setting, this study sought to evaluate the performance and implementation of HABIT in a high school setting using an embedded mixed methods design. Methods: In this pilot implementation study, we first assessed the performance of HABIT using mock case simulations in which we compared contact tracing data collected from mock case interviews (TCT) versus Bluetooth devices (HABIT). For each method, we compared the number of close contacts identified and identification of unique contacts. We then conducted an embedded mixed methods evaluation of the implementation outcomes of HABIT devices using pre- and postimplementation quantitative surveys and qualitative focus group discussions with users and implementers according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Results: In total, 17 students and staff completed mock case simulations in which 161 close contact interactions were detected by interview or Bluetooth devices. We detected significant differences in the number of close contacts detected by interview versus Bluetooth devices (P<.001), with most (127/161, 78.9\%) contacts being reported by interview only. However, a significant number (26/161, 16.1\%; P<.001) of contacts were uniquely identified by Bluetooth devices. The interface, ease of use, coherence, and appropriateness were highly rated by both faculty and students. HABIT provided emotional security to users. However, the prototype design and technical difficulties presented barriers to the uptake and sustained use of HABIT. Conclusions: Implementation of HABIT in a high school was impeded by technical difficulties leading to decreased engagement and adherence. Nonetheless, HABIT identified a significant number of unique contacts not reported by interview, indicating that electronic technologies may augment traditional contact tracing once user preferences are accommodated and technical glitches are overcome. Participants indicated a high degree of acceptance, citing emotional reassurance and a sense of security with the device. ", doi="10.2196/39765", url="https://formative.jmir.org/2023/1/e39765", url="http://www.ncbi.nlm.nih.gov/pubmed/36525333" } @Article{info:doi/10.2196/43836, author="Marques-Cruz, Manuel and Nogueira-Leite, Diogo and Alves, Miguel Jo{\~a}o and Fernandes, Francisco and Fernandes, Miguel Jos{\'e} and Almeida, {\^A}ngelo Miguel and Cunha Correia, Patr{\'i}cia and Perestrelo, Paula and Cruz-Correia, Ricardo and Pita Barros, Pedro", title="COVID-19 Contact Tracing as an Indicator for Evaluating a Pandemic Situation: Simulation Study", journal="JMIR Public Health Surveill", year="2023", month="Apr", day="6", volume="9", pages="e43836", keywords="COVID-19", keywords="public health", keywords="public health surveillance", keywords="quarantine", keywords="infection transmission", keywords="epidemiological models", abstract="Background: Contact tracing is a fundamental intervention in public health. When systematically applied, it enables the breaking of chains of transmission, which is important for controlling COVID-19 transmission. In theoretically perfect contact tracing, all new cases should occur among quarantined individuals, and an epidemic should vanish. However, the availability of resources influences the capacity to perform contact tracing. Therefore, it is necessary to estimate its effectiveness threshold. We propose that this effectiveness threshold may be indirectly estimated using the ratio of COVID-19 cases arising from quarantined high-risk contacts, where higher ratios indicate better control and, under a threshold, contact tracing may fail and other restrictions become necessary. Objective: This study assessed the ratio of COVID-19 cases in high-risk contacts quarantined through contact tracing and its potential use as an ancillary pandemic control indicator. Methods: We built a 6-compartment epidemiological model to emulate COVID-19 infection flow according to publicly available data from Portuguese authorities. Our model extended the usual susceptible-exposed-infected-recovered model by adding a compartment Q with individuals in mandated quarantine who could develop infection or return to the susceptible pool and a compartment P with individuals protected from infection because of vaccination. To model infection dynamics, data on SARS-CoV-2 infection risk (IR), time until infection, and vaccine efficacy were collected. Estimation was needed for vaccine data to reflect the timing of inoculation and booster efficacy. In total, 2 simulations were built: one adjusting for the presence and absence of variants or vaccination and another maximizing IR in quarantined individuals. Both simulations were based on a set of 100 unique parameterizations. The daily ratio of infected cases arising from high-risk contacts (q estimate) was calculated. A theoretical effectiveness threshold of contact tracing was defined for 14-day average q estimates based on the classification of COVID-19 daily cases according to the pandemic phases and was compared with the timing of population lockdowns in Portugal. A sensitivity analysis was performed to understand the relationship between different parameter values and the threshold obtained. Results: An inverse relationship was found between the q estimate and daily cases in both simulations (correlations >0.70). The theoretical effectiveness thresholds for both simulations attained an alert phase positive predictive value of >70\% and could have anticipated the need for additional measures in at least 4 days for the second and fourth lockdowns. Sensitivity analysis showed that only the IR and booster dose efficacy at inoculation significantly affected the q estimates. Conclusions: We demonstrated the impact of applying an effectiveness threshold for contact tracing on decision-making. Although only theoretical thresholds could be provided, their relationship with the number of confirmed cases and the prediction of pandemic phases shows the role as an indirect indicator of the efficacy of contact tracing. ", doi="10.2196/43836", url="https://publichealth.jmir.org/2023/1/e43836", url="http://www.ncbi.nlm.nih.gov/pubmed/36877958" } @Article{info:doi/10.2196/41269, author="Albali, Nawaf and Almudarra, Sami and Al-Farsi, Yahya and Alarifi, Abdullah and Al Wahaibi, Adil and Penttinen, Pasi", title="Comparative Performance Evaluation of the Public Health Surveillance Systems in 6 Gulf Cooperation Countries: Cross-sectional Study", journal="JMIR Form Res", year="2023", month="Apr", day="5", volume="7", pages="e41269", keywords="Gulf Cooperation Council", keywords="surveillance systems", keywords="program evaluation", keywords="performance evaluation", keywords="disease monitoring", keywords="emerging technologies", abstract="Background: Evaluating public health surveillance systems is important to ensure that events of public health importance are appropriately monitored. Evaluation studies based on the Centers for Disease Control and Prevention (CDC) guidelines have been used to appraise surveillance systems globally. Previous evaluation studies undertaken in member countries of the Gulf Cooperation Council (GCC) were limited to specific illnesses within a single nation. Objective: We aimed to evaluate public health surveillance systems in GCC countries using CDC guidelines and recommend necessary improvements to enhance these systems. Methods: The CDC guidelines were used for evaluating the surveillance systems in GCC countries. A total of 6 representatives from GCC countries were asked to rate 43 indicators across the systems' level of usefulness, simplicity, flexibility, acceptability, sensitivity, predictive value positive, representativeness, data quality, stability, and timeliness. Descriptive data analysis and univariate linear regression analysis were performed. Results: All surveillance systems in the GCC covered communicable diseases, and approximately two-thirds (4/6, 67\%, 95\% CI 29.9\%-90.3\%) of them covered health care--associated infections. The mean global score was 147 (SD 13.27). The United Arab Emirates scored the highest in the global score with a rating of 167 (83.5\%, 95\% CI 77.7\%-88.0\%), and Oman obtained the highest scores for usefulness, simplicity, and flexibility. Strong correlations were observed between the global score and the level of usefulness, flexibility, acceptability, representativeness, and timeliness, and a negative correlation was observed between stability and timeliness score. Disease coverage was the most substantial predictor of the GCC surveillance global score. Conclusions: GCC surveillance systems are performing optimally and have shown beneficial outcomes. GCC countries must use the lessons learned from the success of the systems of the United Arab Emirates and Oman. To maintain GCC surveillance systems so that they are viable and adaptable to future potential health risks, measures including centralized information exchange, deployment of emerging technologies, and system architecture reform are necessary. ", doi="10.2196/41269", url="https://formative.jmir.org/2023/1/e41269", url="http://www.ncbi.nlm.nih.gov/pubmed/37018033" } @Article{info:doi/10.2196/45777, author="Zhu, Jianghong and Li, Zepeng and Zhang, Xiu and Zhang, Zhenwen and Hu, Bin", title="Public Attitudes Toward Anxiety Disorder on Sina Weibo: Content Analysis", journal="J Med Internet Res", year="2023", month="Apr", day="4", volume="25", pages="e45777", keywords="anxiety disorder", keywords="linguistic feature", keywords="topic model", keywords="public attitude", keywords="social media", abstract="Background: Anxiety disorder has become a major clinical and public health problem, causing a significant economic burden worldwide. Public attitudes toward anxiety can impact the psychological state, help-seeking behavior, and social activities of people with anxiety disorder. Objective: The purpose of this study was to explore public attitudes toward anxiety disorders and the changing trends of these attitudes by analyzing the posts related to anxiety disorders on Sina Weibo, a Chinese social media platform that has about 582 million users, as well as the psycholinguistic and topical features in the text content of the posts. Methods: From April 2018 to March 2022, 325,807 Sina Weibo posts with the keyword ``anxiety disorder'' were collected and analyzed. First, we analyzed the changing trends in the number and total length of posts every month. Second, a Chinese Linguistic Psychological Text Analysis System (TextMind) was used to analyze the changing trends in the language features of the posts, in which 20 linguistic features were selected and presented. Third, a topic model (biterm topic model) was used for semantic content analysis to identify specific themes in Weibo users' attitudes toward anxiety. Results: The changing trends in the number and the total length of posts indicated that anxiety-related posts significantly increased from April 2018 to March 2022 (R2=0.6512; P<.001 to R2=0.8133; P<.001, respectively) and were greatly impacted by the beginning of a new semester (spring/fall). The analysis of linguistic features showed that the frequency of the cognitive process (R2=0.1782; P=.003), perceptual process (R2=0.1435; P=.008), biological process (R2=0.3225; P<.001), and assent words (R2=0.4412; P<.001) increased significantly over time, while the frequency of the social process words (R2=0.2889; P<.001) decreased significantly, and public anxiety was greatly impacted by the COVID-19 pandemic. Feature correlation analysis showed that the frequencies of words related to work and family are almost negatively correlated with those of other psychological words. Semantic content analysis identified 5 common topical areas: discrimination and stigma, symptoms and physical health, treatment and support, work and social, and family and life. Our results showed that the occurrence probability of the topical area ``discrimination and stigma'' reached the highest value and averagely accounted for 26.66\% in the 4-year period. The occurrence probability of the topical area ``family and life'' (R2=0.1888; P=.09) decreased over time, while that of the other 4 topical areas increased. Conclusions: The findings of our study indicate that public discrimination and stigma against anxiety disorder remain high, particularly in the aspects of self-denial and negative emotions. People with anxiety disorders should receive more social support to reduce the impact of discrimination and stigma. ", doi="10.2196/45777", url="https://www.jmir.org/2023/1/e45777", url="http://www.ncbi.nlm.nih.gov/pubmed/37014691" } @Article{info:doi/10.2196/42628, author="Caponnetto, Pasquale and Campagna, Davide and Maglia, Marilena and Benfatto, Francesca and Emma, Rosalia and Caruso, Massimo and Caci, Grazia and Bus{\`a}, Barbara and Pennisi, Alfio and Ceracchi, Maurizio and Migliore, Marcello and Signorelli, Maria", title="Comparing the Effectiveness, Tolerability, and Acceptability of Heated Tobacco Products and Refillable Electronic Cigarettes for Cigarette Substitution (CEASEFIRE): Randomized Controlled Trial", journal="JMIR Public Health Surveill", year="2023", month="Apr", day="4", volume="9", pages="e42628", keywords="harm reduction", keywords="heat not burn", keywords="electronic cigarettes", keywords="smoking cessation", keywords="smoking reduction", keywords="e-cigarette", keywords="public health", keywords="psychological well-being", abstract="Background: People who smoke and who face challenges trying to quit or wish to continue to smoke may benefit by switching from traditional cigarettes to noncombustible nicotine delivery alternatives, such as heated tobacco products (HTPs) and electronic cigarettes (ECs). HTPs and ECs are being increasingly used to quit smoking, but there are limited data about their effectiveness. Objective: We conducted the first randomized controlled trial comparing quit rates between HTPs and ECs among people who smoke and do not intend to quit. Methods: We conducted a 12-week randomized noninferiority switching trial to compare effectiveness, tolerability, and product satisfaction between HTPs (IQOS 2.4 Plus) and refillable ECs (JustFog Q16) among people who do not intend to quit. The cessation intervention included motivational counseling. The primary endpoint of the study was the carbon monoxide--confirmed continuous abstinence rate from week 4 to week 12 (CAR weeks 4-12). The secondary endpoints included the continuous self-reported ?50\% reduction in cigarette consumption rate (continuous reduction rate) from week 4 to week 12 (CRR weeks 4-12) and 7-day point prevalence of smoking abstinence. Results: A total of 211 participants completed the study. High quit rates (CAR weeks 4-12) of 39.1\% (43/110) and 30.8\% (33/107) were observed for IQOS-HTP and JustFog-EC, respectively. The between-group difference for the CAR weeks 4-12 was not significant (P=.20). The CRR weeks 4-12 values for IQOS-HTP and JustFog-EC were 46.4\% (51/110) and 39.3\% (42/107), respectively, and the between-group difference was not significant (P=.24). At week 12, the 7-day point prevalence of smoking abstinence values for IQOS-HTP and JustFog-EC were 54.5\% (60/110) and 41.1\% (44/107), respectively. The most frequent adverse events were cough and reduced physical fitness. Both study products elicited a moderately pleasant user experience, and the between-group difference was not significant. A clinically relevant improvement in exercise tolerance was observed after switching to the combustion-free products under investigation. Risk perception for conventional cigarettes was consistently higher than that for the combustion-free study products under investigation. Conclusions: Switching to HTPs elicited a marked reduction in cigarette consumption among people who smoke and do not intend to quit, which was comparable to refillable ECs. User experience and risk perception were similar between the HTPs and ECs under investigation. HTPs may be a useful addition to the arsenal of reduced-risk alternatives for tobacco cigarettes and may contribute to smoking cessation. However, longer follow-up studies are required to confirm significant and prolonged abstinence from smoking and to determine whether our results can be generalized outside smoking cessation services offering high levels of support. Trial Registration: ClinicalTrials.gov NCT03569748; https://clinicaltrials.gov/ct2/show/NCT03569748 ", doi="10.2196/42628", url="https://publichealth.jmir.org/2023/1/e42628", url="http://www.ncbi.nlm.nih.gov/pubmed/37014673" } @Article{info:doi/10.2196/41187, author="Korenhof, A. Sophie and Fang, Yuan and Luo, Jie and van der Cammen, M. Tischa J. and Raat, Hein and van Grieken, Amy", title="Monitoring the Well-being of Older People by Energy Usage Patterns: Systematic Review of the Literature and Evidence Synthesis", journal="JMIR Aging", year="2023", month="Mar", day="31", volume="6", pages="e41187", keywords="smart energy meter", keywords="healthy aging", keywords="activities of daily living", keywords="independent living", keywords="monitoring", keywords="older adults", keywords="devices", keywords="risk", keywords="well-being", keywords="effectiveness", keywords="design", keywords="safety", abstract="Background: Due to the aging population, there is a need for monitoring well-being and safety while living independently. A low-intrusive monitoring system is based on a person's use of energy or water. Objective: The study's objective was to provide a systematic overview of studies that monitor the health and well-being of older people using energy (eg, electricity and gas) and water usage data and study the outcomes on health and well-being. Methods: CENTRAL, Embase, MEDLINE (Ovid), Scopus, Web of Science, and Google Scholar were searched systematically from inception until November 8, 2021. The inclusion criteria were that the study had to be published in English, have full-text availability, target independent-living people aged 60 years and older from the general population, have an observational design, and assess the outcomes of a monitoring system based on energy (ie, electricity, gas, or water) usage on well-being and safety. The quality of the studies was assessed by the QualSyst systematic review tool. Results: The search strategy identified 2920 articles. The majority of studies focused on the technical algorithms underlying energy usage data and related sensors. One study was included in this review. This study reported that the smart energy meter data monitoring system was considered unobtrusive and was well accepted by the older people and professionals involved. Energy usage in a household acted as a unique signature and therefore provided useful insight into well-being and safety. This study lacked statistical power due to the small number of participants and the low number of observed events. In addition, the quality of the study was rated as low. Conclusions: This review identified only 1 study that evaluated the impact of an energy usage monitoring system on the well-being and safety of older people. The absence of reliable evidence impedes any definitive guidance or recommendations for practice. Because this emerging field has not yet been studied thoroughly, many questions remain open for further research. Future studies should focus on the further development of a monitoring system and the evaluation of the implementation and outcomes of these systems. Trial Registration: PROSPERO CRD42022245713; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=245713 ", doi="10.2196/41187", url="https://aging.jmir.org/2023/1/e41187", url="http://www.ncbi.nlm.nih.gov/pubmed/37000477" } @Article{info:doi/10.2196/43786, author="Tessier, Anne-Julie and Moyen, Audrey and Lawson, Claire and Rappaport, Ilysse Aviva and Yousif, Hiba and Fleurent-Gr{\'e}goire, Chlo{\'e} and Lalonde-Bester, Sophie and Brazeau, Anne-Sophie and Chevalier, St{\'e}phanie", title="Lifestyle Behavior Changes and Associated Risk Factors During the COVID-19 Pandemic: Results from the Canadian COVIDiet Online Cohort Study", journal="JMIR Public Health Surveill", year="2023", month="Mar", day="30", volume="9", pages="e43786", keywords="healthy lifestyle", keywords="behaviors", keywords="pandemic", keywords="COVID-19", keywords="public health", keywords="body image", keywords="gender", keywords="stress", keywords="risk factor", keywords="physical activity", keywords="mental well-being", keywords="depression", abstract="Background: The COVID-19 pandemic and related lockdowns have impacted lifestyle behaviors, including eating habits and physical activity; yet, few studies have identified the emerging patterns of such changes and associated risk factors. Objective: This study aims to identify the patterns of weight and lifestyle behavior changes, and the potential risk factors, resulting from the pandemic in Canadian adults. Methods: Analyses were conducted on 1609 adults (18-89 years old; n=1450, 90.1\%, women; n=1316, 81.8\%, White) of the Canadian COVIDiet study baseline data (May-December 2020). Self-reported current and prepandemic weight, physical activity, smoking status, perceived eating habits, alcohol intake, and sleep quality were collected through online questionnaires. Based on these 6 indicator variables, latent class analysis (LCA) was used to identify lifestyle behavior change patterns. Associations with potential risk factors, including age, gender, ethnicity, education, income, chronic diseases, body image perception, and changes in the stress level, living situation, and work arrangement, were examined with logistic regressions. Results: Participants' mean BMI was 26.1 (SD 6.3) kg/m2. Of the 1609 participants, 980 (60.9\%) had a bachelor's degree or above. Since the pandemic, 563 (35\%) had decreased income and 788 (49\%) changed their work arrangement. Most participants reported unchanged weight, sleep quality, physical activity level, and smoking and alcohol consumption, yet 708 (44\%) reported a perceived decrease in eating habit quality. From LCA, 2 classes of lifestyle behavior change emerged: healthy and less healthy (probability: 0.605 and 0.395, respectively; Bayesian information criterion [BIC]=15574, entropy=4.8). The healthy lifestyle behavior change group more frequently reported unchanged weight, sleep quality, smoking and alcohol intake, unchanged/improved eating habits, and increased physical activity. The less healthy lifestyle behavior change group reported significant weight gain, deteriorated eating habits and sleep quality, unchanged/increased alcohol intake and smoking, and decreased physical activity. Among risk factors, body image dissatisfaction (odds ratio [OR] 8.8, 95\% CI 5.3-14.7), depression (OR 1.8, 95\% CI 1.3-2.5), increased stress level (OR 3.4, 95\% CI 2.0-5.8), and gender minority identity (OR 5.5, 95\% CI 1.3-22.3) were associated with adopting less healthy behaviors in adjusted models. Conclusions: The COVID-19 pandemic has appeared to have influenced lifestyle behaviors unfavorably in some but favorably in others. Body image perception, change in stress level, and gender identity are factors associated with behavior change patterns; whether these will sustain over time remains to be studied. Findings provide insights into developing strategies for supporting adults with poorer mental well-being in the postpandemic context and promoting healthful behaviors during future disease outbreaks. Trial Registration: ClinicalTrials.gov NCT04407533; https://clinicaltrials.gov/ct2/show/NCT04407533 ", doi="10.2196/43786", url="https://publichealth.jmir.org/2023/1/e43786", url="http://www.ncbi.nlm.nih.gov/pubmed/36848226" } @Article{info:doi/10.2196/43635, author="Meng, Xiaojun and Yin, Hanlu and Ma, Wenjuan and Gu, Jing and Lu, Zhen and Fitzpatrick, Thomas and Zou, Huachun", title="Peer-Led Community-Based Support Services and HIV Treatment Outcomes Among People Living With HIV in Wuxi, China: Propensity Score--Matched Analysis of Surveillance Data From 2006 to 2021", journal="JMIR Public Health Surveill", year="2023", month="Mar", day="24", volume="9", pages="e43635", keywords="people living with HIV", keywords="community health workers", keywords="community-based organizations", keywords="peer-led services", keywords="HIV treatment outcomes", abstract="Background: Community-based organizations deliver peer-led support services to people living with HIV. Systematic reviews have found that peer-led community-based support services can improve HIV treatment outcomes; however, few studies have been implemented to evaluate its impact on mortality using long-term follow-up data. Objective: We aimed to evaluate the associations between the receipt of peer-led community-based support services and HIV treatment outcomes and survival among people living with HIV in Wuxi, China. Methods: We performed a propensity score--matched retrospective cohort study using data collected from the Chinese National HIV/AIDS Comprehensive Information Management System for people living with HIV in Wuxi, China, between 2006 and 2021. People living with HIV who received adjunctive peer-led community-based support for at least 6 months from a local community-based organization (exposure group) were matched to people living with HIV who only received routine clinic-based HIV care (control group). We compared the differences in HIV treatment outcomes and survival between these 2 groups using Kaplan-Meier curves. We used competing risk and Cox proportional hazards models to assess correlates of AIDS-related mortality (ARM) and all-cause mortality. We reported adjusted subdistribution hazard ratio and adjusted hazard ratio with 95\% CIs. Results: A total of 860 people living with HIV were included (430 in the exposure group and 430 in the control group). The exposure group was more likely to adhere to antiretroviral therapy (ART; 396/430, 92.1\% vs 360/430, 83.7\%; P<.001), remain retained in care 12 months after ART initiation (402/430, 93.5\% vs 327/430, 76.1\%; P<.001), and achieve viral suppression 9 to 24 months after ART initiation (357/381, 93.7\% vs 217/243, 89.3\%; P=.048) than the control group. The exposure group had significantly lower ARM (1.8 vs 7.0 per 1000 person-years; P=.01) and all-cause mortality (2.3 vs 9.3 per 1000 person-years; P=.002) and significantly higher cumulative survival rates (P=.003). The exposure group had a 72\% reduction in ARM (adjusted subdistribution hazard ratio 0.28, 95\% CI 0.09-0.95) and a 70\% reduction in all-cause mortality (adjusted hazard ratio 0.30, 95\% CI 0.11-0.82). The nonrandomized retrospective nature of our analysis prevents us from determining whether peer-led community-based support caused the observed differences in HIV treatment outcomes and survival between the exposure and control groups. Conclusions: The receipt of peer-led community-based support services correlated with significantly improved HIV treatment outcomes and survival among people living with HIV in a middle-income country in Asia. The 15-year follow-up period in this study allowed us to identify associations with survival not previously reported in the literature. Future interventional trials are needed to confirm these findings. ", doi="10.2196/43635", url="https://publichealth.jmir.org/2023/1/e43635", url="http://www.ncbi.nlm.nih.gov/pubmed/36961492" } @Article{info:doi/10.2196/43542, author="De Santis, Karolina Karina and Mergenthal, Lea and Christianson, Lara and Busskamp, Annalena and Vonstein, Claudia and Zeeb, Hajo", title="Digital Technologies for Health Promotion and Disease Prevention in Older People: Scoping Review", journal="J Med Internet Res", year="2023", month="Mar", day="23", volume="25", pages="e43542", keywords="digital technology", keywords="health technology", keywords="digital public health", keywords="health promotion", keywords="disease prevention", keywords="healthy aging", keywords="elderly population", keywords="older adult", keywords="older population", keywords="scoping review", abstract="Background: Digital technologies have the potential to contribute to health promotion and disease prevention in the aging world. Objective: This study aims to identify digital technologies for health promotion and disease prevention that could be used independently by older people in nonclinical settings using a scoping review. Methods: Through database (MEDLINE, PsycINFO, CINAHL, and SCOPUS; to March 3, 2022) and manual searches (to June 14, 2022), 90 primary studies and 8 systematic reviews were included in this scoping review. The eligibility was based on the PCC (Population, Concept, and Context) criteria: (1) people aged 50 years or older (population), (2) any digital (health) technology (eg, smartphone apps, websites, virtual reality; concept), and (3) health promotion and disease prevention in daily life in nonclinical and noninstitutional settings (context). Data items included study characteristics, PCC criteria, opportunities versus challenges, and evidence gaps. Data were synthesized using descriptive statistics or narratively described by identifying common themes. Results: The studies were published in 2005-2022 and originated predominantly from North America and Europe. Most primary studies were nonrandomized, reported quantitative data, and investigated effectiveness or feasibility (eg, acceptance or usability) of digital technologies in older people. The participants were aged 50 years to 99 years, predominantly female, affluent (ie, with high income, education, and digital competence), and intended to use or used digital technologies for a median of 3 months independently at home or in community settings. The digital technologies included mobile or nonmobile technologies or virtual reality. The studies used ``modern devices'' (eg, smartphones, wearables, or gaming consoles) or modern and ``older devices'' (eg, computers or mobile phones). The users interacted with digital technologies via websites, emails, text messages, apps, or virtual reality. Health targets of digital technologies were mobility, mental health, nutrition, or cognition. The opportunities versus challenges of digital technologies were (1) potential health benefits versus unclear or no benefits for some outcomes, (2) monitoring of health versus ethical issues with data collection and management, (3) implications for functioning in daily life (ie, potential to prolong independent living) versus unclear application for clinical management or care, (4) tailoring of technical properties and content toward older users versus general use, (5) importance of human support for feasibility versus other factors required to improve feasibility, (6) reduction of social isolation versus access to digital technologies, and (7) improvement in digital competence versus digital divide. Conclusions: Various digital technologies were independently used by people aged 50 years or older for health promotion and disease prevention. Future studies should focus on (1) more diverse populations of older people, (2) new digital technologies, (3) other (clinical and care) settings, and (4) outcome evaluation to identify factors that could enhance any health benefits of digital technologies. International Registered Report Identifier (IRRID): RR2-10.2196/37729 ", doi="10.2196/43542", url="https://www.jmir.org/2023/1/e43542", url="http://www.ncbi.nlm.nih.gov/pubmed/36951896" } @Article{info:doi/10.2196/40814, author="Hirst, Yasemin and Stoffel, T. Sandro and Brewer, R. Hannah and Timotijevic, Lada and Raats, M. Monique and Flanagan, M. James", title="Understanding Public Attitudes and Willingness to Share Commercial Data for Health Research: Survey Study in the United Kingdom", journal="JMIR Public Health Surveill", year="2023", month="Mar", day="23", volume="9", pages="e40814", keywords="commercial data", keywords="data sharing", keywords="participant recruitment", keywords="loyalty cards", keywords="sociodemographic factors", keywords="data donation", keywords="data", keywords="health", keywords="public", keywords="acceptability", keywords="digital", keywords="mobile phone", abstract="Background: Health research using commercial data is increasing. The evidence on public acceptability and sociodemographic characteristics of individuals willing to share commercial data for health research is scarce. Objective: This survey study investigates the willingness to share commercial data for health research in the United Kingdom with 3 different organizations (government, private, and academic institutions), 5 different data types (internet, shopping, wearable devices, smartphones, and social media), and 10 different invitation methods to recruit participants for research studies with a focus on sociodemographic characteristics and psychological predictors. Methods: We conducted a web-based survey using quota sampling based on age distribution in the United Kingdom in July 2020 (N=1534). Chi-squared tests tested differences by sociodemographic characteristics, and adjusted ordered logistic regressions tested associations with trust, perceived importance of privacy, worry about data misuse and perceived risks, and perceived benefits of data sharing. The results are shown as percentages, adjusted odds ratios, and 95\% CIs. Results: Overall, 61.1\% (937/1534) of participants were willing to share their data with the government and 61\% (936/1534) of participants were willing to share their data with academic research institutions compared with 43.1\% (661/1534) who were willing to share their data with private organizations. The willingness to share varied between specific types of data---51.8\% (794/1534) for loyalty cards, 35.2\% (540/1534) for internet search history, 32\% (491/1534) for smartphone data, 31.8\% (488/1534) for wearable device data, and 30.4\% (467/1534) for social media data. Increasing age was consistently and negatively associated with all the outcomes. Trust was positively associated with willingness to share commercial data, whereas worry about data misuse and the perceived importance of privacy were negatively associated with willingness to share commercial data. The perceived risk of sharing data was positively associated with willingness to share when the participants considered all the specific data types but not with the organizations. The participants favored postal research invitations over digital research invitations. Conclusions: This UK-based survey study shows that willingness to share commercial data for health research varies; however, researchers should focus on effectively communicating their data practices to minimize concerns about data misuse and improve public trust in data science. The results of this study can be further used as a guide to consider methods to improve recruitment strategies in health-related research and to improve response rates and participant retention. ", doi="10.2196/40814", url="https://publichealth.jmir.org/2023/1/e40814", url="http://www.ncbi.nlm.nih.gov/pubmed/36951929" } @Article{info:doi/10.2196/40956, author="Wen, Wen and Zhang, Yaru and Shi, Wenjie and Li, Jiajia", title="Association Between Internet Use and Physical Health, Mental Health, and Subjective Health in Middle-aged and Older Adults: Nationally Representative Cross-sectional Survey in China", journal="J Med Internet Res", year="2023", month="Mar", day="21", volume="25", pages="e40956", keywords="internet use", keywords="health status", keywords="middle-aged and older adults", keywords="China", abstract="Background: Internet use is an important means of accessing health-related information. Identifying the associations between internet use and health outcomes could provide insight into strategies for improving public health among middle-aged and older adults (45 years and up). Objective: This study aimed to examine the relationship between internet use and health outcomes in middle-aged and older adults. Methods: Data were obtained from the 2018 China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) Scale, the 10-item Center for Epidemiologic Studies Depression Scale, and the 3-level Self-Rated Health Scale, respectively. The chi-square test and rank sum test were used to explore whether internet use was associated with health status. A multivariate logistic regression model was used to determine this association further after controlling for the confounding factors. Results: Overall, 13\% (1752/13,474) of the participants used the internet. Regression analyses revealed that the prevalence of depression (odds ratio [OR] 0.59, 95\% CI 0.52-0.68; P<.001), negative self-rated health (OR 0.68, 95\% CI 0.61-0.76; P<.001), and difficulty with ADL (OR 0.48, 95\% CI 0.39-0.60; P<.001) in the participating middle-aged and older adult was lower in those using the internet than nonusers. After controlling for confounding factors, internet use was found to be negatively associated with difficulty with ADL (urban: OR 0.44, 95\% CI 0.32-0.61; P<.001 vs rural: OR 0.55, 95\% CI 0.41-0.75; P<.001), depression (urban: OR 0.69, 95\% CI 0.57-0.84; P<.001 vs rural: OR 0.52, 95\% CI: 0.43-0.63; P<.001), and self-rated health status (urban: OR 0.70, 95\% CI 0.61-0.81; P<.001 vs rural: OR 0.67, 95\% CI 0.57-0.78; P<.001) among middle-aged and older adults in both urban and rural areas. Conclusions: Internet use had a positive effect on the physical and mental health of middle-aged and older adults who participated in this study. However, the internet usage rate remains low among older Chinese people. Therefore, the internet penetration rate should be a priority. ", doi="10.2196/40956", url="https://www.jmir.org/2023/1/e40956", url="http://www.ncbi.nlm.nih.gov/pubmed/36943368" } @Article{info:doi/10.2196/43652, author="Stacey, Dawn and Ludwig, Claire and Archambault, Patrick and Smith, Maureen and Taljaard, Monica and Carley, Meg and Plourde, Karine and Boland, Laura and Gogovor, Am{\'e}d{\'e} and Graham, Ian and Kobewka, Daniel and McLean, D. Robert K. and Nelson, A. Michelle L. and Vanderspank-Wright, Brandi and L{\'e}gar{\'e}, France", title="Decisions and Decisional Needs of Canadians From all Provinces and Territories During the COVID-19 Pandemic: Population-Based Cross-sectional Surveys", journal="JMIR Public Health Surveill", year="2023", month="Mar", day="21", volume="9", pages="e43652", keywords="health care decisions", keywords="decisional conflict", keywords="decision regret", keywords="shared decision-making", keywords="COVID-19", keywords="older adults", keywords="caregivers", keywords="parents", keywords="public health decision", keywords="health care", keywords="health outcome", keywords="pandemic preparedness", keywords="public health policy", abstract="Background: Never before COVID-19 had Canadians faced making health-related decisions in a context of significant uncertainty. However, little is known about which type of decisions and the types of difficulties that they faced. Objective: We sought to identify the health-related decisions and decisional needs of Canadians. Methods: Our study was codesigned by researchers and knowledge users (eg, patients, clinicians). Informed by the CHERRIES (the Checklist for Reporting Results of Internet E-Surveys) reporting guideline, we conducted 2 online surveys of random samples drawn from the Leger consumer panel of 400,000 Canadians. Eligible participants were adults (?18 years) who received or were receiving any health services in the past 12 months for themselves (adults) or for their child (parent) or senior with cognitive impairment (caregiver). We assessed decisions and decisional needs using questions informed by the Ottawa Decision Support Framework, including decisional conflict and decision regret using the Decision Conflict Scale (DCS) and the Decision Regret Scale (DRS), respectively. Descriptive statistics were conducted for adults who had decided for themselves or on behalf of someone else. Significant decisional conflict (SDC) was defined as a total DCS score of >37.5 out of 100, and significant decision regret was defined as a total DRS score of >25 out of 100. Results: From May 18 to June 4, 2021, 14,459 adults and 6542 parents/caregivers were invited to participate. The invitation view rate was 15.5\% (2236/14,459) and 28.3\% (1850/6542); participation rate, 69.3\% (1549/2236) and 28.7\% (531/1850); and completion rate, 97.3\% (1507/1549) and 95.1\% (505/531), respectively. The survey was completed by 1454 (97.3\%) adults and 438 (95.1\%) parents/caregivers in English (1598/1892, 84.5\%) or French (294/1892, 15.5\%). Respondents from all 10 Canadian provinces and the northern territories represented a range of ages, education levels, civil statuses, ethnicities, and annual household income. Of 1892 respondents, 541 (28.6\%) self-identified as members of marginalized groups. The most frequent decisions were (adults vs parents/caregivers) as follows: COVID-19 vaccination (490/1454, 33.7\%, vs 87/438, 19.9\%), managing a health condition (253/1454, 17.4\%, vs 47/438, 10.7\%), other COVID-19 decisions (158/1454, 10.9\%, vs 85/438, 19.4\%), mental health care (128/1454, 8.8\%, vs 27/438, 6.2\%), and medication treatments (115/1454, 7.9\%, vs 23/438, 5.3\%). Caregivers also reported decisions about moving family members to/from nursing or retirement homes (48/438, 11.0\%). Adults (323/1454, 22.2\%) and parents/caregivers (95/438, 21.7\%) had SDC. Factors making decisions difficult were worrying about choosing the wrong option (557/1454, 38.3\%, vs 184/438, 42.0\%), worrying about getting COVID-19 (506/1454, 34.8\%, vs 173/438, 39.5\%), public health restrictions (427/1454, 29.4\%, vs 158/438, 36.1\%), information overload (300/1454, 20.6\%, vs 77/438, 17.6\%), difficulty separating misinformation from scientific evidence (297/1454, 20.4\%, vs 77/438, 17.6\%), and difficulty discussing decisions with clinicians (224/1454, 15.4\%, vs 51/438, 11.6\%). For 1318 (90.6\%) adults and 366 (83.6\%) parents/caregivers who had decided, 353 (26.8\%) and 125 (34.2\%) had significant decision regret, respectively. In addition, 1028 (50\%) respondents made their decision alone without considering the opinions of clinicians. Conclusions: During COVID-19, Canadians who responded to the survey faced several new health-related decisions. Many reported unmet decision-making needs, resulting in SDC and decision regret. Interventions can be designed to address their decisional needs and support patients facing new health-related decisions. ", doi="10.2196/43652", url="https://publichealth.jmir.org/2023/1/e43652", url="http://www.ncbi.nlm.nih.gov/pubmed/36688986" } @Article{info:doi/10.2196/43334, author="Chen, Jiarui and Xue, Siyu and Xie, Zidian and Li, Dongmei", title="Characterizing Heated Tobacco Products Marketing on Instagram: Observational Study", journal="JMIR Form Res", year="2023", month="Mar", day="15", volume="7", pages="e43334", keywords="IQOS", keywords="Instagram", keywords="heated tobacco products", keywords="web-based tobacco marketing", abstract="Background: Heated tobacco products (HTPs), including I Quit Ordinary Smoking (IQOS), are new tobacco products that use an electronic device to heat compressed tobacco leaves to generate an aerosol for consumers to inhale. Marketing of HTPs is prevalent on Instagram, a popular social media platform. Objective: This study aims to characterize posts related to HTPs on Instagram and their associations with user engagement. Methods: Through the Instagram application programming interface, 979 Instagram posts were collected using keywords related to HTPs, such as ``IQOS'' and ``heat-not-burn.'' Among them, 596 posts were related to IQOS and other HTP marketing. The codebook was developed from a randomly selected 200 posts on the post content by hand coding, which was applied to the remaining 396 Instagram posts. Summary statistics were calculated, and statistical hypothesis testing was conducted to understand the popularity of Instagram posts on HTPs. Negative binomial regression models were applied to identify Instagram post characteristics associated with user engagement (eg, count). Results: Among Instagram posts related to HTP marketing (N=596), ``product display'' was dominant (n=550, 92.28\%), followed by ``brand promotion'' (n=41, 6.88\%), and ``others'' (n=5, 0.84\%). Among posts within ``product display,'' ``device only'' was the most popular (n=338, 61.45\%), followed by ``heatstick only'' (n=80, 14.55\%), ``accessory'' (n=66, 12\%), ``device and heatstick'' (n=56, 10.18\%), and ``capsule'' (n=10, 1.82\%). A univariate negative binomial regression model with pairwise comparisons across ``product display'' types showed that the number of likes for posts with HTP heatsticks was significantly lower compared to posts with HTP devices, accessories, and device-heatstick sets. Multivariate negative binomial regression models showed that HTP-related Instagram posts with a model or lifestyle elements (;=.60, 95\% CI 0.36-0.84) or without obvious product advertising information (=.69, 95\% CI 0.49-0.89) received more likes. Conclusions: It is shown that posts with product displays were dominant among HTP-related posts on Instagram. Posts with model or lifestyle elements are associated with high user engagement, which might be one of the web-based marketing strategies of HTPs. ", doi="10.2196/43334", url="https://formative.jmir.org/2023/1/e43334", url="http://www.ncbi.nlm.nih.gov/pubmed/36920463" } @Article{info:doi/10.2196/38868, author="Mishra, Ninad and Grant, Reynaldo and Patel, Toth Megan and Guntupalli, Siva and Hamilton, Andrew and Carr, Jeremy and McKnight, Elizabeth and Wise, Wendy and deRoode, David and Jellison, Jim and Collins, Viator Natalie and P{\'e}rez, Alejandro and Karki, Saugat", title="Automating Case Reporting of Chlamydia and Gonorrhea to Public Health Authorities in Illinois Clinics: Implementation and Evaluation of Findings", journal="JMIR Public Health Surveill", year="2023", month="Mar", day="14", volume="9", pages="e38868", keywords="public health surveillance", keywords="sexually transmitted diseases", keywords="gonorrhoea", keywords="chlamydia", keywords="electronic case reporting", keywords="eCR", keywords="health information interoperability", keywords="electronic health records", keywords="EHR", keywords="case reporting", keywords="automated", keywords="reporting", keywords="recording", keywords="patient records", keywords="cases", keywords="health care system", keywords="semantic", keywords="interoperability", keywords="implementation", abstract="Background: Chlamydia and gonorrhea cases continue to rise in Illinois, increasing by 16.4\% and 70.9\% in 2019, respectively, compared with 2015. Providers are required to report both chlamydia and gonorrhea, as mandated by public health laws. Manual reporting remains a huge burden; 90\%-93\% of cases were reported to Illinois Department of Public Health (IDPH) via electronic laboratory reporting (ELR), and the remaining were reported through web-based data entry platforms, faxes, and phone calls. However, cases reported via ELRs only contain information available to a laboratory facility and do not contain additional data needed for public health. Such data are typically found in an electronic health record (EHR). Electronic case reports (eCRs) were developed and automated the generation of case reports from EHRs to be reported to public health agencies. Objective: Prior studies consolidated trigger criteria for eCRs, and compared with manual reporting, found it to be more complete. The goal of this project is to pilot standards-based eCR for chlamydia and gonorrhea. We evaluated the throughput, completeness, and timeliness of eCR compared to ELR, as well as the implementation experience at a large health center--controlled network in Illinois. Methods: For this study, we selected 8 clinics located on the north, west, and south sides of Chicago to implement the eCRs; these cases were reported to IDPH. The study period was 52 days. The centralized EHR used by these clinics leveraged 2 of the 3 case detection scenarios, which were previously defined as the trigger, to generate an eCR. These messages were successfully transmitted via Health Level 7 electronic initial case report standard. Upon receipt by IDPH, these eCRs were parsed and housed in a staging database. Results: During the study period, 183 eCRs representing 135 unique patients were received by IDPH. eCR reported 95\% (n=113 cases) of all the chlamydia cases and 97\% (n=70 cases) of all the gonorrhea cases reported from the participating clinical sites. eCR found an additional 14 (19\%) cases of gonorrhea that were not reported via ELR. However, ELR reported an additional 6 cases of chlamydia and 2 cases of gonorrhea, which were not reported via eCR. ELR reported 100\% of chlamydia cases but only 81\% of gonorrhea cases. While key elements such as patient and provider names were complete in both eCR and ELR, eCR was found to report additional clinical data, including history of present illness, reason for visit, symptoms, diagnosis, and medications. Conclusions: eCR successfully identified and created automated reports for chlamydia and gonorrhea cases in the implementing clinics in Illinois. eCR demonstrated a more complete case report and represents a promising future of reducing provider burden for reporting cases while achieving greater semantic interoperability between health care systems and public health. ", doi="10.2196/38868", url="https://publichealth.jmir.org/2023/1/e38868", url="http://www.ncbi.nlm.nih.gov/pubmed/36917153" } @Article{info:doi/10.2196/41969, author="Wu, Jiaxi and Origgi, Manuel Juan and Ranker, R. Lynsie and Bhatnagar, Aruni and Robertson, Marie Rose and Xuan, Ziming and Wijaya, Derry and Hong, Traci and Fetterman, L. Jessica", title="Compliance With the US Food and Drug Administration's Guidelines for Health Warning Labels and Engagement in Little Cigar and Cigarillo Content: Computer Vision Analysis of Instagram Posts", journal="JMIR Infodemiology", year="2023", month="Mar", day="14", volume="3", pages="e41969", keywords="tobacco", keywords="cigar", keywords="little cigar", keywords="cigarillo", keywords="Instagram", keywords="social media", keywords="influencer promotion", keywords="tobacco advertising", keywords="health warning", keywords="machine learning", keywords="computer vision", keywords="warning label", keywords="health label", keywords="health promotion", keywords="advertising", keywords="advertise", keywords="smoking", keywords="smoker", keywords="algorithm", keywords="visualization", abstract="Background: Health warnings in tobacco advertisements provide health information while also increasing the perceived risks of tobacco use. However, existing federal laws requiring warnings on advertisements for tobacco products do not specify whether the rules apply to social media promotions. Objective: This study aims to examine the current state of influencer promotions of little cigars and cigarillos (LCCs) on Instagram and the use of health warnings in influencer promotions. Methods: Instagram influencers were identified as those who were tagged by any of the 3 leading LCC brand Instagram pages between 2018 and 2021. Posts from identified influencers, which mentioned one of the three brands were considered LCC influencer promotions. A novel Warning Label Multi-Layer Image Identification computer vision algorithm was developed to measure the presence and properties of health warnings in a sample of 889 influencer posts. Negative binomial regressions were performed to examine the associations of health warning properties with post engagement (number of likes and comments). Results: The Warning Label Multi-Layer Image Identification algorithm was 99.3\% accurate in detecting the presence of health warnings. Only 8.2\% (n=73) of LCC influencer posts included a health warning. Influencer posts that contained health warnings received fewer likes (incidence rate ratio 0.59, P<.001, 95\% CI 0.48-0.71) and fewer comments (incidence rate ratio 0.46, P<.001, 95\% CI 0.31-0.67). Conclusions: Health warnings are rarely used by influencers tagged by LCC brands' Instagram accounts. Very few influencer posts met the US Food and Drug Administration's health warning requirement of size and placement for tobacco advertising. The presence of a health warning was associated with lower social media engagement. Our study provides support for the implementation of comparable health warning requirements to social media tobacco promotions. Using an innovative computer vision approach to detect health warning labels in influencer promotions on social media is a novel strategy for monitoring health warning compliance in social media tobacco promotions. ", doi="10.2196/41969", url="https://infodemiology.jmir.org/2023/1/e41969", url="http://www.ncbi.nlm.nih.gov/pubmed/37113379" } @Article{info:doi/10.2196/40554, author="Coelho, Fl{\'a}vio and C{\^a}mara, Portela Daniel Cardoso and Ara{\'u}jo, Correa Eduardo and Bianchi, Monteiro Lucas and Ogasawara, Ivan and Dalal, Jyoti and James, Ananthu and Abbate, L. Jessica and Merzouki, Aziza and dos Reis, Cristina Izabel and Nwosu, David Kene and Keiser, Olivia", title="A Platform for Data-Centric, Continuous Epidemiological Analyses (EpiGraphHub): Descriptive Analysis", journal="J Med Internet Res", year="2023", month="Mar", day="6", volume="25", pages="e40554", keywords="epidemiology", keywords="data analysis", keywords="disease surveillance", keywords="data science", keywords="public health", keywords="durability", keywords="accessibility", keywords="data set", keywords="public", keywords="platform", keywords="data", keywords="application", keywords="decision", keywords="decision-making", abstract="Background: Guaranteeing durability, provenance, accessibility, and trust in open data sets can be challenging for researchers and organizations that rely on public repositories of data critical for epidemiology and other health analytics. The required data repositories are often difficult to locate and may require conversion to a standard data format. Data-hosting websites may also change or become unavailable without warning. A single change to the rules in one repository can hinder updating a public dashboard reliant on data pulled from external sources. These concerns are particularly challenging at the international level, because policies on systems aimed at harmonizing health and related data are typically dictated by national governments to serve their individual needs. Objective: In this paper, we introduce a comprehensive public health data platform, EpiGraphHub, that aims to provide a single interoperable repository for open health and related data. Methods: The platform, curated by the international research community, allows secure local integration of sensitive data while facilitating the development of data-driven applications and reports for decision-makers. Its main components include centrally managed databases with fine-grained access control to data, fully automated and documented data collection and transformation, and a powerful web-based data exploration and visualization tool. Results: EpiGraphHub is already being used for hosting a growing collection of open data sets and for automating epidemiological analyses based on them. The project has also released an open-source software library with the analytical methods used in the platform. Conclusions: The platform is fully open source and open to external users. It is in active development with the goal of maximizing its value for large-scale public health studies. ", doi="10.2196/40554", url="https://www.jmir.org/2023/1/e40554", url="http://www.ncbi.nlm.nih.gov/pubmed/36877539" } @Article{info:doi/10.2196/44741, author="Mitsutake, Seigo and Takahashi, Yoshimitsu and Otsuki, Aki and Umezawa, Jun and Yaguchi-Saito, Akiko and Saito, Junko and Fujimori, Maiko and Shimazu, Taichi and ", title="Chronic Diseases and Sociodemographic Characteristics Associated With Online Health Information Seeking and Using Social Networking Sites: Nationally Representative Cross-sectional Survey in Japan", journal="J Med Internet Res", year="2023", month="Mar", day="2", volume="25", pages="e44741", keywords="chronic diseases", keywords="cross-sectional study", keywords="eHealth literacy, health communication", keywords="internet, social networking", abstract="Background: In an aging society, worsening chronic diseases increase the burden on patients and the health care system. Using online health information including health information via social networking sites (SNSs), such as Facebook and YouTube, may play an important role in the self-management of chronic diseases and health promotion for internet users. Objective: This study aims to improve strategies for promoting access to reliable information for the self-management of chronic diseases via the internet, and to identify populations facing barriers to using the internet for health, we examined chronic diseases and characteristics associated with online health information seeking and the use of SNSs. Methods: This study used data from the INFORM Study 2020, which was a nationally representative cross-sectional postal mail survey conducted using a self-administered questionnaire in 2020. The dependent variables were online health information seeking and SNS use. Online health information seeking was assessed using 1 question about whether respondents used the internet to find health or medical information. SNS use was assessed by inquiring about the following 4 aspects: visiting SNSs, sharing health information on SNSs, writing in an online diary or blog, and watching a health-related video on YouTube. The independent variables were 8 chronic diseases. Other independent variables were sex, age, education status, work, marital status, household income, health literacy, and self-reported health status. We conducted a multivariable logistic regression model adjusted for all independent variables to examine the associations of chronic diseases and other variables with online health information seeking and SNS use. Results: The final sample for analysis comprised 2481 internet users. Hypertension or high blood pressure, chronic lung diseases, depression or anxiety disorder, and cancer were reported by 24.5\%, 10.1\%, 7.7\%, and 7.2\% of respondents, respectively. The odds ratio of online health information seeking among respondents with cancer was 2.19 (95\% CI 1.47-3.27) compared with that among those without cancer, and the odds ratio among those with depression or anxiety disorder was 2.27 (95\% CI 1.46-3.53) compared with that among those without. Further, the odds ratio for watching a health-related YouTube video among those with chronic lung diseases was 1.42 (95\% CI 1.05-1.93) compared with that among those without these diseases. Women, younger age, higher level of education, and high health literacy were positively associated with online health information seeking and SNS use. Conclusions: For patients with cancer, strategies for promoting access to websites with reliable cancer-related information as well as access among patients with chronic lung diseases to YouTube videos providing reliable information may be beneficial for the management of these diseases. Moreover, it is important to improve the online environment to encourage men, older adults, internet users with lower education levels, and those with low health literacy to access online health information. ", doi="10.2196/44741", url="https://www.jmir.org/2023/1/e44741", url="http://www.ncbi.nlm.nih.gov/pubmed/36862482" } @Article{info:doi/10.2196/38667, author="Brusk, J. John and Bensley, J. Robert", title="COVID-19 Response Resource Engagement and User Characteristics of the Wichealth Web-Based Nutrition Education System: Comparative Cross-sectional Study", journal="JMIR Form Res", year="2023", month="Mar", day="2", volume="7", pages="e38667", keywords="COVID-19", keywords="user engagement", keywords="infodemic", keywords="Women, Infants, and Children", keywords="WIC", keywords="educational resource", keywords="health care", keywords="digital health", keywords="nutrition", keywords="web-based education", keywords="web-based nutrition", keywords="pediatric", keywords="parenting", keywords="dashboard", abstract="Background: In response to the COVID-19 pandemic, Wichealth launched 4 information resources on the site's user landing dashboard page. These resources were used consistently during the period in which they were available (April 1, 2020, through October 31, 2021); however, only 9\% (n=50,888) of Wichealth users eligible for inclusion in the study accessed at least one resource. User engagement with emergency response resources within the context of a web-based health educational tool has not been well investigated due to a paucity of opportunities and a lack of the ability to evaluate relevant users at scale. Objective: This investigation was carried out to understand if user characteristics and behaviors measured by the Wichealth web-based education system are associated with a participant's motivation, or lack thereof, to engage with the added COVID-19 resources. Methods: Sociodemographic characteristics were gathered from Wichealth users with at least one lesson completed and a complete user profile to identify which factors increase the likelihood of user access of any of the Wichealth COVID-19 response resources during the 19-month period between April 1, 2020, and October 31, 2021. A logistic regression analysis was conducted to determine the relative importance of all factors on the likelihood of a user accessing the COVID-19 resources. Results: A total of 50,888 unique Wichealth users included in the study accessed the COVID-19 response resources 66,849 times during the time period. During the same period, 510,939 unique Wichealth users completed at least one lesson about how to engage in healthy behaviors with respect to parent-child feeding but did not access any COVID-19 resources. Therefore, only 9\% of Wichealth users who completed a lesson during the time when COVID-19 response resources were available accessed any of the information in those resources. Users of the Spanish language Wichealth version, older users, those less educated, and users with prior Wichealth lesson engagement demonstrated the greatest likelihood of COVID-19 resource use. Conclusions: This investigation presents findings that demonstrate significant differences between Wichealth users that opted to access COVID-19--specific resources and those who chose not to during their web-based educational session. Reaching users of a web-based educational system with supplemental information may require multiple strategies to increase coverage and ensure the widest possible distribution. ", doi="10.2196/38667", url="https://formative.jmir.org/2023/1/e38667", url="http://www.ncbi.nlm.nih.gov/pubmed/36787232" } @Article{info:doi/10.2196/39507, author="Guan, Jieying and Zhu, Yingting and Hu, Qiuyue and Ma, Shuyue and Mu, Jingfeng and Li, Zhidong and Fang, Dong and Zhuo, Xiaohua and Guan, Haifei and Sun, Qianhui and An, Lin and Zhang, Shaochong and Qin, Peiwu and Zhuo, Yehong", title="Prevalence Patterns and Onset Prediction of High Myopia for Children and Adolescents in Southern China via Real-World Screening Data: Retrospective School-Based Study", journal="J Med Internet Res", year="2023", month="Mar", day="1", volume="25", pages="e39507", keywords="vision screening", keywords="high myopia", keywords="prevalence", keywords="random forest", keywords="children", keywords="adolescents", abstract="Background: Patients with high myopia have an increased lifetime risk of complications. The prevalence patterns of high myopia in children and adolescents in southern China are unclear. Early identification of high-risk individuals is critical for reducing the occurrence and development of high myopia and avoiding the resulting complications. Objective: This study aimed to determine the prevalence of high myopia in children and adolescents in southern China via real-world screening data and to predict its onset by studying the risk factors for high myopia based on machine learning. Methods: This retrospective school-based study was conducted in 13 cities with different gross domestic products in southern China. Through data acquisition and filtering, we analyzed the prevalence of high myopia and its association with age, school stage, gross domestic product, and risk factors. A random forest algorithm was used to predict high myopia among schoolchildren and then assessed in an independent hold-out group. Results: There were 1,285,609 participants (mean age 11.80, SD\thinspace3.07, range 6-20 years), of whom 658,516 (51.2\%) were male. The overall prevalence of high myopia was 4.48\% (2019), 4.88\% (2020), and 3.17\% (2021), with an increasing trend from the age of 11 to 17 years. The rates of high myopia increased from elementary schools to high schools but decreased at all school stages from 2019 to 2021. The coastal and southern cities had a higher proportion of high myopia, with an overall prevalence between 2.60\% and 5.83\%. Age, uncorrected distance visual acuity, and spherical equivalents were predictive factors for high myopia onset in schoolchildren. The random forest algorithm achieved a high accuracy of 0.948. The area under the receiver operator characteristic curve (AUC) was 0.975. Both indicated sufficient model efficacy. The performance of the model was validated in an external test with high accuracy (0.971) and a high AUC (0.957). Conclusions: High myopia had a high incidence in Guangdong Province. Its onset in children and adolescents was well predicted with the random forest algorithm. Efficient use of real-world data can contribute to the prevention and early diagnosis of high myopia. ", doi="10.2196/39507", url="https://www.jmir.org/2023/1/e39507", url="http://www.ncbi.nlm.nih.gov/pubmed/36857115" } @Article{info:doi/10.2196/43019, author="Clement, Edwards Meredith and Lovett, Aish and Caldwell, Sylvia and Beckford, Jeremy and Hilgart, Michelle and Corneli, Amy and Flickinger, Tabor and Dillingham, Rebecca and Ingersoll, Karen", title="Development of an mHealth App to Support the Prevention of Sexually Transmitted Infections Among Black Men Who Have Sex With Men Engaged in Pre-exposure Prophylaxis Care in New Orleans, Louisiana: Qualitative User-Centered Design Study", journal="JMIR Form Res", year="2023", month="Feb", day="27", volume="7", pages="e43019", keywords="pre-exposure prophylaxis", keywords="HIV", keywords="mobile apps", keywords="mobile phone", abstract="Background: Sexual health disparities exist for Black men who have sex with men (BMSM) in New Orleans, Louisiana. Rates of sexually transmitted infections (STIs) are high for both BMSM and those taking HIV pre-exposure prophylaxis (PrEP). Objective: In this study, we introduced an existing PrEP adherence app to new potential users---BMSM engaged in PrEP care in New Orleans---to guide app adaptation with STI prevention features and tailoring for the local context. Methods: Using a user-centered design, we conducted 4 focus group discussions (FGDs), with interim app adaptations from December 2020 to March 2021. During the FGDs, a video of the app, app website, and mock-ups were shown to participants. We asked about facilitators of and barriers to STI prevention in general, current app use, impressions of the existing app, new app features to potentially facilitate STI prevention, and how the app should be tailored for BMSM. We used applied qualitative thematic analysis to identify themes and needs of the population. Results: Overall, 4 FGDs were conducted with 24 BMSM taking PrEP. We grouped themes into 4 categories: STI prevention, current app use and preferences, preexisting features and impressions of the prep'd app, and new features and modifications for BMSM. Participants noted concern about STIs and shared that anxiety about some STIs was higher than that for others; some participants shared that since the emergence of PrEP, little thought is given to STIs. However, participants desired STI prevention strategies and suggested prevention methods to implement through the app, including access to resources, educational content, and sex diaries to follow their sexual activity. When discussing app preferences, they emphasized the need for an app to offer relevant features and be easy to use and expressed that some notifications were important to keep users engaged but that they should be limited to avoid notification fatigue. Participants thought that the current app was useful and generally liked the existing features, including the ability to communicate with providers, staff, and each other through the community forum. They had suggestions for modifications for STI prevention, such as the ability to comment on sexual encounters, and for tailoring to the local context, such as depictions of iconic sights from the area. Mental health emerged as an important need to be addressed through the app during discussion of almost all features. Participants also stressed the importance of ensuring privacy and reducing stigma through the app. Conclusions: A PrEP adherence app was iteratively adapted with feedback from BMSM, resulting in a new app modified for the New Orleans context and with STI prevention features. Participants gave the app a new name, PCheck, to be more discreet. Next steps will assess PCheck use and STI prevention outcomes. ", doi="10.2196/43019", url="https://formative.jmir.org/2023/1/e43019", url="http://www.ncbi.nlm.nih.gov/pubmed/36848209" } @Article{info:doi/10.2196/40552, author="Yang, Le and Wu, Jiadong and Mo, Xiaoxiao and Chen, Yaqin and Huang, Shanshan and Zhou, Linlin and Dai, Jiaqi and Xie, Linna and Chen, Siyu and Shang, Hao and Rao, Beibei and Weng, Bingtao and Abulimiti, Ayiguli and Wu, Siying and Xie, Xiaoxu", title="Changes in Mobile Health Apps Usage Before and After the COVID-19 Outbreak in China: Semilongitudinal Survey", journal="JMIR Public Health Surveill", year="2023", month="Feb", day="22", volume="9", pages="e40552", keywords="application", keywords="China", keywords="COVID-19", keywords="mHealth", keywords="health management", keywords="mobile health", keywords="technology", keywords="app", keywords="survey", keywords="data", keywords="user", keywords="user experience", keywords="vaccination", keywords="download", keywords="healthcare", keywords="development", abstract="Background: Mobile health (mHealth) apps are rapidly emerging technologies in China due to strictly controlled medical needs during the COVID-19 pandemic while continuing essential services for chronic diseases. However, there have been no large-scale, systematic efforts to evaluate relevant apps. Objective: We aim to provide a landscape of mHealth apps in China by describing and comparing digital health concerns before and after the COVID-19 outbreak, including mHealth app data flow and user experience, and analyze the impact of COVID-19 on mHealth apps. Methods: We conducted a semilongitudinal survey of 1593 mHealth apps to study the app data flow and clarify usage changes and influencing factors. We selected mHealth apps in app markets, web pages from the Baidu search engine, the 2018 top 100 hospitals with internet hospitals, and online shopping sites with apps that connect to smart devices. For user?experience, we recruited residents from a community in southeastern China from October 2019 to November 2019 (before the outbreak) and from June 2020 to August 2020 (after the outbreak) comparing the attention of the population to apps. We also examined associations between app characteristics, functions, and outcomes at specific quantiles of distribution in download changes using quantile regression models. Results: Rehabilitation medical support was the top-ranked functionality, with a median 1.44 million downloads per app prepandemic and a median 2.74 million downloads per app postpandemic. Among the top 10 functions postpandemic, 4 were related to maternal and child health: pregnancy preparation (ranked second; fold change 4.13), women's health (ranked fifth; fold change 5.16), pregnancy (ranked sixth; fold change 5.78), and parenting (ranked tenth; fold change 4.03). Quantile regression models showed?that?rehabilitation (P75, P90), pregnancy preparation (P90), bodybuilding (P50, P90), and vaccination (P75) were positively associated with an increase in downloads after the outbreak. In the user experience survey, the attention given to health information (prepandemic: 249/375, 66.4\%; postpandemic: 146/178, 82.0\%; P=.006) steadily increased after the outbreak. Conclusions: mHealth apps are an effective health care approach gaining in popularity among the Chinese population following the COVID-19 outbreak. This research provides direction for subsequent mHealth app development and promotion in the postepidemic era, supporting medical model reformation in China as a reference, which may provide new avenues for designing and evaluating indirect public health interventions such as health education and health promotion. ", doi="10.2196/40552", url="https://publichealth.jmir.org/2023/1/e40552", url="http://www.ncbi.nlm.nih.gov/pubmed/36634256" } @Article{info:doi/10.2196/39992, author="Yamada, Yosuke and Namba, Hideyuki and Date, Heiwa and Kitayama, Shinobu and Nakayama, Yui and Kimura, Misaka and Fujita, Hiroyuki and Miyachi, Motohiko", title="Regional Difference in the Impact of COVID-19 Pandemic on Domain-Specific Physical Activity, Sedentary Behavior, Sleeping Time, and Step Count: Web-Based Cross-sectional Nationwide Survey and Accelerometer-Based Observational Study", journal="JMIR Public Health Surveill", year="2023", month="Feb", day="20", volume="9", pages="e39992", keywords="web-based survey", keywords="social distancing measure", keywords="transportation", keywords="physical activity record system", keywords="physical activity", keywords="sedentary", keywords="sleep", keywords="sleeping time", keywords="COVID-19", keywords="impact", keywords="pandemic", keywords="sleeping pattern", keywords="surveillance", keywords="demographic", keywords="regional", keywords="differences", abstract="Background: Physical activity (PA) and sedentary behavior (SB) have been affected by the COVID-19 pandemic and its restrictive environments, such as social distancing and lockdown measures. However, regional differences in the changes in domain-specific PA and SB in response to the COVID-19 pandemic are not clearly understood. Objective: This study aimed to examine regional differences in domain-specific PA and SB, as well as sleeping time in response to the COVID-19 pandemic in Japan. Methods: A web-based cross-sectional nationwide survey and an accelerometer-based longitudinal observation were conducted. In the web-based survey, we recruited 150 Japanese men and 150 Japanese women for each of the following age groups: 20s, 30s, 40s, 50s, 60s, and 70s (n=1800). A total of 1627 adults provided valid responses to web-based surveillance from June to July 2020. Participants were recruited from urban (Greater Tokyo Area, n=1028), urban-rural (regional core cities, n=459), or rural (regional small and medium cities, n=140) areas. They answered sociodemographic and health-related questions and retrospectively registered the PA data of their average day before and during the COVID-19 pandemic in a web-based PA record system. In the accelerometer-based observation, PA and step count data were obtained using a triaxial accelerometer on people living in urban (n=370) and rural (n=308) areas. Results: Before the COVID-19 pandemic, there were no significant differences between these 3 regions in the time spent sleeping, staying at home, working or studying, and exercising (P>.05). By contrast, people living in urban areas had a longer duration of SB and transportation and a shorter duration of moderate-to-vigorous PA and lying or napping time compared with people living in rural areas (P>.05). During the COVID-19 pandemic, a significant decrease was observed in transportation time in urban (--7.2 min/day, P<.001) and urban-rural (--2.0 min/day, P=.009) areas but not in rural (--0.4 min/day, P=.52) areas. The moderate-to-vigorous PA was decreased in urban (--31.3 min/day, P<.001) and urban-rural (--30.0 min/day, P<.001) areas but not in rural areas (--17.3 min/day, P=.08). A significant increase was observed in time spent sleeping in urban (+22.4 min/day, P<.001) and urban-rural (+24.2 min/day, P<.001) but not in rural areas (+3.9 min/day, P=.74). Lying or napping was increased in urban (+14.9 min/day, P<.001) but not in rural areas (?6.9 min/day, P=.68). PA and step count obtained using an accelerometer significantly decreased in urban (P<.05) but not in rural areas (P>.05). Conclusions: The effect of the COVID-19 pandemic on PA and SB was significantly dependent on living area, even in a single country. The effects of PA and SB were greater in the Greater Tokyo Area and regional core cities but were not observed in regional small and medium cities in Japan. ", doi="10.2196/39992", url="https://publichealth.jmir.org/2023/1/e39992", url="http://www.ncbi.nlm.nih.gov/pubmed/36634262" } @Article{info:doi/10.2196/43541, author="He, Siyi and Li, He and Cao, Maomao and Sun, Dianqin and Yang, Fan and Yan, Xinxin and Zhang, Shaoli and Xia, Changfa and Yu, Yiwen and Zhao, Liang and Shi, Jufang and Li, Ni and Yu, Qin Xue and Chen, Wanqing and He, Jie", title="Geographic, Demographic, and Socioeconomic Disparities and Factors Associated With Cancer Literacy in China: National Cross-sectional Study", journal="JMIR Public Health Surveill", year="2023", month="Feb", day="17", volume="9", pages="e43541", keywords="health literacy", keywords="cancer literacy", keywords="cross-sectional study", keywords="Healthy China Initiative", keywords="cancer control", abstract="Background: Cancer literacy is associated with several health-related behaviors and outcomes. However, there is still a lack of nationwide surveys for cancer literacy in China. Objective: This study aims to evaluate cancer literacy in China, explore disparities, and provide scientific evidence for policy makers. Methods: A cross-sectional survey was conducted in mainland China in 2021 using the multistage probability proportional to the size sampling method. Both the reliability and validity of the questionnaire were evaluated. The awareness levels were adjusted by sampling weights and nonrepresentativeness weights to match the actual population distributions. The Rao-Scott adjusted chi-square test was applied to test geographic, demographic, and socioeconomic disparities. A generalized linear model was used to explore potential factors. Results: A total of 80,281 participants aged 15-74 years were finally enrolled from 21 provinces, with an overall response rate of 89.32\%. The national rate of cancer literacy was 70.05\% (95\% CI 69.52\%-70.58\%). The rates were highest regarding knowledge of cancer management (74.96\%, 95\% CI 74.36\%-75.56\%) but were lowest regarding basic knowledge of cancer (66.77\%, 95\% CI 66.22\%-67.33\%). Cancer literacy was highest in East China (72.65\%, 95\% CI 71.82\%-73.49\%), Central China (71.73\%, 95\% CI 70.65\%-72.81\%), and North China (70.73\%, 95\% CI 68.68\%-72.78\%), followed by Northeast (65.38\%, 95\% CI 64.54\%-66.22\%) and South China (63.21\%, 95\% CI 61.84\%-64.58\%), whereas Southwest (59.00\%, 95\% CI 58.11\%-59.89\%) and Northwest China (57.09\%, 95\% CI 55.79\%-58.38\%) showed a need for improvement. Demographic and socioeconomic disparities were also observed. Urban dwellers, the Han ethnic group, and population with higher education level or household income were associated with prior knowledge. The questionnaire showed generally good internal and external reliability and validity. Conclusions: It remains important for China to regularly monitor levels of cancer literacy, narrow disparities, and strengthen health education for dimensions with poor performance and for individuals with limited knowledge to move closer to the goal of Healthy China 2030. ", doi="10.2196/43541", url="https://publichealth.jmir.org/2023/1/e43541", url="http://www.ncbi.nlm.nih.gov/pubmed/36800218" } @Article{info:doi/10.2196/39146, author="Ling, M. Pamela and Hrywna, Mary and Talbot, M. Eugene and Lewis, Jane M.", title="Tobacco-Derived Nicotine Pouch Brands and Marketing Messages on Internet and Traditional Media: Content Analysis", journal="JMIR Form Res", year="2023", month="Feb", day="15", volume="7", pages="e39146", keywords="nicotine pouch", keywords="marketing", keywords="tobacco industry", keywords="web-based advertising", keywords="advertising", keywords="advertisement", keywords="smoking", keywords="tobacco", keywords="nicotine", keywords="smoker", keywords="addiction", keywords="industry", keywords="industrial", keywords="economic", keywords="economy", keywords="commercial", keywords="commerce", keywords="consumer", abstract="Background: Nicotine pouches and lozenges are increasingly available in the United States, and sales are growing. The brands of nicotine pouch products with the largest market share are produced by tobacco companies. Objective: The aim of this study is to examine the marketing of 5 oral nicotine products sold by tobacco companies. Methods: Internet, radio, television, print, and web-based display advertisements between January 2019 and March 2020 for 6 brands of nicotine pouches and lozenges were identified through commercially available marketing surveillance systems supplemented by a manual search of trade press and a review of brand websites. A total of 711 advertisements (122 unique) were analyzed to identify characteristics, themes, marketing strategies, and target audiences, and qualitatively compared by brand. All 5 brand websites were also analyzed. Coders examined the entirety of each advertisement or website for products, marketing claims, and features and recorded the presence or absence of 27 marketing claims and lifestyle elements. Results: All 6 brands of nicotine pouch products spent a total of US \$11.2 million on advertising in 2019, with the most (US \$10.7 million) spent by the brand Velo, and 86.1\% (n=105) of the unique advertisements were web-based. Of the 711 total nicotine pouch advertisements run in 2019, the 2 brands Velo (n=407, 57\%) and ZYN (n=303, 42\%) dominated. These brands also made the greatest number of advertising claims in general. These claims focused on novelty, modernity, and use in a variety of contexts, including urban contexts, workplaces, transportation, and leisure activities. Of the 122 unique advertisements, ZYN's most common claims were to be ``tobacco-free,'' featuring many flavors or varieties, and modern. Velo was the only brand to include urban contexts (n=14, 38.9\% of advertisements) or freedom (n=8, 22.2\%); Velo advertisements portrayed use in the workplace (n=15, 41.7\%), bars or clubs (n=5, 13.9\%), leisure activities (n=4, 11.1\%), transportation (n=4, 11.1\%), sports (n=3, 8.3\%), cooking (n=2, 5.6\%), and with alcohol (n=1, 2.8\%). Velo and ZYN also included most of the images of people, including women and people of color. The 36 Velo ads included people in advertising in 77.8\% (n=28) of advertisements, and of those advertisements with identifiable people, 40\% (n=4) were young adults and 50\% (n=5) were middle-aged. About one-third (n=11, 35.5\%) of the 31 unique ZYN advertisements included people, and most identifiable models appeared to be young adults. Brands such as Rogue, Revel, Dryft, and on! focused mainly on product features. All nicotine pouch products made either tobacco-free, smoke-free, spit-free, or vape-free claims. The most common claim overall was ``tobacco-free,'' found in advertisements from Rogue (1/1, 100\%), ZYN (30/31, 96.8\%), Velo (19/36, 52.8\%), and Dryft (1/3, 33.3\%), but not Revel. Conclusions: Nicotine pouches and lozenges may expand the nicotine market as tobacco-free claims alleviate concerns about health harms and advertising features a greater diversity of people and contexts than typical smokeless tobacco advertising. The market leaders and highest-spending brands, ZYN and Velo, included more lifestyle claims. Surveillance of nicotine pouch marketing and uptake, including influence on tobacco use behaviors, is necessary. ", doi="10.2196/39146", url="https://formative.jmir.org/2023/1/e39146", url="http://www.ncbi.nlm.nih.gov/pubmed/36790840" } @Article{info:doi/10.2196/42863, author="Lin, Shuo-Yu and Cheng, Xiaolu and Zhang, Jun and Yannam, Sindhu Jaya and Barnes, J. Andrew and Koch, Randy J. and Hayes, Rashelle and Gimm, Gilbert and Zhao, Xiaoquan and Purohit, Hemant and Xue, Hong", title="Social Media Data Mining of Antitobacco Campaign Messages: Machine Learning Analysis of Facebook Posts", journal="J Med Internet Res", year="2023", month="Feb", day="13", volume="25", pages="e42863", keywords="tobacco control", keywords="social media campaign", keywords="content analysis", keywords="natural language processing", keywords="topic modeling", keywords="social media", keywords="public health", keywords="tobacco", keywords="youth", keywords="Facebook", keywords="engagement", keywords="use", keywords="smoking", abstract="Background: Social media platforms provide a valuable source of public health information, as one-third of US adults seek specific health information online. Many antitobacco campaigns have recognized such trends among youth and have shifted their advertising time and effort toward digital platforms. Timely evidence is needed to inform the adaptation of antitobacco campaigns to changing social media platforms. Objective: In this study, we conducted a content analysis of major antitobacco campaigns on Facebook using machine learning and natural language processing (NLP) methods, as well as a traditional approach, to investigate the factors that may influence effective antismoking information dissemination and user engagement. Methods: We collected 3515 posts and 28,125 associated comments from 7 large national and local antitobacco campaigns on Facebook between 2018 and 2021, including the Real Cost, Truth, CDC Tobacco Free (formally known as Tips from Former Smokers, where ``CDC'' refers to the Centers for Disease Control and Prevention), the Tobacco Prevention Toolkit, Behind the Haze VA, the Campaign for Tobacco-Free Kids, and Smoke Free US campaigns. NLP methods were used for content analysis, including parsimonious rule--based models for sentiment analysis and topic modeling. Logistic regression models were fitted to examine the relationship of antismoking message-framing strategies and viewer responses and engagement. Results: We found that large campaigns from government and nonprofit organizations had more user engagements compared to local and smaller campaigns. Facebook users were more likely to engage in negatively framed campaign posts. Negative posts tended to receive more negative comments (odds ratio [OR] 1.40, 95\% CI 1.20-1.65). Positively framed posts generated more negative comments (OR 1.41, 95\% CI 1.19-1.66) as well as positive comments (OR 1.29, 95\% CI 1.13-1.48). Our content analysis and topic modeling uncovered that the most popular campaign posts tended to be informational (ie, providing new information), where the key phrases included talking about harmful chemicals (n=43, 43\%) as well as the risk to pets (n=17, 17\%). Conclusions: Facebook users tend to engage more in antitobacco educational campaigns that are framed negatively. The most popular campaign posts are those providing new information, with key phrases and topics discussing harmful chemicals and risks of secondhand smoke for pets. Educational campaign designers can use such insights to increase the reach of antismoking campaigns and promote behavioral changes. ", doi="10.2196/42863", url="https://www.jmir.org/2023/1/e42863", url="http://www.ncbi.nlm.nih.gov/pubmed/36780224" } @Article{info:doi/10.2196/38371, author="Kishore, Kamal and Jaswal, Vidushi and Pandey, Kumar Anuj and Verma, Madhur and Koushal, Vipin", title="Utility of the Comprehensive Health and Stringency Indexes in Evaluating Government Responses for Containing the Spread of COVID-19 in India: Ecological Time-Series Study", journal="JMIR Public Health Surveill", year="2023", month="Feb", day="10", volume="9", pages="e38371", keywords="COVID-19", keywords="government response", keywords="nonpharmaceutical interventions", keywords="lockdown", keywords="Comprehensive Health Index", keywords="Stringency Index", keywords="time-series modeling", keywords="ARIMA", keywords="SARIMA", keywords="Oxford COVID-19 Government Response Tracker", keywords="public health", keywords="surveillance", keywords="Oxford tracker", keywords="ecological study", keywords="health data", keywords="health policy", keywords="Bayesian information criteria", abstract="Background: Many nations swiftly designed and executed government policies to contain the rapid rise in COVID-19 cases. Government actions can be broadly segmented as movement and mass gathering restrictions (such as travel restrictions and lockdown), public awareness (such as face covering and hand washing), emergency health care investment, and social welfare provisions (such as poor welfare schemes to distribute food and shelter). The Blavatnik School of Government, University of Oxford, tracked various policy initiatives by governments across the globe and released them as composite indices. We assessed the overall government response using the Oxford Comprehensive Health Index (CHI) and Stringency Index (SI) to combat the COVID-19 pandemic. Objective: This study aims to demonstrate the utility of CHI and SI to gauge and evaluate the government responses for containing the spread of COVID-19. We expect a significant inverse relationship between policy indices (CHI and SI) and COVID-19 severity indices (morbidity and mortality). Methods: In this ecological study, we analyzed data from 2 publicly available data sources released between March 2020 and October 2021: the Oxford Covid-19 Government Response Tracker and the World Health Organization. We used autoregressive integrated moving average (ARIMA) and seasonal ARIMA to model the data. The performance of different models was assessed using a combination of evaluation criteria: adjusted R2, root mean square error, and Bayesian information criteria. Results: implementation of policies by the government to contain the COVID-19 crises resulted in higher CHI and SI in the beginning. Although the value of CHI and SI gradually fell, they were consistently higher at values of >80\% points. During the initial investigation, we found that cases per million (CPM) and deaths per million (DPM) followed the same trend. However, the final CPM and DPM models were seasonal ARIMA (3,2,1)(1,0,1) and ARIMA (1,1,1), respectively. This study does not support the hypothesis that COVID-19 severity (CPM and DPM) is associated with stringent policy measures (CHI and SI). Conclusions: Our study concludes that the policy measures (CHI and SI) do not explain the change in epidemiological indicators (CPM and DPM). The study reiterates our understanding that strict policies do not necessarily lead to better compliance but may overwhelm the overstretched physical health systems. Twenty-first--century problems thus demand 21st-century solutions. The digital ecosystem was instrumental in the timely collection, curation, cloud storage, and data communication. Thus, digital epidemiology can and should be successfully integrated into existing surveillance systems for better disease monitoring, management, and evaluation. ", doi="10.2196/38371", url="https://publichealth.jmir.org/2023/1/e38371", url="http://www.ncbi.nlm.nih.gov/pubmed/36395334" } @Article{info:doi/10.2196/39097, author="Riley, Victoria and Gidlow, Christopher and Fedorowicz, Sophia and Lagord, Catherine and Thompson, Katherine and Woolner, Joshua and Taylor, Rosie and Clark, Jade and Lloyd-Harris, Andrew", title="The Impact and Perception of England's Web-Based Heart Age Test of Cardiovascular Disease Risk: Mixed Methods Study", journal="JMIR Cardio", year="2023", month="Feb", day="6", volume="7", pages="e39097", keywords="heart age", keywords="cardiovascular disease", keywords="CVD prevention", keywords="web-based risk assessment", keywords="CVD risk", keywords="qualitative research", keywords="cross-sectional design", keywords="cardiology", keywords="risk assessment", keywords="cardiovascular risk", keywords="heart health", keywords="user perception", keywords="risk knowledge", keywords="engagement", keywords="web-based", abstract="Background: It is well documented that individuals struggle to understand cardiovascular disease (CVD) percentage risk scores, which led to the development of heart age as a means of communicating risk. Developed for clinical use, its application in raising public awareness of heart health as part of a self-directed digital test has not been considered previously. Objective: This study aimed to understand who accesses England's heart age test (HAT) and its effect on user perception, knowledge, and understanding of CVD risk; future behavior intentions; and potential engagement with primary care services. Methods: There were 3 sources of data: routinely gathered data on all individuals accessing the HAT (February 2015 to June 2020); web-based survey, distributed between January 2021 and March 2021; and interviews with a subsample of survey respondents (February 2021 to March 2021). Data were used to describe the test user population and explore knowledge and understanding of CVD risk, confidence in interpreting and controlling CVD risk, and effect on future behavior intentions and potential engagement with primary care. Interviews were analyzed using reflexive thematic analysis. Results: Between February 2015 and June 2020, the HAT was completed approximately 5 million times, with more completions by men (2,682,544/4,898,532, 54.76\%), those aged between 50 to 59 years (1,334,195/4,898,532, 27.24\%), those from White ethnic background (3,972,293/4,898,532, 81.09\%), and those living in the least deprived 20\% of areas (707,747/4,898,532, 14.45\%). The study concluded with 819 survey responses and 33 semistructured interviews. Participants stated that they understood the meaning of high estimated heart age and self-reported at least some improvement in the understanding and confidence in understanding and controlling CVD risk. Negative emotional responses were provoked among users when estimated heart age did not equate to their previous risk perceptions. The limited information needed to complete it or the production of a result when physiological risk factor information was missing (ie, blood pressure and cholesterol level) led some users to question the credibility of the test. However, most participants who were interviewed mentioned that they would recommend or had already recommended the test to others, would use it again in the future, and would be more likely to take up the offer of a National Health Service Health Check and self-reported that they had made or intended to make changes to their health behavior or felt encouraged to continue to make changes to their health behavior. Conclusions: England's web-based HAT has engaged large number of people in their heart health. Improvements to England's HAT, noted in this paper, may enhance user satisfaction and prevent confusion. Future studies to understand the long-term benefit of the test on behavioral outcomes are warranted. ", doi="10.2196/39097", url="https://cardio.jmir.org/2023/1/e39097", url="http://www.ncbi.nlm.nih.gov/pubmed/36745500" } @Article{info:doi/10.2196/40156, author="Myneni, Sahiti and Cuccaro, Paula and Montgomery, Sarah and Pakanati, Vivek and Tang, Jinni and Singh, Tavleen and Dominguez, Olivia and Cohen, Trevor and Reininger, Belinda and Savas, S. Lara and Fernandez, E. Maria", title="Lessons Learned From Interdisciplinary Efforts to Combat COVID-19 Misinformation: Development of Agile Integrative Methods From Behavioral Science, Data Science, and Implementation Science", journal="JMIR Infodemiology", year="2023", month="Feb", day="3", volume="3", pages="e40156", keywords="COVID-19", keywords="misinformation", keywords="social media", keywords="health belief model", keywords="deep learning", keywords="community engagement", abstract="Background: Despite increasing awareness about and advances in addressing social media misinformation, the free flow of false COVID-19 information has continued, affecting individuals' preventive behaviors, including masking, testing, and vaccine uptake. Objective: In this paper, we describe our multidisciplinary efforts with a specific focus on methods to (1) gather community needs, (2) develop interventions, and (3) conduct large-scale agile and rapid community assessments to examine and combat COVID-19 misinformation. Methods: We used the Intervention Mapping framework to perform community needs assessment and develop theory-informed interventions. To supplement these rapid and responsive efforts through large-scale online social listening, we developed a novel methodological framework, comprising qualitative inquiry, computational methods, and quantitative network models to analyze publicly available social media data sets to model content-specific misinformation dynamics and guide content tailoring efforts. As part of community needs assessment, we conducted 11 semistructured interviews, 4 listening sessions, and 3 focus groups with community scientists. Further, we used our data repository with 416,927 COVID-19 social media posts to gather information diffusion patterns through digital channels. Results: Our results from community needs assessment revealed the complex intertwining of personal, cultural, and social influences of misinformation on individual behaviors and engagement. Our social media interventions resulted in limited community engagement and indicated the need for consumer advocacy and influencer recruitment. The linking of theoretical constructs underlying health behaviors to COVID-19--related social media interactions through semantic and syntactic features using our computational models has revealed frequent interaction typologies in factual and misleading COVID-19 posts and indicated significant differences in network metrics such as degree. The performance of our deep learning classifiers was reasonable, with an F-measure of 0.80 for speech acts and 0.81 for behavior constructs. Conclusions: Our study highlights the strengths of community-based field studies and emphasizes the utility of large-scale social media data sets in enabling rapid intervention tailoring to adapt grassroots community interventions to thwart misinformation seeding and spread among minority communities. Implications for consumer advocacy, data governance, and industry incentives are discussed for the sustainable role of social media solutions in public health. ", doi="10.2196/40156", url="https://infodemiology.jmir.org/2023/1/e40156", url="http://www.ncbi.nlm.nih.gov/pubmed/37113378" } @Article{info:doi/10.2196/41762, author="Brewer, R. Hannah and Hirst, Yasemin and Chadeau-Hyam, Marc and Johnson, Eric and Sundar, Sudha and Flanagan, M. James", title="Association Between Purchase of Over-the-Counter Medications and Ovarian Cancer Diagnosis in the Cancer Loyalty Card Study (CLOCS): Observational Case-Control Study", journal="JMIR Public Health Surveill", year="2023", month="Jan", day="26", volume="9", pages="e41762", keywords="ovarian cancer", keywords="early diagnosis", keywords="transactional data", keywords="health informatics", keywords="cancer risk", keywords="medication", keywords="self-medication", keywords="self-care", keywords="over-the-counter medication", keywords="nonspecific symptoms", keywords="pain medication", keywords="indigestion medication", abstract="Background: Over-the-counter (OTC) medications are frequently used to self-care for nonspecific ovarian cancer symptoms prior to diagnosis. Monitoring such purchases may provide an opportunity for earlier diagnosis. Objective: The aim of the Cancer Loyalty Card Study (CLOCS) was to investigate purchases of OTC pain and indigestion medications prior to ovarian cancer diagnosis in women with and without ovarian cancer in the United Kingdom using loyalty card data. Methods: An observational case-control study was performed comparing purchases of OTC pain and indigestion medications prior to diagnosis in women with (n=153) and without (n=120) ovarian cancer using loyalty card data from two UK-based high street retailers. Monthly purchases of pain and indigestion medications for cases and controls were compared using the Fisher exact test, conditional logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: Pain and indigestion medication purchases were increased among cases 8 months before diagnosis, with maximum discrimination between cases and controls 8 months before diagnosis (Fisher exact odds ratio [OR] 2.9, 95\% CI 2.1-4.1). An increase in indigestion medication purchases was detected up to 9 months before diagnosis (adjusted conditional logistic regression OR 1.38, 95\% CI 1.04-1.83). The ROC analysis for indigestion medication purchases showed a maximum area under the curve (AUC) at 13 months before diagnosis (AUC=0.65, 95\% CI 0.57-0.73), which further improved when stratified to late-stage ovarian cancer (AUC=0.68, 95\% CI 0.59-0.78). Conclusions: There is a difference in purchases of pain and indigestion medications among women with and without ovarian cancer up to 8 months before diagnosis. Facilitating earlier presentation among those who self-care for symptoms using this novel data source could improve ovarian cancer patients' options for treatment and improve survival. Trial Registration: ClinicalTrials.gov NCT03994653; https://clinicaltrials.gov/ct2/show/NCT03994653 ", doi="10.2196/41762", url="https://publichealth.jmir.org/2023/1/e41762", url="http://www.ncbi.nlm.nih.gov/pubmed/36701184" } @Article{info:doi/10.2196/43639, author="Kittipimpanon, Kamonrat and Noyudom, Angun and Panjatharakul, Pawanrat and Visudtibhan, Janepanish Poolsuk", title="Use of and Satisfaction With Mobile Health Education During the COVID-19 Pandemic in Thailand: Cross-sectional Study", journal="JMIR Form Res", year="2023", month="Jan", day="24", volume="7", pages="e43639", keywords="mHealth", keywords="COVID-19", keywords="chatbot", keywords="use", keywords="satisfaction", abstract="Background: RamaCovid is a mobile health (mHealth) education system that provides the Thai population with information about COVID-19 and self-risk assessment. RamaCovid has a chatbot system that provides automatic conversations (available 24 hours per day) and a live chat function that allows users to directly communicate with health professionals (available 4 hours per day in the evening). The system consists of (1) COVID-19 vaccine information, (2) self-care after vaccination, (3) frequently asked questions, (4) self-risk assessment, (5) hospital finding, (6) contact number finding, and (7) live chat with a health professional. Objective: This study investigates the use of and satisfaction with the RamaCovid system. Methods: Overall, 400 people were recruited via RamaCovid by broadcasting an infographic about the study. Questionnaires collected demographic data, users' experiences of RamaCovid, and the use of and satisfaction with the system. The questions were answered using a 5-point Likert scale. Descriptive statistics were used to describe the participant characteristics and their use of and satisfaction with the RamaCovid system. The Mann-Whitney U test was performed to examine the difference in use and satisfaction between the adult and older adult groups. Results: The participants showed high use of and satisfaction with the RamaCovid system. They used the information to take care of themselves and their family, and they gained information about their COVID-19 risk. The users were satisfied with the system because the information was easy to understand, trustworthy, and up to date. However, the older adult group had lower use of and satisfaction with the system compared to the adult group. Conclusions: RamaCovid is an example of the successful implementation of mHealth education. It was an alternative way to work with the call center during the COVID-19 pandemic and increased access to health information and health care services. Providing ongoing updated information, improving the attractiveness of the media information, and the age group difference are important issues for further system development. ", doi="10.2196/43639", url="https://formative.jmir.org/2023/1/e43639", url="http://www.ncbi.nlm.nih.gov/pubmed/36596210" } @Article{info:doi/10.2196/35748, author="Park, G. Linda and Meyer, L. Oanh and Dougan, M. Marcelle and Golden, Bethany and Ta, Kevin and Nam, Bora and Tsoh, Y. Janice and Tzuang, Marian and Park, Ta Van M.", title="Social Support and Technology Use and Their Association With Mental and Physical Health During the COVID-19 Pandemic Among Asian Americans: The COMPASS Cross-sectional Study", journal="JMIR Public Health Surveill", year="2023", month="Jan", day="23", volume="9", pages="e35748", keywords="health disparities", keywords="mental health", keywords="depression", keywords="anxiety", keywords="social support technology", keywords="COVID-19", keywords="pandemic", keywords="disparity", keywords="support", keywords="technology", keywords="physical health", keywords="race", keywords="survey", keywords="population", keywords="discrimination", keywords="outcome", keywords="AAPI", abstract="Background: The global COVID-19 pandemic disproportionately affected Asian Americans and Pacific Islanders (AAPIs) and revealed significant health disparities with reports of increased discrimination and xenophobia. Among AAPIs, the pandemic exacerbated their social, linguistic, and geographic isolation. Social support may be especially important for AAPIs given the salience of collectivism as a cultural value. Another mechanism for support among AAPIs was technology use, as it is generally widespread among this population. However, older adults may not perceive the same benefits. Objective: We examined social support and technology use and their relationships with mental and physical health outcomes through the COVID-19 pandemic among AAPIs. Methods: Data were drawn from the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) for the time period of October 2020 to February 2021. COMPASS was a cross-sectional, multilingual, national survey conducted online, by phone, and in person with AAPI adults who were ?18 years of age, in collaboration with academic and community partners in the United States. Data were analyzed using multivariable linear regression using the outcome variables of mental and physical health with various predictors such as social support and technology use. We tested for interactions specific to age and ethnicity. Results: Among 4631 AAPIs (mean age 45.9, SD 16.3 years; 2992/4631, 63.1\% female), we found that (1) increased social support was associated with better physical health, (2) total social support was positively associated with better mental health, (3) higher technology use was associated with poorer mental health and inversely associated with poorer physical health, (4) the association of technology use with mental health was weaker among those with low social support (vs those with high social support), (5) adults younger than 60 years old (vs ?60 years old) were more negatively affected with social support and mental health, and (6) Korean Americans appeared to be a high-risk group for poor physical health with increased technology use. Conclusions: Our paper identified mental and physical health needs along with supportive therapies observed among AAPIs during the pandemic. Future research on how social support can be leveraged, especially among AAPIs younger than 60 years old, and how various types of technology are being utilized are important to guide the recovery efforts to address both mental and physical disparities across communities as a result of the COVID-19 pandemic. ", doi="10.2196/35748", url="https://publichealth.jmir.org/2023/1/e35748", url="http://www.ncbi.nlm.nih.gov/pubmed/36395324" } @Article{info:doi/10.2196/35713, author="Zhou, Yuyin and Cheng, Feng and Xu, Junfang", title="Vulnerability to HIV Infection Among International Immigrants in China: Cross-sectional Web-Based Survey", journal="JMIR Public Health Surveill", year="2023", month="Jan", day="10", volume="9", pages="e35713", keywords="international immigrants", keywords="HIV", keywords="risky sexual behavior", keywords="China", abstract="Background: The rising number of migrants worldwide, including in China given its recent rapid economic development, poses a challenge for the public health system to prevent infectious diseases, including sexually transmitted infections (STIs) caused by risky sexual behaviors. Objective: The aim of this study was to explore the risky sexual behaviors of international immigrants living in China to provide evidence for establishment of a localized public health service system. Methods: Risky sexual behaviors were divided into multiple sexual partners and unprotected sexual behaviors. Basic characteristics, sexual knowledge, and behaviors of international immigrants were summarized with descriptive statistics. Multivariate logistic regression analyses were used to identify factors associated with risky sexual behaviors, and the associations of demographic characteristics and risk behaviors with HIV testing and intention to test for HIV. Results: In total, 1433 international immigrants were included in the study, 61.76\% (n=885) of whom had never heard of STIs, and the mean HIV knowledge score was 5.42 (SD 2.138). Overall, 8.23\% (118/1433) of the participants had been diagnosed with an STI. Among the 1433 international immigrants, 292 indicated that they never use a condom for homosexual sex, followed by sex with a stable partner (n=252), commercial sex (n=236), group sex (n=175), and casual sex (n=137). In addition, 119 of the international immigrants had more than three sex partners. Individuals aged 31-40 years were more likely to have multiple sexual partners (adjusted odds ratio [AOR] 2.364, 95\% CI 1.149-4.862). Married participants were more likely to have unprotected sexual behaviors (AOR 3.096, 95\% CI --1.705 to 5.620), whereas Asians were less likely to have multiple sexual partners (AOR 0.446, 95\% CI 0.328-0.607) and unprotected sexual behaviors (AOR 0.328, 95\% CI 0.219-0.492). Women were more likely to have taken an HIV test than men (AOR 1.413, 95\% CI 1.085-1.841). Those who were married (AOR 0.577, 95\% CI 0.372-0.894), with an annual disposable income >150,000 yuan ({\textasciitilde}US \$22,000; AOR 0.661, 95\% CI 0.439-0.995), considered it impossible to become infected with HIV (AOR 0.564, 95\% CI 0.327-0.972), and of Asian ethnicity (AOR 0.330, 95\% CI 0.261-0.417) were less likely to have an HIV test. People who had multiple sexual partners were more likely to have taken an HIV test (AOR 2.041, 95\% CI 1.442-2.890) and had greater intention to test for HIV (AOR 1.651, 95\% CI 1.208-2.258). Conclusions: International immigrants in China exhibit risky sexual behaviors, especially those aged over 30 years. In addition, the level of HIV-related knowledge is generally low. Therefore, health interventions such as targeted, tailored programming including education and testing are urgently needed to prevent new HIV infections and transmission among international immigrants and the local population. ", doi="10.2196/35713", url="https://publichealth.jmir.org/2023/1/e35713", url="http://www.ncbi.nlm.nih.gov/pubmed/36626224" } @Article{info:doi/10.2196/38922, author="Miyaji, Atsuko and Watanabe, Kaname and Takano, Yuuki and Nakasho, Kazuhisa and Nakamura, Sho and Wang, Yuntao and Narimatsu, Hiroto", title="A Privacy-Preserving Distributed Medical Data Integration Security System for Accuracy Assessment of Cancer Screening: Development Study of Novel Data Integration System", journal="JMIR Med Inform", year="2022", month="Dec", day="30", volume="10", number="12", pages="e38922", keywords="data linkage", keywords="data security", keywords="secure data integration", keywords="privacy-preserving linkage", keywords="secure matching privacy-preserving linkage", keywords="private set intersection", keywords="PSI", keywords="privacy-preserving distributed data integration", keywords="PDDI", keywords="big data", keywords="medical informatics", keywords="cancer prevention", keywords="cancer epidemiology", keywords="epidemiological survey", abstract="Background: Big data useful for epidemiological research can be obtained by integrating data corresponding to individuals between databases managed by different institutions. Privacy information must be protected while performing efficient, high-level data matching. Objective: Privacy-preserving distributed data integration (PDDI) enables data matching between multiple databases without moving privacy information; however, its actual implementation requires matching security, accuracy, and performance. Moreover, identifying the optimal data item in the absence of a unique matching key is necessary. We aimed to conduct a basic matching experiment using a model to assess the accuracy of cancer screening. Methods: To experiment with actual data, we created a data set mimicking the cancer screening and registration data in Japan and conducted a matching experiment using a PDDI system between geographically distant institutions. Errors similar to those found empirically in data sets recorded in Japanese were artificially introduced into the data set. The matching-key error rate of the data common to both data sets was set sufficiently higher than expected in the actual database: 85.0\% and 59.0\% for the data simulating colorectal and breast cancers, respectively. Various combinations of name, gender, date of birth, and address were used for the matching key. To evaluate the matching accuracy, the matching sensitivity and specificity were calculated based on the number of cancer-screening data points, and the effect of matching accuracy on the sensitivity and specificity of cancer screening was estimated based on the obtained values. To evaluate the performance, we measured central processing unit use, memory use, and network traffic. Results: For combinations with a specificity ?99\% and high sensitivity, the date of birth and first name were used in the data simulating colorectal cancer, and the matching sensitivity and specificity were 55.00\% and 99.85\%, respectively. In the data simulating breast cancer, the date of birth and family name were used, and the matching sensitivity and specificity were 88.71\% and 99.98\%, respectively. Assuming the sensitivity and specificity of cancer screening at 90\%, the apparent values decreased to 74.90\% and 89.93\%, respectively. A trial calculation was performed using a combination with the same data set and 100\% specificity. When the matching sensitivity was 82.26\%, the apparent screening sensitivity was maintained at 90\%, and the screening specificity decreased to 89.89\%. For 214 data points, the execution time was 82 minutes and 26 seconds without parallelization and 11 minutes and 38 seconds with parallelization; 19.33\% of the calculation time was for the data-holding institutions. Memory use was 3.4 GB for the PDDI server and 2.7 GB for the data-holding institutions. Conclusions: We demonstrated the rudimentary feasibility of introducing a PDDI system for cancer-screening accuracy assessment. We plan to conduct matching experiments based on actual data and compare them with the existing methods. ", doi="10.2196/38922", url="https://medinform.jmir.org/2022/12/e38922", url="http://www.ncbi.nlm.nih.gov/pubmed/36583931" } @Article{info:doi/10.2196/40150, author="Yeh, Teresa Ping and Kennedy, Elizabeth Caitlin and Minamitani, Ayako and Baggaley, Rachel and Shah, Purvi and Verster, Annette and Luhmann, Niklas and de Mello, Brito Maeve and Macdonald, Virginia", title="Web-Based Service Provision of HIV, Viral Hepatitis, and Sexually Transmitted Infection Prevention, Testing, Linkage, and Treatment for Key Populations: Systematic Review and Meta-analysis", journal="J Med Internet Res", year="2022", month="Dec", day="22", volume="24", number="12", pages="e40150", keywords="online service delivery", keywords="digital health interventions", keywords="HIV", keywords="viral hepatitis", keywords="sexually transmitted infections", keywords="key populations", keywords="systematic review", keywords="mobile phone", abstract="Background: Despite the growth of web-based interventions for HIV, viral hepatitis (VH), and sexually transmitted infections (STIs) for key populations, the evidence for the effectiveness of these interventions has not been reported. Objective: This study aimed to inform the World Health Organization guidelines for HIV, VH, and STI prevention, diagnosis, and treatment services for key populations by systematically reviewing the effectiveness, values and preferences, and costs of web-based outreach, web-based case management, and targeted web-based health information for key populations (men who have sex with men, sex workers, people who inject drugs, trans and gender-diverse people, and people in prisons and other closed settings). Methods: We searched CINAHL, PsycINFO, PubMed, and Embase in May 2021 for peer-reviewed studies; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials (RCTs) and observational studies. We assessed the risk of bias using the Cochrane Collaboration tool for RCTs and the Evidence Project and Risk of Bias in Non-randomized Studies of Interventions tools for non-RCTs. Values and preferences and cost data were summarized descriptively. Results: Of 2711 records identified, we included 13 (0.48\%) articles in the effectiveness review (3/13, 23\% for web-based outreach; 7/13, 54\% for web-based case management; and 3/13, 23\% for targeted web-based health information), 15 (0.55\%) articles in the values and preferences review, and 1 (0.04\%) article in the costs review. Nearly all studies were conducted among men who have sex with men in the United States. These articles provided evidence that web-based approaches are as effective as face-to-face services in terms of reaching new people, use of HIV, VH, and STI prevention services, and linkage to and retention in HIV care. A meta-analysis of 2 RCTs among men who have sex with men in China found increased HIV testing after web-based outreach (relative risk 1.39, 95\% CI 1.21-1.60). Among men who have sex with men in the United States, such interventions were considered feasible and acceptable. One cost study among Canadian men who have sex with men found that syphilis testing campaign advertisements had the lowest cost-per-click ratio on hookup platforms compared with more traditional social media platforms. Conclusions: Web-based services for HIV, VH, and STIs may be a feasible and acceptable approach to expanding services to key populations with similar outcomes as standard of care, but more research is needed in low-resource settings, among key populations other than men who have sex with men, and for infections other than HIV (ie, VH and STIs). ", doi="10.2196/40150", url="https://www.jmir.org/2022/12/e40150", url="http://www.ncbi.nlm.nih.gov/pubmed/36548036" } @Article{info:doi/10.2196/42179, author="de Vere Hunt, Isabella and Linos, Eleni", title="Social Media for Public Health: Framework for Social Media--Based Public Health Campaigns", journal="J Med Internet Res", year="2022", month="Dec", day="14", volume="24", number="12", pages="e42179", keywords="social media", keywords="digital heath", keywords="health communication", keywords="campaign", keywords="public health", keywords="framework", keywords="health promotion", keywords="public awareness", keywords="misinformation", keywords="tailored message", keywords="tailored messaging", keywords="information sharing", keywords="information exchange", keywords="advertise", keywords="advertising", doi="10.2196/42179", url="https://www.jmir.org/2022/12/e42179", url="http://www.ncbi.nlm.nih.gov/pubmed/36515995" } @Article{info:doi/10.2196/42619, author="Taira, Kazuya and Itaya, Takahiro and Fujita, Sumio", title="Predicting Smoking Prevalence in Japan Using Search Volumes in an Internet Search Engine: Infodemiology Study", journal="J Med Internet Res", year="2022", month="Dec", day="14", volume="24", number="12", pages="e42619", keywords="health policy", keywords="internet use", keywords="quality indicators", keywords="search engine", keywords="smoking", keywords="tobacco use", keywords="public health", keywords="infodemiology", keywords="smoking trend", keywords="health indicator", keywords="health promotion", abstract="Background: Tobacco smoking is an important public health issue and a core indicator of public health policy worldwide. However, global pandemics and natural disasters have prevented surveys from being conducted. Objective: The purpose of this study was to predict smoking prevalence by prefecture and sex in Japan using Internet search trends. Methods: This study used the infodemiology approach. The outcome variable was smoking prevalence by prefecture, obtained from national surveys. The predictor variables were the search volumes on Yahoo! Japan Search. We collected the search volumes for queries related to terms from the thesaurus of the Japanese medical article database Ichu-shi. Predictor variables were converted to per capita values and standardized as z scores. For smoking prevalence, the values for 2016 and 2019 were used, and for search volume, the values for the April 1 to March 31 fiscal year (FY) 1 year prior to the survey (ie, FY 2015 and FY 2018) were used. Partial correlation coefficients, adjusted for data year, were calculated between smoking prevalence and search volume, and a regression analysis using a generalized linear mixed model with random effects was conducted for each prefecture. Several models were tested, including a model that included all search queries, a variable reduction method, and one that excluded cigarette product names. The best model was selected with the Akaike information criterion corrected (AICC) for small sample size and the Bayesian information criterion (BIC). We compared the predicted and actual smoking prevalence in 2016 and 2019 based on the best model and predicted the smoking prevalence in 2022. Results: The partial correlation coefficients for men showed that 9 search queries had significant correlations with smoking prevalence, including cigarette (r=--0.417, P<.001), cigar in kanji (r=--0.412, P<.001), and cigar in katakana (r=-0.399, P<.001). For women, five search queries had significant correlations, including vape (r=0.335, P=.001), quitting smoking (r=0.288, P=.005), and cigar (r=0.286, P=.006). The models with all search queries were the best models for both AICC and BIC scores. Scatter plots of actual and estimated smoking prevalence in 2016 and 2019 confirmed a relatively high degree of agreement. The average estimated smoking prevalence in 2022 in the 47 prefectures for the total sample was 23.492\% (95\% CI 21.617\%-25.367\%), showing an increasing trend, with an average of 29.024\% (95\% CI 27.218\%-30.830\%) for men and 8.793\% (95\% CI 7.531\%-10.054\%) for women. Conclusions: This study suggests that the search volume of tobacco-related queries in internet search engines can predict smoking prevalence by prefecture and sex in Japan. These findings will enable the development of low-cost, timely, and crisis-resistant health indicators that will enable the evaluation of health measures and contribute to improved public health. ", doi="10.2196/42619", url="https://www.jmir.org/2022/12/e42619", url="http://www.ncbi.nlm.nih.gov/pubmed/36515993" } @Article{info:doi/10.2196/39340, author="Li, Chuqin and Jordan, Alexis and Song, Jun and Ge, Yaorong and Park, Albert", title="A Novel Approach to Characterize State-level Food Environment and Predict Obesity Rate Using Social Media Data: Correlational Study", journal="J Med Internet Res", year="2022", month="Dec", day="13", volume="24", number="12", pages="e39340", keywords="obesity", keywords="social media", keywords="machine learning", keywords="lifestyle", keywords="environment", keywords="food", keywords="correlation", keywords="modeling", keywords="predict", keywords="rates", keywords="outcome", keywords="category", keywords="dishes", keywords="popular", keywords="mobile phone", abstract="Background: Community obesity outcomes can reflect the food environment to which the community belongs. Recent studies have suggested that the local food environment can be measured by the degree of food accessibility, and survey data are normally used to calculate food accessibility. However, compared with survey data, social media data are organic, continuously updated, and cheaper to collect. Objective: The objective of our study was to use publicly available social media data to learn the relationship between food environment and obesity rates at the state level. Methods: To characterize the caloric information of the local food environment, we used food categories from Yelp and collected caloric information from MyFitnessPal for each category based on their popular dishes. We then calculated the average calories for each category and created a weighted score for each state. We also calculated 2 other dimensions from the concept of access, acceptability and affordability, to build obesity prediction models. Results: The local food environment characterized using only publicly available social media data had a statistically significant correlation with the state obesity rate. We achieved a Pearson correlation of 0.796 between the predicted obesity rate and the reported obesity rate from the Behavioral Risk Factor Surveillance System across US states and the District of Columbia. The model with 3 generated feature sets achieved the best performance. Conclusions: Our study proposed a method for characterizing state-level food environments only using continuously updated social media data. State-level food environments were accurately described using social media data, and the model also showed a disparity in the available food between states with different obesity rates. The proposed method should elastically apply to local food environments of different sizes and predict obesity rates effectively. ", doi="10.2196/39340", url="https://www.jmir.org/2022/12/e39340", url="http://www.ncbi.nlm.nih.gov/pubmed/36512396" } @Article{info:doi/10.2196/40370, author="Huang, Junjie and Pang, Sze Wing and Wong, Yan Yuet and Mak, Yu Fung and Chan, W. Florence S. and Cheung, K. Clement S. and Wong, Nam Wing and Cheung, Tseung Ngai and Wong, S. Martin C.", title="Factors Associated With the Acceptance of an eHealth App for Electronic Health Record Sharing System: Population-Based Study", journal="J Med Internet Res", year="2022", month="Dec", day="12", volume="24", number="12", pages="e40370", keywords="digital health", keywords="eHealth", keywords="electronic health record", keywords="system", keywords="mobile app", keywords="app", keywords="public", keywords="private", keywords="community", keywords="caregiver", keywords="awareness", keywords="perception", keywords="improvement", keywords="utility", keywords="technology", keywords="model", keywords="health information", abstract="Background: In the second stage of the Electronic Health Record Sharing System (eHRSS) development, a mobile app (eHealth app) was launched to further enhance collaborative care among the public sector, the private sector, the community, and the caregivers. Objective: This study aims to investigate the factors associated with the downloading and utilization of the app, as well as the awareness, perception, and future improvement of the app. Methods: We collected 2110 surveys; respondents were stratified into 3 groups according to their status of enrollment in the eHRSS. The primary outcome measure was the downloading and acceptance of the eHealth app. We collected the data on social economics factors, variables of the Technology Acceptance Model and Theory of Planned Behavior. Any factors identified as significant in the univariate analysis (P<.20) will be included in a subsequent multivariable regression analysis model. All P values ?.05 will be considered statistically significant in multiple logistic regression analysis. The structural equation modeling was performed to identify interactions among the variables. Results: The respondents had an overall high satisfaction rate and a positive attitude toward continuing to adopt and recommend the app. However, the satisfaction rate among respondents who have downloaded but not adopted the app was relatively lower, and few of them perceived that the downloading and acceptance processes are difficult. A high proportion of current users expressed a positive attitude about continuing to adopt and recommend the app to friends, colleagues, and family members. The behavioral intention strongly predicted the acceptance of the eHealth app ($\beta$=.89; P<.001). Attitude ($\beta$=.30; P<.001) and perceived norm; $\beta$=.37; P<.001) played important roles in determining behavioral intention, which could predict the downloading and acceptance of the eHealth app ($\beta$=.14; P<.001). Conclusions: Despite the high satisfaction rate among the respondents, privacy concerns and perceived difficulties in adopting the app were the major challenges of promoting eHealth. Further promotion could be made through doctors and publicity. For future improvement, comprehensive health records and tailored health information should be included. ", doi="10.2196/40370", url="https://www.jmir.org/2022/12/e40370", url="http://www.ncbi.nlm.nih.gov/pubmed/36382349" } @Article{info:doi/10.2196/34809, author="Chen, Huilong and Zhan, Yuan and Zhang, Jinxiang and Cheng, Sheng and Zhou, Yuhao and Chen, Liyuan and Zeng, Zhilin", title="The Global, Regional, and National Burden and Trends of NAFLD in 204 Countries and Territories: An Analysis From Global Burden of Disease 2019", journal="JMIR Public Health Surveill", year="2022", month="Dec", day="12", volume="8", number="12", pages="e34809", keywords="non-alcoholic fatty liver disease", keywords="Global Burden of Disease Study 2019", keywords="epidemiologic change", keywords="diabetes mellitus type 2", keywords="stroke", keywords="ischemic heart disease", keywords="incidence", keywords="prevalence", keywords="mortality", keywords="disability-adjusted life-years", abstract="Background: Nonalcoholic fatty liver disease (NAFLD) poses a substantial socioeconomic burden and is becoming the fastest growing driver of chronic liver disease, potentially accompanied by a poor prognosis. Objective: We aim to elucidate the global and regional epidemiologic changes in NAFLD during the past 30 years and explore the interconnected diseases. Methods: Data on NAFLD incidence, prevalence, death, and disability-adjusted life-years (DALYs) were extracted from the Global Burden of Disease Study 2019. The age-standardized incident rate (ASIR), age-standardized prevalent rate (ASPR), age-standardized death rate (ASDR), and age-standardized DALYs were calculated to eliminate the confounding effects of age when comparing the epidemiologic changes between different geographical regions. In addition, we also investigated the correlation between the NAFLD burden and the sociodemographic index (SDI). Finally, the associations of the 3 common comorbidities with NAFLD were determined. Results: Globally, the incidence and prevalence of NAFLD both increased drastically during the past 3 decades (incidence: from 88,180 in 1990 to 172,330 in 2019, prevalence: from 561,370,000 in 1990 to 1,235,700,000 in 2019), mainly affecting young adults who were aged from 15 to 49 years. The ASIR increased slightly from 1.94 per 100,000 population in 1990 to 2.08 per 100,000 population in 2019, while ASPR increased from 12,070 per 100,000 population in 1990 to 15,020 per 100,000 population in 2019. In addition, the number of deaths and DALYs attributable to NAFLD increased significantly as well from 93,760 in 1990 to 168,970 in 2019 and from 2,711,270 in 1990 to 4,417,280 in 2019, respectively. However, the ASDR and age-standardized DALYs presented decreasing trends with values of estimated annual percentage change equaling to --0.67 and --0.82, respectively (ASDR: from 2.39 per 100,000 population in 1990 to 2.09 per 100,000 population in 2019; age-standardized DALYs: from 63.28 per 100,000 population in 1990 to 53.33 per 100,000 population in 2019). Thereinto, the burden of death and DALYs dominated the patients with NAFLD who are older than 50 years. Moreover, SDI appeared to have obvious negative associations with ASPR, ASDR, and age-standardized DALYs among 21 regions and 204 countries, although there is no marked association with ASIR. Finally, we found that the incidence and prevalence of NAFLD were positively related to those of diabetes mellitus type 2, stroke, and ischemic heart disease. Conclusions: NAFLD is leading to increasingly serious health challenges worldwide. The morbidity presented a clear shift toward the young populations, while the heavier burden of death and DALYs in NAFLD was observed in the aged populations and in regions with relatively low SDI. Comprehensive acquisition of the epidemiologic pattern for NAFLD and the identification of high-risk comorbidities may help policy makers and clinical physicians develop cost-effective prevention and control strategies, especially in countries with a high NAFLD burden. ", doi="10.2196/34809", url="https://publichealth.jmir.org/2022/12/e34809", url="http://www.ncbi.nlm.nih.gov/pubmed/36508249" } @Article{info:doi/10.2196/40302, author="Zhang, Zhan and Vaghefi, Isaac", title="Continued Use of Contact-Tracing Apps in the United States and the United Kingdom: Insights From a Comparative Study Through the Lens of the Health Belief Model", journal="JMIR Form Res", year="2022", month="Dec", day="8", volume="6", number="12", pages="e40302", keywords="contact tracing", keywords="app adoption", keywords="app continued use", keywords="public attitudes", keywords="health belief model", keywords="COVID-19", abstract="Background: To contain the spread of SARS-CoV-2, contact-tracing (CT) mobile apps were developed and deployed to identify and notify individuals who have exposure to the virus. However, the effectiveness of these apps depends not only on their adoption by the general population but also on their continued use in the long term. Limited research has investigated the facilitators of and barriers to the continued use of CT apps. Objective: In this study, we aimed to examine factors influencing the continued use intentions of CT apps based on the health belief model. In addition, we investigated the differences between users and nonusers and between the US and UK populations. Methods: We administered a survey in the United States and the United Kingdom. Respondents included individuals who had previously used CT technologies and those without experience. We used the structural equation modeling technique to validate the proposed research model and hypotheses. Results: Analysis of data collected from 362 individuals showed that perceived benefits, self-efficacy, perceived severity, perceived susceptibility, and cues to action positively predicted the continued use intentions of CT apps, while perceived barriers could reduce them. We observed few differences between the US and UK groups; the only exception was the effect of COVID-19 threat susceptibility, which was significant for the UK group but not for the US group. Finally, we found that the only significant difference between users and nonusers was related to perceived barriers, which may not influence nonusers' continued use intentions but significantly reduce experienced users' intentions. Conclusions: Our findings have implications for technological design and policy. These insights can potentially help governments, technology companies, and media outlets to create strategies and policies to promote app adoption for new users and sustain continued use for existing users in the long run. ", doi="10.2196/40302", url="https://formative.jmir.org/2022/12/e40302", url="http://www.ncbi.nlm.nih.gov/pubmed/36351080" } @Article{info:doi/10.2196/37669, author="Cauchi, Paul John and Borg, Maria-Louise and D?iugyt?, Au{\vs}ra and Attard, Jessica and Melillo, Tanya and Zahra, Graziella and Barbara, Christopher and Spiteri, Michael and Drago, Allan and Zammit, Luke and Debono, Joseph and Souness, Jorgen and Agius, Steve and Young, Sharon and Dimech, Alan and Chetcuti, Ian and Camenzuli, Mark and Borg, Ivan and Calleja, Neville and Tabone, Lorraine and Gauci, Charmaine and Vassallo, Pauline and Baruch, Joaquin", title="Digitalizing and Upgrading Severe Acute Respiratory Infections Surveillance in Malta: System Development", journal="JMIR Public Health Surveill", year="2022", month="Dec", day="5", volume="8", number="12", pages="e37669", keywords="surveillance", keywords="public health", keywords="epidemiology", keywords="COVID-19", keywords="disease prevention", keywords="disease surveillance", keywords="digital health", keywords="health system", keywords="pandemic", keywords="public hospital", keywords="patient data", keywords="health data", keywords="electronic record", keywords="monitoring", abstract="Background: In late 2020, the European Centre for Disease Prevention and Control and Epiconcept started implementing a surveillance system for severe acute respiratory infections (SARI) across Europe. Objective: We sought to describe the process of digitizing and upgrading SARI surveillance in Malta, an island country with a centralized health system, during the COVID-19 pandemic from February to November 2021. We described the characteristics of people included in the surveillance system and compared different SARI case definitions, including their advantages and disadvantages. This study also discusses the process, output, and future for SARI and other public health surveillance opportunities. Methods: Malta has one main public hospital where, on admission, patient data are entered into electronic records as free text. Symptoms and comorbidities are manually extracted from these records, whereas other data are collected from registers. Collected data are formatted to produce weekly and monthly reports to inform public health actions. From October 2020 to February 2021, we established an analogue incidence-based system for SARI surveillance. From February 2021 onward, we mapped key stakeholders and digitized most surveillance processes. Results: By November 30, 2021, 903 SARI cases were reported, with 380 (42.1\%) positive for SARS-CoV-2. Of all SARI hospitalizations, 69 (7.6\%) were admitted to the intensive care unit, 769 (85.2\%) were discharged, 27 (3\%) are still being treated, and 107 (11.8\%) died. Among the 107 patients who died, 96 (89.7\%) had more than one underlying condition, the most common of which were hypertension (n=57, 53.3\%) and chronic heart disease (n=49, 45.8\%). Conclusions: The implementation of enhanced SARI surveillance in Malta was completed by the end of May 2021, allowing the monitoring of SARI incidence and patient characteristics. A future shift to register-based surveillance should improve SARI detection through automated processes. ", doi="10.2196/37669", url="https://publichealth.jmir.org/2022/12/e37669", url="http://www.ncbi.nlm.nih.gov/pubmed/36227157" } @Article{info:doi/10.2196/42241, author="Tang, Qihang and Zhou, Runtao and Xie, Zidian and Li, Dongmei", title="Monitoring and Identifying Emerging e-Cigarette Brands and Flavors on Twitter: Observational Study", journal="JMIR Form Res", year="2022", month="Dec", day="5", volume="6", number="12", pages="e42241", keywords="e-cigarettes", keywords="brand", keywords="flavor", keywords="Twitter", abstract="Background: Flavored electronic cigarettes (e-cigarettes) have become very popular in recent years. e-Cigarette users like to share their e-cigarette products and e-cigarette use (vaping) experiences on social media. e-Cigarette marketing and promotions are also prevalent online. Objective: This study aims to develop a method to identify new e-cigarette brands and flavors mentioned on Twitter and to monitor e-cigarette brands and flavors mentioned on Twitter from May 2021 to December 2021. Methods: We collected 1.9 million tweets related to e-cigarettes between May 3, 2021, and December 31, 2021, by using the Twitter streaming application programming interface. Commercial and noncommercial tweets were characterized based on promotion-related keywords. We developed a depletion method to identify new e-cigarette brands by removing the keywords that already existed in the reference data set (Twitter data related to e-cigarettes from May 3, 2021, to August 31, 2021) or our previously identified brand list from the keywords in the target data set (e-cigarette--related Twitter data from September 1, 2021, to December 31, 2021), followed by a manual Google search to identify new e-cigarette brands. To identify new e-cigarette flavors, we constructed a flavor keyword list based on our previously collected e-cigarette flavor names, which were used to identify potential tweet segments that contain at least one of the e-cigarette flavor keywords. Tweets or tweet segments with flavor keywords but not any known flavor names were marked as potential new flavor candidates, which were further verified by a web-based search. The longitudinal trends in the number of tweets mentioning e-cigarette brands and flavors were examined in both commercial and noncommercial tweets. Results: Through our developed methods, we identified 34 new e-cigarette brands and 97 new e-cigarette flavors from commercial tweets as well as 56 new e-cigarette brands and 164 new e-cigarette flavors from noncommercial tweets. The longitudinal trend of the e-cigarette brands showed that JUUL was the most popular e-cigarette brand mentioned on Twitter; however, there was a decreasing trend in the mention of JUUL over time on Twitter. Menthol flavor was the most popular e-cigarette flavor mentioned in the commercial tweets, whereas mango flavor was the most popular e-cigarette flavor mentioned in the noncommercial tweets during our study period. Conclusions: Our proposed methods can successfully identify new e-cigarette brands and flavors mentioned on Twitter. Twitter data can be used for monitoring the dynamic changes in the popularity of e-cigarette brands and flavors. ", doi="10.2196/42241", url="https://formative.jmir.org/2022/12/e42241", url="http://www.ncbi.nlm.nih.gov/pubmed/36469415" } @Article{info:doi/10.2196/40341, author="Ngiam, Wen Nerice Heng and Yee, Qi Wan and Teo, Nigel and Yow, Shing Ka and Soundararajan, Amrish and Lim, Xin Jie and Lim, A. Haikel and Tey, Angeline and Tang, Aaron Kai Wen and Tham, Xin Celine Yi and Tan, Ying Jamaica Pei and Lu, Yinn Si and Yoon, Sungwon and Ng, Yi Kennedy Yao and Low, Leng Lian", title="Building Digital Literacy in Older Adults of Low Socioeconomic Status in Singapore (Project Wire Up): Nonrandomized Controlled Trial", journal="J Med Internet Res", year="2022", month="Dec", day="2", volume="24", number="12", pages="e40341", keywords="digital literacy", keywords="health determinants", keywords="COVID-19 pandemic", keywords="social distancing", keywords="older adults", keywords="loneliness", keywords="social connectedness", keywords="quality of life", keywords="well-being", keywords="digital inclusivity", keywords="web-based", keywords="information and communication technology", abstract="Background: In a rapidly digitalizing world, the inability of older adults to leverage digital technology has been associated with weaker social connections and poorer health outcomes. Despite the widespread digital adoption in Singapore, older adults, especially those of lower socioeconomic status (SES), still face difficulties in adopting information and communications technology and are typically digitally excluded. Objective: We aimed to examine the impact of the volunteer-led, one-on-one, and home-based digital literacy program on digital literacy and health-related outcomes such as self-reported loneliness, social connectedness, quality of life, and well-being for older adults of low SES. Methods: A nonrandomized controlled study was carried out in Singapore between July 2020 and November 2021 involving 138 digitally excluded community-dwelling older adults aged ?55 years and of lower SES. Older adults awaiting participation in the program served as controls. Older adults under the intervention were equipped with a smartphone and cellular data, underwent fortnightly to monthly digital literacy training with volunteers to learn digital skills, and digitally connected to their existing social networks. Primary outcome was the improvement in self-reported digital literacy. Secondary outcomes included improvements in University of California, Los Angeles 3-item loneliness scale, Lubben Social Network Scale-6, EQ-5D-3L and EQ visual analogue scale scores, and Personal Wellbeing Score. Results: There were significant improvements in digital literacy scores in the intervention group as compared to controls (mean difference 2.28, 95\% CI 1.37-3.20; P<.001). Through multiple linear regression analyses, this difference in digital literacy scores remained independently associated with group membership after adjusting for differences in baseline scores, age, gender, education, living arrangement, housing type, and baseline social connectivity and loneliness status. There was no statistically significant difference in University of California, Los Angeles 3-item loneliness scale, Lubben Social Network Scale-6, Personal Wellbeing Score, or EQ-5D Utility and visual analogue scale score. Conclusions: This study adds to the growing research on digital inclusion by showing that a volunteer-led, one-on-one, and home-based digital literacy program contributed to increase digital literacy in older adults of low SES. Future studies should look into developing more older adult--friendly digital spaces and technology design to encourage continued digital adoption in older adults and, eventually, impact health-related outcomes. ", doi="10.2196/40341", url="https://www.jmir.org/2022/12/e40341", url="http://www.ncbi.nlm.nih.gov/pubmed/36459398" } @Article{info:doi/10.2196/41785, author="Galimov, Artur and Vassey, Julia and Galstyan, Ellen and Unger, B. Jennifer and Kirkpatrick, G. Matthew and Allem, Jon-Patrick", title="Ice Flavor--Related Discussions on Twitter: Content Analysis", journal="J Med Internet Res", year="2022", month="Nov", day="30", volume="24", number="11", pages="e41785", keywords="electronic cigarettes", keywords="Twitter", keywords="social media", keywords="ice flavors", keywords="tobacco policy", keywords="public health", keywords="infodemiology", keywords="FDA", keywords="tobacco", keywords="smoking", keywords="vaping", keywords="e-cigarette", keywords="public", abstract="Background: The US Food and Drug Administration (FDA) recently restricted characterizing flavors in tobacco products. As a result, ice hybrid--flavored e-cigarettes, which combine a cooling flavor with fruit or other flavors (eg, banana ice), emerged on the market. Like menthol, ice-flavored e-cigarettes produce a cooling sensory experience. It is unclear if ice hybrid--flavored e-cigarettes should be considered characterizing flavors or menthol, limiting regulatory action. Monitoring the public's conversations about ice-flavored e-cigarettes on Twitter may help inform the tobacco control community about these products and contribute to the US FDA policy targets in the future. Objective: This study documented the themes pertaining to vaping and ice flavor--related conversations on Twitter. Our goal was to identify key conversation trends and ascertain users' recent experiences with ice-flavored e-cigarette products. Methods: Posts containing vaping-related (eg, ``vape,'' ``ecig,'' ``e-juice,'' or ``e-cigarette'') and ice-related (ie, ``Ice,'' ``Cool,'' ``Frost,'' and ``Arctic'') terms were collected from Twitter's streaming application programming interface from January 1 to July 21, 2021. After removing retweets, a random sample of posts (N=2001) was selected, with 590 posts included in the content analysis. Themes were developed through an inductive approach. Theme co-occurrence was also examined. Results: Many of the 590 posts were marked as (or consisted of) marketing material (n=306, 51.9\%), contained positive personal testimonials (n=180, 30.5\%), and mentioned disposable pods (n=117, 19.8\%). Other themes had relatively low prevalence in the sample: neutral personal testimonials (n=45, 7.6\%), cannabidiol products (n=41, 7\%), negative personal testimonials (n=41, 7\%), ``official'' flavor description (n=37, 6.3\%), ice-flavored JUUL (n=19, 3.2\%), information seeking (n=14, 2.4\%), and comparison to combustible tobacco (n=10, 1.7\%). The most common co-occurring themes in a single tweet were related to marketing and disposable pods (n=73, 12.4\%). Conclusions: Our findings offer insight into the public's experience with and understanding of ice-flavored e-cigarette products. Ice-flavored e-cigarette products are actively marketed on Twitter, and the messages about them are positive. Public health education campaigns on the harms of flavored e-cigarettes may help to reduce positive social norms about ice-flavored products. Future studies should evaluate the relationship between exposure to personal testimonials of ice-flavored vaping products and curiosity, harm perceptions, and experimentation with these products among priority populations. ", doi="10.2196/41785", url="https://www.jmir.org/2022/11/e41785", url="http://www.ncbi.nlm.nih.gov/pubmed/36449326" } @Article{info:doi/10.2196/40380, author="Takats, Courtney and Kwan, Amy and Wormer, Rachel and Goldman, Dari and Jones, E. Heidi and Romero, Diana", title="Ethical and Methodological Considerations of Twitter Data for Public Health Research: Systematic Review", journal="J Med Internet Res", year="2022", month="Nov", day="29", volume="24", number="11", pages="e40380", keywords="systematic review", keywords="Twitter", keywords="social media", keywords="public health ethics", keywords="public health", keywords="ethics", keywords="ethical considerations", keywords="public health research", keywords="research topics", keywords="Twitter data", keywords="ethical framework", keywords="research ethics", abstract="Background: Much research is being carried out using publicly available Twitter data in the field of public health, but the types of research questions that these data are being used to answer and the extent to which these projects require ethical oversight are not clear. Objective: This review describes the current state of public health research using Twitter data in terms of methods and research questions, geographic focus, and ethical considerations including obtaining informed consent from Twitter handlers. Methods: We implemented a systematic review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of articles published between January 2006 and October 31, 2019, using Twitter data in secondary analyses for public health research, which were found using standardized search criteria on SocINDEX, PsycINFO, and PubMed. Studies were excluded when using Twitter for primary data collection, such as for study recruitment or as part of a dissemination intervention. Results: We identified 367 articles that met eligibility criteria. Infectious disease (n=80, 22\%) and substance use (n=66, 18\%) were the most common topics for these studies, and sentiment mining (n=227, 62\%), surveillance (n=224, 61\%), and thematic exploration (n=217, 59\%) were the most common methodologies employed. Approximately one-third of articles had a global or worldwide geographic focus; another one-third focused on the United States. The majority (n=222, 60\%) of articles used a native Twitter application programming interface, and a significant amount of the remainder (n=102, 28\%) used a third-party application programming interface. Only one-third (n=119, 32\%) of studies sought ethical approval from an institutional review board, while 17\% of them (n=62) included identifying information on Twitter users or tweets and 36\% of them (n=131) attempted to anonymize identifiers. Most studies (n=272, 79\%) included a discussion on the validity of the measures and reliability of coding (70\% for interreliability of human coding and 70\% for computer algorithm checks), but less attention was paid to the sampling frame, and what underlying population the sample represented. Conclusions: Twitter data may be useful in public health research, given its access to publicly available information. However, studies should exercise greater caution in considering the data sources, accession method, and external validity of the sampling frame. Further, an ethical framework is necessary to help guide future research in this area, especially when individual, identifiable Twitter users and tweets are shared and discussed. Trial Registration: PROSPERO CRD42020148170; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=148170 ", doi="10.2196/40380", url="https://www.jmir.org/2022/11/e40380", url="http://www.ncbi.nlm.nih.gov/pubmed/36445739" } @Article{info:doi/10.2196/37016, author="Chen, Sisi and Ren, Feng and Huang, Xiaojie and Xu, Ling and Gao, Yao and Zhang, Xiangying and Cao, Yaling and Fan, Zihao and Tian, Yuan and Liu, Mei", title="Underestimated Prevalence of HIV, Hepatitis B Virus (HBV), and Hepatitis D Virus (HDV) Triple Infection Globally: Systematic Review and Meta-analysis", journal="JMIR Public Health Surveill", year="2022", month="Nov", day="29", volume="8", number="11", pages="e37016", keywords="HIV", keywords="HBV", keywords="HDV", keywords="triple infection", keywords="epidemiology", keywords="public health", abstract="Background: Hepatitis delta virus (HDV) is a satellite RNA virus that relies on hepatitis B virus (HBV) for transmission. HIV/HBV/HDV coinfection or triple infection is common and has a worse prognosis than monoinfection. Objective: We aimed to reveal the epidemiological characteristics of HIV/HBV/HDV triple infection in the global population. Methods: A systematic literature search in PubMed, Embase, and the Cochrane Library was performed for studies of the prevalence of HIV/HBV/HDV triple infection published from January 1, 1990, to May 31, 2021. The Der Simonian-Laird random effects model was used to calculate the pooled prevalence. Results: We included 14 studies with 11,852 participants. The pooled triple infection rate in the global population was 7.4\% (877/11,852; 95\% CI 0.73\%-29.59\%). The results of the subgroup analysis showed that the prevalence of triple infection was significantly higher in the Asian population (214/986, 21.4\%; 95\% CI 7.1\%-35.8\%), in men (212/5579, 3.8\%; 95\% CI 2.5\%-5.2\%), and in men who have sex with men (216/2734, 7.9\%; 95\% CI 4.3\%-11.4\%). In addition, compared with people living with HIV, the HIV/HBV/HDV triple infection rate was higher in people with hepatitis B. Conclusions: This meta-analysis suggests that the prevalence of HIV/HBV/HDV triple infection in the global population is underestimated, and we should focus more effort on the prevention and control of HIV/HBV/HDV triple infection. Trial Registration: PROSPERO CRD42021273949; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=273949 ", doi="10.2196/37016", url="https://publichealth.jmir.org/2022/11/e37016", url="http://www.ncbi.nlm.nih.gov/pubmed/36445732" } @Article{info:doi/10.2196/40089, author="Aisyah, Nur Dewi and Manikam, Logan and Kiasatina, Thifal and Naman, Maryan and Adisasmito, Wiku and Kozlakidis, Zisis", title="The Use of a Health Compliance Monitoring System During the COVID-19 Pandemic in Indonesia: Evaluation Study", journal="JMIR Public Health Surveill", year="2022", month="Nov", day="22", volume="8", number="11", pages="e40089", keywords="COVID-19, public health informatics", keywords="behavioral change", keywords="digital health", keywords="public health policy", keywords="monitoring", keywords="Asia", keywords="mask", keywords="social distance", keywords="mobile app", keywords="app", keywords="transmission", keywords="policy", keywords="health compliance", abstract="Background: COVID-19 cases are soaring in Asia. Indonesia, Southeast Asia's most populous country, is now ranked second in the number of cases and deaths in Asia, after India. The compliance toward mask wearing, social distancing, and hand washing needs to be monitored to assess public behavioral changes that can reduce transmission. Objective: This study aimed to evaluate this compliance in Indonesia between October 2020 and May 2021 and demonstrate the use of the Bersatu Lawan COVID-19 (BLC) mobile app in monitoring this compliance. Methods: Data were collected in real time by the BLC app from reports submitted by personnel of military services, police officers, and behavioral change ambassadors. Subsequently, the data were analyzed automatically by the system managed by the Indonesia National Task Force for the Acceleration of COVID-19 Mitigation. Results: Between October 1, 2020, and May 2, 2021, the BLC app generated more than 165 million reports, with 469 million people monitored and 124,315,568 locations under observation in 514 districts/cities in 34 provinces in Indonesia. This paper grouped them into 4 colored zones, based on the degree of compliance, and analyzed variations among regions and locations. Conclusions: Compliance rates vary among the 34 provinces and among the districts and cities of those provinces. However, compliance to mask wearing seems slightly higher than social distancing. This finding suggests that policy makers need to promote higher compliance in other measures, including social distancing and hand washing, whose efficacies have been proven to break the chain of transmission when combined with masks wearing. ", doi="10.2196/40089", url="https://publichealth.jmir.org/2022/11/e40089", url="http://www.ncbi.nlm.nih.gov/pubmed/36219836" } @Article{info:doi/10.2196/40764, author="Xue, Haoning and Zhang, Jingwen and Sagae, Kenji and Nishimine, Brian and Fukuoka, Yoshimi", title="Analyzing Public Conversations About Heart Disease and Heart Health on Facebook From 2016 to 2021: Retrospective Observational Study Applying Latent Dirichlet Allocation Topic Modeling", journal="JMIR Cardio", year="2022", month="Nov", day="22", volume="6", number="2", pages="e40764", keywords="heart health", keywords="heart disease", keywords="topic modeling", keywords="sentiment analysis", keywords="social media", keywords="Facebook", keywords="COVID-19", keywords="women's heart health", abstract="Background: Heart disease continues to be the leading cause of death in men and women in the United States. The COVID-19 pandemic has further led to increases in various long-term cardiovascular complications. Objective: This study analyzed public conversations related to heart disease and heart health on Facebook in terms of their thematic topics and sentiments. In addition, it provided in-depth analyses of 2 subtopics with important practical implications: heart health for women and heart health during the COVID-19 pandemic. Methods: We collected 34,885 posts and 51,835 comments spanning from June 2016 to June 2021 that were related to heart disease and health from public Facebook pages and groups. We used latent Dirichlet allocation topic modeling to extract discussion topics illuminating the public's interests and concerns regarding heart disease and heart health. We also used Linguistic Inquiry and Word Count (Pennebaker Conglomerates, Inc) to identify public sentiments regarding heart health. Results: We observed an increase in discussions related to heart health on Facebook. Posts and comments increased from 3102 and 3632 in 2016 to 8550 (176\% increase) and 14,617 (302\% increase) in 2021, respectively. Overall, 35.37\% (12,340/34,885) of the posts were created after January 2020, the start of the COVID-19 pandemic. In total, 39.21\% (13,677/34,885) of the posts were by nonprofit health organizations. We identified 6 topics in the posts (heart health promotion, personal experiences, risk-reduction education, heart health promotion for women, educational information, and physicians' live discussion sessions). We identified 6 topics in the comments (personal experiences, survivor stories, risk reduction, religion, medical questions, and appreciation of physicians and information on heart health). During the pandemic (from January 2020 to June 2021), risk reduction was a major topic in both posts and comments. Unverified information on alternative treatments and promotional content was also prevalent. Among all posts, 14.91\% (5200/34,885) were specifically about heart health for women centering on local event promotion and distinctive symptoms of heart diseases for women. Conclusions: Our results tracked the public's ongoing discussions on heart disease and heart health on one prominent social media platform, Facebook. The public's discussions and information sharing on heart health increased over time, especially since the start of the COVID-19 pandemic. Various levels of health organizations on Facebook actively promoted heart health information and engaged a large number of users. Facebook presents opportunities for more targeted heart health interventions that can reach and engage diverse populations. ", doi="10.2196/40764", url="https://cardio.jmir.org/2022/2/e40764", url="http://www.ncbi.nlm.nih.gov/pubmed/36318640" } @Article{info:doi/10.2196/40996, author="Wong, Sze Ngai and Kwan, Ho Tsz and Chan, C. Denise P. and Lui, Y. Grace C. and Lee, Shan Shui", title="Regular Testing of HIV and Sexually Transmitted Infections With Self-Collected Samples From Multiple Anatomic Sites to Monitor Sexual Health in Men Who Have Sex With Men: Longitudinal Study", journal="JMIR Form Res", year="2022", month="Nov", day="18", volume="6", number="11", pages="e40996", keywords="HIV testing", keywords="STI testing", keywords="self-sampling", keywords="internet-based testing", keywords="men who have sex with men", keywords="HIV", keywords="monitoring", keywords="sex", keywords="infection", keywords="prevention", keywords="community", keywords="engagement", keywords="cohort study", keywords="testing", abstract="Background: Regular HIV and sexually transmitted infection (STI) testing for men who have sex with men (MSM) is an important means of infection prevention, the adoption of which remains suboptimal in the community. Objective: On the hypothesis that engagement plays an important role in sexual health monitoring, this study aimed to pilot-test internet-based HIV and STI testing with self-sampling to enhance engagement of MSM with regular testing. Methods: This 1-year cohort study was conducted on HIV-negative MSM aged 18 years or older. A designated website was set up to enable participants to make appointments for baseline and follow-up visits at 3-monthly intervals. On-site blood sampling was performed for HIV and syphilis tests, along with self-collection of pharyngeal swabs, rectal swabs, and urine samples for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing. Full engagement, as defined by having made at least 3 visits over a 6-12 months' follow-up period, was compared with partial engagement in the bivariable logistic regression model. Results: Between August 2019 and October 2020, 204 MSM were recruited, after the exclusion of 2 baseline HIV-positive MSM. The majority (189/204, 92.7\%) were Chinese, the median age was 31 (IQR 26-39) years, and 58.0\% (116/200) had experience with pre-exposure prophylaxis (PrEP) at baseline. Full engagement (146/204, 71.6\%) was associated with incident STI during the follow-ups (odds ratio [OR] 4.23, 95\% CI 1.63-10.94), seeking a medical referral after STI detection (OR 10.25, 95\% CI 3.25-29.79), and a synchronized schedule of HIV and STI testing with PrEP visits (OR 51.85, 95\% CI 19.30-139.34). No incident HIV was detected in the follow-up period. At baseline, the overall STI (CT, NG, or syphilis) prevalence was 30\%, with CT at 18\%, NG at 13\%, and syphilis at 5\%. During follow-up, the incidences were 59.08/100 person-years (py) for any STI, 33.05/100 py for CT, 29.86/100 py for NG, and 10.4/100 py for syphilis. The detection rates of CT and NG in urine samples were lower than with pharyngeal swabs and rectal swabs. The scores for convenience, confidence of correct sampling, and accuracy of self-sampling were high (7 to 8 out of 10). Conclusions: Both baseline prevalence and incidence of STI were high among MSM engaged in regular testing. A high degree of engagement in regular STI and HIV testing was positively associated with incident STI, history of health-seeking behaviors, and perceived convenience of self-sampling. Self-sampling could be introduced as a means of enhancing engagement in regular HIV and STI testing. ", doi="10.2196/40996", url="https://formative.jmir.org/2022/11/e40996", url="http://www.ncbi.nlm.nih.gov/pubmed/36399372" } @Article{info:doi/10.2196/39571, author="Yoon, Young Ho and You, Han Kyung and Kwon, Hye Jung and Kim, Sun Jung and Rha, Young Sun and Chang, Jung Yoon and Lee, Sang-Cheol", title="Understanding the Social Mechanism of Cancer Misinformation Spread on YouTube and Lessons Learned: Infodemiological Study", journal="J Med Internet Res", year="2022", month="Nov", day="14", volume="24", number="11", pages="e39571", keywords="cancer misinformation", keywords="social media health misinformation", keywords="fenbendazole", keywords="self-administration", keywords="complex contagion", keywords="YouTube", keywords="social media factual information delivery strategy", abstract="Background: A knowledge gap exists between the list of required actions and the action plan for countering cancer misinformation on social media. Little attention has been paid to a social media strategy for disseminating factual information while also disrupting misinformation on social media networks. Objective: The aim of this study was to, first, identify the spread structure of cancer misinformation on YouTube. We asked the question, ``How do YouTube videos play an important role in spreading information about the self-administration of anthelmintics for dogs as a cancer medicine for humans?'' Second, the study aimed to suggest an action strategy for disrupting misinformation diffusion on YouTube by exploiting the network logic of YouTube information flow and the recommendation system. We asked the question, ``What would be a feasible and effective strategy to block cancer misinformation diffusion on YouTube?'' Methods: The study used the YouTube case of the self-administration of anthelmintics for dogs as an alternative cancer medicine in South Korea. We gathered Korean YouTube videos about the self-administration of fenbendazole. Using the YouTube application programming interface for the query ``fenbendazole,'' 702 videos from 227 channels were compiled. Then, videos with at least 50,000 views, uploaded between September 2019 and September 2020, were selected from the collection, resulting in 90 videos. Finally, 10 recommended videos for each of the 90 videos were compiled, totaling 573 videos. Social network visualization for the recommended videos was used to identify three intervention strategies for disrupting the YouTube misinformation network. Results: The study found evidence of complex contagion by human and machine recommendation systems. By exposing stakeholders to multiple information sources on fenbendazole self-administration and by linking them through a recommendation algorithm, YouTube has become the perfect infrastructure for reinforcing the belief that fenbendazole can cure cancer, despite government warnings about the risks and dangers of self-administration. Conclusions: Health authorities should upload pertinent information through multiple channels and should exploit the existing YouTube recommendation algorithm to disrupt the misinformation network. Considering the viewing habits of patients and caregivers, the direct use of YouTube hospital channels is more effective than the indirect use of YouTube news media channels or government channels that report public announcements and statements. Reinforcing through multiple channels is the key. ", doi="10.2196/39571", url="https://www.jmir.org/2022/11/e39571", url="http://www.ncbi.nlm.nih.gov/pubmed/36374534" } @Article{info:doi/10.2196/37101, author="Huang, Heyin and Wang, Yichen and Zhang, Lanzhi and Zhang, Qinxiu and Wu, Xiaojuan and He, Hengsheng", title="Psychological Disorders of Patients With Allergic Rhinitis in Chengdu, China: Exploratory Research", journal="JMIR Form Res", year="2022", month="Nov", day="10", volume="6", number="11", pages="e37101", keywords="psychological disorders", keywords="allergic rhinitis", keywords="Chengdu", keywords="China", abstract="Background: The number of patients with allergic rhinitis (AR) has exceeded 500 million worldwide due to the unstable curative effect that can easily produce mental and psychological disorders. However, most of the relevant existing literature is one-on-one retrospective analyses or targeted meta-analyses of AR with psychological disorders like irritability, depression, and anxiety, while ``multi-hospital + interdisciplinary'' multiple regression analyses are scarce. Objective: This study aims to precisely identify the psychological disorders of patients with AR who were diagnosed and treated in the five most renowned hospitals in Chengdu, China over the past 5 years using 10 classification methods so as to attract attention and care from otolaryngologists. Methods: The Symptom Checklist 90 (SCL-90) was used to group and score the mental state of 827 strictly screened patients with AR according to 9 classification criteria. The scores were then compared within groups. Intergroup comparisons were made between the study group and the Chinese norm, and the positive factors for psychological disorders were extracted. Four symptoms in the study group, that is, nasal itching, sneezing, clear discharge, and nasal congestion, were scored on a visual analog scale. Partial correlation analysis was performed between the extracted positive factors for psychological disorders and the symptom scores by the multiple regression statistical method. Results: Among 827 patients, 124 (15\%) had no mental health impairments, 176 (21.3\%) had mild impairments, 474 (57.3\%) had mild to moderate impairments, 41 (5\%) had moderate to severe impairments, and 12 (1.4\%) had severe impairments. The average score of the SCL-90 for all 827 patients was 2.64 (SD 0.25), which corresponded to mild to moderate mental health impairments. The 827 patients scored significantly higher for the 4 positive factors: depression, anxiety, psychosis, and other (sleep, diet). Depression was positively correlated with sneezing and clear discharge, anxiety was positively correlated with nasal itching and congestion, psychosis was positively correlated with nasal itching and sneezing, and other (sleep, diet) was positively correlated with clear discharge and nasal congestion. Conclusions: Patients with AR have mild to moderate mental health impairments, with women and those with abnormal BMI, aged ?45 years, with a monthly salary <{\textyen}5110 (US \$700), with a disease duration <13 years, residing in urban areas, with a high school or above education, or who are indoor laborers being at high risk and requiring more care, follow-up, and comprehensive therapy from otolaryngologists. ", doi="10.2196/37101", url="https://formative.jmir.org/2022/11/e37101", url="http://www.ncbi.nlm.nih.gov/pubmed/36355407" } @Article{info:doi/10.2196/38701, author="Di Filippo, Marzia and Avellone, Alessandro and Belingheri, Michael and Paladino, Emilia Maria and Riva, Augusto Michele and Zambon, Antonella and Pescini, Dario", title="A Mobile App Leveraging Citizenship Engagement to Perform Anonymized Longitudinal Studies in the Context of COVID-19 Adverse Drug Reaction Monitoring: Development and Usability Study", journal="JMIR Hum Factors", year="2022", month="Nov", day="4", volume="9", number="4", pages="e38701", keywords="ADR reporting", keywords="adverse drug reaction--reporting systems", keywords="mobile apps", keywords="longitudinal studies", keywords="COVID-19 vaccination campaign", keywords="COVID-19", keywords="vaccine", keywords="apps", keywords="adverse drug reaction", keywords="pharmacovigilance", keywords="anonymity", abstract="Background: Over the past few years, studies have increasingly focused on the development of mobile apps as complementary tools to existing traditional pharmacovigilance surveillance systems for improving and facilitating adverse drug reaction (ADR) reporting. Objective: In this research, we evaluated the potentiality of a new mobile app (vaxEffect@UniMiB) to perform longitudinal studies, while preserving the anonymity of the respondents. We applied the app to monitor the ADRs during the COVID-19 vaccination campaign in a sample of the Italian population. Methods: We administered vaxEffect@UniMiB to a convenience sample of academic subjects vaccinated at the Milano-Bicocca University hub for COVID-19 during the Italian national vaccination campaign. vaxEffect@UniMiB was developed for both Android and iOS devices. The mobile app asks users to send their medical history and, upon every vaccine administration, their vaccination data and the ADRs that occurred within 7 days postvaccination, making it possible to follow the ADR dynamics for each respondent. The app sends data over the web to an application server. The server, along with receiving all user data, saves the data in a SQL database server and reminds patients to submit vaccine and ADR data by push notifications sent to the mobile app through Firebase Cloud Messaging (FCM). On initial startup of the app, a unique user identifier (UUID) was generated for each respondent, so its anonymity was completely ensured, while enabling longitudinal studies. Results: A total of 3712 people were vaccinated during the first vaccination wave. A total of 2733 (73.6\%) respondents between the ages of 19 and 80 years, coming from the University of Milano-Bicocca (UniMiB) and the Politecnico of Milan (PoliMi), participated in the survey. Overall, we collected information about vaccination and ADRs to the first vaccine dose for 2226 subjects (60.0\% of the first dose vaccinated), to the second dose for 1610 subjects (43.4\% of the second dose vaccinated), and, in a nonsponsored fashion, to the third dose for 169 individuals (4.6\%). Conclusions: vaxEffect@UniMiB was revealed to be the first attempt in performing longitudinal studies to monitor the same subject over time in terms of the reported ADRs after each vaccine administration, while guaranteeing complete anonymity of the subject. A series of aspects contributed to the positive involvement from people in using this app to report their ADRs to vaccination: ease of use, availability from multiple platforms, anonymity of all survey participants and protection of the submitted data, and the health care workers' support. ", doi="10.2196/38701", url="https://humanfactors.jmir.org/2022/4/e38701", url="http://www.ncbi.nlm.nih.gov/pubmed/35930561" } @Article{info:doi/10.2196/38855, author="Yun, Ke and Yu, Jiaming and Liu, Changyang and Zhang, Xinxin", title="A Cost-effectiveness Analysis of a Mobile Phone--Based Integrated HIV-Prevention Intervention Among Men Who Have Sex With Men in China: Economic Evaluation", journal="J Med Internet Res", year="2022", month="Nov", day="2", volume="24", number="11", pages="e38855", keywords="cost-effectiveness", keywords="digital intervention", keywords="men who have sex with men", keywords="mathematical model", abstract="Background: Mobile phone--based digital interventions have been shown to be a promising strategy for HIV prevention among men who have sex with men (MSM). Objective: This study aimed to evaluate the cost-effectiveness of a mobile phone--based digital intervention for HIV prevention among MSM in China from the perspective of a public health provider. Methods: The cost-effectiveness of the mobile phone--based digital intervention was estimated for a hypothetical cohort of 10,000 HIV-negative MSM who were followed for 1 year. A model was developed with China-specific data to project the clinical impact and cost-effectiveness of two mobile phone--based digital strategies for HIV prevention among MSM. The intervention group received an integrated behavioral intervention that included 1) individualized HIV infection risk assessment, 2) recommendation of centers testing for HIV and other STIs, 3) free online order of condoms and HIV and syphilis self-test kits and 4) educational materials about HIV/AIDS. The control group was only given educational materials about HIV/AIDS. Outcomes of interest were the number of HIV infections among MSM averted by the intervention, intervention costs, cost per HIV infection averted by the mobile phone--based digital intervention, and quality-adjusted life-years (QALYs). Univariate and multivariate sensitivity analyses were also conducted to examine the robustness of the results. Results: It is estimated that the intervention can prevent 48 MSM from becoming infected with HIV and can save 480 QALYs. The cost of preventing 1 case of HIV infection was US \$2599.87, and the cost-utility ratio was less than 0. Sensitivity analysis showed that the cost-effectiveness of the mobile phone--based digital intervention was mainly impacted by the average number of sexual behaviors with each sexual partner. Additionally, the higher the HIV prevalence among MSM, the greater the benefit of the intervention. Conclusions: Mobile phone--based digital interventions are a cost-effective HIV-prevention strategy for MSM and could be considered for promotion and application among high-risk MSM subgroups. ", doi="10.2196/38855", url="https://www.jmir.org/2022/11/e38855", url="http://www.ncbi.nlm.nih.gov/pubmed/36322123" } @Article{info:doi/10.2196/36211, author="Ganser, Iris and Thi{\'e}baut, Rodolphe and Buckeridge, L. David", title="Global Variations in Event-Based Surveillance for Disease Outbreak Detection: Time Series Analysis", journal="JMIR Public Health Surveill", year="2022", month="Oct", day="31", volume="8", number="10", pages="e36211", keywords="event-based surveillance", keywords="digital disease detection", keywords="public health surveillance", keywords="influenza", keywords="infectious disease outbreak", keywords="surveillance", keywords="disease", keywords="outbreak", keywords="analysis", keywords="public health", keywords="data", keywords="detection", keywords="detect", keywords="epidemic", abstract="Background: Robust and flexible infectious disease surveillance is crucial for public health. Event-based surveillance (EBS) was developed to allow timely detection of infectious disease outbreaks by using mostly web-based data. Despite its widespread use, EBS has not been evaluated systematically on a global scale in terms of outbreak detection performance. Objective: The aim of this study was to assess the variation in the timing and frequency of EBS reports compared to true outbreaks and to identify the determinants of variability by using the example of seasonal influenza epidemic in 24 countries. Methods: We obtained influenza-related reports between January 2013 and December 2019 from 2 EBS systems, that is, HealthMap and the World Health Organization Epidemic Intelligence from Open Sources (EIOS), and weekly virological influenza counts for the same period from FluNet as the gold standard. Influenza epidemic periods were detected based on report frequency by using Bayesian change point analysis. Timely sensitivity, that is, outbreak detection within the first 2 weeks before or after an outbreak onset was calculated along with sensitivity, specificity, positive predictive value, and timeliness of detection. Linear regressions were performed to assess the influence of country-specific factors on EBS performance. Results: Overall, while monitoring the frequency of EBS reports over 7 years in 24 countries, we detected 175 out of 238 outbreaks (73.5\%) but only 22 out of 238 (9.2\%) within 2 weeks before or after an outbreak onset; in the best case, while monitoring the frequency of health-related reports, we identified 2 out of 6 outbreaks (33\%) within 2 weeks of onset. The positive predictive value varied between 9\% and 100\% for HealthMap and from 0 to 100\% for EIOS, and timeliness of detection ranged from 13\% to 94\% for HealthMap and from 0\% to 92\% for EIOS, whereas system specificity was generally high (59\%-100\%). The number of EBS reports available within a country, the human development index, and the country's geographical location partially explained the high variability in system performance across countries. Conclusions: We documented the global variation of EBS performance and demonstrated that monitoring the report frequency alone in EBS may be insufficient for the timely detection of outbreaks. In particular, in low- and middle-income countries, low data quality and report frequency impair the sensitivity and timeliness of disease surveillance through EBS. Therefore, advances in the development and evaluation and EBS are needed, particularly in low-resource settings. ", doi="10.2196/36211", url="https://publichealth.jmir.org/2022/10/e36211", url="http://www.ncbi.nlm.nih.gov/pubmed/36315218" } @Article{info:doi/10.2196/40049, author="Bacsu, Juanita-Dawne and Cammer, Allison and Ahmadi, Soheila and Azizi, Mehrnoosh and Grewal, S. Karl and Green, Shoshana and Gowda-Sookochoff, Rory and Berger, Corinne and Knight, Sheida and Spiteri, J. Raymond and O'Connell, E. Megan", title="Examining the Twitter Discourse on Dementia During Alzheimer's Awareness Month in Canada: Infodemiology Study", journal="JMIR Form Res", year="2022", month="Oct", day="26", volume="6", number="10", pages="e40049", keywords="Twitter", keywords="social media", keywords="dementia", keywords="Alzheimer disease", keywords="awareness", keywords="public health campaigns", abstract="Background: Twitter has become a primary platform for public health campaigns, ranging from mental health awareness week to diabetes awareness month. However, there is a paucity of knowledge about how Twitter is being used during health campaigns, especially for Alzheimer's Awareness Month. Objective: The purpose of our study was to examine dementia discourse during Canada's Alzheimer's Awareness Month in January to inform future awareness campaigns. Methods: We collected 1289 relevant tweets using the Twint application in Python from January 1 to January 31, 2022. Thematic analysis was used to analyze the data. Results: Guided by our analysis, 4 primary themes were identified: dementia education and advocacy, fundraising and promotion, experiences of dementia, and opportunities for future actions. Conclusions: Although our study identified many educational, promotional, and fundraising tweets to support dementia awareness, we also found numerous tweets with cursory messaging (ie, simply referencing January as Alzheimer's Awareness Month in Canada). While these tweets promoted general awareness, they also highlight an opportunity for targeted educational content to counter stigmatizing messages and misinformation about dementia. In addition, awareness strategies partnering with diverse stakeholders (such as celebrities, social media influencers, and people living with dementia and their care partners) may play a pivotal role in fostering dementia dialogue and education. Further research is needed to develop, implement, and evaluate dementia awareness strategies on Twitter. Increased knowledge, partnerships, and research are essential to enhancing dementia awareness during Canada's Alzheimer's Awareness Month and beyond. ", doi="10.2196/40049", url="https://formative.jmir.org/2022/10/e40049", url="http://www.ncbi.nlm.nih.gov/pubmed/36287605" } @Article{info:doi/10.2196/31136, author="Ndeikoundam Ngangro, Ndeindo and Pioche, Corinne and Vaux, Sophie and Viriot, Delphine and Durand, Julien and Berat, B{\'e}n{\'e}dicte and Hamdaoui, Mohammed and Lot, Florence", title="An Automated Surveillance System (SurCeGGID) for the French Sexually Transmitted Infection Clinics: Epidemiological Monitoring Study", journal="JMIR Form Res", year="2022", month="Oct", day="25", volume="6", number="10", pages="e31136", keywords="HIV", keywords="hepatitis B", keywords="hepatitis C", keywords="STI", keywords="sexual health", keywords="epidemiology", keywords="surveillance", abstract="Background: Viral and bacterial sexually transmitted infections (STIs) are public health concerns worldwide, but surveillance systems are not comprehensive enough to design and monitor accurately STI control strategies in most countries. In 2016, 320 STI clinics (CeGIDDs in French) were implemented in France, primarily targeting most exposed populations, although access is free of charge for anybody. Objective: This article describes the mandatory surveillance system (SurCeGIDD) based on CeGIDD's individual data aiming to better guide STI prevention. Methods: A decree ensured the use of software to manage consultations in CeGIDDs and to transfer surveillance data. A web service was implemented to secure data transfer from CeGIDDs' software to a centralized database. CeGIDDs can also transfer data in CSV format via a secured data-sharing platform. Then, data are automatically checked before integration. Data on sociodemographic variables, sexual exposure, blood exposure, symptoms, STI tests, STI diagnoses, and sexual health services delivery were collected for the previous year (n--1). Preliminary and descriptive analyses of 2017-2018 data transmitted in 2018 and 2019, respectively, were performed using numbers and proportions for qualitative variables. Results: In 2017, 54/320 (16.9\%) CeGIDDs transmitted their data. In 2018, this number of participants increased to 143/320 (44.7\%) CeGIDDs. The corresponding volume of records increased from 2414 in 2017 to 382,890 in 2018. In 2018, most attendances were hospital based (263,480/382,890, 68.81\%). In 2018, attendees were mostly men 227,326/379,921 (59.84\%), while 151,963/379,921 (40\%) were women 632/379,921 (0.17\%) transgenders. The median age was 27 years for men, 23 years for women, and 30 years for transgender. Half of the attendees (81,964/174,932, 46.85\%) were heterosexual men, 69,016/174,932 (39.45\%) heterosexual women, 20,764/174,932 (11.87\%) men who have sex with men, and 3188/174,932 (1.82\%) women who have sex with women. A majority of them were born in France (227,698/286,289, 79.53\%) and unemployed 115,913/211,707 (54.75\%). The positivity rates were 0.37\% for 205,348 HIV serologies, 1.31\% for 131,551 hepatitis B virus serologies, 7.16\% for 161,241 Chlamydia trachomatis PCR, 2.83\% for 146,649 gonorrhea PCR, 1.04\% for the syphilis combination of treponema and nontreponema serologies, and 5.96\% for 13,313 Mycoplasma genitalium PCR. Conclusions: Despite challenges, the effectiveness of the SurCeGIDD surveillance based on routine patients' records was demonstrated. The wide range of information, including socioeconomic determinants, might help to better guide and evaluate the prevention policies and services delivery. However, the growing volumes of information will require adapted tools and algorithms for the data management and analyses. ", doi="10.2196/31136", url="https://formative.jmir.org/2022/10/e31136", url="http://www.ncbi.nlm.nih.gov/pubmed/36282557" } @Article{info:doi/10.2196/40558, author="Pepper, Cecily and Reyes-Cruz, Gisela and Pena, Rita Ana and Dowthwaite, Liz and Babbage, M. Camilla and Wagner, Hanne and Nichele, Elena and Fischer, E. Joel", title="Understanding Trust and Changes in Use After a Year With the NHS COVID-19 Contact Tracing App in the United Kingdom: Longitudinal Mixed Methods Study", journal="J Med Internet Res", year="2022", month="Oct", day="14", volume="24", number="10", pages="e40558", keywords="COVID-19", keywords="tracing app", keywords="digital contact tracing", keywords="trust", keywords="public health", keywords="technology adoption", keywords="compliance", keywords="longitudinal", keywords="mixed methods", keywords="thematic analysis", keywords="mobile phone", abstract="Background: Digital contact tracing (DCT) apps have been implemented as a response to the COVID-19 pandemic. Research has focused on understanding acceptance and adoption of these apps, but more work is needed to understand the factors that may contribute to their sustained use. This is key to public health because DCT apps require a high uptake rate to decrease the transmission of the virus within the general population. Objective: This study aimed to understand changes in the use of the National Health Service Test \& Trace (T\&T) COVID-19 DCT app and explore how public trust in the app evolved over a 1-year period. Methods: We conducted a longitudinal mixed methods study consisting of a digital survey in December 2020 followed by another digital survey and interview in November 2021, in which responses from 9 participants were explored in detail. Thematic analysis was used to analyze the interview transcripts. This paper focuses on the thematic analysis to unpack the reasoning behind participants' answers. Results: In this paper, 5 themes generated through thematic analysis are discussed: flaws in the T\&T app, usefulness and functionality affecting trust in the app, low trust in the UK government, varying degrees of trust in other stakeholders, and public consciousness and compliance dropping over time. Mistrust evolved from participants experiencing sociotechnical flaws in the app and led to concerns about the app's usefulness. Similarly, mistrust in the government was linked to perceived poor pandemic handling and the creation and procurement of the app. However, more variability in trust in other stakeholders was highlighted depending on perceived competence and intentions. For example, Big Tech companies (ie, Apple and Google), large hospitality venues, and private contractors were seen as more capable, but participants mistrust their intentions, and small hospitality venues, local councils, and the National Health Service (ie, public health system) were seen as well-intentioned but there is mistrust in their ability to handle pandemic matters. Participants reported complying, or not, with T\&T and pandemic guidance to different degrees but, overall, observed a drop in compliance over time. Conclusions: These findings contribute to the wider implications of changes in DCT app use over time for public health. Findings suggest that trust in the wider T\&T app ecosystem could be linked to changes in the use of the app; however, further empirical and theoretical work needs to be done to generalize the results because of the small, homogeneous sample. Initial novelty effects occurred with the app, which lessened over time as public concern and media representation of the pandemic decreased and normalization occurred. Trust in the sociotechnical capabilities of the app, stakeholders involved, and salience maintenance of the T\&T app in conjunction with other measures are needed for sustained use. ", doi="10.2196/40558", url="https://www.jmir.org/2022/10/e40558", url="http://www.ncbi.nlm.nih.gov/pubmed/36112732" } @Article{info:doi/10.2196/35272, author="Luo, Ganfeng and Su, Lingyun and Feng, Anping and Lin, Yi-Fan and Zhou, Yiguo and Yuan, Tanwei and Hu, Yuqing and Fan, Song and Lu, Yong and Lai, Yingsi and Shi, Qian and Li, Jun and Han, Mengjie and Zou, Huachun", title="Spatiotemporal Distribution of HIV Self-testing Kits Purchased on the Web and Implications for HIV Prevention in China: Population-Based Study", journal="JMIR Public Health Surveill", year="2022", month="Oct", day="4", volume="8", number="10", pages="e35272", keywords="HIV self-testing", keywords="spatiotemporal patterns", keywords="China", keywords="e-commerce platform", abstract="Background: HIV self-testing (HIVST) holds great promise for expanding HIV testing. Nonetheless, large-scale data on HIVST behavior are scant. Millions of HIVST kits are sold through e-commerce platforms each year. Objective: This study aims to analyze the spatiotemporal distribution of the HIVST kit--purchasing population (HIVSTKPP) in China. Methods: Deidentified transaction data were retrieved from a leading e-commerce platform in China. A joinpoint regression model was used to examine annual trends of the HIVSTKPP rates by calculating average annual percentage change. Bayesian spatiotemporal analysis was performed to locate hot spots with HIVSTKPP rates. Spatial autocorrelation analysis and space-time cluster analysis were conducted to identify clusters of HIVSTKPP. High-high clusters of HIVSTKPP can be identified by spatial autocorrelation analysis, and high-high clusters indicate that a region and its surrounding region jointly had a higher-than-average HIVSTKPP rate. Spatial regression analysis was used to elucidate the association between the number of HIV testing facilities, urbanization ratio (the proportion of urban population in the total population), and gross domestic product per capita and the HIVSTKPP. Results: Between January 1, 2016, and December 31, 2019, a total of 2.18 million anonymous persons in China placed 4.15 million orders and purchased 4.51 million HIVST kits on the web. In each of these 4 years, the observed monthly size of the HIVSTKPP peaked in December, the month of World AIDS Day. HIVSTKPP rates per 100,000 population significantly increased from 20.62 in 2016 to 64.82 in 2019 (average annual percentage change=48.2\%; P<.001). Hot spots were mainly located in municipalities, provincial capitals, and large cities, whereas high-high clusters and high-demand clusters were predominantly detected in cities along the southeast coast. We found positive correlations between a region's number of HIV testing facilities, urbanization ratio, and gross domestic product per capita and the HIVSTKPP. Conclusions: Our study identified key areas with larger demand for HIVST kits for public health policy makers to reallocate resources and optimize the HIV care continuum. Further research combining spatiotemporal patterns of HIVST with HIV surveillance data is urgently needed to identify potential gaps in current HIV-monitoring practices. ", doi="10.2196/35272", url="https://publichealth.jmir.org/2022/10/e35272", url="http://www.ncbi.nlm.nih.gov/pubmed/36194453" } @Article{info:doi/10.2196/37846, author="Tetteh, Kwabena Emmanuel and Combs, Todd and Geng, Hsing Elvin and McKay, Ruth Virginia", title="Public Health Information Seeking, Trust, and COVID-19 Prevention Behaviors: Cross-sectional Study", journal="J Med Internet Res", year="2022", month="Sep", day="30", volume="24", number="9", pages="e37846", keywords="COVID-19", keywords="public health", keywords="health communication", keywords="trust and mistrust", keywords="disease prevention", keywords="health measure", keywords="health information", keywords="cross-sectional study", keywords="Health Belief Model", abstract="Background: Preventative health measures such as shelter in place and mask wearing have been widely encouraged to curb the spread of the COVID-19 disease. People's attitudes toward preventative behaviors may be dependent on their sources of information and trust in the information. Objective: The aim of this study was to understand the relationship between trusting in COVID-19 information and preventative behaviors in a racially and politically diverse metropolitan area in the United States. Methods: We conducted a web-based cross-sectional survey of residents in St. Louis City and County in Missouri. Individuals aged ?18 years were eligible to participate. Participants were recruited using a convenience sampling approach through social media and email. The Health Belief Model and the Socioecological Model informed instrument development, as well as COVID-19--related questions from the Centers for Disease Control and Prevention. We performed an ordinary least squares linear regression model to estimate social distancing practices, perceptions, and trust in COVID-19 information sources. Results: Of the 1650 eligible participants, the majority (n=1381, 83.7\%) had sought or received COVID-19--related information from a public health agency, the Centers for Disease Control and Prevention, or both. Regression analysis showed a 1\% increase in preventative behaviors for every 12\% increase in trust in governmental health agencies. At their lowest levels of trust, women were 68\% more likely to engage in preventative behaviors than men. Overall, those aged 18-45 years without vulnerable medical conditions were the least likely to engage in preventative behaviors. Conclusions: Trust in COVID-19 information increases an individual's likelihood of practicing preventative behaviors. Effective health communication strategies should be used to effectively disseminate health information during disease outbreaks. ", doi="10.2196/37846", url="https://www.jmir.org/2022/9/e37846", url="http://www.ncbi.nlm.nih.gov/pubmed/36084197" } @Article{info:doi/10.2196/40436, author="Nguyen, Jean Cassandra and Pham, Christian and Jackson, M. Alexandra and Ellison, Kamakahiolani Nicole Lee and Sinclair, Ka`imi", title="Online Food Security Discussion Before and During the COVID-19 Pandemic in Native Hawaiian and Pacific Islander Community Groups and Organizations: Content Analysis of Facebook Posts", journal="Asian Pac Isl Nurs J", year="2022", month="Sep", day="30", volume="6", number="1", pages="e40436", keywords="social media", keywords="oceanic ancestry group", keywords="food insecurity", keywords="social networking", keywords="COVID-19", keywords="Facebook", keywords="community", keywords="Hawaiian", keywords="Pacific Islander", keywords="online", keywords="food", keywords="risk factor", keywords="disease", keywords="cardiometabolic", keywords="diabetes", keywords="hypertension", keywords="food security", keywords="digital", keywords="support", keywords="culture", abstract="Background: The Native Hawaiian and Pacific Islander (NHPI) population experiences disproportionately higher rates of food insecurity, which is a risk factor for cardiometabolic diseases such as cardiovascular disease, type 2 diabetes, obesity, and hypertension, when compared to white individuals. Novel and effective approaches that address food insecurity are needed for the NHPI population, particularly in areas of the continental United States, which is a popular migration area for many NHPI families. Social media may serve as an opportune setting to reduce food insecurity and thus the risk factors for cardiometabolic diseases among NHPI people; however, it is unclear if and how food insecurity is discussed in online communities targeting NHPI individuals. Objective: The objective of this study was to characterize the quantity, nature, and audience engagement of messages related to food insecurity posted online in community groups and organizations that target NHPI audiences. Methods: Publicly accessible Facebook pages and groups focused on serving NHPI community members living in the states of Washington or Oregon served as the data source. Facebook posts between March and June 2019 (before the COVID-19 pandemic) and from March to June 2020 (during the COVID-19 pandemic) that were related to food security were identified using a set of 36 related keywords. Data on the post and any user engagement (ie, comments, shares, or digital reactions) were extracted for all relevant posts. A content analytical approach was used to identify and quantify the nature of the identified posts and any related comments. The codes resulting from the content analysis were described and compared by year, page type, and engagement. Results: Of the 1314 nonduplicated posts in the 7 relevant Facebook groups and pages, 88 were related to food security (8 in 2019 and 80 in 2020). The nature of posts was broadly classified into literature-based codes, food assistance (the most common), perspectives of food insecurity, community gratitude and support, and macrolevel contexts. Among the 88 posts, 74\% (n=65) had some form of engagement, and posts reflecting community gratitude and support or culture had more engagement than others (mean 19.9, 95\% CI 11.2-28.5 vs mean 6.1, 95\% CI 1.7-10.4; and mean 26.8, 95\% CI 12.7-40.9 vs mean 5.3, 95\% CI 3.0-7.7, respectively). Conclusions: Food security--related posts in publicly accessible Facebook groups targeting NHPI individuals living in Washington and Oregon largely focused on food assistance, although cultural values of gratitude, maintaining NHPI culture, and supporting children were also reflected. Future work should capitalize on social media as a potential avenue to reach a unique cultural group in the United States experiencing inequitably high rates of food insecurity and risk of cardiometabolic diseases. ", doi="10.2196/40436", url="https://apinj.jmir.org/2022/1/e40436", url="http://www.ncbi.nlm.nih.gov/pubmed/36212246" } @Article{info:doi/10.2196/35973, author="Hota, Bala and Casey, Paul and McIntyre, F. Anne and Khan, Jawad and Rab, Shafiq and Chopra, Aneesh and Lateef, Omar and Layden, E. Jennifer", title="A Standard-Based Citywide Health Information Exchange for Public Health in Response to COVID-19: Development Study", journal="JMIR Public Health Surveill", year="2022", month="Sep", day="27", volume="8", number="9", pages="e35973", keywords="public health", keywords="informatics", keywords="surveillance", keywords="disease surveillance", keywords="epidemiology", keywords="health data", keywords="electronic health record", keywords="data hub", keywords="acute care hospital", keywords="COVID-19", keywords="pandemic", keywords="data governance", abstract="Background: Disease surveillance is a critical function of public health, provides essential information about the disease burden and the clinical and epidemiologic parameters of disease, and is an important element of effective and timely case and contact tracing. The COVID-19 pandemic demonstrates the essential role of disease surveillance in preserving public health. In theory, the standard data formats and exchange methods provided by electronic health record (EHR) meaningful use should enable rapid health care data exchange in the setting of disruptive health care events, such as a pandemic. In reality, access to data remains challenging and, even if available, often lacks conformity to regulated standards. Objective: We sought to use regulated interoperability standards already in production to generate awareness of regional bed capacity and enhance the capture of epidemiological risk factors and clinical variables among patients tested for SARS-CoV-2. We described the technical and operational components, governance model, and timelines required to implement the public health order that mandated electronic reporting of data from EHRs among hospitals in the Chicago jurisdiction. We also evaluated the data sources, infrastructure requirements, and the completeness of data supplied to the platform and the capacity to link these sources. Methods: Following a public health order mandating data submission by all acute care hospitals in Chicago, we developed the technical infrastructure to combine multiple data feeds from those EHR systems---a regional data hub to enhance public health surveillance. A cloud-based environment was created that received ELR, consolidated clinical data architecture, and bed capacity data feeds from sites. Data governance was planned from the project initiation to aid in consensus and principles for data use. We measured the completeness of each feed and the match rate between feeds. Results: Data from 88,906 persons from CCDA records among 14 facilities and 408,741 persons from ELR records among 88 facilities were submitted. Most (n=448,380, 90.1\%) records could be matched between CCDA and ELR feeds. Data fields absent from ELR feeds included travel histories, clinical symptoms, and comorbidities. Less than 5\% of CCDA data fields were empty. Merging CCDA with ELR data improved race, ethnicity, comorbidity, and hospitalization information data availability. Conclusions: We described the development of a citywide public health data hub for the surveillance of SARS-CoV-2 infection. We were able to assess the completeness of existing ELR feeds, augment those feeds with CCDA documents, establish secure transfer methods for data exchange, develop a cloud-based architecture to enable secure data storage and analytics, and produce dashboards for monitoring of capacity and the disease burden. We consider this public health and clinical data registry as an informative example of the power of common standards across EHRs and a potential template for future use of standards to improve public health surveillance. ", doi="10.2196/35973", url="https://publichealth.jmir.org/2022/9/e35973", url="http://www.ncbi.nlm.nih.gov/pubmed/35544440" } @Article{info:doi/10.2196/35648, author="Stafylis, Chrysovalantis and Vavala, Gabriella and Wang, Qiao and McLeman, Bethany and Lemley, M. Shea and Young, D. Sean and Xie, Haiyi and Matthews, G. Abigail and Oden, Neal and Revoredo, Leslie and Shmueli-Blumberg, Dikla and Hichborn, G. Emily and McKelle, Erin and Moran, M. Landhing and Jacobs, Petra and Marsch, A. Lisa and Klausner, D. Jeffrey", title="Relative Effectiveness of Social Media, Dating Apps, and Information Search Sites in Promoting HIV Self-testing: Observational Cohort Study", journal="JMIR Form Res", year="2022", month="Sep", day="23", volume="6", number="9", pages="e35648", keywords="HIV prevention", keywords="PrEP", keywords="home HIV test", keywords="social media", keywords="dating apps", keywords="search engines", keywords="HIV", keywords="human immunodeficiency virus", keywords="self-testing", keywords="infection", keywords="digital health", keywords="health promotion", keywords="MSM", keywords="pre-exposure prophylaxis", keywords="medical information", abstract="Background: Social media sites, dating apps, and information search sites have been used to reach individuals at high risk for HIV infection. However, it is not clear which platform is the most efficient in promoting home HIV self-testing, given that the users of various platforms may have different characteristics that impact their readiness for HIV testing. Objective: This study aimed to compare the relative effectiveness of social media sites, dating apps, and information search sites in promoting HIV self-testing among minority men who have sex with men (MSM) at an increased risk of HIV infection. Test kit order rates were used as a proxy to evaluate promotion effectiveness. In addition, we assessed differences in characteristics between participants who ordered and did not order an HIV test kit. Methods: Culturally appropriate advertisements were placed on popular sites of three different platforms: social media sites (Facebook, Instagram), dating apps (Grindr, Jack'D), and information search sites (Google, Bing). Advertisements targeted young (18-30 years old) and minority (Black or Latinx) MSM at risk of HIV exposure. Recruitment occurred in 2 waves, with each wave running advertisements on 1 platform of each type over the same period. Participants completed a baseline survey assessing sexual or injection use behavior, substance use including alcohol, psychological readiness to test, attitudes toward HIV testing and treatment, and HIV-related stigma. Participants received an electronic code to order a free home-based HIV self-test kit. Follow-up assessments were conducted to assess HIV self-test kit use and uptake of pre-exposure prophylaxis (PrEP) at 14 and 60 days post enrollment. Results: In total, 271 participants were enrolled, and 254 were included in the final analysis. Among these 254 participants, 177 (69.7\%) ordered a home HIV self-test kit. Most of the self-test kits were ordered by participants enrolled from dating apps. Due to waves with low enrollment, between wave statistical comparisons were not feasible. Within wave comparison revealed that Jack'D showed higher order rates (3.29 kits/day) compared to Instagram (0.34 kits/day) and Bing (0 kits/day). There were no associations among self-test kit ordering and HIV-related stigma, perceptions about HIV testing and treatment, and mistrust of medical organizations. Conclusions: Our findings show that using popular dating apps might be an efficient way to promote HIV self-testing. Stigma, perceptions about HIV testing and treatment, or mistrust of medical organizations may not affect order rates of HIV test kits promoted on the internet. Trial Registration: ClinicalTrials.gov NCT04155502; https://clinicaltrials.gov/ct2/show/NCT04155502 International Registered Report Identifier (IRRID): RR2-10.2196/20417 ", doi="10.2196/35648", url="https://formative.jmir.org/2022/9/e35648", url="http://www.ncbi.nlm.nih.gov/pubmed/36149729" } @Article{info:doi/10.2196/40331, author="Silver, Nathan and Kierstead, Elexis and Kostygina, Ganna and Tran, Hy and Briggs, Jodie and Emery, Sherry and Schillo, Barbara", title="The Influence of Provaping ``Gatewatchers'' on the Dissemination of COVID-19 Misinformation on Twitter: Analysis of Twitter Discourse Regarding Nicotine and the COVID-19 Pandemic", journal="J Med Internet Res", year="2022", month="Sep", day="22", volume="24", number="9", pages="e40331", keywords="social media", keywords="tobacco", keywords="COVID-19", keywords="nicotine", keywords="misinformation", keywords="Twitter", keywords="information", keywords="infodemiology", keywords="vaping", keywords="therapeutic", keywords="influence", keywords="environment", keywords="harmful", keywords="consequences", abstract="Background: There is a lot of misinformation about a potential protective role of nicotine against COVID-19 spread on Twitter despite significant evidence to the contrary. We need to examine the role of vape advocates in the dissemination of such information through the lens of the gatewatching framework, which posits that top users can amplify and exert a disproportionate influence over the dissemination of certain content through curating, sharing, or, in the case of Twitter, retweeting it, serving more as a vector for misinformation rather than the source. Objective: This research examines the Twitter discourse at the intersection of COVID-19 and tobacco (1) to identify the extent to which the most outspoken contributors to this conversation self-identify as vaping advocates and (2) to understand how and to what extent these vape advocates serve as gatewatchers through disseminating content about a therapeutic role of tobacco, nicotine, or vaping against COVID-19. Methods: Tweets about tobacco, nicotine, or vaping and COVID-19 (N=1,420,271) posted during the first 9 months of the pandemic (January-September 2020) were identified from within a larger corpus of tobacco-related tweets using validated keyword filters. The top posters (ie, tweeters and retweeters) were identified and characterized, along with the most shared Uniform Resource Locators (URLs), most used hashtags, and the 1000 most retweeted posts. Finally, we examined the role of both top users and vape advocates in retweeting the most retweeted posts about the therapeutic role of nicotine, tobacco, or vaping against COVID-19. Results: Vape advocates comprised between 49.7\% (n=81) of top 163 and 88\% (n=22) of top 25 users discussing COVID-19 and tobacco on Twitter. Content about the ability of tobacco, nicotine, or vaping to treat or prevent COVID-19 was disseminated broadly, accounting for 22.5\% (n=57) of the most shared URLs and 10\% (n=107) of the most retweeted tweets. Finally, among top users, retweets comprised an average of 78.6\% of the posts from vape advocates compared to 53.1\% from others (z=3.34, P<.001). Vape advocates were also more likely to retweet the top tweeted posts about a therapeutic role of nicotine, with 63\% (n=51) of vape advocates retweeting at least 1 post compared to 40.3\% (n=29) of other top users (z=2.80, P=.01). Conclusions: Provaping users dominated discussions of tobacco use during the COVID-19 pandemic on Twitter and were instrumental in disseminating the most retweeted posts about a potential therapeutic role of tobacco use against the virus. Subsequent research is needed to better understand the extent of this influence and how to mitigate the influence of vape advocates over the broader narrative of tobacco regulation on Twitter. ", doi="10.2196/40331", url="https://www.jmir.org/2022/9/e40331", url="http://www.ncbi.nlm.nih.gov/pubmed/36070451" } @Article{info:doi/10.2196/38244, author="Gaither, W. Thomas and Sigalos, T. John and Landovitz, J. Raphael and Mills, N. Jesse and Litwin, S. Mark and Eleswarapu, V. Sriram", title="Engagement With HIV and COVID-19 Prevention: Nationwide Cross-sectional Analysis of Users on a Geosocial Networking App", journal="J Med Internet Res", year="2022", month="Sep", day="22", volume="24", number="9", pages="e38244", keywords="geosocial networking apps", keywords="pre-exposure prophylaxis", keywords="vaccination", keywords="rural", keywords="men who have sex with men", keywords="surveillance", keywords="digital surveillance", keywords="COVID-19", keywords="digital application", keywords="geosocial network", keywords="public health", keywords="surveillance platform", keywords="health platform", keywords="mobile health", abstract="Background: Geosocial networking (GSN) apps play a pivotal role in catalyzing sexual partnering, especially among men who have sex with men. Objective: To quantify the prevalence and disparities in disclosure of pre-exposure prophylaxis (PrEP) use and COVID-19 vaccination among GSN app users, mostly men who have sex with men, in the United States. Methods: Web-based Grindr profiles from the top 50 metropolitan areas as well as the 50 most rural counties in the United States by population were randomly sampled. Grindr provides an option to disclose current PrEP use (HIV positive, HIV negative, or HIV negative with PrEP use). The free text in all profiles was analyzed, and any mention of COVID-19 vaccination was recorded. Multivariable logistic regression to assess independent associations with PrEP disclosure and COVID-19 vaccination was performed. Imputation analyses were used to test the robustness of the results. Results: We evaluated 1889 urban and 384 rural profiles. Mean age among urban profiles was 32.9 (SD 9.6) years; mean age among rural profiles was 33.5 (SD 12.1) years (P=.41). Among the urban profiles, 16\% reported being vaccinated against COVID-19 and 23\% reported PrEP use compared to 10\% and 8\% in rural profiles, respectively (P=.002 and P<.001, respectively). Reporting COVID-19 vaccination (adjusted odds ratio [aOR] 1.7, 95\% CI 1.2-2.4), living in an urban center (aOR 3.2, 95\% CI 1.8-5.7), and showing a face picture as part of the Grindr profile (aOR 4.0, 95\% CI 2.3-7.0) were positively associated with PrEP disclosure. Self-identified Black and Latino users were less likely to report PrEP use (aOR 0.6, 95\% CI 0.4-0.9 and aOR 0.5, 95\% CI 0.4-0.9, respectively). Reporting PrEP use (aOR 1.7, 95\% CI 1.2-2.4), living in an urban center (aOR 2.5, 95\% CI 1.4-4.5), having a ``discreet'' status (aOR 1.6, 95\% CI 1.0-2.5), and showing a face picture (aOR 2.7, 95\% CI 1.5-4.8) were positively associated with reporting COVID-19 vaccination on their profile. Users in the southern United States were less likely to report COVID-19 vaccination status than those in the northeast United States (aOR 0.6, 95\% CI 0.3-0.9). Conclusions: Variations in PrEP disclosure are associated with race, whereas COVID-19 vaccination disclosure is associated with geographic area. However, rural GSN users were less likely to report both PrEP use and COVID-19 vaccination. The data demonstrate a need to expand health preventative services in the rural United States for sexual minorities. GSN platforms may be ideal for deployment of preventative interventions to improve access for this difficult-to-reach population. ", doi="10.2196/38244", url="https://www.jmir.org/2022/9/e38244", url="http://www.ncbi.nlm.nih.gov/pubmed/36026586" } @Article{info:doi/10.2196/38297, author="Thompson, L. Erika and Preston, M. Sharice and Francis, R. Jenny K. and Rodriguez, A. Serena and Pruitt, L. Sandi and Blackwell, James-Michael and Tiro, A. Jasmin", title="Social Media Perceptions and Internet Verification Skills Associated With Human Papillomavirus Vaccine Decision-Making Among Parents of Children and Adolescents: Cross-sectional Survey", journal="JMIR Pediatr Parent", year="2022", month="Sep", day="14", volume="5", number="3", pages="e38297", keywords="HPV vaccination", keywords="human papillomavirus", keywords="social media", keywords="decision-making", keywords="vaccination", keywords="teens", keywords="adolescents", keywords="parent", keywords="USA", keywords="United States", keywords="misinformation", keywords="internet", keywords="survey", keywords="unvaccinated", keywords="child", keywords="online", keywords="health", keywords="literacy", keywords="decision", keywords="health care", keywords="teen", keywords="vaccine", abstract="Background: Human Papillomavirus (HPV) vaccination is recommended for children aged 11-12 years in the United States. One factor that may contribute to low national HPV vaccine uptake is parental exposure to misinformation on social media. Objective: This study aimed to examine the association between parents' perceptions of the HPV vaccine information on social media and internet verification strategies used with the HPV vaccine decision-making stage for their child. Methods: Parents of children and adolescents aged 9-17 years were recruited for a cross-sectional survey in North Texas (n=1192) and classified into 3 groups: children and adolescents who (1) were vaccinated, (2) unvaccinated and did not want the vaccine, and (3) unvaccinated and wanted the vaccine. Multinomial logistic regression models were estimated to identify factors associated with the HPV vaccine decision-making stage with children and adolescents who were vaccinated as the referent group. Results: Of the 1192 respondents, 44.7\% (n=533) had an HPV-vaccinated child, 38.8\% (n=463) had an unvaccinated child and did not want the vaccine, and 16.4\% (n=196) had an unvaccinated child and wanted the vaccine. Respondents were less likely to be ``undecided/not wanting the vaccine'' if they agreed that HPV information on social media is credible (adjusted odds ratio [aOR] 0.40, 95\% CI 0.26-0.60; P=.001), disagreed that social media makes them question the HPV vaccine (aOR 0.22, 95\% CI 0.15-0.33; P<.001), or had a higher internet verification score (aOR 0.74, 95\% CI 0.62-0.88; P<.001). Conclusions: Interventions that promote web-based health literacy skills are needed so parents can protect their families from misinformation and make informed health care decisions. ", doi="10.2196/38297", url="https://pediatrics.jmir.org/2022/3/e38297", url="http://www.ncbi.nlm.nih.gov/pubmed/36103216" } @Article{info:doi/10.2196/34472, author="Templ, Matthias and Kanjala, Chifundo and Siems, Inken", title="Privacy of Study Participants in Open-access Health and Demographic Surveillance System Data: Requirements Analysis for Data Anonymization", journal="JMIR Public Health Surveill", year="2022", month="Sep", day="2", volume="8", number="9", pages="e34472", keywords="longitudinal data and event history data", keywords="low- and middle-income countries", keywords="LMIC", keywords="anonymization", keywords="health and demographic surveillance system", abstract="Background: Data anonymization and sharing have become popular topics for individuals, organizations, and countries worldwide. Open-access sharing of anonymized data containing sensitive information about individuals makes the most sense whenever the utility of the data can be preserved and the risk of disclosure can be kept below acceptable levels. In this case, researchers can use the data without access restrictions and limitations. Objective: This study aimed to highlight the requirements and possible solutions for sharing health surveillance event history data. The challenges lie in the anonymization of multiple event dates and time-varying variables. Methods: A sequential approach that adds noise to event dates is proposed. This approach maintains the event order and preserves the average time between events. In addition, a nosy neighbor distance-based matching approach to estimate the risk is proposed. Regarding the key variables that change over time, such as educational level or occupation, we make 2 proposals: one based on limiting the intermediate statuses of the individual and the other to achieve k-anonymity in subsets of the data. The proposed approaches were applied to the Karonga health and demographic surveillance system (HDSS) core residency data set, which contains longitudinal data from 1995 to the end of 2016 and includes 280,381 events with time-varying socioeconomic variables and demographic information. Results: An anonymized version of the event history data, including longitudinal information on individuals over time, with high data utility, was created. Conclusions: The proposed anonymization of event history data comprising static and time-varying variables applied to HDSS data led to acceptable disclosure risk, preserved utility, and being sharable as public use data. It was found that high utility was achieved, even with the highest level of noise added to the core event dates. The details are important to ensure consistency or credibility. Importantly, the sequential noise addition approach presented in this study does not only maintain the event order recorded in the original data but also maintains the time between events. We proposed an approach that preserves the data utility well but limits the number of response categories for the time-varying variables. Furthermore, using distance-based neighborhood matching, we simulated an attack under a nosy neighbor situation and by using a worst-case scenario where attackers have full information on the original data. We showed that the disclosure risk is very low, even when assuming that the attacker's database and information are optimal. The HDSS and medical science research communities in low- and middle-income country settings will be the primary beneficiaries of the results and methods presented in this paper; however, the results will be useful for anyone working on anonymizing longitudinal event history data with time-varying variables for the purposes of sharing. ", doi="10.2196/34472", url="https://publichealth.jmir.org/2022/9/e34472", url="http://www.ncbi.nlm.nih.gov/pubmed/36053573" } @Article{info:doi/10.2196/39144, author="Stoner, CD Marie and Browne, N. Erica and Tweedy, David and Pettifor, E. Audrey and Maragh-Bass, C. Allysha and Toval, Christina and Tolley, E. Elizabeth and Comello, G. Maria Leonora and Muessig, E. Kathryn and Budhwani, Henna and Hightow-Weidman, B. Lisa", title="Exploring Motivations for COVID-19 Vaccination Among Black Young Adults in 3 Southern US States: Cross-sectional Study", journal="JMIR Form Res", year="2022", month="Sep", day="2", volume="6", number="9", pages="e39144", keywords="COVID-19", keywords="COVID-19 vaccination", keywords="young people", keywords="vaccination motivations", keywords="vaccination beliefs", keywords="online survey", keywords="health disparity", keywords="minority population", keywords="vaccine hesitancy", keywords="misinformation", keywords="vaccine safety", abstract="Background: Few studies have focused on attitudes toward COVID-19 vaccination among Black or African American young adults (BYA) in the Southern United States, despite high levels of infection in this population. Objective: To understand this gap, we conducted an online survey to explore beliefs and experiences related to COVID-19 vaccination among BYA (aged 18-29 years) in 3 southern states. Methods: We recruited 150 BYA to participate in an online survey as formative research for an intervention to address vaccine hesitancy in Alabama, Georgia, and North Carolina from September 22, 2021, to November 18, 2021. Participants were recruited through social media ads on Facebook, Twitter, Instagram, and YouTube. Additionally, we distributed information about the survey through organizations working with BYA in Alabama, Georgia, and North Carolina; our community partners; and network collaborations. We used measures that had been used and were previously validated in prior surveys, adapting them to the context of this study. Results: Roughly 28 (19\%) of the participants had not received any doses of the COVID-19 vaccine. Half of the unvaccinated respondents (n=14, 50\%) reported they wanted to wait longer before getting vaccinated. Motivators to get vaccinated were similar between unvaccinated and vaccinated respondents (eg, if required, to protect the health of others), but the main motivator for those vaccinated was to protect one's own health. Among unvaccinated individuals, reasons for not receiving the COVID-19 vaccine included concern about vaccine side effects (n=15, 54\%) and mistrust of vaccine safety (n=13, 46\%), of effectiveness (n=12, 43\%), and of the government's involvement with vaccines (n=12, 43\%). Experiences of discrimination (n=60, 40\%) and mistrust of vaccines (n=54, 36\%) were common overall. Among all respondents, those who said they would be motivated to get vaccinated if it was required for school, work, or travel were more likely to endorse negative beliefs about vaccines compared to those motivated for other reasons. Conclusions: Mistrust in COVID-19 vaccine safety and efficacy is common among BYA in the Southern United States, irrespective of vaccination status. Other motivators, such as safety of family and community and vaccination requirements, may be able to tip the scales toward a decision to be vaccinated among those who are initially hesitant. However, it is unclear how vaccine requirements among BYA in the South affect trust in the government or health care in the long term. Interventions that include BYA in vaccination messaging and programs may more proactively build feelings of trust and combat misinformation. ", doi="10.2196/39144", url="https://formative.jmir.org/2022/9/e39144", url="http://www.ncbi.nlm.nih.gov/pubmed/35969516" } @Article{info:doi/10.2196/37850, author="Xu, Xianglong and Yu, Zhen and Ge, Zongyuan and Chow, F. Eric P. and Bao, Yining and Ong, J. Jason and Li, Wei and Wu, Jinrong and Fairley, K. Christopher and Zhang, Lei", title="Web-Based Risk Prediction Tool for an Individual's Risk of HIV and Sexually Transmitted Infections Using Machine Learning Algorithms: Development and External Validation Study", journal="J Med Internet Res", year="2022", month="Aug", day="25", volume="24", number="8", pages="e37850", keywords="HIV", keywords="sexually transmitted infections", keywords="syphilis", keywords="gonorrhea", keywords="chlamydia", keywords="sexual health", keywords="sexual transmission", keywords="sexually transmitted", keywords="prediction", keywords="web-based", keywords="risk assessment", keywords="machine learning", keywords="model", keywords="algorithm", keywords="predictive", keywords="risk", keywords="development", keywords="validation", abstract="Background: HIV and sexually transmitted infections (STIs) are major global public health concerns. Over 1 million curable STIs occur every day among people aged 15 years to 49 years worldwide. Insufficient testing or screening substantially impedes the elimination of HIV and STI transmission. Objective: The aim of our study was to develop an HIV and STI risk prediction tool using machine learning algorithms. Methods: We used clinic consultations that tested for HIV and STIs at the Melbourne Sexual Health Centre between March 2, 2015, and December 31, 2018, as the development data set (training and testing data set). We also used 2 external validation data sets, including data from 2019 as external ``validation data 1'' and data from January 2020 and January 2021 as external ``validation data 2.'' We developed 34 machine learning models to assess the risk of acquiring HIV, syphilis, gonorrhea, and chlamydia. We created an online tool to generate an individual's risk of HIV or an STI. Results: The important predictors for HIV and STI risk were gender, age, men who reported having sex with men, number of casual sexual partners, and condom use. Our machine learning--based risk prediction tool, named MySTIRisk, performed at an acceptable or excellent level on testing data sets (area under the curve [AUC] for HIV=0.78; AUC for syphilis=0.84; AUC for gonorrhea=0.78; AUC for chlamydia=0.70) and had stable performance on both external validation data from 2019 (AUC for HIV=0.79; AUC for syphilis=0.85; AUC for gonorrhea=0.81; AUC for chlamydia=0.69) and data from 2020-2021 (AUC for HIV=0.71; AUC for syphilis=0.84; AUC for gonorrhea=0.79; AUC for chlamydia=0.69). Conclusions: Our web-based risk prediction tool could accurately predict the risk of HIV and STIs for clinic attendees using simple self-reported questions. MySTIRisk could serve as an HIV and STI screening tool on clinic websites or digital health platforms to encourage individuals at risk of HIV or an STI to be tested or start HIV pre-exposure prophylaxis. The public can use this tool to assess their risk and then decide if they would attend a clinic for testing. Clinicians or public health workers can use this tool to identify high-risk individuals for further interventions. ", doi="10.2196/37850", url="https://www.jmir.org/2022/8/e37850", url="http://www.ncbi.nlm.nih.gov/pubmed/36006685" } @Article{info:doi/10.2196/38370, author="Wiciak, Teresa Michelle and Shazley, Omar and Santhosh, Daphne", title="An Observational Report of Screen Time Use Among Young Adults (Ages 18-28 Years) During the COVID-19 Pandemic and Correlations With Mental Health and Wellness: International, Online, Cross-sectional Study", journal="JMIR Form Res", year="2022", month="Aug", day="24", volume="6", number="8", pages="e38370", keywords="coronavirus", keywords="COVID-19", keywords="pandemic", keywords="mental health", keywords="depression", keywords="anxiety", keywords="screen-time usage", keywords="young adults", keywords="students", keywords="international study", keywords="observational study", keywords="cross-sectional study", keywords="smoking", abstract="Background: Screen time (ST) drastically increased during the COVID-19 pandemic, but there is little research on the specific type of ST use, degree of change from before COVID-19, and possible associations with other factors. Young adults are a particular interest since previous studies have shown the detriment ST has on a young person's health. With the combination of a life-changing pandemic, there are unreached depths regarding ST and young adults. This study aims to provide insight into these unknowns. Objective: This study aims to assess ST in 3 domains (entertainment, social media [SM], and educational/professional) in young adults early in the COVID-19 pandemic; identify trends; and identify any correlations with demographics, mental health, substance abuse, and overall wellness. Methods: An online, cross-sectional observational study was performed from September 2020 to January 2021 with 183 eligible respondents. Data were collected on ST, trauma from COVID-19, anxiety, depression, substance use, BMI, and sleep. Results: The average total ST during COVID-19 was 23.26 hours/week, entertainment ST was 7.98 hours/week, SM ST was 6.79 hours/week, and ST for educational or professional purposes was 8.49 hours/week. For all categories, the average ST during COVID-19 was higher than before COVID-19 (P<.001). We found ST differences between genders, student status, and continent of location. Increased well-being scores during COVID-19 were correlated with greater change in total ST (P=.01). Poorer sleep quality (P=.01) and longer sleep duration (P=.03) were associated with a greater change in entertainment ST (P=.01).?More severe depression and more severe anxiety was associated with the amount of entertainment ST (P=.047, P=.03, respectively) and greater percent change in SM (P=.007, P=.002, respectively). Greater stress from COVID-19 was associated with the amount of ST for educational/professional purposes (P=.05), change in total ST (P=.006), change in entertainment ST (P=.01), and change in ST for educational/professional purposes (P=.02). Higher Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) tobacco scores were associated with greater change in total ST (P=.004), and higher pack-years were associated with greater change in SM ST (P=.003). Higher alcohol scores (P=.004) and servings of alcohol per week (P=.003) were associated with greater change in entertainment ST. Quarantining did not negatively impact these variables. Conclusions: There is no doubt ST and worsening mental health increased during COVID-19 in young adults. However, these findings indicate there are many significant associations between ST use and mental health. These associations are more complex than originally thought, especially since we found quarantining is not associated with mental health. Although other factors need to be further investigated, this study emphasizes different types of ST and degree of change in ST affect various groups of people in discrete ways. Acknowledging these findings can help young adults optimize their mental health during pandemics. ", doi="10.2196/38370", url="https://formative.jmir.org/2022/8/e38370", url="http://www.ncbi.nlm.nih.gov/pubmed/35878157" } @Article{info:doi/10.2196/37821, author="Delanerolle, Gayathri and Williams, Robert and Stipancic, Ana and Byford, Rachel and Forbes, Anna and Tsang, M. Ruby S. and Anand, N. Sneha and Bradley, Declan and Murphy, Siobh{\'a}n and Akbari, Ashley and Bedston, Stuart and Lyons, A. Ronan and Owen, Rhiannon and Torabi, Fatemeh and Beggs, Jillian and Chuter, Antony and Balharry, Dominique and Joy, Mark and Sheikh, Aziz and Hobbs, Richard F. D. and de Lusignan, Simon", title="Methodological Issues in Using a Common Data Model of COVID-19 Vaccine Uptake and Important Adverse Events of Interest: Feasibility Study of Data and Connectivity COVID-19 Vaccines Pharmacovigilance in the United Kingdom", journal="JMIR Form Res", year="2022", month="Aug", day="22", volume="6", number="8", pages="e37821", keywords="Systematized Nomenclature of Medicine", keywords="COVID-19 vaccines", keywords="COVID-19", keywords="sinus thrombosis", keywords="anaphylaxis", keywords="pharmacovigilance", keywords="vaccine uptake", keywords="medical outcome", keywords="clinical coding system", keywords="health database", keywords="health information", keywords="clinical outcome", keywords="vaccine effect", keywords="data model", abstract="Background: The Data and Connectivity COVID-19 Vaccines Pharmacovigilance (DaC-VaP) UK-wide collaboration was created to monitor vaccine uptake and effectiveness and provide pharmacovigilance using routine clinical and administrative data. To monitor these, pooled analyses may be needed. However, variation in terminologies present a barrier as England uses the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), while the rest of the United Kingdom uses the Read v2 terminology in primary care. The availability of data sources is not uniform across the United Kingdom. Objective: This study aims to use the concept mappings in the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) to identify common concepts recorded and to report these in a repeated cross-sectional study. We planned to do this for vaccine coverage and 2 adverse events of interest (AEIs), cerebral venous sinus thrombosis (CVST) and anaphylaxis. We identified concept mappings to SNOMED CT, Read v2, the World Health Organization's International Classification of Disease Tenth Revision (ICD-10) terminology, and the UK Dictionary of Medicines and Devices (dm+d). Methods: Exposures and outcomes of interest to DaC-VaP for pharmacovigilance studies were selected. Mappings of these variables to different terminologies used across the United Kingdom's devolved nations' health services were identified from the Observational Health Data Sciences and Informatics (OHDSI) Automated Terminology Harmonization, Extraction, and Normalization for Analytics (ATHENA) online browser. Lead analysts from each nation then confirmed or added to the mappings identified. These mappings were then used to report AEIs in a common format. We reported rates for windows of 0-2 and 3-28 days postvaccine every 28 days. Results: We listed the mappings between Read v2, SNOMED CT, ICD-10, and dm+d. For vaccine exposure, we found clear mapping from OMOP to our clinical terminologies, though dm+d had codes not listed by OMOP at the time of searching. We found a list of CVST and anaphylaxis codes. For CVST, we had to use a broader cerebral venous thrombosis conceptual approach to include Read v2. We identified 56 SNOMED CT codes, of which we selected 47 (84\%), and 15 Read v2 codes. For anaphylaxis, our refined search identified 60 SNOMED CT codes and 9 Read v2 codes, of which we selected 10 (17\%) and 4 (44\%), respectively, to include in our repeated cross-sectional studies. Conclusions: This approach enables the use of mappings to different terminologies within the OMOP CDM without the need to catalogue an entire database. However, Read v2 has less granular concepts than some terminologies, such as SNOMED CT. Additionally, the OMOP CDM cannot compensate for limitations in the clinical coding system. Neither Read v2 nor ICD-10 is sufficiently granular to enable CVST to be specifically flagged. Hence, any pooled analysis will have to be at the less specific level of cerebrovascular venous thrombosis. Overall, the mappings within this CDM are useful, and our method could be used for rapid collaborations where there are only a limited number of concepts to pool. ", doi="10.2196/37821", url="https://formative.jmir.org/2022/8/e37821", url="http://www.ncbi.nlm.nih.gov/pubmed/35786634" } @Article{info:doi/10.2196/32968, author="Qin, Pei and He, Jianmei and Yang, Xue and Chen, Siyu and Chen, Xi and Jiang, Hui and Fung, Tung Ada Wai and Wang, Zixin and Lau, Fai Joseph Tak", title="The Role of Depressive Symptoms and Physical Activity Levels in Mediating the Association Between HIV Status and Neurocognitive Functions Among Individuals Aged at Least 50 Years in China: Cross-sectional Study", journal="JMIR Public Health Surveill", year="2022", month="Aug", day="19", volume="8", number="8", pages="e32968", keywords="neurocognitive performance", keywords="HIV sero-status", keywords="depressive symptoms", keywords="level of physical activity", keywords="mediation effects", keywords="HIV", keywords="depression", keywords="physical activity", keywords="neurocognitive", keywords="mental health", keywords="public health", abstract="Background: Neurocognitive impairments are prevalent among older people in China. It is more problematic among older people living with HIV. Objective: This study aims to compare neurocognitive performance between older people living with HIV and HIV-negative controls, and to explore whether the association between HIV status and neurocognitive performance was mediated by depressive symptoms and level of physical activity. Methods: A cross-sectional study was conducted in Yongzhou, China. All people living with HIV aged ?50 years listed in the registry were invited. Frequency matching was used to sample HIV-negative controls from the general population according to the distribution of age, sex, and years of formal education of older people living with HIV. A total of 315 older people living with HIV and 350 HIV-negative controls completed the face-to-face interview and comprehensive neuropsychological assessment of seven domains (learning, memory, working memory, verbal fluency, processing speed, executive function, and motor skills). Results: As compared to HIV-negative controls, older people living with HIV performed worse in global score and all seven domains (P<.05). HIV infection was associated with higher depressive symptoms (P<.001) and lower level of physical activity (P<.001). Depressive symptoms and physical activity were negatively correlated (P<.001). Depressive symptoms and level of physical activity mediated the association between HIV status and global z-score and four domain z-scores of neurocognitive performance (learning, memory, verbal fluency, and processing speed). Conclusions: Change in mental health and physical activity after HIV infection may partially explain why older people living with HIV are more susceptible to neurocognitive impairment. Promoting mental health and physical activity are potential entry points to slow down the progress of neurocognitive impairment among older people living with HIV. ", doi="10.2196/32968", url="https://publichealth.jmir.org/2022/8/e32968", url="http://www.ncbi.nlm.nih.gov/pubmed/35984684" } @Article{info:doi/10.2196/34150, author="Yang, Zijie and Wei, Lan and Xie, Wei and Chen, Lin and Yang, Zhengrong and Zhang, Yan and Liu, Shaochu and Tan, Wei and Zheng, Chenli and Gan, Yongxia and Li, Dongmin and Zou, Huachun and Chen, Wanying and Ma, Ling and Ju, Niu and Sun, Yinghui and Lv, Fan and Zhao, Jin", title="Estimating Changes in Population Size and Behavioral Characteristics in Men Who Have Sex With Men Between 2014 and 2019: Longitudinal Study", journal="JMIR Public Health Surveill", year="2022", month="Aug", day="16", volume="8", number="8", pages="e34150", keywords="men who have sex with men", keywords="population size", keywords="HIV/AIDS", keywords="behavioral characteristics", abstract="Background: Men who have sex with men (MSM) are at high risk for HIV infection. Accurate estimation of the population size and monitoring the risk sexual behavioral change of MSM is of great importance to develop targeted HIV prevention and interventions. Objective: The goal of the research was accurate estimation of the population size and monitoring the risk sexual behavioral change of MSM. Methods: Street interception investigation methods were conducted among males aged 16 years and older in selected sites in Shenzhen in 2014 and 2019. A population survey was used to estimate the population size of MSM. Logistic regression analysis was applied to evaluate the difference in behavioral characteristics in MSM from 2014 to 2019. Results: In this study, we surveyed 10,170 participants in 2014, of whom 448 (4.41\%, 95\% CI 4.01\%-4.80\%) participants were men who have ever had sex with another man (MSMe) and 229 (2.25\%, 95\% CI 1.96\%-2.54\%) were men who had sex with another man in the previous 6 months (MSMa). A total of 10,226 participants were surveyed in 2019, of which 500 (4.90\%, 95\% CI 4.47\%-5.31\%) and 208 (2.03\%, 95\% CI 1.76\%-2.31\%) participants were MSMe and MSMa, respectively. The results showed that the population size of MSM who are active (MSMa) in Shenzhen was 155,469 (2.29\%, 95\% CI 2.28\%-2.30\%) in 2014 and 167,337 (2.05\%, 95\% CI 2.04\%-2.06\%) in 2019. It was estimated that there were about 12,005,445 (2.04\%, 95\% CI 2.04\%-2.04\%) MSMa in China in 2019. Compared with 2014, the MSMa in 2019 were more likely to seek sex partners through mobile phone apps and less likely to have male and female sex partners in addition to having inconsistent condom use and more than 6 sex partners in the previous 6 months. Conclusions: In Shenzhen, the proportion of MSMa among the general male population was lower in 2019 than in 2014, and the prevalence of HIV risk behavior was reduced in 2019. Although the preferred platform to find male sex partners among MSM has changed, intervention with high--HIV risk MSM could still help to reduce HIV risk behaviors among the whole MSM group. Because MSM prefer to seek sex partners through mobile phone apps, further study is needed to strengthen internet interventions with high--HIV risk MSM to curb the spread of HIV. ", doi="10.2196/34150", url="https://publichealth.jmir.org/2022/8/e34150", url="http://www.ncbi.nlm.nih.gov/pubmed/35972779" } @Article{info:doi/10.2196/34858, author="Vargas-Herrera, Javier and Meneses, Giovanni and Cortez-Escalante, Juan", title="Physicians' Perceptions as Predictors of the Future Use of the National Death Information System in Peru: Cross-sectional Study", journal="J Med Internet Res", year="2022", month="Aug", day="15", volume="24", number="8", pages="e34858", keywords="death certificates", keywords="health information system", keywords="mortality", keywords="vital statistics", keywords="Technology Acceptance Model", keywords="model", keywords="acceptance model", keywords="certificates", keywords="information system", keywords="physicians", keywords="predictors", keywords="cross-sectional study", keywords="analysis", keywords="death", abstract="Background: A computer application called the National Death Information System (SINADEF) was implemented in Peru so that physicians can prepare death certificates in electronic format and the information is available online. In 2018, only half of the estimated deaths in Peru were certified using SINADEF. When a death is certified in paper format, the probability being entered in the mortality database decreases. It is important to know, from the user's perspective, the factors that can influence the successful implementation of SINADEF. SINADEF can only be successfully implemented if it is known whether physicians believe that it is useful and easy to operate. Objective: The aim of this study was to identify the perceptions of physicians and other factors as predictors of their behavioral intention to use SINADEF to certify a death. Methods: This study had an observational, cross-sectional design. A survey was provided to physicians working in Peru, who used SINADEF to certify a death for a period of 12 months, starting in November 2019. A questionnaire was adapted based on the Technology Acceptance Model. The questions measured the dimensions of subjective norm, image, job relevance, output quality, demonstrability of results, perceived usefulness, perceived ease of use, and behavioral intention to use. Chi-square and logistic regression tests were used in the analysis, and a confidence level of 95\% was chosen to support a significant association. Results: In this study, 272 physicians responded to the survey; 184 (67.6\%) were men and the average age was 45.3 (SD 10.1) years. The age range was 24 to 73 years. In the bivariate analysis, the intention to use SINADEF was found to be associated with (1) perceived usefulness, expressed as ``using SINADEF avoids falsifying a death certificate'' (P<.001), ``using SINADEF reduces the risk of errors'' (P<.001), and ``using SINADEF allows for filling out a certificate in less time'' (P<.001); and (2) perceived ease of use, expressed as ``I think SINADEF is easy to use'' (P<.001). In the logistic regression, perceived usefulness (odds ratio [OR] 8.5, 95\% CI 2.2-32.3; P=.002), perceived ease of use (OR 10.1, 95\% CI 2.4-41.8; P=.001), and training in filling out death certificates (OR 8.3, 95\% CI 1.6-42.8; P=.01) were found to be predictors of the behavioral intention to use SINADEF. Conclusions: The behavioral intention to use SINADEF was related to the perception that it is an easy-to-use system, the belief that it improves the performance of physicians in carrying out the task at hand, and with training in filling out death certificates. ", doi="10.2196/34858", url="https://www.jmir.org/2022/8/e34858", url="http://www.ncbi.nlm.nih.gov/pubmed/35969435" } @Article{info:doi/10.2196/38443, author="Park, Ta Van and Tsoh, Y. Janice and Dougan, Marcelle and Nam, Bora and Tzuang, Marian and Park, G. Linda and Vuong, N. Quyen and Bang, Joon and Meyer, L. Oanh", title="Racial Bias Beliefs Related to COVID-19 Among Asian Americans, Native Hawaiians, and Pacific Islanders: Findings From the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS)", journal="J Med Internet Res", year="2022", month="Aug", day="9", volume="24", number="8", pages="e38443", keywords="COVID-19", keywords="racial bias", keywords="Asian American", keywords="Native Hawaiian and Pacific Islander", keywords="mobile phone", abstract="Background: During the COVID-19 pandemic, there have been increased reports of racial biases against Asian American and Native Hawaiian and Pacific Islander individuals. However, the extent to which different Asian American and Native Hawaiian and Pacific Islander groups perceive and experience (firsthand or as a witness to such experiences) how COVID-19 has negatively affected people of their race has not received much attention. Objective: This study used data from the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS), a nationwide, multilingual survey, to empirically examine COVID-19--related racial bias beliefs among Asian American and Native Hawaiian and Pacific Islander individuals and the factors associated with these beliefs. Methods: COMPASS participants were Asian American and Native Hawaiian and Pacific Islander adults who were able to speak English, Chinese (Cantonese or Mandarin), Korean, Samoan, or Vietnamese and who resided in the United States during the time of the survey (October 2020 to May 2021). Participants completed the survey on the web, via phone, or in person. The Coronavirus Racial Bias Scale (CRBS) was used to assess COVID-19--related racial bias beliefs toward Asian American and Native Hawaiian and Pacific Islander individuals. Participants were asked to rate the degree to which they agreed with 9 statements on a 5-point Likert scale (ie, 1=strongly disagree to 5=strongly agree). Multivariable linear regression was used to examine the associations between demographic, health, and COVID-19--related characteristics and perceived racial bias. Results: A total of 5068 participants completed the survey (mean age 45.4, SD 16.4 years; range 18-97 years). Overall, 73.97\% (3749/5068) agreed or strongly agreed with ?1 COVID-19--related racial bias belief in the past 6 months (during the COVID-19 pandemic). Across the 9 racial bias beliefs, participants scored an average of 2.59 (SD 0.96, range 1-5). Adjusted analyses revealed that compared with Asian Indians, those who were ethnic Chinese, Filipino, Hmong, Japanese, Korean, Vietnamese, and other or multicultural had significantly higher mean CRBS scores, whereas no significant differences were found among Native Hawaiian and Pacific Islander individuals. Nonheterosexual participants had statistically significant and higher mean CRBS scores than heterosexual participants. Compared with participants aged ?60 years, those who were younger (aged <30, 30-39, 40-49, and 50-59 years) had significantly higher mean CRBS scores. US-born participants had significantly higher mean CRBS scores than foreign-born participants, whereas those with limited English proficiency (relative to those reporting no limitation) had lower mean CRBS scores. Conclusions: Many COMPASS participants reported racial bias beliefs because of the COVID-19 pandemic. Relevant sociodemographic contexts and pre-existing and COVID-19--specific factors across individual, community, and society levels were associated with the perceived racial bias of being Asian during the pandemic. The findings underscore the importance of addressing the burden of racial bias on Asian American and Native Hawaiian and Pacific Islander communities among other COVID-19--related sequelae. ", doi="10.2196/38443", url="https://www.jmir.org/2022/8/e38443", url="http://www.ncbi.nlm.nih.gov/pubmed/35658091" } @Article{info:doi/10.2196/35283, author="Pedamallu, Havisha and Ehrhardt, J. Matthew and Maki, Julia and Carcone, Idalski April and Hudson, M. Melissa and Waters, A. Erika", title="Technology-Delivered Adaptations of Motivational Interviewing for the Prevention and Management of Chronic Diseases: Scoping Review", journal="J Med Internet Res", year="2022", month="Aug", day="9", volume="24", number="8", pages="e35283", keywords="motivational interviewing", keywords="technology", keywords="telehealth", keywords="health behavior", keywords="chronic disease", keywords="socioeconomic factors", keywords="health promotion", keywords="disease management", keywords="primary prevention", keywords="secondary prevention", keywords="minority health", abstract="Background: Motivational interviewing (MI) can increase health-promoting behaviors and decrease health-damaging behaviors. However, MI is often resource intensive, precluding its use with people with limited financial or time resources. Mobile health--based versions of MI interventions or technology-delivered adaptations of MI (TAMIs) might increase reach. Objective: We aimed to understand the characteristics of existing TAMIs. We were particularly interested in the inclusion of people from marginalized sociodemographic groups, whether the TAMI addressed sociocontextual factors, and how behavioral and health outcomes were reported. Methods: We employed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews to conduct our scoping review. We searched PubMed, CINAHL, and PsycInfo from January 1, 1996, to April 6, 2022, to identify studies that described interventions incorporating MI into a mobile or electronic health platform. For inclusion, the study was required to (1) describe methods/outcomes of an MI intervention, (2) feature an intervention delivered automatically via a mobile or electronic health platform, and (3) report a behavioral or health outcome. The exclusion criteria were (1) publication in a language other than English and (2) description of only in-person intervention delivery (ie, no TAMI). We charted results using Excel (Microsoft Corp). Results: Thirty-four studies reported the use of TAMIs. Sample sizes ranged from 10 to 2069 participants aged 13 to 70 years. Most studies (n=27) directed interventions toward individuals engaging in behaviors that increased chronic disease risk. Most studies (n=22) oversampled individuals from marginalized sociodemographic groups, but few (n=3) were designed specifically with marginalized groups in mind. TAMIs used text messaging (n=8), web-based intervention (n=22), app + text messaging (n=1), and web-based intervention + text messaging (n=3) as delivery platforms. Of the 34 studies, 30 (88\%) were randomized controlled trials reporting behavioral and health-related outcomes, 23 of which reported statistically significant improvements in targeted behaviors with TAMI use. TAMIs improved targeted health behaviors in the remaining 4 studies. Moreover, 11 (32\%) studies assessed TAMI feasibility, acceptability, or satisfaction, and all rated TAMIs highly in this regard. Among 20 studies with a disproportionately high number of people from marginalized racial or ethnic groups compared with the general US population, 16 (80\%) reported increased engagement in health behaviors or better health outcomes. However, no TAMIs included elements that addressed sociocontextual influences on behavior or health outcomes. Conclusions: Our findings suggest that TAMIs may improve some health promotion and disease management behaviors. However, few TAMIs were designed specifically for people from marginalized sociodemographic groups, and none included elements to help address sociocontextual challenges. Research is needed to determine how TAMIs affect individual health outcomes and how to incorporate elements that address sociocontextual factors, and to identify the best practices for implementing TAMIs into clinical practice. ", doi="10.2196/35283", url="https://www.jmir.org/2022/8/e35283", url="http://www.ncbi.nlm.nih.gov/pubmed/35943775" } @Article{info:doi/10.2196/38551, author="McNeil, Carrie and Verlander, Sarah and Divi, Nomita and Smolinski, Mark", title="The Landscape of Participatory Surveillance Systems Across the One Health Spectrum: Systematic Review", journal="JMIR Public Health Surveill", year="2022", month="Aug", day="5", volume="8", number="8", pages="e38551", keywords="participatory surveillance", keywords="One Health", keywords="citizen science", keywords="community-based surveillance", keywords="infectious disease", keywords="digital disease detection", keywords="community participation", keywords="mobile phone", abstract="Background: Participatory surveillance systems augment traditional surveillance systems through bidirectional community engagement. The digital platform evolution has enabled the expansion of participatory surveillance systems, globally, for the detection of health events impacting people, animals, plants, and the environment, in other words, across the entire One Health spectrum. Objective: The aim of this landscape was to identify and provide descriptive information regarding system focus, geography, users, technology, information shared, and perceived impact of ongoing participatory surveillance systems across the One Health spectrum. Methods: This landscape began with a systematic literature review to identify potential ongoing participatory surveillance systems. A survey was sent to collect standardized data from the contacts of systems identified in the literature review and through direct outreach to stakeholders, experts, and professional organizations. Descriptive analyses of survey and literature review results were conducted across the programs. Results: The landscape identified 60 ongoing single-sector and multisector participatory surveillance systems spanning five continents. Of these, 29 (48\%) include data on human health, 26 (43\%) include data on environmental health, and 24 (40\%) include data on animal health. In total, 16 (27\%) systems are multisectoral; of these, 9 (56\%) collect animal and environmental health data; 3 (19\%) collect human, animal, and environmental health data; 2 (13\%) collect human and environmental health data; and 2 (13\%) collect human and animal health data. Out of 60 systems, 31 (52\%) are designed to cover a national scale, compared to those with a subnational (n=19, 32\%) or multinational (n=10, 17\%) focus. All systems use some form of digital technology. Email communication or websites (n=40, 67\%) and smartphones (n=29, 48\%) are the most common technologies used, with some using both. Systems have capabilities to download geolocation data (n=31, 52\%), photographs (n=29, 48\%), and videos (n=6, 10\%), and can incorporate lab data or sample collection (n=15, 25\%). In sharing information back with users, most use visualization, such as maps (n=43, 72\%); training and educational materials (n=37, 62\%); newsletters, blogs, and emails (n=34, 57\%); and disease prevention information (n=32, 53\%). Out of the 46 systems responding to the survey regarding perceived impacts of their systems, 36 (78\%) noted ``improved community knowledge and understanding'' and 31 (67\%) noted ``earlier detection.'' Conclusions: The landscape demonstrated the breadth of applicability of participatory surveillance around the world to collect data from community members and trained volunteers in order to inform the detection of events, from invasive plant pests to weekly influenza symptoms. Acknowledging the importance of bidirectionality of information, these systems simultaneously share findings back with the users. Such directly engaged community detection systems capture events early and provide opportunities to stop outbreaks quickly. ", doi="10.2196/38551", url="https://publichealth.jmir.org/2022/8/e38551", url="http://www.ncbi.nlm.nih.gov/pubmed/35930345" } @Article{info:doi/10.2196/39888, author="Kaur, Manpreet and Costello, Jeremy and Willis, Elyse and Kelm, Karen and Reformat, Z. Marek and Bolduc, V. Francois", title="Deciphering the Diversity of Mental Models in Neurodevelopmental Disorders: Knowledge Graph Representation of Public Data Using Natural Language Processing", journal="J Med Internet Res", year="2022", month="Aug", day="5", volume="24", number="8", pages="e39888", keywords="concept map", keywords="neurodevelopmental disorder", keywords="knowledge graph", keywords="text analysis", keywords="semantic relatedness", keywords="PubMed", keywords="forums", keywords="mental model", abstract="Background: Understanding how individuals think about a topic, known as the mental model, can significantly improve communication, especially in the medical domain where emotions and implications are high. Neurodevelopmental disorders (NDDs) represent a group of diagnoses, affecting up to 18\% of the global population, involving differences in the development of cognitive or social functions. In this study, we focus on 2 NDDs, attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), which involve multiple symptoms and interventions requiring interactions between 2 important stakeholders: parents and health professionals. There is a gap in our understanding of differences between mental models for each stakeholder, making communication between stakeholders more difficult than it could be. Objective: We aim to build knowledge graphs (KGs) from web-based information relevant to each stakeholder as proxies of mental models. These KGs will accelerate the identification of shared and divergent concerns between stakeholders. The developed KGs can help improve knowledge mobilization, communication, and care for individuals with ADHD and ASD. Methods: We created 2 data sets by collecting the posts from web-based forums and PubMed abstracts related to ADHD and ASD. We utilized the Unified Medical Language System (UMLS) to detect biomedical concepts and applied Positive Pointwise Mutual Information followed by truncated Singular Value Decomposition to obtain corpus-based concept embeddings for each data set. Each data set is represented as a KG using a property graph model. Semantic relatedness between concepts is calculated to rank the relation strength of concepts and stored in the KG as relation weights. UMLS disorder-relevant semantic types are used to provide additional categorical information about each concept's domain. Results: The developed KGs contain concepts from both data sets, with node sizes representing the co-occurrence frequency of concepts and edge sizes representing relevance between concepts. ADHD- and ASD-related concepts from different semantic types shows diverse areas of concerns and complex needs of the conditions. KG identifies converging and diverging concepts between health professionals literature (PubMed) and parental concerns (web-based forums), which may correspond to the differences between mental models for each stakeholder. Conclusions: We show for the first time that generating KGs from web-based data can capture the complex needs of families dealing with ADHD or ASD. Moreover, we showed points of convergence between families and health professionals' KGs. Natural language processing--based KG provides access to a large sample size, which is often a limiting factor for traditional in-person mental model mapping. Our work offers a high throughput access to mental model maps, which could be used for further in-person validation, knowledge mobilization projects, and basis for communication about potential blind spots from stakeholders in interactions about NDDs. Future research will be needed to identify how concepts could interact together differently for each stakeholder. ", doi="10.2196/39888", url="https://www.jmir.org/2022/8/e39888", url="http://www.ncbi.nlm.nih.gov/pubmed/35930346" } @Article{info:doi/10.2196/37367, author="Skafle, Ingjerd and Nordahl-Hansen, Anders and Quintana, S. Daniel and Wynn, Rolf and Gabarron, Elia", title="Misinformation About COVID-19 Vaccines on Social Media: Rapid Review", journal="J Med Internet Res", year="2022", month="Aug", day="4", volume="24", number="8", pages="e37367", keywords="social media", keywords="misinformation", keywords="COVID-19 vaccines", keywords="vaccination hesitancy", keywords="autism spectrum disorder", abstract="Background: The development of COVID-19 vaccines has been crucial in fighting the pandemic. However, misinformation about the COVID-19 pandemic and vaccines is spread on social media platforms at a rate that has made the World Health Organization coin the phrase infodemic. False claims about adverse vaccine side effects, such as vaccines being the cause of autism, were already considered a threat to global health before the outbreak of COVID-19. Objective: We aimed to synthesize the existing research on misinformation about COVID-19 vaccines spread on social media platforms and its effects. The secondary aim was to gain insight and gather knowledge about whether misinformation about autism and COVID-19 vaccines is being spread on social media platforms. Methods: We performed a literature search on September 9, 2021, and searched PubMed, PsycINFO, ERIC, EMBASE, Cochrane Library, and the Cochrane COVID-19 Study Register. We included publications in peer-reviewed journals that fulfilled the following criteria: original empirical studies, studies that assessed social media and misinformation, and studies about COVID-19 vaccines. Thematic analysis was used to identify the patterns (themes) of misinformation. Narrative qualitative synthesis was undertaken with the guidance of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 Statement and the Synthesis Without Meta-analysis reporting guideline. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tool. Ratings of the certainty of evidence were based on recommendations from the Grading of Recommendations Assessment, Development and Evaluation Working Group. Results: The search yielded 757 records, with 45 articles selected for this review. We identified 3 main themes of misinformation: medical misinformation, vaccine development, and conspiracies. Twitter was the most studied social media platform, followed by Facebook, YouTube, and Instagram. A vast majority of studies were from industrialized Western countries. We identified 19 studies in which the effect of social media misinformation on vaccine hesitancy was measured or discussed. These studies implied that the misinformation spread on social media had a negative effect on vaccine hesitancy and uptake. Only 1 study contained misinformation about autism as a side effect of COVID-19 vaccines. Conclusions: To prevent these misconceptions from taking hold, health authorities should openly address and discuss these false claims with both cultural and religious awareness in mind. Our review showed that there is a need to examine the effect of social media misinformation on vaccine hesitancy with a more robust experimental design. Furthermore, this review also demonstrated that more studies are needed from the Global South and on social media platforms other than the major platforms such as Twitter and Facebook. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021277524; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42021277524 International Registered Report Identifier (IRRID): RR2-10.31219/osf.io/tyevj ", doi="10.2196/37367", url="https://www.jmir.org/2022/8/e37367", url="http://www.ncbi.nlm.nih.gov/pubmed/35816685" } @Article{info:doi/10.2196/33309, author="Bezerra, Barros Daniel Rodrigues and Jalil, Moreira Cristina and Jalil, Moreira Emilia and Coelho, Esteves Lara and Netto, Carvalheira Eduardo and Freitas, Josias and Monteiro, Laylla and Santos, Toni and Souza, Cleo and Hoagland, Brenda and Veloso, Gon{\c{c}}alves Valdilea and Grinsztejn, Beatriz and Cardoso, Wagner Sandra and Torres, Silva Thiago", title="Comparing Web-Based Venues to Recruit Gay, Bisexual, and Other Cisgender Men Who Have Sex With Men to a Large HIV Prevention Service in Brazil: Evaluation Study", journal="JMIR Form Res", year="2022", month="Aug", day="4", volume="6", number="8", pages="e33309", keywords="social media", keywords="web-based recruitment strategies", keywords="men who have sex with men", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="HIV prevention", keywords="Brazil", keywords="Latin America", keywords="HIV", abstract="Background: Internet and mobile phones, widely available in Brazil, could be used to disseminate information about HIV prevention and to recruit gay, bisexual, and other cisgender men who have sex with men (MSM) to HIV prevention services. Data evaluating the characteristics of MSM recruited through different web-based strategies and estimating their cost and yield in the country are not available. Objective: We aimed to describe a web-based recruitment cascade, compare the characteristics of MSM recruited to a large HIV prevention service in Rio de Janeiro according to web-based venues, and estimate the cost per participant for each strategy. Methods: We promoted advertisements on geosocial networking (GSN) apps (Hornet and Grindr) and social media (Facebook and Instagram) from March 2018 to October 2019. The advertisements invited viewers to contact a peer educator to schedule a visit at the HIV prevention service. Performance of web-based recruitment cascade was based on how many MSM (1) were reached by the advertisement, (2) contacted the peer educator, and (3) attended the service. We used chi-square tests to compare MSM recruited through GSN apps and social media. The estimated advertisement cost to recruit a participant was calculated by dividing total advertisement costs by number of participants who attended the service or initiated preexposure prophylaxis (PrEP). Results: Advertisement reached 1,477,344 individuals; 1270 MSM contacted the peer educator (86 contacts per 100,000 views)---564 (44.4\%), 401 (31.6\%) and 305 (24.0\%)---through social media, Grindr, and Hornet. Among the 1270 individuals who contacted the peer educator, 36.3\% (n=461) attended the service with similar proportion for each web-based strategy (social media: 203/564, 36.0\%; Grindr: 152/401, 37.9\%; and Hornet: 107/305, 35.1\%). MSM recruited through GSN apps were older (mean age 30 years vs 26 years; P<.001), more frequently self-reported as White (111/247, 44.9\% vs 62/191, 32.5\%; P=.03), and had higher schooling level (postsecondary: 157/254, 61.8\% vs 94/194, 48.5\%; P=.007) than MSM recruited through social media. GSN apps recruited MSM with higher HIV risk as measured by PrEP eligibility (207/239, 86.6\% vs 133/185, 71.9\%; P<.001) compared with social media, but there was no difference in PrEP uptake between the two strategies (P=.22). The estimated advertisement costs per participant attending the HIV prevention service were US \$28.36 for GSN apps and US \$12.17 for social media. The estimated advertisement costs per participant engaging on PrEP were US \$58.77 for GSN apps and US \$27.75 for social media. Conclusions: Social media and GSN app advertisements were useful to disseminate information on HIV prevention strategies and to recruit MSM to a large HIV prevention service in Brazil. Compared to GSN apps, social media advertisements were less expensive and reached more vulnerable and younger MSM. Digital marketing campaigns should use different and complementary web-based venues to reach a plurality of MSM. ", doi="10.2196/33309", url="https://formative.jmir.org/2022/8/e33309", url="http://www.ncbi.nlm.nih.gov/pubmed/35925658" } @Article{info:doi/10.2196/32286, author="Chabata, T. Sungai and Makandwa, Rumbidzo and Hensen, Bernadette and Mushati, Phillis and Chiyaka, Tarisai and Musemburi, Sithembile and Busza, Joanna and Floyd, Sian and Birdthistle, Isolde and Hargreaves, R. James and Cowan, M. Frances", title="Strategies to Identify and Reach Young Women Who Sell Sex With HIV Prevention and Care Services: Lessons Learnt From the Implementation of DREAMS Services in Two Cities in Zimbabwe", journal="JMIR Public Health Surveill", year="2022", month="Jul", day="27", volume="8", number="7", pages="e32286", keywords="respondent-driven sampling", keywords="peer outreach", keywords="female sex worker", keywords="young women who sell sex", keywords="HIV prevention", keywords="Zimbabwe", keywords="sub-Saharan Africa", abstract="Background: Young women who sell sex (YWSS), are underserved by available HIV prevention and care services. The Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) Partnership aimed to reduce the risk of HIV acquisition among vulnerable populations of adolescent girls and young women, including YWSS, in 10 sub-Saharan African countries. We describe 2 methods, respondent-driven sampling (RDS) and peer outreach, used to refer YWSS for DREAMS services in Zimbabwe, and compare the characteristics and engagement of YWSS referred to these services by each method. We hypothesized that RDS would identify YWSS at higher risk of HIV and those who were less engaged with HIV prevention and care services than peer outreach. Objective: We aimed to compare respondent-driven sampling and peer outreach in recruiting and referring high-risk populations for HIV prevention and care services. Methods: We used RDS, a sampling method designed to reach a representative sample of the network of key populations, and peer outreach, a programmatic approach to identify, reach, and refer YWSS for DREAMS between April and July 2017, and January 2017 and July 2018, respectively, in 2 cities in Zimbabwe. For RDS, we conducted detailed mapping to understand sex work typology and geography, and then purposively selected 10 ``seed'' participants in each city to initiate RDS. For peer outreach, we initiated recruitment through 18 trained and age-matched peer educators using youth-tailored community mobilization. We described the characteristics and service engagement of YWSS who accessed DREAMS services by each referral approach and assessed the association of these characteristics with referral approach using the chi-square test. Analysis was performed with and without restricting the period when RDS took place. We estimated the relative incremental costs of recruiting YWSS using each strategy for referral to DREAMS services. Results: Overall, 5386 and 1204 YWSS were referred for DREAMS services through peer outreach and RDS, respectively. YWSS referred through RDS were more likely to access DREAMS services compared to YWSS referred through peer outreach (501/1204, 41.6\% vs 930/5386, 17.3\%; P<.001). Regardless of referral approach, YWSS who accessed DREAMS had similar education levels, and a similar proportion tested HIV negative and reported not using a condom at the last sex act. A higher proportion of YWSS accessing DREAMS through RDS were aged 18-19 years (167/501, 33.3\% vs 243/930, 26.1\%; P=.004) and more likely to be aware of their HIV status (395/501, 78.8\% vs 396/930, 42.6\%; P<.001) compared to those accessing DREAMS services through peer outreach. The incremental cost per young woman who sells sex recruited was US \$7.46 for peer outreach and US \$52.81 for RDS. Conclusions: Peer outreach and RDS approaches can reach and refer high-risk but different groups of YWSS for HIV services, and using both approaches will likely improve reach. International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5085-6 ", doi="10.2196/32286", url="https://publichealth.jmir.org/2022/7/e32286", url="http://www.ncbi.nlm.nih.gov/pubmed/35896024" } @Article{info:doi/10.2196/37720, author="Bito, Seiji and Hayashi, Yachie and Fujita, Takanori and Yonemura, Shigeto", title="Public Attitudes Regarding Trade-offs Between the Functional Aspects of a Contact-Confirming App for COVID-19 Infection Control and the Benefits to Individuals and Public Health: Cross-sectional Survey", journal="JMIR Form Res", year="2022", month="Jul", day="20", volume="6", number="7", pages="e37720", keywords="internet questionnaire survey", keywords="contact-confirming app", keywords="COVID-19", keywords="privacy", keywords="ethics in public health", keywords="health application", keywords="application development", keywords="health service", keywords="mobile phone", keywords="survey platform", keywords="public health", keywords="digital information", keywords="health information", abstract="Background: It is expected that personal health information collected through mobile information terminals will be used to develop health strategies that benefit the public. Against this background, several countries have actively attempted to use mobile phones to control infectious diseases. These collected data, such as activity logs and contact history, are countermeasures against diseases such as COVID-19. In Japan, the Ministry of Health, Labor, and Welfare has developed and disseminated a contact-confirming app (COVID-19 Contact-Confirming Application [COCOA]) to the public, which detects and notifies individuals whether they have been near someone who had subsequently tested positive for COVID-19. However, there are concerns about leakage and misuse of the personal information collected by such information terminals. Objective: This study aimed to investigate the possible trade-off between effectiveness in preventing infectious diseases and infringement of personal privacy in COCOA. In addition, we analyzed whether resistance to COCOA would reduce if the app contributed to public health or if a discount was provided on mobile phone charges. Methods: A cross-sectional, quantitative survey of Japanese citizens was conducted using Survey Monkey, a general-purpose web-based survey platform. When developing the questions for the questionnaire, we included the installation status of COCOA and recorded the anxiety stemming from the potential leakage or misuse of personal information collected for COVID-19 infection control. The respondents were asked to rate various factors to determine their perceptions on a 5-point scale. Results: In total, 1058 participants were included in the final analysis. In response to the question of whether the spread of the disease was being controlled by the infection control measures taken by the government, 25.71\% (272/1058) of the respondents answered that they strongly agreed or agreed. One-quarter of the respondents indicated that they had already installed COCOA. This study found that the sense of resistance to government intervention was not alleviated by the benefits provided to individuals when using the app. The only factors that were positively associated with the response absolutely opposed to use of the app, even with a discount on mobile phone use charges, were those regarding leaks and misuse of personal information, which was true for all functions (function A: odds ratio [OR] 1.8, 95\% CI 1.3-2.4; function B: OR 1.9, 95\% CI 1.5-2.6; function C: OR 1.8, 95\% CI 1.4-2.4). Conclusions: Public organizations need to emphasize the general benefits of allowing them to manage personal information and assure users that this information is being managed safely rather than offering incentives to individuals to provide such personal information. When collecting and using citizens' health information, it is essential that governments and other entities focus on contributing to the public good and ensuring safety rather than returning benefits to individual citizens. ", doi="10.2196/37720", url="https://formative.jmir.org/2022/7/e37720", url="http://www.ncbi.nlm.nih.gov/pubmed/35610182" } @Article{info:doi/10.2196/35276, author="Otridge, Jeremy and Ogden, L. Cynthia and Bernstein, T. Kyle and Knuth, Martha and Fishman, Julie and Brooks, T. John", title="Publication and Impact of Preprints Included in the First 100 Editions of the CDC COVID-19 Science Update: Content Analysis", journal="JMIR Public Health Surveill", year="2022", month="Jul", day="15", volume="8", number="7", pages="e35276", keywords="preprints", keywords="preprint", keywords="publishing", keywords="publish", keywords="bioRxiv", keywords="medRxiv", keywords="Centers for Disease Control and Prevention", keywords="CDC", keywords="preprint server", keywords="public health", keywords="health information", keywords="COVID-19", keywords="pandemic", keywords="publication", keywords="Altmetric attention score", keywords="Altmetric", keywords="attention score", keywords="citation count", keywords="citation", keywords="science update", keywords="decision-making", abstract="Background: Preprints are publicly available manuscripts posted to various servers that have not been peer reviewed. Although preprints have existed since 1961, they have gained increased popularity during the COVID-19 pandemic due to the need for immediate, relevant information. Objective: The aim of this study is to evaluate the publication rate and impact of preprints included in the Centers for Disease Control and Prevention (CDC) COVID-19 Science Update and assess the performance of the COVID-19 Science Update team in selecting impactful preprints. Methods: All preprints in the first 100 editions (April 1, 2020, to July 30, 2021) of the Science Update were included in the study. Preprints that were not published were categorized as ``unpublished preprints.'' Preprints that were subsequently published exist in 2 versions (in a peer-reviewed journal and on the original preprint server), which were analyzed separately and referred to as ``peer-reviewed preprint'' and ``original preprint,'' respectively. Time to publish was the time interval between the date on which a preprint was first posted and the date on which it was first available as a peer-reviewed article. Impact was quantified by Altmetric Attention Score and citation count for all available manuscripts on August 6, 2021. Preprints were analyzed by publication status, publication rate, preprint server, and time to publication. Results: Of the 275 preprints included in the CDC COVID-19 Science Update during the study period, most came from three servers: medRxiv (n=201, 73.1\%), bioRxiv (n=41, 14.9\%), and SSRN (n=25, 9.1\%), with 8 (2.9\%) coming from other sources. Additionally, 152 (55.3\%) were eventually published. The median time to publish was 2.3 (IQR 1.4-3.7). When preprints posted in the last 2.3 months were excluded (to account for the time to publish), the publication rate was 67.8\%. Moreover, 76 journals published at least one preprint from the CDC COVID-19 Science Update, and 18 journals published at least three. The median Altmetric Attention Score for unpublished preprints (n=123, 44.7\%) was 146 (IQR 22-552) with a median citation count of 2 (IQR 0-8); for original preprints (n=152, 55.2\%), these values were 212 (IQR 22-1164) and 14 (IQR 2-40), respectively; for peer-review preprints, these values were 265 (IQR 29-1896) and 19 (IQR 3-101), respectively. Conclusions: Prior studies of COVID-19 preprints found publication rates between 5.4\% and 21.1\%. Preprints included in the CDC COVID-19 Science Update were published at a higher rate than overall COVID-19 preprints, and those that were ultimately published were published within months and received higher attention scores than unpublished preprints. These findings indicate that the Science Update process for selecting preprints had a high fidelity in terms of their likelihood to be published and their impact. The incorporation of high-quality preprints into the CDC COVID-19 Science Update improves this activity's capacity to inform meaningful public health decision-making. ", doi="10.2196/35276", url="https://publichealth.jmir.org/2022/7/e35276", url="http://www.ncbi.nlm.nih.gov/pubmed/35544426" } @Article{info:doi/10.2196/34114, author="Gao, Yankun and Xie, Zidian and Li, Dongmei", title="Investigating the Impact of the New York State Flavor Ban on e-Cigarette--Related Discussions on Twitter: Observational Study", journal="JMIR Public Health Surveill", year="2022", month="Jul", day="8", volume="8", number="7", pages="e34114", keywords="New York State flavor ban", keywords="e-cigarettes", keywords="twitter", keywords="topic modeling", keywords="sentiment analysis", abstract="Background: On May 18, 2020, the New York State Department of Health implemented a statewide flavor ban to prohibit the sales of all flavored vapor products, except for tobacco or any other authorized flavor. Objective: This study aims to investigate the discussion changes in e-cigarette--related tweets over time with the implementation of the New York State flavor ban. Methods: Through the Twitter streaming application programming interface, 59,883 e-cigarette--related tweets were collected within the New York State from February 6, 2020, to May 17, 2020 (period 1, before the implementation of the flavor ban), May 18, 2020-June 30, 2020 (period 2, between the implementation of the flavor ban and the online sales ban), July 1, 2020-September 15, 2020 (period 3, the short term after the online sales ban), and September 16, 2020-November 30, 2020 (period 4, the long term after the online sales ban). Sentiment analysis and topic modeling were conducted to investigate the changes in public attitudes and discussions in e-cigarette--related tweets. The popularity of different e-cigarette flavor categories was compared before and after the implementation of the New York State flavor ban. Results: Our results showed that the proportion of e-cigarette--related tweets with negative sentiment significantly decreased (4305/13,246, 32.5\% vs 3855/14,455, 26.67\%, P<.001), and tweets with positive sentiment significantly increased (5246/13,246, 39.6\% vs 7038/14,455, 48.69\%, P<.001) in period 4 compared to period 3. ``Teens and nicotine products'' was the most frequently discussed e-cigarette--related topic in the negative tweets. In contrast, ``nicotine products and quitting'' was more prevalent in positive tweets. The proportion of tweets mentioning mint and menthol flavors significantly increased right after the flavor ban and decreased to lower levels over time. The proportions of fruit and sweet flavors were most frequently mentioned in period 1, decreased in period 2, and dominated again in period 4. Conclusions: The proportion of e-cigarette--related tweets with different attitudes and frequently discussed flavor categories changed over time after the implementation of the New York State ban of flavored vaping products. This change indicated a potential impact of the flavor ban on public discussions of flavored e-cigarettes. ", doi="10.2196/34114", url="https://publichealth.jmir.org/2022/7/e34114", url="http://www.ncbi.nlm.nih.gov/pubmed/35802417" } @Article{info:doi/10.2196/34605, author="Francombe, Joseph and Ali, Gemma-Claire and Gloinson, Ryen Emily and Feijao, Carolina and Morley, I. Katherine and Gunashekar, Salil and de Carvalho Gomes, Helena", title="Assessing the Implementation of Digital Innovations in Response to the COVID-19 Pandemic to Address Key Public Health Functions: Scoping Review of Academic and Nonacademic Literature", journal="JMIR Public Health Surveill", year="2022", month="Jul", day="6", volume="8", number="7", pages="e34605", keywords="digital technologies", keywords="COVID-19", keywords="key public health functions", keywords="scoping review", keywords="digital health", keywords="pandemic", keywords="surveillance", keywords="mobile phone", abstract="Background: Digital technologies have been central to efforts to respond to the COVID-19 pandemic. In this context, a range of literature has reported on developments regarding the implementation of new digital technologies for COVID-19--related surveillance, prevention, and control. Objective: In this study, scoping reviews of academic and nonacademic literature were undertaken to obtain an overview of the evidence regarding digital innovations implemented to address key public health functions in the context of the COVID-19 pandemic. This study aimed to expand on the work of existing reviews by drawing on additional data sources (including nonacademic sources) by considering literature published over a longer time frame and analyzing data in terms of the number of unique digital innovations. Methods: We conducted a scoping review of the academic literature published between January 1, 2020, and September 15, 2020, supplemented by a further scoping review of selected nonacademic literature published between January 1, 2020, and October 13, 2020. Both reviews followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach. Results: A total of 226 academic articles and 406 nonacademic articles were included. The included articles provided evidence of 561 (academic literature) and 497 (nonacademic literature) unique digital innovations. The most common implementation settings for digital innovations were the United States, China, India, and the United Kingdom. Technologies most commonly used by digital innovations were those belonging to the high-level technology group of integrated and ubiquitous fixed and mobile networks. The key public health functions most commonly addressed by digital innovations were communication and collaboration and surveillance and monitoring. Conclusions: Digital innovations implemented in response to the COVID-19 pandemic have been wide ranging in terms of their implementation settings, the digital technologies used, and the public health functions addressed. However, evidence gathered through this study also points to a range of barriers that have affected the successful implementation of digital technologies for public health functions. It is also evident that many digital innovations implemented in response to the COVID-19 pandemic are yet to be formally evaluated or assessed. ", doi="10.2196/34605", url="https://publichealth.jmir.org/2022/7/e34605", url="http://www.ncbi.nlm.nih.gov/pubmed/35605152" } @Article{info:doi/10.2196/34285, author="Sigalo, Nekabari and St Jean, Beth and Frias-Martinez, Vanessa", title="Using Social Media to Predict Food Deserts in the United States: Infodemiology Study of Tweets", journal="JMIR Public Health Surveill", year="2022", month="Jul", day="5", volume="8", number="7", pages="e34285", keywords="social media", keywords="Twitter", keywords="food deserts", keywords="food insecurity", abstract="Background: The issue of food insecurity is becoming increasingly important to public health practitioners because of the adverse health outcomes and underlying racial disparities associated with insufficient access to healthy foods. Prior research has used data sources such as surveys, geographic information systems, and food store assessments to identify regions classified as food deserts but perhaps the individuals in these regions unknowingly provide their own accounts of food consumption and food insecurity through social media. Social media data have proved useful in answering questions related to public health; therefore, these data are a rich source for identifying food deserts in the United States. Objective: The aim of this study was to develop, from geotagged Twitter data, a predictive model for the identification of food deserts in the United States using the linguistic constructs found in food-related tweets. Methods: Twitter's streaming application programming interface was used to collect a random 1\% sample of public geolocated tweets across 25 major cities from March 2020 to December 2020. A total of 60,174 geolocated food-related tweets were collected across the 25 cities. Each geolocated tweet was mapped to its respective census tract using point-to-polygon mapping, which allowed us to develop census tract--level features derived from the linguistic constructs found in food-related tweets, such as tweet sentiment and average nutritional value of foods mentioned in the tweets. These features were then used to examine the associations between food desert status and the food ingestion language and sentiment of tweets in a census tract and to determine whether food-related tweets can be used to infer census tract--level food desert status. Results: We found associations between a census tract being classified as a food desert and an increase in the number of tweets in a census tract that mentioned unhealthy foods (P=.03), including foods high in cholesterol (P=.02) or low in key nutrients such as potassium (P=.01). We also found an association between a census tract being classified as a food desert and an increase in the proportion of tweets that mentioned healthy foods (P=.03) and fast-food restaurants (P=.01) with positive sentiment. In addition, we found that including food ingestion language derived from tweets in classification models that predict food desert status improves model performance compared with baseline models that only include socioeconomic characteristics. Conclusions: Social media data have been increasingly used to answer questions related to health and well-being. Using Twitter data, we found that food-related tweets can be used to develop models for predicting census tract food desert status with high accuracy and improve over baseline models. Food ingestion language found in tweets, such as census tract--level measures of food sentiment and healthiness, are associated with census tract--level food desert status. ", doi="10.2196/34285", url="https://publichealth.jmir.org/2022/7/e34285", url="http://www.ncbi.nlm.nih.gov/pubmed/35788108" } @Article{info:doi/10.2196/31921, author="Wienert, Julian and Jahnel, Tina and Maa{\ss}, Laura", title="What are Digital Public Health Interventions? First Steps Toward a Definition and an Intervention Classification Framework", journal="J Med Internet Res", year="2022", month="Jun", day="28", volume="24", number="6", pages="e31921", keywords="digital health", keywords="digital Public Health", keywords="digital public health interventions", keywords="digital health technologies", keywords="mHealth", keywords="eHealth", keywords="participatory approach", keywords="framework", keywords="mobile phone", doi="10.2196/31921", url="https://www.jmir.org/2022/6/e31921", url="http://www.ncbi.nlm.nih.gov/pubmed/35763320" } @Article{info:doi/10.2196/35663, author="Silva, Martha and Walker, Jonathan and Portillo, Erin and Dougherty, Leanne", title="Strengthening the Merci Mon H{\'e}ros Campaign Through Adaptive Management: Application of Social Listening Methodology", journal="JMIR Public Health Surveill", year="2022", month="Jun", day="28", volume="8", number="6", pages="e35663", keywords="social media", keywords="health communication", keywords="young people", keywords="reproductive health", abstract="Background: Between 2014 and 2018, the penetration of smartphones in sub-Saharan Africa increased from 10\% to 30\%, enabling increased access to the internet, Facebook, Twitter, Pinterest, and YouTube. These platforms engage users in multidirectional communication and provide public health programs with the tools to inform and engage diverse audiences on a range of public health issues, as well as monitor opinions and behaviors on health topics. Objective: This paper details the process used by the U.S. Agency for International Development--funded Breakthrough RESEARCH to apply social media monitoring and social listening techniques in Burkina Faso, C{\^o}te d'Ivoire, Niger, and Togo for the adaptive management of the Merci Mon H{\'e}ros campaign. We documented how these approaches were applied and how the lessons learned can be used to support future public health communication campaigns. Methods: The process involved 6 steps: (1) ensure there is a sufficient volume of topic-specific web-based conversation in the target countries; (2) develop measures to monitor the campaign's social media strategy; (3) identify search terms to assess campaign and related conversations; (4) quantitatively assess campaign audience demographics, campaign reach, and engagement through social media monitoring; (5) qualitatively assess audience attitudes, opinions, and behaviors and understand conversation context through social media listening; and (6) adapt campaign content and approach based on the analysis of social media data. Results: We analyzed posts across social media platforms from November 2019 to October 2020 based on identified key search terms related to family planning, reproductive health, menstruation, sexual activity, and gender. Based on the quantitative and qualitative assessments in steps 4 and 5, there were several adaptive shifts in the campaign's content and approach, of which the following 3 shifts are highlighted. (1) Social media monitoring identified that the Facebook campaign fans were primarily male, which prompted the campaign to target calls to action to the male audience already following the campaign and shift marketing approaches to increase the proportion of female followers. (2) Shorter videos had a higher chance of being viewed in their entirety. In response to this, the campaign shortened video lengths and created screenshot teasers to promote videos. (3) The most negative sentiment related to the campaign videos was associated with beliefs against premarital sex. In response to this finding, the campaign included videos and Facebook Live sessions with religious leaders who promoted talking openly with young people to support intergenerational discussion about reproductive health. Conclusions: Prior to launching health campaigns, programs should test the most relevant social media platforms and their limitations. Inherent biases to internet and social media access are important challenges, and ethical considerations around data privacy must continue to guide the advances in this technology's use for research. However, social listening and social media monitoring can be powerful monitoring and evaluation tools that can be used to aid the adaptive management of health campaigns that engage populations who have a digital presence. ", doi="10.2196/35663", url="https://publichealth.jmir.org/2022/6/e35663", url="http://www.ncbi.nlm.nih.gov/pubmed/35763319" } @Article{info:doi/10.2196/33867, author="Choi, Ki Seul and Golinkoff, Jesse and Michna, Mark and Connochie, Daniel and Bauermeister, Jos{\'e}", title="Correlates of Engagement Within an Online HIV Prevention Intervention for Single Young Men Who Have Sex With Men: Randomized Controlled Trial", journal="JMIR Public Health Surveill", year="2022", month="Jun", day="27", volume="8", number="6", pages="e33867", keywords="paradata", keywords="mobile health", keywords="mHealth", keywords="digital health intervention", keywords="risk reduction", keywords="HIV prevention", keywords="public health", keywords="digital health", keywords="sexual health", keywords="sexual risks", abstract="Background: Digital HIV interventions (DHI) have been efficacious in reducing sexual risk behaviors among sexual minority populations, yet challenges in promoting and sustaining users' engagement in DHI persist. Understanding the correlates of DHI engagement and their impact on HIV-related outcomes remains a priority. This study used data from a DHI (myDEx) designed to promote HIV prevention behaviors among single young men who have sex with men (YMSM; ages 18-24 years) seeking partners online. Objective: The goal of this study is to conduct a secondary analysis of the myDex project data to examine whether YMSM's online behaviors (eg, online partner-seeking behaviors and motivations) are linked to participants' engagement (ie, the number of log-ins and the number of sessions viewed). Methods: We recruited 180 YMSM who were randomized into either myDEx arm or attention-control arm using a stratified 2:1 block randomization. In the myDEx arm, we had 120 YMSM who had access to the 6-session intervention content over a 3-month period. We used Poisson regressions to assess the association between YMSM's baseline characteristics on their DHI engagement. We then examined the association between the participants' engagement and their self-reported changes in HIV-related outcomes at the 3-month follow-up. Results: The mean number of log-ins was 5.44 (range 2-14), and the number of sessions viewed was 6.93 (range 0-22) across the 3-month trial period. In multivariable models, the number of log-ins was positively associated with high education attainment (estimated Poisson regression coefficient [$\beta$]=.22; P=.045). The number of sessions viewed was associated with several baseline characteristics, including the greater number of sessions viewed among non-Hispanic YMSM ($\beta$=.27; P=.002), higher education attainment ($\beta$=.22; P=.003), higher perceived usefulness of online dating for hookups ($\beta$=.13; P=.002) and perceived loneliness ($\beta$=.06; P=.004), as well as lower experienced online discrimination ($\beta$=--.01; P=.007) and limerence ($\beta$=--.02; P=.004). The number of sessions viewed was negatively associated with changes in internalized homophobia ($\beta$=--.06; P<.001) and with changes in perceived usefulness of online dating for hookups ($\beta$=--.20; P<.001). There were no significant associations between the number of log-ins and changes in the participants' behaviors at the 90-day follow-up. Conclusions: DHI engagement is linked to participants' sociodemographic and online behaviors. Given the importance of intervention engagement in the intervention's effectiveness, DHIs with personalized intervention components that consider the individuals' differences could increase the overall engagement and efficacy of DHIs. Trial Registration: ClinicalTrials.gov NCT02842060; https://clinicaltrials.gov/ct2/show/NCT02842060. ", doi="10.2196/33867", url="https://publichealth.jmir.org/2022/6/e33867", url="http://www.ncbi.nlm.nih.gov/pubmed/35759333" } @Article{info:doi/10.2196/38099, author="Sokoya, Temiloluwa and Zhou, Yuchun and Diaz, Sebastian and Law, Timothy and Himawan, Lina and Lekey, Francisca and Shi, Lu and Gimbel, W. Ronald and Jing, Xia", title="Health Indicators as Measures of Individual Health Status and Their Public Perspectives: Cross-sectional Survey Study", journal="J Med Internet Res", year="2022", month="Jun", day="21", volume="24", number="6", pages="e38099", keywords="health status measurement", keywords="individual health indicators", keywords="public perspectives", keywords="surveys and questionnaires", abstract="Background: Disease status (eg, cancer stage) has been used in routine clinical practice to determine more accurate treatment plans. Health-related indicators, such as mortality, morbidity, and population group life expectancy, have also been used. However, few studies have specifically focused on the comprehensive and objective measures of individual health status. Objective: The aim of this study was to analyze the perspectives of the public toward 29 health indicators obtained from a literature review to provide evidence for further prioritization of the indicators. The difference between health status and disease status should be considered. Methods: This study used a cross-sectional design. Online surveys were administered through Ohio University, ResearchMatch, and Clemson University, resulting in three samples. Participants aged 18 years or older rated the importance of the 29 health indicators. The rating results were aggregated and analyzed as follows (in each case, the dependent variables were the individual survey responses): (1) to determine the agreement among the three samples regarding the importance of each indicator, where the independent variables (IVs) were the three samples; (2) to examine the mean differences between the retained indicators with agreement across the three samples, where the IVs were the identified indicators; and (3) to rank the groups of indicators into various levels after grouping the indicators with no mean differences, where the IVs were the groups of indicators. Results: In total, 1153 valid responses were analyzed. Descriptive statistics revealed that the top five--rated indicators were drug or substance abuse, smoking or tobacco use, alcohol abuse, major depression, and diet and nutrition. Among the 29 health indicators, the three samples agreed upon the importance of 13 indicators. Inferential statistical analysis indicated that some of the 13 indicators held equal importance. Therefore, the 13 indicators were categorized by rank into seven levels: level 1 included blood sugar level and immunization and vaccination; level 2 included LDL cholesterol; level 3 included HDL cholesterol, blood triglycerides, cancer screening detection, and total cholesterol; level 4 included health literacy rate; level 5 included personal care needs and air quality index greater than 100; level 6 included self-rated health status and HIV testing; and level 7 included the supply of dentists. Levels 1 to 3 were rated significantly higher than levels 4 to 7. Conclusions: This study provides a baseline for prioritizing 29 health indicators, which can be used by electronic health record or personal health record system designers or developers to determine what can be included in the systems to capture an individual's health status. Currently, self-rated health status is the predominantly used health indicator. Additionally, this study provides a foundation for tracking and measuring preventive health care services more accurately and for developing an individual health status index. ", doi="10.2196/38099", url="https://www.jmir.org/2022/6/e38099", url="http://www.ncbi.nlm.nih.gov/pubmed/35623051" } @Article{info:doi/10.2196/35754, author="Ritschl, Valentin and Eibensteiner, Fabian and Mosor, Erika and Omara, Maisa and Sperl, Lisa and Nawaz, A. Faisal and Siva Sai, Chandragiri and Cenanovic, Merisa and Devkota, Prasad Hari and Hribersek, Mojca and De, Ronita and Klager, Elisabeth and Schaden, Eva and Kletecka-Pulker, Maria and V{\"o}lkl-Kernstock, Sabine and Willschke, Harald and Aufricht, Christoph and Atanasov, G. Atanas and Stamm, Tanja", title="Mandatory Vaccination Against COVID-19: Twitter Poll Analysis on Public Health Opinion", journal="JMIR Form Res", year="2022", month="Jun", day="21", volume="6", number="6", pages="e35754", keywords="COVID-19", keywords="SARS-CoV-2", keywords="vaccine", keywords="vaccination", keywords="Twitter", keywords="survey", keywords="mandatory vaccination", keywords="vaccination hesitancy", keywords="coronavirus", keywords="hesitancy", keywords="social media", keywords="questionnaire", keywords="mandatory", keywords="support", keywords="poll", keywords="opinion", keywords="public health", keywords="perception", abstract="Background: On January 30, 2020, the World Health Organization Emergency Committee declared the rapid worldwide spread of COVID-19 a global health emergency. By December 2020, the safety and efficacy of the first COVID-19 vaccines had been demonstrated. However, international vaccination coverage rates have remained below expectations (in Europe at the time of manuscript submission). Controversial mandatory vaccination is currently being discussed and has already been introduced in some countries (Austria, Greece, and Italy). We used the Twitter survey system as a viable method to quickly and comprehensively gather international public health insights on mandatory vaccination against COVID-19. Objective: The purpose of this study was to better understand the public's perception of mandatory COVID-19 vaccination in real time using Twitter polls. Methods: Two Twitter polls were developed (in the English language) to seek the public's opinion on the possibility of mandatory vaccination. The polls were pinned to the Digital Health and Patient Safety Platform's (based in Vienna, Austria) Twitter timeline for 1 week in mid-November 2021, 3 days after the official public announcement of mandatory COVID-19 vaccination in Austria. Twitter users were asked to participate and retweet the polls to reach the largest possible audience. Results: Our Twitter polls revealed two extremes on the topic of mandatory vaccination against COVID-19. Almost half of the 2545 respondents (n=1246, 49\%) favor mandatory vaccination, at least in certain areas. This attitude contrasts with the 45.7\% (n=1162) who categorically reject mandatory vaccination. Over one-quarter (n=621, 26.3\%) of participating Twitter users said they would never get vaccinated, as reflected by the current Western European and North American vaccination coverage rate. Concatenating interpretation of these two polls should be done cautiously as participating populations might substantially differ. Conclusions: Mandatory vaccination against COVID-19 (in at least certain areas) is favored by less than 50\%, whereas it is opposed by almost half of the surveyed Twitter users. Since (social) media strongly influences public perceptions and views, and social media discussions and surveys are specifically susceptible to the ``echo chamber effect,'' the results should be interpreted as a momentary snapshot. Therefore, the results of this study need to be complemented by long-term surveys to maintain their validity. ", doi="10.2196/35754", url="https://formative.jmir.org/2022/6/e35754", url="http://www.ncbi.nlm.nih.gov/pubmed/35617671" } @Article{info:doi/10.2196/32718, author="Oh, Jimin and Bonett, Stephen and Kranzler, C. Elissa and Saconi, Bruno and Stevens, Robin", title="User- and Message-Level Correlates of Endorsement and Engagement for HIV-Related Messages on Twitter: Cross-sectional Study", journal="JMIR Public Health Surveill", year="2022", month="Jun", day="17", volume="8", number="6", pages="e32718", keywords="HIV prevention", keywords="social media", keywords="public health", keywords="young adults", keywords="LASSO", keywords="HIV", keywords="Twitter", keywords="digital health", abstract="Background: Youth and young adults continue to experience high rates of HIV and are also frequent users of social media. Social media platforms such as Twitter can bolster efforts to promote HIV prevention for these individuals, and while HIV-related messages exist on Twitter, little is known about the impact or reach of these messages for this population. Objective: This study aims to address this gap in the literature by identifying user and message characteristics that are associated with tweet endorsement (favorited) and engagement (retweeted) among youth and young men (aged 13-24 years). Methods: In a secondary analysis of data from a study of HIV-related messages posted by young men on Twitter, we used model selection techniques to examine user and tweet-level factors associated with tweet endorsement and engagement. Results: Tweets from personal user accounts garnered greater endorsement and engagement than tweets from institutional users (aOR 3.27, 95\% CI 2.75-3.89; P<.001). High follower count was associated with increased endorsement and engagement (aOR 1.05, 95\% CI 1.04-1.06; P<.001); tweets that discussed STIs garnered lower endorsement and engagement (aOR 0.59, 95\% CI 0.47-1.74; P<.001). Conclusions: Findings suggest practitioners should partner with youth to design and disseminate HIV prevention messages on social media, incorporate content that resonates with youth audiences, and work to challenge stigma and foster social norms conducive to open conversation about sex, sexuality, and health. ", doi="10.2196/32718", url="https://publichealth.jmir.org/2022/6/e32718", url="http://www.ncbi.nlm.nih.gov/pubmed/35713945" } @Article{info:doi/10.2196/37479, author="Patel, Pragna and Kerzner, Michael and Reed, B. Jason and Sullivan, Sean Patrick and El-Sadr, M. Wafaa", title="Public Health Implications of Adapting HIV Pre-exposure Prophylaxis Programs for Virtual Service Delivery in the Context of the COVID-19 Pandemic: Systematic Review", journal="JMIR Public Health Surveill", year="2022", month="Jun", day="7", volume="8", number="6", pages="e37479", keywords="HIV", keywords="pre-exposure prophylaxis", keywords="COVID-19", keywords="virtual service delivery", keywords="HIV prevention", keywords="public health", keywords="systematic review", keywords="virtual service", keywords="health intervention", keywords="digital intervention", keywords="health technology", keywords="social media platform", keywords="telehealth", keywords="public health message", abstract="Background: The novel coronavirus disease COVID-19 caused by SARS-CoV-2 threatens to disrupt global progress toward HIV epidemic control. Opportunities exist to leverage ongoing public health responses to mitigate the impacts of COVID-19 on HIV services, and novel approaches to care provision might help address both epidemics. Objective: As the COVID-19 pandemic continues, novel approaches to maintain comprehensive HIV prevention service delivery are needed. The aim of this study was to summarize the related literature to highlight adaptations that could address potential COVID-19--related service interruptions. Methods: We performed a systematic review and searched six databases, OVID/Medline, Scopus, Cochrane Library, CINAHL, PsycINFO, and Embase, for studies published between January 1, 2010, and October 26, 2021, related to recent technology-based interventions for virtual service delivery. Search terms included ``telemedicine,'' ``telehealth,'' ``mobile health,'' ``eHealth,'' ``mHealth,'' ``telecommunication,'' ``social media,'' ``mobile device,'' and ``internet,'' among others. Of the 6685 abstracts identified, 1259 focused on HIV virtual service delivery, 120 of which were relevant for HIV prevention efforts; 48 pertained to pre-exposure prophylaxis (PrEP) and 19 of these focused on evaluations of interventions for the virtual service delivery of PrEP. Of the 16 systematic reviews identified, three were specific to PrEP. All 35 papers were reviewed for outcomes of efficacy, feasibility, and/or acceptability. Limitations included heterogeneity of the studies' methodological approaches and outcomes; thus, a meta-analysis was not performed. We considered the evidence-based interventions found in our review and developed a virtual service delivery model for HIV prevention interventions. We also considered how this platform could be leveraged for COVID-19 prevention and care. Results: We summarize 19 studies of virtual service delivery of PrEP and 16 relevant reviews. Examples of technology-based interventions that were effective, feasible, and/or acceptable for PrEP service delivery include: use of SMS, internet, and smartphone apps such as iText (50\% [95\% CI 16\%-71\%] reduction in discontinuation of PrEP) and PrEPmate (OR 2.62, 95\% CI 1.24-5.5.4); telehealth and eHealth platforms for virtual visits such as PrEPTECH and IowaTelePrEP; and platforms for training of health care workers such as Extension for Community Healthcare Outcomes (ECHO). We suggest a virtual service delivery model for PrEP that can be leveraged for COVID-19 using the internet and social media for demand creation, community-based self-testing, telehealth platforms for risk assessment and follow-up, applications for support groups and adherence/appointment reminders, and applications for monitoring. Conclusions: Innovations in the virtual service provision of PrEP occurred before COVID-19 but have new relevance during the COVID-19 pandemic. The innovations we describe might strengthen HIV prevention service delivery during the COVID-19 pandemic and in the long run by engaging traditionally hard-to-reach populations, reducing stigma, and creating a more accessible health care platform. These virtual service delivery platforms can mitigate the impacts of the COVID-19 pandemic on HIV services, which can be leveraged to facilitate COVID-19 pandemic control now and for future responses. ", doi="10.2196/37479", url="https://publichealth.jmir.org/2022/6/e37479", url="http://www.ncbi.nlm.nih.gov/pubmed/35486813" } @Article{info:doi/10.2196/30070, author="Zhang, Chun Ke and Fang, Yuan and Cao, He and Chen, Hongbiao and Hu, Tian and Chen, Qi Ya and Zhou, Xiaofeng and Wang, Zixin", title="The Impacts of the COVID-19 Pandemic on HIV Testing Utilization Among Men Who Have Sex With Men in China: Cross-sectional Online Survey", journal="JMIR Public Health Surveill", year="2022", month="May", day="25", volume="8", number="5", pages="e30070", keywords="COVID-19", keywords="HIV testing", keywords="sexual risk behaviors", keywords="structural barriers", keywords="perception", keywords="men who have sex with men", keywords="China", keywords="MSM", keywords="HIV", keywords="testing", keywords="impact", keywords="utilization", keywords="cross-sectional", keywords="online survey", keywords="barrier", keywords="access", abstract="Background: The COVID-19 pandemic has created disruptions in HIV prevention and sexual health services for men who have sex with men (MSM). Objective: This study compared HIV testing utilization in 3 different reference periods (period 1: before the COVID-19 outbreak, November 2019-January 2020; period 2: after the outbreak, February-April 2020; and period 3: after the pandemic was under initial control, May-July 2020). Factors associated with HIV testing utilization after the COVID-19 outbreak (combined periods 2 and 3) were also investigated. Methods: Participants were MSM aged ?18 years living in Shenzhen, China. Those self-reporting as HIV positive were excluded. A total of 595 participants recruited through multiple sources completed a self-administered online survey during August-September 2020. HIV testing utilization after the COVID-19 outbreak was the dependent variable, and multivariate logistic regression models were fitted. Results: HIV testing utilization was significantly lower in period 2 than in period 1 (n=262 vs 363, 44.0\% vs 61.0\%, P<.001). However, HIV testing utilization was not significantly higher in period 3 than in period 2 (n=277 vs 262, 46.6\% vs 44.0\%, P=.21). The prevalence of HIV testing utilization after the COVID-19 outbreak was seen in 331 (55.6\%) participants. After adjusting for significant background characteristics, condomless anal intercourse (CAI) with regular male sex partners (RPs; adjusted odds ratio [AOR] 2.15, 95\% CI 1.29-3.57) and sexualized drug use (SDU; AOR 2.94, 95\% CI 1.41-6.06) both before and after the COVID-19 outbreak, CAI with RPs (AOR 2.07, 95\% CI 1.06-4.07) and nonregular male sex partners (NRPs; AOR 3.57, 95\%CI: 1.43-8.89) only after the COVID-19 outbreak was positively associated with the dependent variable. Regarding HIV prevention service utilization, HIV testing utilization before the COVID-19 outbreak (AOR 10.75, 95\% CI 7.22-16.02) and the use of sexually transmitted infection (STI) testing (AOR 7.02, 95\% CI 4.10-12.02), other HIV/STI prevention (AOR 3.15, 95\% CI 2.16-4.60), and preexposure prophylaxis (PrEP; AOR 3.58, 95\% CI 1.54-8.34) after the COVID-19 outbreak were associated with higher HIV testing utilization. The current perceived risk of HIV infection was higher than that before the COVID-19 outbreak (AOR 1.15, 95\% CI 1.01-1.30), and perceived COVID-19 preventive measures taken by HIV testing service providers to be effective (AOR 1.52, 95\% CI 1.29-1.78) and perceived higher behavioral control to undergo HIV testing (AOR 1.18, 95\% CI 1.00-1.40) were positively associated with HIV testing utilization. Concerns about COVID-19 infection during HIV testing (AOR 0.78, 95\% CI 0.68-0.89), avoiding crowded places (AOR 0.68, 95\% CI 0.48-0.98), and HIV testing service providers reducing their working hours (AOR 0.59, 95\% CI 0.48-0.98) were negatively associated with the dependent variable. Conclusions: HIV testing utilization among Chinese MSM declined after the COVID-19 outbreak and did not increase after the pandemic was under initial control. Removing structural barriers to accessing HIV testing caused by COVID-19, modifying perceptions related to HIV testing, and making use of HIV self-testing (HIVST) might be useful strategies to improve HIV testing among MSM during the pandemic. ", doi="10.2196/30070", url="https://publichealth.jmir.org/2022/5/e30070", url="http://www.ncbi.nlm.nih.gov/pubmed/35486811" } @Article{info:doi/10.2196/29469, author="Simba, Daudi and Sukums, Felix and Kumalija, Claud and Asiimwe, Eden Sarah and Pothepragada, Kumar Sai and Githendu, Warui Patrick", title="Perceived Usefulness, Competency, and Associated Factors in Using District Health Information System Data Among District Health Managers in Tanzania: Cross-sectional Study", journal="JMIR Form Res", year="2022", month="May", day="23", volume="6", number="5", pages="e29469", keywords="DHIS2", keywords="Tanzania", keywords="health information system", keywords="health management information system", keywords="perception", keywords="competency", keywords="usefulness", abstract="Background: Tanzania introduced District Health Information Software (version 2; DHIS2) in 2013 to support existing health management information systems and to improve data quality and use. However, to achieve these objectives, it is imperative to build human resource capabilities to address the challenges of new technologies, especially in resource-constrained countries. Objective: This study aimed to determine the perceived usefulness, competency, and associated factors in using DHIS2 data among district health managers (DHMs) in Tanzania. Methods: This descriptive cross-sectional study used a quantitative approach, which involved using a self-administered web-based questionnaire. This study was conducted between April and September 2019. We included all core and co-opted members of the council or district health management teams (DHMTs) from all 186 districts in the country. Frequency and bivariate analyses were conducted, and the differences among categories were measured by using a chi-square test. P values of <.05 were considered significant. Results: A total of 2667 (77.96\%) of the expected 3421 DHMs responded, of which 2598 (97.41\%) consented and completed the questionnaires. Overall, the DHMs were satisfied with DHIS2 (2074/2596, 79.83\%) because of workload reduction (2123/2598, 81.72\%), the ease of learning (1953/2598, 75.17\%), and enhanced data use (2239/2598, 86.18\%). Although only half of the managers had user accounts (1380/2598, 53.12\%) and were trained on DHIS2 data analysis (1237/2598, 47.61\%), most claimed to have average to advanced skills in data validation (1774/2598, 68.28\%), data visualization (1563/2598, 60.16\%), and DHIS2 data use (1321/2598, 50.85\%). The biggest challenges facing DHMs included the use of a paper-based system as the primary data source (1890/2598, 72.75\%) and slow internet speed (1552/2598, 59.74\%). Core members were more confident in using DHIS2 compared with other members (P=.004), whereas program coordinators were found to receive more training on data analysis and use (P=.001) and were more confident in using DHIS2 data compared with other DHMT members (P=.001). Conclusions: This study showed that DHMs have appreciable competencies in using the DHIS2 and its data. However, their skill levels have not been commensurate with the duration of DHIS2 use. This study recommends improvements in the access to and use of DHIS2 data. More training on data use is required and should involve using cost-effective approaches to include both the core and noncore members of the DHMTs. Moreover, enhancing the culture and capacity of data use will ensure the better management and accountability of health system performance. ", doi="10.2196/29469", url="https://formative.jmir.org/2022/5/e29469", url="http://www.ncbi.nlm.nih.gov/pubmed/35604763" } @Article{info:doi/10.2196/37931, author="Klann, G. Jeffrey and Strasser, H. Zachary and Hutch, R. Meghan and Kennedy, J. Chris and Marwaha, S. Jayson and Morris, Michele and Samayamuthu, Jebathilagam Malarkodi and Pfaff, C. Ashley and Estiri, Hossein and South, M. Andrew and Weber, M. Griffin and Yuan, William and Avillach, Paul and Wagholikar, B. Kavishwar and Luo, Yuan and and Omenn, S. Gilbert and Visweswaran, Shyam and Holmes, H. John and Xia, Zongqi and Brat, A. Gabriel and Murphy, N. Shawn", title="Distinguishing Admissions Specifically for COVID-19 From Incidental SARS-CoV-2 Admissions: National Retrospective Electronic Health Record Study", journal="J Med Internet Res", year="2022", month="May", day="18", volume="24", number="5", pages="e37931", keywords="COVID-19", keywords="medical informatics", keywords="public health", keywords="phenotype", keywords="electronic health records", keywords="clinical research informatics", keywords="health data", keywords="SARS-CoV-2", keywords="patient data", keywords="health care", abstract="Background: Admissions are generally classified as COVID-19 hospitalizations if the patient has a positive SARS-CoV-2 polymerase chain reaction (PCR) test. However, because 35\% of SARS-CoV-2 infections are asymptomatic, patients admitted for unrelated indications with an incidentally positive test could be misclassified as a COVID-19 hospitalization. Electronic health record (EHR)--based studies have been unable to distinguish between a hospitalization specifically for COVID-19 versus an incidental SARS-CoV-2 hospitalization. Although the need to improve classification of COVID-19 versus incidental SARS-CoV-2 is well understood, the magnitude of the problems has only been characterized in small, single-center studies. Furthermore, there have been no peer-reviewed studies evaluating methods for improving classification. Objective: The aims of this study are to, first, quantify the frequency of incidental hospitalizations over the first 15 months of the pandemic in multiple hospital systems in the United States and, second, to apply electronic phenotyping techniques to automatically improve COVID-19 hospitalization classification. Methods: From a retrospective EHR-based cohort in 4 US health care systems in Massachusetts, Pennsylvania, and Illinois, a random sample of 1123 SARS-CoV-2 PCR-positive patients hospitalized from March 2020 to August 2021 was manually chart-reviewed and classified as ``admitted with COVID-19'' (incidental) versus specifically admitted for COVID-19 (``for COVID-19''). EHR-based phenotyping was used to find feature sets to filter out incidental admissions. Results: EHR-based phenotyped feature sets filtered out incidental admissions, which occurred in an average of 26\% of hospitalizations (although this varied widely over time, from 0\% to 75\%). The top site-specific feature sets had 79\%-99\% specificity with 62\%-75\% sensitivity, while the best-performing across-site feature sets had 71\%-94\% specificity with 69\%-81\% sensitivity. Conclusions: A large proportion of SARS-CoV-2 PCR-positive admissions were incidental. Straightforward EHR-based phenotypes differentiated admissions, which is important to assure accurate public health reporting and research. ", doi="10.2196/37931", url="https://www.jmir.org/2022/5/e37931", url="http://www.ncbi.nlm.nih.gov/pubmed/35476727" } @Article{info:doi/10.2196/38508, author="Taramarcaz, Victor and Herren, Tara and Golay, Eric and Regard, Simon and Martin-Achard, S{\'e}bastien and Mach, Francois and Schnetzler, Nicolas and Ricci, Ga{\"e}tan and Zamberg, Ido and Larribau, Robert and Niquille, Marc and Suppan, M{\'e}lanie and Schiffer, Eduardo and Suppan, Laurent", title="A Short Intervention and an Interactive e-Learning Module to Motivate Medical and Dental Students to Enlist as First Responders: Implementation Study", journal="J Med Internet Res", year="2022", month="May", day="18", volume="24", number="5", pages="e38508", keywords="basic life support", keywords="cardiopulmonary resuscitation", keywords="first responder", keywords="undergraduate medical education", keywords="out-of-hospital cardiac arrest", keywords="medical education", keywords="e-learning", keywords="digital education", keywords="medical student", keywords="blended learning", abstract="Background: Prompt and proficient basic life support (BLS) maneuvers are essential to increasing the odds of survival after out-of-hospital cardiac arrest. However, significant time can elapse before the arrival of professional rescuers. To decrease these delays, many countries have developed first responder networks. These networks are composed of BLS-certified lay or professional rescuers who can be dispatched by emergency medical communication centers to take care of those who experience out-of-hospital cardiac arrest. Many systems are, however, limited by a relatively low number of active first responders, and first-year medical and dental students may represent an almost untapped pool of potential rescuers. On top of providing an enhanced BLS coverage to the population, this could also help medical students be better prepared to their future role as certified health care providers and address societal expectations regarding health care students. Objective: Our objective was to describe the impact of a short motivational intervention followed by a blended BLS course (e-learning and practice session) designed to motivate first-year medical and dental students to enlist as first responders. Methods: A short, web-based, motivational intervention presenting this project took place, and first-year University of Geneva, Faculty of Medicine students were provided with a link to the study platform. Those who agreed to participate were redirected to a demographic questionnaire before registering on the platform. The participants were then asked to answer a second questionnaire designed to determine their baseline knowledge prior to following an interactive e-learning module. Upon completion, a web-based booking form enabling them to register for a 1-hour practice session was displayed. These sessions were held by senior medical students who had been trained and certified as BLS instructors. The participants who attended these practice sessions were asked to answer a postcourse questionnaire before receiving the certificate enabling them to register as first responders. Results: Out of the 529 first-year students registered at University of Geneva, Faculty of Medicine on January 14, 2021, 190 (35.9\%) initially agreed to participate. Moreover, 102 (19.3\%) attended the practice sessions, and 48 (9.1\%) had completed all training and enlisted as first responders on the dedicated platform, Save a Life, at 6 months (July 14, 2021). Postcourse confidence in resuscitation skills was associated with a higher likelihood of registering as first responder (P=.03). No association was found between prior BLS knowledge and the probability of registering to a practice session (P=.59), of obtaining a course completion certificate (P=.29), or of enlisting as first responder (P=.56). Conclusions: This study shows that a motivational intervention associated with a short BLS course can convince medical students to enlist as first responders. Further studies are needed to understand the rather low proportion of medical students finally registering as first responders. International Registered Report Identifier (IRRID): RR2-10.2196/24664 ", doi="10.2196/38508", url="https://www.jmir.org/2022/5/e38508", url="http://www.ncbi.nlm.nih.gov/pubmed/35583927" } @Article{info:doi/10.2196/34104, author="Oetomo, Arlene and Jalali, Niloofar and Costa, Paro Paula Dornhofer and Morita, Pelegrini Plinio", title="Indoor Temperatures in the 2018 Heat Wave in Quebec, Canada: Exploratory Study Using Ecobee Smart Thermostats", journal="JMIR Form Res", year="2022", month="May", day="12", volume="6", number="5", pages="e34104", keywords="Internet of Things", keywords="IoT", keywords="heat waves", keywords="public health", keywords="smart home technology", keywords="smart thermostats", keywords="indoor temperature", keywords="air conditioning", keywords="heat alert response systems", keywords="thermostat", keywords="unsafe temperatures", keywords="uHealth", abstract="Background: Climate change, driven by human activity, is rapidly changing our environment and posing an increased risk to human health. Local governments must adapt their cities and prepare for increased periods of extreme heat and ensure that marginalized populations do not suffer detrimental health outcomes. Heat warnings traditionally rely on outdoor temperature data which may not reflect indoor temperatures experienced by individuals. Smart thermostats could be a novel and highly scalable data source for heat wave monitoring. Objective: The objective of this study was to explore whether smart thermostats can be used to measure indoor temperature during a heat wave and identify houses experiencing indoor temperatures above 26{\textdegree}C. Methods: We used secondary data---indoor temperature data recorded by ecobee smart thermostats during the Quebec heat waves of 2018 that claimed 66 lives, outdoor temperature data from Environment Canada weather stations, and indoor temperature data from 768 Quebec households. We performed descriptive statistical analyses to compare indoor temperatures differences between air conditioned and non--air conditioned houses in Montreal, Gatineau, and surrounding areas from June 1 to August 31, 2018. Results: There were significant differences in indoor temperature between houses with and without air conditioning on both heat wave and non--heat wave days (P<.001). Households without air conditioning consistently recorded daily temperatures above common indoor temperature standards. High indoor temperatures persisted for an average of 4 hours per day in non--air conditioned houses. Conclusions: Our findings were consistent with current literature on building warming and heat retention during heat waves, which contribute to increased risk of heat-related illnesses. Indoor temperatures can be captured continuously using smart thermostats across a large population. When integrated with local heat health action plans, these data could be used to strengthen existing heat alert response systems and enhance emergency medical service responses. ", doi="10.2196/34104", url="https://formative.jmir.org/2022/5/e34104", url="http://www.ncbi.nlm.nih.gov/pubmed/35550317" } @Article{info:doi/10.2196/31847, author="Xu, Junfang and Luo, Yan and Dong, Hengjin and Zhao, Gang", title="The Effects of Internet Exposure on Sexual Risk Behavior Among Sexually Experienced Male College Students in China: Cross-sectional Study", journal="JMIR Public Health Surveill", year="2022", month="May", day="2", volume="8", number="5", pages="e31847", keywords="college males", keywords="internet exposure", keywords="sexual partners", keywords="risk behavior", keywords="HIV", keywords="MSM", keywords="social networks", keywords="students", keywords="sexually transmitted infections", keywords="public health", abstract="Background: As a young subgroup, college students have become the main users of mobile social networks. Considering that people can indiscriminately access explicit sexual content on the internet, coupled with the increase of HIV infections in male college students, the role of the internet in meeting sexual partners and its correlation to risky sexual behavior has become an important topic. Objective: The aim of this study is to explore the effects of internet exposure on sexual partners and sexual risk behavior among sexually experienced male college students. Methods: An institution-based cross-sectional study design was used to collect data through a paper-based questionnaire administered to male college students recruited from colleges and gay organizations in Hangzhou, Zhejiang Province, China. A total of 1045 sexually experienced male students were incorporated in our analysis, with the following information collected: sociodemographic characteristics, sexual intercourse--related behaviors, and sexually transmitted disease (STD) knowledge. Mann-Whitney U and Kruskal-Wallis tests were used to examine differences regarding basic characteristics and sexual risk behaviors between male college students who meet sexual partners via the internet and those who do not. Sequential logistic regression models were employed to examine the influence of meeting sexual partners via the internet on risky sexual behaviors after controlling for other factors. Results: The mean age of the sexually experienced male students was 21.6 (SD 2.0) years. The likelihood of risky sexual behavior was varied, yet it was the highest for those who aim to meet paid sexual partners (145/192, 75.5\% to 19/22, 86.4\%), followed by those seeking partners for love or romance (258/435, 59.3\%). Compared to non-internet partner seekers, internet partner seekers tended to have more casual intercourse (292/542, 53.9\% versus 51/503, 10.1\%), paid intercourse (32/542, 5.9\% versus 12/503, 2.4\%), and intercourse with same-sex partners (349/542, 64.4\% versus 41/503, 8.2\%); they were also more likely to use psychoactive drugs (125/349, 35.8\% versus 5/41, 12.2\%) and have more than 2 partners. With the increase of HIV and STD knowledge, the probability of having unprotected intercourse decreased for non-internet partner seekers. However, it increased for internet partner seekers with a rising HIV knowledge score. Sequential logistic regression showed that meeting sexual partners on the internet was statistically associated with sexual risk behaviors with multiple sexual partners (odds ratio 4.434; P<.001). Conclusions: Meeting sexual partners via the internet is a common behavior among sexually experienced male college students, and those who meet partners on the internet exhibited higher levels of risky sexual behaviors although they had sufficient HIV and STD knowledge; this is especially true for students who aimed to find partners for sexual intercourse. Thus, more attention should be paid to young adults to address the risky sexual behaviors that may contribute to STD spread among this population. ", doi="10.2196/31847", url="https://publichealth.jmir.org/2022/5/e31847", url="http://www.ncbi.nlm.nih.gov/pubmed/35499864" } @Article{info:doi/10.2196/32405, author="Klein, Z. Ari and Meanley, Steven and O'Connor, Karen and Bauermeister, A. Jos{\'e} and Gonzalez-Hernandez, Graciela", title="Toward Using Twitter for PrEP-Related Interventions: An Automated Natural Language Processing Pipeline for Identifying Gay or Bisexual Men in the United States", journal="JMIR Public Health Surveill", year="2022", month="Apr", day="25", volume="8", number="4", pages="e32405", keywords="natural language processing", keywords="social media", keywords="data mining", keywords="PrEP", keywords="pre-exposure prophylaxis", keywords="HIV", keywords="AIDS", abstract="Background: Pre-exposure prophylaxis (PrEP) is highly effective at preventing the acquisition of HIV. There is a substantial gap, however, between the number of people in the United States who have indications for PrEP and the number of them who are prescribed PrEP. Although Twitter content has been analyzed as a source of PrEP-related data (eg, barriers), methods have not been developed to enable the use of Twitter as a platform for implementing PrEP-related interventions. Objective: Men who have sex with men (MSM) are the population most affected by HIV in the United States. Therefore, the objectives of this study were to (1) develop an automated natural language processing (NLP) pipeline for identifying men in the United States who have reported on Twitter that they are gay, bisexual, or MSM and (2) assess the extent to which they demographically represent MSM in the United States with new HIV diagnoses. Methods: Between September 2020 and January 2021, we used the Twitter Streaming Application Programming Interface (API) to collect more than 3 million tweets containing keywords that men may include in posts reporting that they are gay, bisexual, or MSM. We deployed handwritten, high-precision regular expressions---designed to filter out noise and identify actual self-reports---on the tweets and their user profile metadata. We identified 10,043 unique users geolocated in the United States and drew upon a validated NLP tool to automatically identify their ages. Results: By manually distinguishing true- and false-positive self-reports in the tweets or profiles of 1000 (10\%) of the 10,043 users identified by our automated pipeline, we established that our pipeline has a precision of 0.85. Among the 8756 users for which a US state--level geolocation was detected, 5096 (58.2\%) were in the 10 states with the highest numbers of new HIV diagnoses. Among the 6240 users for which a county-level geolocation was detected, 4252 (68.1\%) were in counties or states considered priority jurisdictions by the Ending the HIV Epidemic initiative. Furthermore, the age distribution of the users reflected that of MSM in the United States with new HIV diagnoses. Conclusions: Our automated NLP pipeline can be used to identify MSM in the United States who may be at risk of acquiring HIV, laying the groundwork for using Twitter on a large scale to directly target PrEP-related interventions at this population. ", doi="10.2196/32405", url="https://publichealth.jmir.org/2022/4/e32405", url="http://www.ncbi.nlm.nih.gov/pubmed/35468092" } @Article{info:doi/10.2196/27061, author="Melendez-Torres, GJ and Meiksin, Rebecca and Witzel, Charles T. and Weatherburn, Peter and Falconer, Jane and Bonell, Chris", title="eHealth Interventions to Address HIV and Other Sexually Transmitted Infections, Sexual Risk Behavior, Substance Use, and Mental Ill-health in Men Who Have Sex With Men: Systematic Review and Meta-analysis", journal="JMIR Public Health Surveill", year="2022", month="Apr", day="6", volume="8", number="4", pages="e27061", keywords="men who have sex with men", keywords="HIV and sexually transmitted infections", keywords="mental health", keywords="substance use", keywords="mobile apps", keywords="HIV", keywords="eHealth", keywords="electronic media", keywords="mobile phone apps", keywords="sexual risk", abstract="Background: Men who have sex with men experience disproportionately high levels of HIV and other sexually transmitted infections (STIs), sexual risk behavior, substance use, and mental ill-health. These experiences are interrelated, and these interrelations are potentiated by structural conditions of discrimination, stigma, and unequal access to appropriate health services, and they magnify each other and have intersecting causal pathways, worsening both risk for each condition and risk for the negative sequelae of each condition. eHealth interventions could address these issues simultaneously and thus have wide-ranging and greater effects than would be for any 1 outcome alone. Objective: We systematically reviewed the evidence for the effectiveness of eHealth interventions in addressing these outcomes separately or together. Methods: We searched 19 databases for randomized trials of interactive or noninteractive eHealth interventions delivered via mobile phone apps, internet, or other electronic media to populations consisting entirely or principally of men who have sex with men to prevent HIV, STIs, sexual risk behavior, alcohol and drug use, or common mental illnesses. We extracted data and appraised each study, estimated meta-analyses where possible by using random effects and robust variance estimation, and assessed the certainty of our findings (closeness of the estimated effect to the true effect) by using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Results: We included 14 trials, of which 13 included active versus control comparisons; none reported mental health outcomes, and all drew from 12 months or less of follow-up postintervention. Findings for STIs drew on low numbers of studies and did not suggest consistent short-term (<3 months postintervention; d=0.17, 95\% CI --0.18 to 0.52; I2=0\%; 2 studies) or midterm (3-12 months postintervention, no meta-analysis, 1 study) evidence of effectiveness. Eight studies considering sexual risk behavior outcomes suggested a short-term, nonsignificant reduction (d=--0.14, 95\% CI --0.30 to 0.03) with very low certainty, but 6 studies reporting midterm follow-ups suggested a significant impact on reducing sexual risk behavior (d=--0.12, 95\% CI --0.19 to --0.05) with low certainty. Meta-analyses could not be undertaken for alcohol and drug use (2 heterogeneous studies) or for HIV infections (1 study for each of short-term or midterm follow-up), and alcohol outcomes alone were not captured in the included studies. Certainty was graded as low to very low for most outcomes, including all meta-analyses. Conclusions: To create a comprehensive eHealth intervention that targets multiple outcomes, intervention evaluations should seek to generalize both mechanisms and components that are successfully used to achieve change in 1 outcome over multiple outcomes. However, additional evaluations of interventions seeking to address outcomes other than sexual risk behavior are needed before development and evaluation of a joined-up intervention. ", doi="10.2196/27061", url="https://publichealth.jmir.org/2022/4/e27061", url="http://www.ncbi.nlm.nih.gov/pubmed/35384845" } @Article{info:doi/10.2196/35073, author="Haithcoat, Timothy and Liu, Danlu and Young, Tiffany and Shyu, Chi-Ren", title="Investigating Health Context Using a Spatial Data Analytical Tool: Development of a Geospatial Big Data Ecosystem", journal="JMIR Med Inform", year="2022", month="Apr", day="6", volume="10", number="4", pages="e35073", keywords="context", keywords="Geographic Information System", keywords="big data", keywords="equity", keywords="population health", keywords="public health", keywords="digital health", keywords="eHealth", keywords="location", keywords="geospatial", keywords="data analytics", keywords="analytical framework", keywords="medical informatics", keywords="research knowledgebase", abstract="Background: Enabling the use of spatial context is vital to understanding today's digital health problems. Any given location is associated with many different contexts. The strategic transformation of population health, epidemiology, and eHealth studies requires vast amounts of integrated digital data. Needed is a novel analytical framework designed to leverage location to create new contextual knowledge. The Geospatial Analytical Research Knowledgebase (GeoARK), a web-based research resource has robust, locationally integrated, social, environmental, and infrastructural information to address today's complex questions, investigate context, and spatially enable health investigations. GeoARK is different from other Geographic Information System (GIS) resources in that it has taken the layered world of the GIS and flattened it into a big data table that ties all the data and information together using location and developing its context. Objective: It is paramount to build a robust spatial data analytics framework that integrates social, environmental, and infrastructural knowledge to empower health researchers' use of geospatial context to timely answer population health issues. The goal is twofold in that it embodies an innovative technological approach and serves to ease the educational burden for health researchers to think spatially about their problems. Methods: A unique analytical tool using location as the key was developed. It allows integration across source, geography, and time to create a geospatial big table with over 162 million individual locations (X-Y points that serve as rows) and 5549 attributes (represented as columns). The concept of context (adjacency, proximity, distance, etc) is quantified through geoanalytics and captured as new distance, density, or neighbor attributes within the system. Development of geospatial analytics permits contextual extraction and investigator-initiated eHealth and mobile health (mHealth) analysis across multiple attributes. Results: We built a unique geospatial big data ecosystem called GeoARK. Analytics on this big table occur across resolution groups, sources, and geographies for extraction and analysis of information to gain new insights. Case studies, including telehealth assessment in North Carolina, national income inequality and health outcome disparity, and a Missouri COVID-19 risk assessment, demonstrate the capability to support robust and efficient geospatial understanding of a wide spectrum of population health questions. Conclusions: This research identified, compiled, transformed, standardized, and integrated multifaceted data required to better understand the context of health events within a large location-enabled database. The GeoARK system empowers health professionals to engage more complex research where the synergisms of health and geospatial information will be robustly studied beyond what could be accomplished today. No longer is the need to know how to perform geospatial processing an impediment to the health researcher, but rather the development of how to think spatially becomes the greater challenge. ", doi="10.2196/35073", url="https://medinform.jmir.org/2022/4/e35073", url="http://www.ncbi.nlm.nih.gov/pubmed/35311683" } @Article{info:doi/10.2196/32156, author="Chiou, Piao-Yi and Hung, Chien-Ching and Chen, Chien-Yu", title="Sexual Partner Referral for HIV Testing Through Social Networking Platforms: Cross-sectional Study", journal="JMIR Public Health Surveill", year="2022", month="Apr", day="5", volume="8", number="4", pages="e32156", keywords="HIV testing", keywords="men who have sex with men", keywords="mobile health", keywords="motivational interviewing", keywords="referral and consultation", keywords="risk behavior", keywords="sexual partners", keywords="social networking", abstract="Background: Men who have sex with men (MSM) who undergo voluntary HIV counseling and testing (VCT) often report condomless anal sexual intercourse, having many sexual partners, and being exposed to risky sexual networks. Limited research has discussed the application of motivational interviewing and convenience referral platforms to facilitate the referral of sexual partners for HIV testing among MSM. Objective: This study aimed to evaluate the effects of VCT referral by sexual partners through social networking platforms and the test results after elicited interviews with MSM; compare the characteristics and risk behaviors among MSM tested without referral, index subjects, and referred sexual partners; and explore unknown sexual affiliations through visualizing and quantifying the social network graph. Methods: This was a cross-sectional study. Purposeful sampling was used to recruit index subjects from a community HIV screening station frequented by MSM in Taipei City on Friday and Saturday nights. Respondent-driven sampling was used to recruit sexual partners. Partner-elicited interviews were conducted by trained staff before VCT to motivate MSM to become index subjects and refer sexual partners via the Line app, or to disclose the accounts and profiles of sexual partners on relevant social networking platforms. Referred sexual partners received rapid HIV testing, and the recruitment process was repeated until leads were exhausted. Results: After the interviews, 28.2\% (75/266) of MSM were successfully persuaded to become index subjects in the first wave, referring 127 sexual partners via the Line app for rapid HIV testing and disclosing 40 sexual partners. The index subjects and tested sexual partners had more sexual partners (F2=3.83, P=.02), more frequent anal intercourse (F2=10.10, P<.001), and higher percentages of those who had not previously received HIV testing ($\chi$21=6.1, P=.047) compared with MSM tested without referrals. The new HIV-seropositivity rate among tested sexual partners was 2.4\%, which was higher than the rate in the other 2 groups. The social network analysis revealed the following 4 types of sexual affiliation: chain, Y, star, and complicated. Among the HIV-negative sexual partners, 26.9\% (43/160) had sexual affiliations with HIV-positive nodes, and 40\% (10/25) were untested sexual partners with a direct sexual affiliation with an HIV-positive node. Four transmission bridges were found in the network graph. Conclusions: Partner-elicited interviews can effectively promote referral for HIV testing and case identification via Line, and can clarify unknown sexual affiliations of MSM to facilitate the development of a tailored prevention program. Social network analysis is needed for an insightful understanding of the different network structures. ", doi="10.2196/32156", url="https://publichealth.jmir.org/2022/4/e32156", url="http://www.ncbi.nlm.nih.gov/pubmed/35380540" } @Article{info:doi/10.2196/33404, author="Maa{\ss}, Laura and Pan, Chen-Chia and Freye, Merle", title="Mapping Digital Public Health Interventions Among Existing Digital Technologies and Internet-Based Interventions to Maintain and Improve Population Health in Practice: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2022", month="Mar", day="31", volume="11", number="3", pages="e33404", keywords="digital public health", keywords="telemedicine", keywords="electronic health records", keywords="ePrescription", keywords="eReferral", keywords="eConsultation", keywords="eSurveillance", keywords="eVaccination registries", keywords="scoping review", keywords="protocol", abstract="Background: Rapid developments and implementation of digital technologies in public health domains throughout the last decades have changed the landscape of health delivery and disease prevention globally. A growing number of countries are introducing interventions such as online consultations, electronic health records, or telemedicine to their health systems to improve their populations' health and improve access to health care. Despite multiple definitions for digital public health and the development of different digital interventions, no study has analyzed whether the utilized technologies fit the definition or the core characteristics of digital public health interventions. A scoping review is therefore needed to explore the extent of the literature on this topic. Objective: The main aim of this scoping review is to outline real-world digital public health interventions on all levels of health care, prevention, and health. The second objective will be the mapping of reported intervention characteristics. These will include nontechnical elements and the technical features of an intervention. Methods: We searched for relevant literature in the following databases: PubMed, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), IEEE (Institute of Electrical and Electronics Engineers) Xplore, and the Association for Computing Machinery (ACM) Full-Text Collection. All original study types (observational studies, experimental trials, qualitative studies, and health-economic analyses), as well as governmental reports, books, book chapters, or peer-reviewed full-text conference papers were included when the evaluation and description of a digital health intervention was the primary intervention component. Two authors screened the articles independently in three stages (title, abstract, and full text). Two independent authors will also perform the data charting. We will report our results following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Results: An additional systematic search in IEEE Xplore and ACM, performed on December 1, 2021, identified another 491 titles. We identified a total of 13,869 papers after deduplication. As of March 2022, the abstract screening state is complete, and we are in the state of screening the 1417 selected full texts for final inclusion. We estimate completing the review in April 2022. Conclusions: To our knowledge, this will be the first scoping review to fill the theoretical definitions of digital public health with concrete interventions and their characteristics. Our scoping review will display the landscape of worldwide existing digital public health interventions that use information and communication technologies. The results of this review will be published in a peer-reviewed journal in early 2022, which can serve as a blueprint for the development of future digital public health interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/33404 ", doi="10.2196/33404", url="https://www.researchprotocols.org/2022/3/e33404", url="http://www.ncbi.nlm.nih.gov/pubmed/35357321" } @Article{info:doi/10.2196/34050, author="Purushothaman, Vidya and McMann, Tiana and Nali, Matthew and Li, Zhuoran and Cuomo, Raphael and Mackey, K. Tim", title="Content Analysis of Nicotine Poisoning (Nic Sick) Videos on TikTok: Retrospective Observational Infodemiology Study", journal="J Med Internet Res", year="2022", month="Mar", day="30", volume="24", number="3", pages="e34050", keywords="nic sick", keywords="vaping", keywords="tobacco", keywords="social media", keywords="TikTok", keywords="content analysis", keywords="smoking", keywords="nicotine", keywords="e-cigarette", keywords="adverse effects", keywords="public health", keywords="infodemiology", abstract="Background: TikTok is a microvideo social media platform currently experiencing rapid growth and with 60\% of its monthly users between the ages of 16 and 24 years. Increased exposure to e-cigarette content on social media may influence patterns of use, including the risk of overconsumption and possible nicotine poisoning, when users engage in trending challenges online. However, there is limited research assessing the characteristics of nicotine poisoning--related content posted on social media. Objective: We aimed to assess the characteristics of content on TikTok that is associated with a popular nicotine poisoning--related hashtag. Methods: We collected TikTok posts associated with the hashtag \#nicsick, using a Python programming package (Selenium) and used an inductive coding approach to analyze video content and characteristics of interest. Videos were manually annotated to generate a codebook of the nicotine sickness--related themes. Statistical analysis was used to compare user engagement characteristics and video length in content with and without active nicotine sickness TikTok topics. Results: A total of 132 TikTok videos associated with the hashtag \#nicsick were manually coded, with 52.3\% (69/132) identified as discussing firsthand and secondhand reports of suspected nicotine poisoning symptoms and experiences. More than one-third of nicotine poisoning--related content (26/69, 37.68\%) portrayed active vaping by users, which included content with vaping behavior such as vaping tricks and overconsumption, and 43\% (30/69) of recorded users self-reported experiencing nicotine sickness, poisoning, or adverse events such as vomiting following nicotine consumption. The average follower count of users posting content related to nicotine sickness was significantly higher than that for users posting content unrelated to nicotine sickness (W=2350.5, P=.03). Conclusions: TikTok users openly discuss experiences, both firsthand and secondhand, with nicotine adverse events via the \#nicsick hashtag including reports of overconsumption resulting in sickness. These study results suggest that there is a need to assess the utility of digital surveillance on emerging social media platforms for vaping adverse events, particularly on sites popular among youth and young adults. As vaping product use-patterns continue to evolve, digital adverse event detection likely represents an important tool to supplement traditional methods of public health surveillance (such as poison control center prevalence numbers). ", doi="10.2196/34050", url="https://www.jmir.org/2022/3/e34050", url="http://www.ncbi.nlm.nih.gov/pubmed/35353056" } @Article{info:doi/10.2196/34544, author="Elgersma, Hess Ingeborg and Fretheim, Atle and Indseth, Thor and Munch, Thorolvsen Anita and Johannessen, B{\o}e Live and Hansen, Engh Christine", title="The Evaluation of a Social Media Campaign to Increase COVID-19 Testing in Migrant Groups: Cluster Randomized Trial", journal="J Med Internet Res", year="2022", month="Mar", day="24", volume="24", number="3", pages="e34544", keywords="COVID-19", keywords="SARS-CoV-2", keywords="social media", keywords="campaign", keywords="cluster randomized trial", keywords="nonpharmaceutical interventions", keywords="migrant", keywords="intervention", keywords="testing", keywords="strategy", keywords="public health", keywords="Facebook", keywords="communication", abstract="Background: A low test positivity rate is key to keeping the COVID-19 pandemic under control. Throughout the pandemic, several migrant groups in Norway have seen higher rates of confirmed COVID-19 and related hospitalizations, while test positivity has remained high in the same groups. The Norwegian government has used several platforms for communication, and targeted social media advertisements have in particular been an important part of the communication strategy to reach these groups. Objective: In this study, we aimed to investigate whether such a targeted Facebook campaign increased the rate of COVID-19 tests performed in certain migrant groups. Methods: We randomly assigned 386 Norwegian municipalities and city districts to intervention or control groups. Individuals born in Eritrea, Iraq, Pakistan, Poland, Russia, Somalia, Syria, and Turkey residing in intervention areas were targeted with a social media campaign aiming at increasing the COVID-19 test rate. The campaign message was in a simple language and conveyed in the users' main language or in English. Results: During the 2-week follow-up period, the predicted probability of having a COVID-19 test taken was 4.82\% (95\% CI 4.47\%-5.18\%) in the control group, and 5.58\% (95\% CI 5.20\%-5.99\%) in the intervention group (P=.004). Conclusions: Our targeted social media intervention led to a modest increase in test rates among certain migrant groups in Norway. Trial Registration: ClinicalTrials.gov NCT04866589; https://clinicaltrials.gov/ct2/show/NCT04866589 ", doi="10.2196/34544", url="https://www.jmir.org/2022/3/e34544", url="http://www.ncbi.nlm.nih.gov/pubmed/35285811" } @Article{info:doi/10.2196/35181, author="Limingoja, Leevi and Antila, Kari and Jormanainen, Vesa and R{\"o}ntynen, Joel and J{\"a}gerroos, Vilma and Soininen, Leena and Nordlund, Hanna and Veps{\"a}l{\"a}inen, Kristian and Kaikkonen, Risto and Lallukka, Tea", title="Impact of a Conformit{\'e} Europ{\'e}enne (CE) Certification--Marked Medical Software Sensor on COVID-19 Pandemic Progression Prediction: Register-Based Study Using Machine Learning Methods", journal="JMIR Form Res", year="2022", month="Mar", day="17", volume="6", number="3", pages="e35181", keywords="health care", keywords="health technology assessment", keywords="machine learning", keywords="COVID-19", keywords="COVID-19 forecasting", keywords="pandemic", keywords="health technology", keywords="digital health", keywords="online symptom checker", keywords="health data", keywords="admission data", keywords="viral spread", abstract="Background: To address the current COVID-19 and any future pandemic, we need robust, real-time, and population-scale collection and analysis of data. Rapid and comprehensive knowledge on the trends in reported symptoms in populations provides an earlier window into the progression of viral spread, and helps to predict the needs and timing of professional health care. Objective: The objective of this study was to use a Conformit{\'e} Europ{\'e}enne (CE)-marked medical online symptom checker service, Omaolo, and validate the data against the national demand for COVID-19--related care to predict the pandemic progression in Finland. Methods: Our data comprised real-time Omaolo COVID-19 symptom checker responses (414,477 in total) and daily admission counts in nationwide inpatient and outpatient registers provided by the Finnish Institute for Health and Welfare from March 16 to June 15, 2020 (the first wave of the pandemic in Finland). The symptom checker responses provide self-triage information input to a medically qualified algorithm that produces a personalized probability of having COVID-19, and provides graded recommendations for further actions. We trained linear regression and extreme gradient boosting (XGBoost) models together with F-score and mutual information feature preselectors to predict the admissions once a week, 1 week in advance. Results: Our models reached a mean absolute percentage error between 24.2\% and 36.4\% in predicting the national daily patient admissions. The best result was achieved by combining both Omaolo and historical patient admission counts. Our best predictor was linear regression with mutual information as the feature preselector. Conclusions: Accurate short-term predictions of COVID-19 patient admissions can be made, and both symptom check questionnaires and daily admissions data contribute to the accuracy of the predictions. Thus, symptom checkers can be used to estimate the progression of the pandemic, which can be considered when predicting the health care burden in a future pandemic. ", doi="10.2196/35181", url="https://formative.jmir.org/2022/3/e35181", url="http://www.ncbi.nlm.nih.gov/pubmed/35179497" } @Article{info:doi/10.2196/32302, author="Chang, Angela and Schulz, Johannes Peter and Jiao, Wen and Yu, Guoming and Yang, Ya", title="Media Source Characteristics Regarding Food Fraud Misinformation According to the Health Information National Trends Survey (HINTS) in China: Comparative Study", journal="JMIR Form Res", year="2022", month="Mar", day="16", volume="6", number="3", pages="e32302", keywords="risk assessment", keywords="food rumor", keywords="risk management", keywords="conspiracy narratives", keywords="population health", keywords="food safety", abstract="Background: Ongoing rumors and fake news regarding food fraud, adulteration, and contamination are highly visible. Health risk information circulating through media and interpersonal communication channels has made health crisis an important research agenda. Objective: This study explored the issue of food fraud and the effect of misinformation. Further, it assessed whether and how these issues have provided evidence-based interventions for food handlers and regulators to mitigate fraud misinformation. Methods: The Health Information National Trends Survey (HINTS) was adopted for a collaborative study in China, after which a cross-sectional survey with door-to-door interviews was performed. Participants from Beijing and Hefei were selected using multistage sampling of adults in May 2017. Based on 4 government surveillance reports on food rumors and safety incidents, a descriptive analysis, correlation analysis, and analysis of variance were performed on the data. Results: A total of 3090 results were gathered and analyzed. Among the respondents, 83.6\% (2584/3090) heard at least one food rumor. Learning about food fraud was correlated with interpersonal connections (eg, doctors or health specialists) for accessing food health information. Overall, Chinese citizens with a higher level of interpersonal connection were more likely to be concerned about food incidents with a statistical difference (P<.001). Interpersonal connection was the most frequent communication source (698/1253, 55.7\%), followed by traditional media (325/1253, 25.9\%) and internet portals (144/1253, 11.5\%). There was a significant relationship between media use and media category in Beijing (P<.001) and Hefei (P<.001). Overall, responses to food fraud and incident risks were lower in Beijing than in Hefei (P=.006). The respondents in Beijing were confronted more frequently by food rumors (range 346-1253) than those in Hefei (range 155-946). The urban dwellers in Beijing and their rural counterparts in Hefei also differed in terms of perceiving different levels of food risks from different media sources. The food rumor narratives that examined the conspiracy belief showed that social media played more important roles in influencing attitudes against misinformation for users in Hefei than in Beijing. Conclusions: This study shows that consumers have to be on guard against not only fake food, but also spreading fake information and rumors, as well as conspiracy beliefs involving fake food. This study focused on characterizing media sources, types of food fraud misinformation, and risk perceptions of food safety, which mix urgency and suspicion, and attempted to provide evidence-based interventions for risk management guidance, with the hypothesis of significant correlations between media types and sources, and consumer exposure and perception levels of food rumors and risks. ", doi="10.2196/32302", url="https://formative.jmir.org/2022/3/e32302", url="http://www.ncbi.nlm.nih.gov/pubmed/34939565" } @Article{info:doi/10.2196/34003, author="Yeung, Kan Andy Wai and Wochele-Thoma, Thomas and Eibensteiner, Fabian and Klager, Elisabeth and Hribersek, Mojca and Parvanov, D. Emil and Hrg, Dalibor and V{\"o}lkl-Kernstock, Sabine and Kletecka-Pulker, Maria and Schaden, Eva and Willschke, Harald and Atanasov, G. Atanas", title="Official Websites Providing Information on COVID-19 Vaccination: Readability and Content Analysis", journal="JMIR Public Health Surveill", year="2022", month="Mar", day="15", volume="8", number="3", pages="e34003", keywords="COVID-19", keywords="coronavirus", keywords="SARS-CoV-2", keywords="vaccine", keywords="readability", keywords="content quality", keywords="online health information", keywords="side effect", keywords="public health", keywords="medicine", keywords="quality", keywords="perception", abstract="Background: Online information on COVID-19 vaccination may influence people's perception and willingness to be vaccinated. Official websites of vaccination programs have not been systematically assessed before. Objective: This study aims to assess and compare the readability and content quality of web-based information on COVID-19 vaccination posted on official/governmental websites. Furthermore, the relationship between evaluated website parameters and country vaccination rates were calculated. Methods: By referring to an open data set hosted at Our World in Data, the 58 countries/regions with the highest total vaccination count as of July 8, 2021, were identified. Together with the websites from the World Health Organization and European Union, a total of 60 vaccination campaign websites were targeted. The ``frequently asked questions'' or ``questions and answers'' section of the websites were evaluated in terms of readability (Flesch Reading Ease score and Flesch-Kincaid Grade Level), quality (Health On the Net Foundation code [HONcode] certification and Quality Evaluation Scoring Tool), and content stating vaccination duration of protection and potential side effects. Results: In terms of readability, the Flesch Reading Ease score of the vaccination frequently asked questions websites ranged between 11.2 and 69.5, with a mean of 40.9 (SD 13.2). Meanwhile, the Flesch-Kincaid Grade Level ranged between 6.5 and 17.6, with a mean of 12.1 (SD 2.8). In terms of quality, only 2 websites were HONcode certified, and the Quality Evaluation Scoring Tool score of the websites ranged between 7 and 20, with a mean of 15.3 (SD 3.1). Half of the websites (25/50) did not present a publication date or date of the last update. Regarding the duration of protection offered by the vaccines, 46\% (23/50) of the websites stated that they do not know, and another 40\% (20/50) did not address it. Five side effects of the vaccinations were most frequently mentioned, namely, fever/chill (41/50, 82\%), various injection site discomfort events (eg, swelling, redness, or pain; 39/50, 78\%), headache (36/50, 72\%), fatigue (33/50, 66\%), and muscle/joint pain (31/50, 62\%). Conclusions: In general, the content quality of most of the evaluated websites was good, but HONcode certification should be considered, content should be written in a more readable manner, and a publication date or date of the last update should be presented. ", doi="10.2196/34003", url="https://publichealth.jmir.org/2022/3/e34003", url="http://www.ncbi.nlm.nih.gov/pubmed/35073276" } @Article{info:doi/10.2196/32722, author="Ndlovu, Kagiso and Mauco, Leonard Kabelo and Keetile, Mpho and Kadimo, Khutsafalo and Senyatso, Yvonne Refilwe and Ntebela, Davies and Valela, Buthugwashe and Murambi, Clement", title="Acceptance of the District Health Information System Version 2 Platform for Malaria Case-Based Surveillance By Health Care Workers in Botswana: Web-Based Survey", journal="JMIR Form Res", year="2022", month="Mar", day="15", volume="6", number="3", pages="e32722", keywords="malaria case-based surveillance", keywords="district health information system", keywords="eHealth", keywords="technology acceptance model", keywords="Botswana", keywords="DHIS2", keywords="malaria", keywords="surveillance", keywords="public health", keywords="technology adoption", keywords="user acceptance", abstract="Background: Similar to many low- and middle-income countries, Botswana has identified eHealth as a means of improving health care service provision and delivery. The National Malaria Programme (NMP) in Botswana has implemented the District Health Information System version 2 (DHIS2) to support timely malaria case reporting across its 27 health districts; however, the implementation of an eHealth system is never without challenges. Barriers to the implementation of eHealth innovations within health care settings may arise at the individual or organizational levels. As such, the evaluation of user perceptions of the technology is an important step that can inform its sustainable implementation. The DHIS2 was implemented without evaluating user perceptions beforehand; therefore, the Botswana Ministry of Health and Wellness was uncertain about the likelihood of acceptance and use of the platform. Objective: We aimed to determine the acceptance of the DHIS2 platform by the NMP in Botswana to gauge whether adoption would be successful. Methods: The study's design was informed by constructs of the technology acceptance model. A survey, with items assessed using a 7-point Likert scale, and focus group discussions were undertaken with DHIS2 core users from 27 health districts and NMP personnel at the Ministry of Health and Wellness. The web-based survey was administered from August 3, 2020 to September 30, 2020. Results: Survey participants were core users (n=27). Focus group participants were NMP personnel (n=5). Overall, participants' survey responses (frequently occurring scores of 7) showed their confidence in the DHIS2 platform for case-based surveillance of malaria; however, participants also noted some organizational issues that could compromise user acceptance of the DHIS2 platform. Conclusions: Participants' responses indicated their acceptance of the DHIS2 platform; however, the consideration of factors related to organizational readiness could further enhance successful acceptance, and consequently, successful adoption of the platform by the malaria program in Botswana. ", doi="10.2196/32722", url="https://formative.jmir.org/2022/3/e32722", url="http://www.ncbi.nlm.nih.gov/pubmed/35289760" } @Article{info:doi/10.2196/25614, author="Tian, Hao and Gaines, Christy and Launi, Lori and Pomales, Ana and Vazquez, Germaine and Goharian, Amanda and Goodnight, Bradley and Haney, Erica and Reh, M. Christopher and Rogers, D. Rachel", title="Understanding Public Perceptions of Per- and Polyfluoroalkyl Substances: Infodemiology Study of Social Media", journal="J Med Internet Res", year="2022", month="Mar", day="11", volume="24", number="3", pages="e25614", keywords="PFAS", keywords="per- and polyfluoroalkyl substances", keywords="social media", keywords="public perceptions", abstract="Background: Per- and polyfluoroalkyl substances (PFAS) are environmental contaminants that have received significant public attention. PFAS are a large group of human-made chemicals that have been used in industry and consumer products worldwide since the 1950s. Human exposure to PFAS is a growing public health concern. Studies suggest that exposure to PFAS may increase the risk of some cancers and have negative health impacts on the endocrine, metabolic, and immune systems. Federal and state health partners are investigating the exposure to and possible health effects associated with PFAS. Government agencies can observe social media discourse on PFAS to better understand public concerns and develop targeted communication and outreach efforts. Objective: The primary objective of this study is to understand how social media is used to share, disseminate, and engage in public discussions of PFAS-related information in the United States. Methods: We investigated PFAS-related content across 2 social media platforms between May 1, 2017, and April 30, 2019, to identify how social media is used in the United States to seek and disseminate PFAS-related information. Our key variable of interest was posts that mentioned ``PFAS,'' ``PFOA,'' ``PFOS,'' and their hashtag variations across social media platforms. Additional variables included post type, time, PFAS event, and geographic location. We examined term use and post type differences across platforms. We used descriptive statistics and regression analysis to assess the incidence of PFAS discussions and to identify the date, event, and geographic patterns. We qualitatively analyzed social media content to determine the most prevalent themes discussed on social media platforms. Results: Our analysis revealed that Twitter had a significantly greater volume of PFAS-related posts compared with Reddit (98,264 vs 3126 posts). PFAS-related social media posts increased by 670\% over 2 years, indicating a marked increase in social media users' interest in and awareness of PFAS. Active engagement varied across platforms, with Reddit posts demonstrating more in-depth discussions compared with passive likes and reposts among Twitter users. Spikes in PFAS discussions were evident and connected to the discovery of contamination events, media coverage, and scientific publications. Thematic analysis revealed that social media users see PFAS as a significant public health concern and seek a trusted source of information about PFAS-related public health efforts. Conclusions: The analysis identified a prevalent theme---on social media, PFAS are perceived as an immediate public health concern, which demonstrates a growing sense of urgency to understand this emerging contaminant and its potential health impacts. Government agencies can continue using social media research to better understand the changing community sentiment on PFAS and disseminate targeted information and then use social media as a forum for dispelling misinformation, communicating scientific findings, and providing resources for relevant public health services. ", doi="10.2196/25614", url="https://www.jmir.org/2022/3/e25614", url="http://www.ncbi.nlm.nih.gov/pubmed/35275066" } @Article{info:doi/10.2196/29819, author="Okunoye, Babatunde and Ning, Shaoyang and Jemielniak, Dariusz", title="Searching for HIV and AIDS Health Information in South Africa, 2004-2019: Analysis of Google and Wikipedia Search Trends", journal="JMIR Form Res", year="2022", month="Mar", day="11", volume="6", number="3", pages="e29819", keywords="HIV/AIDS", keywords="web search", keywords="big data", keywords="public health", keywords="Wikipedia", keywords="information seeking behavior", keywords="online behavior", keywords="online health information", keywords="Google Trends", abstract="Background: AIDS, caused by HIV, is a leading cause of mortality in Africa. HIV/AIDS is among the greatest public health challenges confronting health authorities, with South Africa having the greatest prevalence of the disease in the world. There is little research into how Africans meet their health information needs on HIV/AIDS online, and this research gap impacts programming and educational responses to the HIV/AIDS pandemic. Objective: This paper reports on how, in general, interest in the search terms ``HIV'' and ``AIDS'' mirrors the increase in people living with HIV and the decline in AIDS cases in South Africa. Methods: Data on search trends for HIV and AIDS for South Africa were found using the search terms ``HIV'' and ``AIDS'' (categories: health, web search) on Google Trends. This was compared with data on estimated adults and children living with HIV, and AIDS-related deaths in South Africa, from the Joint United Nations Programme on HIV/AIDS, and also with search interest in the topics ``HIV'' and ``AIDS'' on Wikipedia Afrikaans, the most developed local language Wikipedia service in South Africa. Nonparametric statistical tests were conducted to support the trends and associations identified in the data. Results: Google Trends shows a statistically significant decline (P<.001) in search interest for AIDS relative to HIV in South Africa. This trend mirrors progress on the ground in South Africa and is significantly associated (P<.001) with a decline in AIDS-related deaths and people living longer with HIV. This trend was also replicated on Wikipedia Afrikaans, where there was a greater interest in HIV than AIDS. Conclusions: This statistically significant (P<.001) association between interest in the search terms ``HIV'' and ``AIDS'' in South Africa (2004-2019) and the number of people living with HIV and AIDS in the country (2004-2019) might be an indicator that multilateral efforts at combating HIV/AIDS---particularly through awareness raising and behavioral interventions in South Africa---are bearing fruit, and this is not only evident on the ground, but is also reflected in the online information seeking on the HIV/AIDS pandemic. We acknowledge the limitation that in studying the association between Google search interests on HIV/AIDS and cases/deaths, causal relationships should not be drawn due to the limitations of the data. ", doi="10.2196/29819", url="https://formative.jmir.org/2022/3/e29819", url="http://www.ncbi.nlm.nih.gov/pubmed/35275080" } @Article{info:doi/10.2196/32499, author="Fradkin, Nick and Zbikowski, M. Susan and Christensen, Trevor", title="Analysis of Demographic Characteristics of Users of a Free Tobacco Cessation Smartphone App: Observational Study", journal="JMIR Public Health Surveill", year="2022", month="Mar", day="9", volume="8", number="3", pages="e32499", keywords="mobile applications", keywords="mHealth", keywords="eHealth", keywords="smartphone app", keywords="tobacco", keywords="smoking cessation", keywords="public health", keywords="smoking", keywords="application", abstract="Background: Tobacco use continues to be the leading preventable cause of death, disease, and disability in the United States. Since 2000, Washington state has offered free tobacco ``quitline'' services to help its residents stop using tobacco. In 2015, the state began offering free access to a tobacco cessation smartphone app to absorb excess quitline demand. Since most publicly funded tobacco cessation programs are designed to provide access to populations disproportionately impacted by tobacco use, it is important to consider who these public health interventions reach. Objective: The aim of this study is to understand who used a free cessation app and the extent to which users represented populations disproportionately impacted by tobacco use. Methods: This is an observational study of 1280 adult Washington state residents who registered for and activated the cessation app. Demographic data were collected as part of the sign-up process, examined using standard descriptive measures, and assessed against state-level surveillance data for representativeness. Results: Participants were primarily non-Hispanic White (978/1218, 80.3\%), identified as female (780/1236, 63.1\%), were between ages 25-54 years (903/1186, 76.1\%), had at least some college education (836/1222, 68.4\%), and reported a household income under US \$50,000 (742/1055, 70.3\%). Fewer respondents were from rural counties (359/1220, 29.4\%); identified as lesbian, gay, bisexual, pansexual, queer, questioning, or asexual (LGBQA; 153/1222, 12.5\%); were uninsured (147/1206, 12.2\%); or were currently pregnant, planning pregnancy, or breastfeeding (42/624, 6.7\%). However, relative to available state data for tobacco users, there was high representation of women, 35- to 54-year-olds, college graduates, and LGBQA individuals, as well as individuals with low household income, poor mental health, Medicaid insurance, and those residing in rural counties. Conclusions: A diverse population of tobacco users will use a free cessation app, including some demographic groups disproportionately impacted by tobacco use. With high reach and high efficacy, it is possible to address health disparities associated with tobacco use and dependence treatment among certain underserved and at-risk groups. ", doi="10.2196/32499", url="https://publichealth.jmir.org/2022/3/e32499", url="http://www.ncbi.nlm.nih.gov/pubmed/35262491" } @Article{info:doi/10.2196/33277, author="Genevi{\`e}ve, Darryl Lester and Martani, Andrea and Wangmo, Tenzin and Elger, Simone Bernice", title="Precision Public Health and Structural Racism in the United States: Promoting Health Equity in the COVID-19 Pandemic Response", journal="JMIR Public Health Surveill", year="2022", month="Mar", day="4", volume="8", number="3", pages="e33277", keywords="precision public health", keywords="structural racism", keywords="COVID-19", keywords="pandemic", keywords="social justice", keywords="health equity", keywords="SARS-CoV-2", keywords="stigma", keywords="discrimination", keywords="disparity", keywords="inequality", keywords="precision health", keywords="public health", keywords="racism", keywords="equity", keywords="mortality", keywords="morbidity", doi="10.2196/33277", url="https://publichealth.jmir.org/2022/3/e33277", url="http://www.ncbi.nlm.nih.gov/pubmed/35089868" } @Article{info:doi/10.2196/24787, author="Young, D. Sean and Zhang, Qingpeng and Zeng, Dajun Daniel and Zhan, Yongcheng and Cumberland, William", title="Social Media Images as an Emerging Tool to Monitor Adherence to COVID-19 Public Health Guidelines: Content Analysis", journal="J Med Internet Res", year="2022", month="Mar", day="3", volume="24", number="3", pages="e24787", keywords="internet", keywords="social media", keywords="health informatics", keywords="tool", keywords="monitor", keywords="adherence", keywords="COVID-19", keywords="public health", keywords="guidelines", keywords="content analysis", keywords="policy", abstract="Background: Innovative surveillance methods are needed to assess adherence to COVID-19 recommendations, especially methods that can provide near real-time or highly geographically targeted data. Use of location-based social media image data (eg, Instagram images) is one possible approach that could be explored to address this problem. Objective: We seek to evaluate whether publicly available near real-time social media images might be used to monitor COVID-19 health policy adherence. Methods: We collected a sample of 43,487 Instagram images in New York from February 7 to April 11, 2020, from the following location hashtags: \#Centralpark (n=20,937), \#Brooklyn Bridge (n=14,875), and \#Timesquare (n=7675). After manually reviewing images for accuracy, we counted and recorded the frequency of valid daily posts at each of these hashtag locations over time, as well as rated and counted whether the individuals in the pictures at these location hashtags were social distancing (ie, whether the individuals in the images appeared to be distanced from others vs next to or touching each other). We analyzed the number of images posted over time and the correlation between trends among hashtag locations. Results: We found a statistically significant decline in the number of posts over time across all regions, with an approximate decline of 17\% across each site (P<.001). We found a positive correlation between hashtags (\#Centralpark and \#Brooklynbridge: r=0.40; \#BrooklynBridge and \#Timesquare: r=0.41; and \#Timesquare and \#Centralpark: r=0.33; P<.001 for all correlations). The logistic regression analysis showed a mild statistically significant increase in the proportion of posts over time with people appearing to be social distancing at Central Park (P=.004) and Brooklyn Bridge (P=.02) but not for Times Square (P=.16). Conclusions: Results suggest the potential of using location-based social media image data as a method for surveillance of COVID-19 health policy adherence. Future studies should further explore the implementation and ethical issues associated with this approach. ", doi="10.2196/24787", url="https://www.jmir.org/2022/3/e24787", url="http://www.ncbi.nlm.nih.gov/pubmed/34995205" } @Article{info:doi/10.2196/32364, author="Cai, Owen and Sousa-Pinto, Bernardo", title="United States Influenza Search Patterns Since the Emergence of COVID-19: Infodemiology Study", journal="JMIR Public Health Surveill", year="2022", month="Mar", day="3", volume="8", number="3", pages="e32364", keywords="COVID-19", keywords="influenza", keywords="surveillance", keywords="media coverage", keywords="Google Trends", keywords="infodemiology", keywords="monitoring", keywords="trend", keywords="United States", keywords="information-seeking", keywords="online health information", abstract="Background: The emergence and media coverage of COVID-19 may have affected influenza search patterns, possibly affecting influenza surveillance results using Google Trends. Objective: We aimed to investigate if the emergence of COVID-19 was associated with modifications in influenza search patterns in the United States. Methods: We retrieved US Google Trends data (relative number of searches for specified terms) for the topics influenza, Coronavirus disease 2019, and symptoms shared between influenza and COVID-19. We calculated the correlations between influenza and COVID-19 search data for a 1-year period after the first COVID-19 diagnosis in the United States (January 21, 2020 to January 20, 2021). We constructed a seasonal autoregressive integrated moving average model and compared predicted search volumes, using the 4 previous years, with Google Trends relative search volume data. We built a similar model for shared symptoms data. We also assessed correlations for the past 5 years between Google Trends influenza data, US Centers for Diseases Control and Prevention influenza-like illness data, and influenza media coverage data. Results: We observed a nonsignificant weak correlation ($\rho$= --0.171; P=0.23) between COVID-19 and influenza Google Trends data. Influenza search volumes for 2020-2021 distinctly deviated from values predicted by seasonal autoregressive integrated moving average models---for 6 weeks within the first 13 weeks after the first COVID-19 infection was confirmed in the United States, the observed volume of searches was higher than the upper bound of 95\% confidence intervals for predicted values. Similar results were observed for shared symptoms with influenza and COVID-19 data. The correlation between Google Trends influenza data and CDC influenza-like-illness data decreased after the emergence of COVID-19 (2020-2021: $\rho$=0.643; 2019-2020: $\rho$=0.902), while the correlation between Google Trends influenza data and influenza media coverage volume remained stable (2020-2021: $\rho$=0.746; 2019-2020: $\rho$=0.707). Conclusions: Relevant differences were observed between predicted and observed influenza Google Trends data the year after the onset of the COVID-19 pandemic in the United States. Such differences are possibly due to media coverage, suggesting limitations to the use of Google Trends as a flu surveillance tool. ", doi="10.2196/32364", url="https://publichealth.jmir.org/2022/3/e32364", url="http://www.ncbi.nlm.nih.gov/pubmed/34878996" } @Article{info:doi/10.2196/31813, author="Jalali, Niloofar and Tran, Ken N. and Sen, Anindya and Morita, Pelegrini Plinio", title="Identifying the Socioeconomic, Demographic, and Political Determinants of Social Mobility and Their Effects on COVID-19 Cases and Deaths: Evidence From US Counties", journal="JMIR Infodemiology", year="2022", month="Mar", day="3", volume="2", number="1", pages="e31813", keywords="COVID-19", keywords="cases", keywords="deaths", keywords="mobility", keywords="Google mobility data", keywords="clustering", abstract="Background: The spread of COVID-19 at the local level is significantly impacted by population mobility. The U.S. has had extremely high per capita COVID-19 case and death rates. Efficient nonpharmaceutical interventions to control the spread of COVID-19 depend on our understanding of the determinants of public mobility. Objective: This study used publicly available Google data and machine learning to investigate population mobility across a sample of US counties. Statistical analysis was used to examine the socioeconomic, demographic, and political determinants of mobility and the corresponding patterns of per capita COVID-19 case and death rates. Methods: Daily Google population mobility data for 1085 US counties from March 1 to December 31, 2020, were clustered based on differences in mobility patterns using K-means clustering methods. Social mobility indicators (retail, grocery and pharmacy, workplace, and residence) were compared across clusters. Statistical differences in socioeconomic, demographic, and political variables between clusters were explored to identify determinants of mobility. Clusters were matched with daily per capita COVID-19 cases and deaths. Results: Our results grouped US counties into 4 Google mobility clusters. Clusters with more population mobility had a higher percentage of the population aged 65 years and over, a greater population share of Whites with less than high school and college education, a larger percentage of the population with less than a college education, a lower percentage of the population using public transit to work, and a smaller share of voters who voted for Clinton during the 2016 presidential election. Furthermore, clusters with greater population mobility experienced a sharp increase in per capita COVID-19 case and death rates from November to December 2020. Conclusions: Republican-leaning counties that are characterized by certain demographic characteristics had higher increases in social mobility and ultimately experienced a more significant incidence of COVID-19 during the latter part of 2020. ", doi="10.2196/31813", url="https://infodemiology.jmir.org/2022/1/e31813", url="http://www.ncbi.nlm.nih.gov/pubmed/35287305" } @Article{info:doi/10.2196/30085, author="Moon, Hana and Lee, Ho Geon and Cho, Jeong Yoon", title="Readability of Korean-Language COVID-19 Information from the South Korean National COVID-19 Portal Intended for the General Public: Cross-sectional Infodemiology Study", journal="JMIR Form Res", year="2022", month="Mar", day="3", volume="6", number="3", pages="e30085", keywords="COVID-19", keywords="health literacy", keywords="readability", keywords="public health", keywords="health equity", keywords="consumer health information", keywords="information dissemination", keywords="health education", keywords="eHealth", keywords="online", keywords="social media", keywords="pandemic", keywords="infodemic", abstract="Background: The coronavirus pandemic has increased reliance on the internet as a tool for disseminating information; however, information is useful only when it can be understood. Prior research has shown that web-based health information is not always easy to understand. It is not yet known whether the Korean-language COVID-19 information from the internet is easy for the general public to understand. Objective: We aimed to evaluate the readability of Korean-language COVID-19 information intended for the general public from the national COVID-19 portal of South Korea. Methods: A total of 122 publicly available COVID-19 information documents written in Korean were obtained from the South Korean national COVID-19 portal. We determined the level of readability (at or below ninth grade, 10th to 12th grade, college, or professional) of each document using a readability tool for Korean-language text. We measured the reading time, character count, word count, sentence count, and paragraph count for each document. We also evaluated the characteristics of difficult-to-read documents to modify the readability from difficult to easy. Results: The median readability level was at a professional level; 90.2\% (110/122) of the information was difficult to read. In all 4 topics, few documents were easy to read (overview: 5/12, 41.7\%; prevention: 6/97, 6.2\%; test: 0/5, 0\%; treatment: 1/8, 12.5\%; P=.006), with a median 11th-grade readability level for overview, a median professional readability level for prevention, and median college readability levels for test and treatment. Difficult-to-read information had the following characteristics in common: literacy style, medical jargon, and unnecessary detail. Conclusions: In all 4 topics, most of the Korean-language COVID-19 web-based information intended for the general public provided by the national COVID-19 portal of South Korea was difficult to read; the median readability levels exceeded the recommended ninth-grade level. Readability should be a key consideration in developing public health documents, which play an important role in disease prevention and health promotion. ", doi="10.2196/30085", url="https://formative.jmir.org/2022/3/e30085", url="http://www.ncbi.nlm.nih.gov/pubmed/35072633" } @Article{info:doi/10.2196/33058, author="Teague, J. Samantha and Shatte, R. Adrian B. and Weller, Emmelyn and Fuller-Tyszkiewicz, Matthew and Hutchinson, M. Delyse", title="Methods and Applications of Social Media Monitoring of Mental Health During Disasters: Scoping Review", journal="JMIR Ment Health", year="2022", month="Feb", day="28", volume="9", number="2", pages="e33058", keywords="social media", keywords="SNS", keywords="mental health", keywords="disaster", keywords="big data", keywords="digital psychiatry", abstract="Background: With the increasing frequency and magnitude of disasters internationally, there is growing research and clinical interest in the application of social media sites for disaster mental health surveillance. However, important questions remain regarding the extent to which unstructured social media data can be harnessed for clinically meaningful decision-making. Objective: This comprehensive scoping review synthesizes interdisciplinary literature with a particular focus on research methods and applications. Methods: A total of 6 health and computer science databases were searched for studies published before April 20, 2021, resulting in the identification of 47 studies. Included studies were published in peer-reviewed outlets and examined mental health during disasters or crises by using social media data. Results: Applications across 31 mental health issues were identified, which were grouped into the following three broader themes: estimating mental health burden, planning or evaluating interventions and policies, and knowledge discovery. Mental health assessments were completed by primarily using lexical dictionaries and human annotations. The analyses included a range of supervised and unsupervised machine learning, statistical modeling, and qualitative techniques. The overall reporting quality was poor, with key details such as the total number of users and data features often not being reported. Further, biases in sample selection and related limitations in generalizability were often overlooked. Conclusions: The application of social media monitoring has considerable potential for measuring mental health impacts on populations during disasters. Studies have primarily conceptualized mental health in broad terms, such as distress or negative affect, but greater focus is required on validating mental health assessments. There was little evidence for the clinical integration of social media--based disaster mental health monitoring, such as combining surveillance with social media--based interventions or developing and testing real-world disaster management tools. To address issues with study quality, a structured set of reporting guidelines is recommended to improve the methodological quality, replicability, and clinical relevance of future research on the social media monitoring of mental health during disasters. ", doi="10.2196/33058", url="https://mental.jmir.org/2022/2/e33058", url="http://www.ncbi.nlm.nih.gov/pubmed/35225815" } @Article{info:doi/10.2196/28704, author="Sinicrope, S. Pamela and Young, D. Colleen and Resnicow, Ken and Merritt, T. Zoe and McConnell, R. Clara and Hughes, A. Christine and Koller, R. Kathryn and Bock, J. Martha and Decker, A. Paul and Flanagan, A. Christie and Meade, D. Crystal and Thomas, K. Timothy and Prochaska, J. Judith and Patten, A. Christi", title="Lessons Learned From Beta-Testing a Facebook Group Prototype to Promote Treatment Use in the ``Connecting Alaska Native People to Quit Smoking'' (CAN Quit) Study", journal="J Med Internet Res", year="2022", month="Feb", day="17", volume="24", number="2", pages="e28704", keywords="Web 2.0", keywords="social media", keywords="Facebook", keywords="Alaska Native", keywords="American Indian", keywords="Alaska", keywords="smoking", keywords="cessation", keywords="cancer prevention", keywords="Quitline", keywords="mobile phone", doi="10.2196/28704", url="https://www.jmir.org/2022/2/e28704", url="http://www.ncbi.nlm.nih.gov/pubmed/35175208" } @Article{info:doi/10.2196/30524, author="Kilgallon, L. John and Tewarie, Ashwini Ishaan and Broekman, D. Marike L. and Rana, Aakanksha and Smith, R. Timothy", title="Passive Data Use for Ethical Digital Public Health Surveillance in a Postpandemic World", journal="J Med Internet Res", year="2022", month="Feb", day="15", volume="24", number="2", pages="e30524", keywords="passive data", keywords="public health surveillance", keywords="digital public health surveillance", keywords="pandemic response", keywords="data privacy", keywords="digital phenotyping", keywords="smartphone", keywords="mobile phone", keywords="mHealth", keywords="digital health", keywords="informed consent", keywords="data equity", keywords="data ownership", doi="10.2196/30524", url="https://www.jmir.org/2022/2/e30524", url="http://www.ncbi.nlm.nih.gov/pubmed/35166676" } @Article{info:doi/10.2196/32355, author="Shakeri Hossein Abad, Zahra and Butler, P. Gregory and Thompson, Wendy and Lee, Joon", title="Physical Activity, Sedentary Behavior, and Sleep on Twitter: Multicountry and Fully Labeled Public Data Set for Digital Public Health Surveillance Research", journal="JMIR Public Health Surveill", year="2022", month="Feb", day="14", volume="8", number="2", pages="e32355", keywords="digital public health surveillance", keywords="social media analysis", keywords="physical activity", keywords="sedentary behavior", keywords="sleep", keywords="machine learning", keywords="online health information", keywords="infodemiology", keywords="public health database", abstract="Background: Advances in automated data processing and machine learning (ML) models, together with the unprecedented growth in the number of social media users who publicly share and discuss health-related information, have made public health surveillance (PHS) one of the long-lasting social media applications. However, the existing PHS systems feeding on social media data have not been widely deployed in national surveillance systems, which appears to stem from the lack of practitioners and the public's trust in social media data. More robust and reliable data sets over which supervised ML models can be trained and tested reliably is a significant step toward overcoming this hurdle. The health implications of daily behaviors (physical activity, sedentary behavior, and sleep [PASS]), as an evergreen topic in PHS, are widely studied through traditional data sources such as surveillance surveys and administrative databases, which are often several months out-of-date by the time they are used, costly to collect, and thus limited in quantity and coverage. Objective: The main objective of this study is to present a large-scale, multicountry, longitudinal, and fully labeled data set to enable and support digital PASS surveillance research in PHS. To support high-quality surveillance research using our data set, we have conducted further analysis on the data set to supplement it with additional PHS-related metadata. Methods: We collected the data of this study from Twitter using the Twitter livestream application programming interface between November 28, 2018, and June 19, 2020. To obtain PASS-related tweets for manual annotation, we iteratively used regular expressions, unsupervised natural language processing, domain-specific ontologies, and linguistic analysis. We used Amazon Mechanical Turk to label the collected data to self-reported PASS categories and implemented a quality control pipeline to monitor and manage the validity of crowd-generated labels. Moreover, we used ML, latent semantic analysis, linguistic analysis, and label inference analysis to validate the different components of the data set. Results: LPHEADA (Labelled Digital Public Health Dataset) contains 366,405 crowd-generated labels (3 labels per tweet) for 122,135 PASS-related tweets that originated in Australia, Canada, the United Kingdom, or the United States, labeled by 708 unique annotators on Amazon Mechanical Turk. In addition to crowd-generated labels, LPHEADA provides details about the three critical components of any PHS system: place, time, and demographics (ie, gender and age range) associated with each tweet. Conclusions: Publicly available data sets for digital PASS surveillance are usually isolated and only provide labels for small subsets of the data. We believe that the novelty and comprehensiveness of the data set provided in this study will help develop, evaluate, and deploy digital PASS surveillance systems. LPHEADA will be an invaluable resource for both public health researchers and practitioners. ", doi="10.2196/32355", url="https://publichealth.jmir.org/2022/2/e32355", url="http://www.ncbi.nlm.nih.gov/pubmed/35156938" } @Article{info:doi/10.2196/33522, author="Sullivan, Sean Patrick and Woodyatt, R. Cory and Kouzouian, Oskian and Parrish, J. Kristen and Taussig, Jennifer and Conlan, Chris and Phillips, Harold", title="America's HIV Epidemic Analysis Dashboard: Protocol for a Data Resource to Support Ending the HIV Epidemic in the United States", journal="JMIR Public Health Surveill", year="2022", month="Feb", day="10", volume="8", number="2", pages="e33522", keywords="HIV", keywords="dashboard", keywords="data", keywords="data dashboard", keywords="infectious disease", keywords="infodemiology", keywords="surveillance", keywords="public health", keywords="United States", keywords="monitoring", abstract="Background: The Ending the HIV Epidemic (EHE) plan aims to end the HIV epidemic in the United States by 2030. Having timely and accessible data to assess progress toward EHE goals at the local level is a critical resource to achieve this goal. Objective: The aim of this paper was to introduce America's HIV Epidemic Analysis Dashboard (AHEAD), a data visualization tool that displays relevant data on the 6 HIV indicators provided by the Centers for Disease Control and Prevention. AHEAD can be used to monitor progress toward ending the HIV epidemic in local communities across the United States. Its objective is to make data available to stakeholders, which can be used to measure national and local progress toward 2025 and 2030 EHE goals and to help jurisdictions make local decisions that are grounded in high-quality data. Methods: AHEAD displays data from public health data systems (eg, surveillance systems and census data), organized around the 6 EHE indicators (HIV incidence, knowledge of HIV status, HIV diagnoses, linkage to HIV medical care, viral HIV suppression, and preexposure prophylaxis coverage). Data are displayed for each of the EHE priority areas (48 counties in Washington, District of Columbia, and San Juan, Puerto Rico) which accounted for more than 50\% of all US HIV diagnoses in 2016 and 2017 and 7 primarily southern states with high rates of HIV in rural communities. AHEAD also displays data for the 43 remaining states for which data are available. Data features prioritize interactive data visualization tools that allow users to compare indicator data stratified by sex at birth, race or ethnicity, age, and transmission category within a jurisdiction (when available) or compare data on EHE indicators between jurisdictions. Results: AHEAD was launched on August 14, 2020. In the 11 months since its launch, the Dashboard has been visited 26,591 times by 17,600 unique users. About one-quarter of all users returned to the Dashboard at least once. On average, users engaged with 2.4 pages during their visit to the Dashboard, indicating that the average user goes beyond the informational landing page to engage with 1 or more pages of data and content. The most frequently visited content pages are the jurisdiction webpages. Conclusions: The Ending the HIV Epidemic plan is described as a ``whole of society'' effort. Societal public health initiatives require objective indicators and require that all societal stakeholders have transparent access to indicator data at the level of the health jurisdictions responsible for meeting the goals of the plan. Data transparency empowers local stakeholders to track movement toward EHE goals, identify areas with needs for improvement, and make data-informed adjustments to deploy the expertise and resources required to locally tailor and implement strategies to end the HIV epidemic in their jurisdiction. ", doi="10.2196/33522", url="https://publichealth.jmir.org/2022/2/e33522", url="http://www.ncbi.nlm.nih.gov/pubmed/35142639" } @Article{info:doi/10.2196/32680, author="Joseph, A. Heather and Ingber, Z. Susan and Austin, Chelsea and Westnedge, Caroline and Strona, V. F. and Lee, Leslie and Shah, B. Ami and Roper, Lauren and Patel, Anita", title="An Evaluation of the Text Illness Monitoring (TIM) Platform for COVID-19: Cross-sectional Online Survey of Public Health Users", journal="JMIR Public Health Surveill", year="2022", month="Feb", day="7", volume="8", number="2", pages="e32680", keywords="COVID-19", keywords="contact tracing", keywords="SMS text system", keywords="symptom monitoring", abstract="Background: The US public health response to the COVID-19 pandemic has required contact tracing and symptom monitoring at an unprecedented scale. The US Centers for Disease Control and Prevention and several partners created the Text Illness Monitoring (TIM) platform in 2015 to assist US public health jurisdictions with symptom monitoring for potential novel influenza virus outbreaks. Since May 2020, 142 federal, state, and local public health agencies have deployed TIM for COVID-19 symptom monitoring. Objective: The aim of this study was to evaluate the utility, benefits, and challenges of TIM to help guide decision-making for improvements and expansion to support future public health emergency response efforts. Methods: We conducted a brief online survey of previous and current TIM administrative users (admin users) from November 28 through December 21, 2020. Closed- and open-ended questions inquired about the onboarding process, decision to use TIM, groups monitored with TIM, comparison of TIM to other symptom monitoring systems, technical challenges and satisfaction with TIM, and user support. A total of 1479 admin users were invited to participate. Results: A total of 97 admin users from 43 agencies responded to the survey. Most admin users represented the Indian Health Service (35/97, 36\%), state health departments (26/97, 27\%), and local or county health departments (18/97, 19\%), and almost all were current users of TIM (85/94, 90\%). Among the 43 agencies represented, 11 (26\%) used TIM for monitoring staff exclusively, 13 (30\%) monitored community members exclusively, and 19 (44\%) monitored both staff and community members. Agencies most frequently used TIM to monitor symptom development in contacts of cases among community members (28/43, 65\%), followed by symptom development among staff (27/43, 63\%) and among staff contacts of cases (24/43, 56\%). Agencies also reported using TIM to monitor patients with COVID-19 for the worsening of symptoms among staff (21/43, 49\%) and community members (18/43, 42\%). When asked to compare TIM to previous monitoring systems, 78\% (40/51) of respondents rated TIM more favorably than their previous monitoring system, 20\% (10/51) said there was no difference, and 2\% (1/51) rated the previous monitoring system more favorably than TIM. Most respondents found TIM favorable in terms of time burden, staff burden, timeliness of the data, and the ability to monitor large population sizes. TIM compared negatively to other systems in terms of effort to enroll participants (ie, persons TIM monitors) and accuracy of the data. Most respondents (76/85, 89\%) reported that they would highly or somewhat recommend TIM to others for symptom monitoring. Conclusions: This evaluation of TIM showed that agencies used TIM for a variety of purposes and rated TIM favorably compared to previously used monitoring systems. We also identified opportunities to improve TIM; for example, enhancing the flexibility of alert deliveries would better meet admin users' varying needs. We also suggest continuous program evaluation practices to assess and respond to implementation gaps. ", doi="10.2196/32680", url="https://publichealth.jmir.org/2022/2/e32680", url="http://www.ncbi.nlm.nih.gov/pubmed/34882572" } @Article{info:doi/10.2196/25216, author="Sun, Li and Lu, Xinyi and Xie, Zidian and Li, Dongmei", title="Public Reactions to the New York State Policy on Flavored Electronic Cigarettes on Twitter: Observational Study", journal="JMIR Public Health Surveill", year="2022", month="Feb", day="3", volume="8", number="2", pages="e25216", keywords="New York State policy", keywords="flavored e-cigarettes", keywords="Twitter", keywords="social media", keywords="vaping", keywords="e-cigarette", abstract="Background: Flavored electronic cigarettes (e-cigarettes) have become popular in recent years, especially among youth and young adults. To address the epidemic of e-cigarettes, New York State approved a ban on sales of most flavored vaping products other than tobacco and menthol flavors on September 17, 2019. Objective: This study aims to examine the attitude of Twitter users to the policy on flavored e-cigarettes in New York State and the impact of this policy on public perceptions of e-cigarettes. This study also compares the attitudes and topics between New York Twitter users and Twitter users from other states who were not directly affected by this policy. Methods: Tweets related to e-cigarettes and the New York State policy on flavored e-cigarettes were collected using the Twitter streaming application programming interface from June 2019 to December 2019. Tweets from New York State and those from other states that did not have a flavored e-cigarette policy were extracted. Sentiment analysis was applied to analyze the proportion of negative and positive tweets about e-cigarettes or the flavor policy. Topic modeling was applied to e-cigarette--related data sets and New York flavor policy--related data sets to identify the most frequent topics before and after the announcement of the New York State policy. Results: We found that the average number of tweets related to e-cigarettes and the New York State policy on flavored e-cigarettes increased in both New York State and other states after the flavor policy announcement. Sentiment analysis revealed that after the announcement of the New York State flavor policy, in both New York State and other states, the proportion of negative tweets on e-cigarettes increased from 34.07\% (4531/13,299) to 44.58\% (18,451/41,390) and from 32.48\% (14,320/44,090) to 44.40\% (64,262/144,734), respectively, while positive tweets decreased significantly from 39.03\% (5191/13,299) to 32.86\% (13,601/41,390) and from 42.78\% (18,863/44,090) to 33.93\% (49,105/144,734), respectively. The majority of tweets related to the New York State flavor policy were negative both before and after the announcement of this policy in both New York (87/98, 89\% and 3810/4565, 83.46\%, respectively) and other states (200/255, 78.4\% and 12,695/15,569, 81.54\%, respectively), while New York State had a higher proportion of negative tweets than other states. Topic modeling results demonstrated that teenage vaping and health problems were the most discussed topics associated with e-cigarettes. Conclusions: Public attitudes toward e-cigarettes became more negative on Twitter after New York State announced the policy on flavored e-cigarettes. Twitter users in other states that did not have such a policy on flavored e-cigarettes paid close attention to the New York State flavor policy. This study provides some valuable information about the potential impact of the flavored e-cigarettes policy in New York State on public attitudes toward flavored e-cigarettes. ", doi="10.2196/25216", url="https://publichealth.jmir.org/2022/2/e25216", url="http://www.ncbi.nlm.nih.gov/pubmed/35113035" } @Article{info:doi/10.2196/30811, author="O'Connor, Cara and Leyritana, Katerina and Doyle, M. Aoife and Lewis, J. James and Gill, Randeep and Salva{\~n}a, Maurice Edsel", title="Interactive Mobile Phone HIV Adherence Support for Men Who Have Sex With Men in the Philippines Connect for Life Study: Mixed Methods Approach to Intervention Development and Pilot Testing", journal="JMIR Form Res", year="2022", month="Feb", day="3", volume="6", number="2", pages="e30811", keywords="mHealth", keywords="adherence", keywords="HIV", keywords="antiretroviral therapy", keywords="intervention development", keywords="mobile phone", abstract="Background: The HIV epidemic in the Philippines is one of the fastest growing epidemics globally, and infections among men who have sex with men are rising at an alarming rate. The World Health Organization recommends the use of mobile health (mHealth) technologies to engage patients in care and ensure high levels of adherence to antiretroviral therapy (ART). Existing mHealth interventions can be adapted and tailored to the context and population served. Objective: This study aims to create a locally tailored intervention using a mobile phone platform to support treatment adherence for HIV patients on ART in the Philippines. Methods: A mixed methods approach guided by the Behavior Change Wheel framework was used to adapt an existing mHealth adherence support platform for the local setting and target population. A literature review, retrospective clinical record review, and focus group discussions with patients were conducted to understand the drivers of ART adherence and tailor the intervention accordingly. The resulting intervention was pilot-tested for 8 weeks, followed by focus group discussions with patients who received the intervention to assess the acceptability of the design. Results: Key issues contributing to nonadherence included side effects, lack of behavioral skills for pill taking, social support, mental health, and substance use. Patients identified mHealth as an acceptable mode of intervention delivery and wanted mHealth services to be highly personalizable. The study team, clinicians, and software developers integrated these findings into the intervention, which included a menu of services as follows: pill reminders, health tips, adherence feedback, appointment reminders, and symptom reporting. During the pilot phase, technical issues in the interactive voice response system (IVRS) were identified and addressed. Patients who participated in the pilot phase expressed a preference for SMS text messaging over the IVRS. Patients responded positively to the appointment reminders and health tips, whereas patient feedback on daily and weekly pill reminders and adherence feedback was mixed. Conclusions: The mobile phone--based SMS text messaging and IVRS intervention was acceptable to men who have sex with men in Manila, the Philippines, and qualitative analysis suggested that the intervention helped promote ART adherence and appointment attendance. ", doi="10.2196/30811", url="https://formative.jmir.org/2022/2/e30811", url="http://www.ncbi.nlm.nih.gov/pubmed/35113030" } @Article{info:doi/10.2196/34574, author="Sullivan, Sean Patrick and Stephenson, Rob and Hirshfield, Sabina and Mehta, Christina Cyra and Zahn, Ryan and Bauermeister, A. Jose and Horvath, Keith and Chiasson, Ann Mary and Gelaude, Deborah and Mullin, Shelby and Downing Jr, J. Martin and Olansky, Jolene Evelyn and Wiatrek, Sarah and Rogers, Q. Erin and Rosenberg, Eli and Siegler, J. Aaron and Mansergh, Gordon", title="Behavioral Efficacy of a Sexual Health Mobile App for Men Who Have Sex With Men: Randomized Controlled Trial of Mobile Messaging for Men", journal="J Med Internet Res", year="2022", month="Feb", day="2", volume="24", number="2", pages="e34574", keywords="HIV prevention", keywords="mHealth", keywords="tool", keywords="video", keywords="randomized clinical trial", keywords="app", keywords="prevention", keywords="HIV", keywords="PrEP", keywords="STI", keywords="testing", keywords="behavior", keywords="efficacy", keywords="men who have sex with men", keywords="MSM", keywords="sexuality", keywords="gay", keywords="bisexual", keywords="United States", abstract="Background: Gay, bisexual, and other men who have sex with men (GBMSM) face the highest burden of HIV in the United States, and there is a paucity of efficacious mobile health (mHealth) HIV prevention and care interventions tailored specifically for GBMSM. We tested a mobile app combining prevention messages and access to core prevention services for GBMSM. Objective: This study aims to measure the efficacy of the Mobile Messaging for Men (M-cubed) app and related services to increase HIV prevention and care behaviors in diverse US GBMSM. Methods: We conducted a randomized open-label study with a waitlist control group among GBMSM in 3 groups (low-risk HIV-negative group, high-risk HIV-negative group, and living-with-HIV [LWH] group) recruited online and in venues in Atlanta, Detroit, and New York City. Participants were randomly assigned to receive access to the app immediately or at 9 months after randomization. The app provided prevention messages in 6 domains of sexual health and offered ordering of at-home HIV and sexually transmitted infection test kits, receiving preexposure prophylaxis (PrEP) evaluations and navigation, and service locators. Serostatus- and risk-specific prevention outcomes were evaluated at baseline, at the end of the intervention period, and at 3, 6, and 9 months after the intervention period. Results: In total, 1226 GBMSM were enrolled and randomized; of these 611 (49.84\%) were assigned to the intervention group and 608 (99.51\%) were analyzed, while 615 (50.16\%) were assigned to the control group and 612 (99.51\%) were analyzed. For high-risk GBMSM, allocation to the intervention arm was associated with higher odds of HIV testing during the intervention period (adjusted odds ratio [aOR] 2.02, 95\% CI 1.11-3.66) and with higher odds of using PrEP in the 3 months after the intervention period (aOR 2.41, 95\% CI 1.00-5.76, P<.05). No changes in HIV prevention or care were associated with allocation to the intervention arm for the low-risk HIV-negative and LWH groups. Conclusions: Access to the M-cubed app was associated with increased HIV testing and PrEP use among high-risk HIV-negative GBMSM in 3 US cities. The app could be made available through funded HIV prevention providers; additional efforts are needed to understand optimal strategies to implement the app outside of the research setting. Trial Registration: ClinicalTrials.gov NCT03666247; https://clinicaltrials.gov/ct2/show/NCT03666247 International Registered Report Identifier (IRRID): RR2-10.2196/16439 ", doi="10.2196/34574", url="https://www.jmir.org/2022/2/e34574", url="http://www.ncbi.nlm.nih.gov/pubmed/35025755" } @Article{info:doi/10.2196/21063, author="Stark, Lea Anna and Geukes, Cornelia and Dockweiler, Christoph", title="Digital Health Promotion and Prevention in Settings: Scoping Review", journal="J Med Internet Res", year="2022", month="Jan", day="28", volume="24", number="1", pages="e21063", keywords="setting approach", keywords="health promotion", keywords="health prevention", keywords="eHealth", keywords="internet", keywords="behavior change", keywords="web-based intervention", keywords="technology", keywords="mobile phone", abstract="Background: Digital technologies are increasingly integrating into people's daily living environments such as schools, sport clubs, and health care facilities. These settings play a crucial role for health promotion and prevention because they affect the health of their members, as the World Health Organization has declared. Implementing digital health promotion and prevention in settings offers the opportunity to reach specific target groups, lower the costs of implementation, and improve the health of the population. Currently, there is a lack of scientific evidence that reviews the research on digital health promotion and prevention in settings. Objective: This scoping review aims to provide an overview of research targeting digital health promotion and primary prevention in settings. It assesses the range of scientific literature regarding outcomes such as applied technology, targeted setting, and area of health promotion or prevention, as well as identifies research gaps. Methods: The scoping review was conducted following the Levac, Colquhoun, and O'Brien framework. We searched scientific databases and gray literature for articles on digital setting--based health promotion and prevention published from 2010 to January 2020. We included empirical and nonempirical publications in English or German and excluded secondary or tertiary prevention and health promotion at the workplace. Results: From 8888 records, the search resulted in 200 (2.25\%) included publications. We identified a huge diversity of literature regarding digital setting--based health promotion and prevention. The variety of technology types extends from computer- and web-based programs to mobile devices (eg, smartphone apps) and telemonitoring devices (sensors). We found analog, digital, and blended settings in which digital health promotion and prevention takes place. The most frequent analog settings were schools (39/200, 19.5\%) and neighborhoods or communities (24/200, 12\%). Social media apps were also included because in some studies they were defined as a (digital) setting. They accounted for 31.5\% (63/200) of the identified settings. The most commonly focused areas of health promotion and prevention were physical activity (81/200, 40.5\%), nutrition (45/200, 22.5\%), and sexual health (34/200, 17\%). Most of the interventions combined several health promotion or prevention methods, including environmental change; providing information, social support, training, or incentives; and monitoring. Finally, we found that the articles mostly reported on behavioral rather than structural health promotion and prevention. Conclusions: The research field of digital health promotion and prevention in settings is heterogeneous. At the same time, we identified research gaps regarding the absence of valid definitions of relevant terms (eg, digital settings) and the lack of literature on structural health promotion and prevention in settings. Therefore, it remains unclear how digital technologies can contribute to structural (or organizational) changes in settings. More research is needed to successfully implement digital technologies to achieve health promotion and prevention in settings. ", doi="10.2196/21063", url="https://www.jmir.org/2022/1/e21063", url="http://www.ncbi.nlm.nih.gov/pubmed/35089140" } @Article{info:doi/10.2196/29894, author="Chejfec-Ciociano, Matias Jonathan and Mart{\'i}nez-Herrera, Pablo Juan and Parra-Guerra, Darianna Alexa and Chejfec, Ricardo and Barbosa-Camacho, Jos{\'e} Francisco and Ibarrola-Pe{\~n}a, Carlos Juan and Cervantes-Guevara, Gabino and Cervantes-Cardona, Alonso Guillermo and Fuentes-Orozco, Clotilde and Cervantes-P{\'e}rez, Enrique and Garc{\'i}a-Reyna, Benjam{\'i}n and Gonz{\'a}lez-Ojeda, Alejandro", title="Misinformation About and Interest in Chlorine Dioxide During the COVID-19 Pandemic in Mexico Identified Using Google Trends Data: Infodemiology Study", journal="JMIR Infodemiology", year="2022", month="Jan", day="27", volume="2", number="1", pages="e29894", keywords="coronavirus", keywords="COVID-19", keywords="Google Trends", keywords="chlorine dioxide", keywords="COVID-19 misinformation", keywords="public health surveillance", keywords="infodemiology", keywords="internet behavior", keywords="digital epidemiology", keywords="internet", keywords="mHealth", keywords="mobile health", keywords="pandemic", keywords="tele-epidemiology", abstract="Background: The COVID-19 pandemic has prompted the increasing popularity of several emerging therapies or preventives that lack scientific evidence or go against medical directives. One such therapy involves the consumption of chlorine dioxide, which is commonly used in the cleaning industry and is available commercially as a mineral solution. This substance has been promoted as a preventive or treatment agent for several diseases, including SARS-CoV-2 infection. As interest in chlorine dioxide has grown since the start of the pandemic, health agencies, institutions, and organizations worldwide have tried to discourage and restrict the consumption of this substance. Objective: The aim of this study is to analyze search engine trends in Mexico to evaluate changes in public interest in chlorine dioxide since the beginning of the COVID-19 pandemic. Methods: We retrieved public query data for the Spanish equivalent of the term ``chlorine dioxide'' from the Google Trends platform. The location was set to Mexico, and the time frame was from March 3, 2019, to February 21, 2021. A descriptive analysis was performed. The Kruskal-Wallis and Dunn tests were used to identify significant changes in search volumes for this term between four consecutive time periods, each of 13 weeks, from March 1, 2020, to February 27, 2021. Results: From the start of the pandemic in Mexico (February 2020), an upward trend was observed in the number of searches compared with that in 2019. Maximum volume trends were recorded during the week of July 19-25, 2020. The search volumes declined between September and November 2020, but another peak was registered in December 2020 through February 2021, which reached a maximum value on January 10. Percentage change from the first to the fourth time periods was +312.85, --71.35, and +228.18, respectively. Pairwise comparisons using the Kruskal-Wallis and Dunn tests showed significant differences between the four periods (P<.001). Conclusions: Misinformation is a public health risk because it can lower compliance with the recommended measures and encourage the use of therapies that have not been proven safe. The ingestion of chlorine dioxide presents a danger to the population, and several adverse reactions have been reported. Programs should be implemented to direct those interested in this substance to accurate medical information. ", doi="10.2196/29894", url="https://infodemiology.jmir.org/2022/1/e29894", url="http://www.ncbi.nlm.nih.gov/pubmed/35155994" } @Article{info:doi/10.2196/26781, author="Gonzalez, Gabriela and Vaculik, Kristina and Khalil, Carine and Zektser, Yuliya and Arnold, Corey and Almario, V. Christopher and Spiegel, Brennan and Anger, Jennifer", title="Using Large-scale Social Media Analytics to Understand Patient Perspectives About Urinary Tract Infections: Thematic Analysis", journal="J Med Internet Res", year="2022", month="Jan", day="25", volume="24", number="1", pages="e26781", keywords="female urology", keywords="urinary tract infections", keywords="health services research", keywords="social media", keywords="online community", keywords="online forum", keywords="latent Dirichlet allocation", keywords="data mining", keywords="digital ethnography", abstract="Background: Current qualitative literature about the experiences of women dealing with urinary tract infections (UTIs) is limited to patients recruited from tertiary centers and medical clinics. However, traditional focus groups and interviews may limit what patients share. Using digital ethnography, we analyzed free-range conversations of an online community. Objective: This study aimed to investigate and characterize the patient perspectives of women dealing with UTIs using digital ethnography. Methods: A data-mining service was used to identify online posts. A thematic analysis was conducted on a subset of the identified posts. Additionally, a latent Dirichlet allocation (LDA) probabilistic topic modeling method was applied to review the entire data set using a semiautomatic approach. Each identified topic was generated as a discrete distribution over the words in the collection, which can be thought of as a word cloud. We also performed a thematic analysis of the word cloud topic model results. Results: A total of 83,589 posts by 53,460 users from 859 websites were identified. Our hand-coding inductive analysis yielded the following 7 themes: quality-of-life impact, knowledge acquisition, support of the online community, health care utilization, risk factors and prevention, antibiotic treatment, and alternative therapies. Using the LDA topic model method, 105 themes were identified and consolidated into 9 categories. Of the LDA-derived themes, 25.7\% (27/105) were related to online community support, and 22\% (23/105) focused on UTI risk factors and prevention strategies. Conclusions: Our large-scale social media analysis supports the importance and reproducibility of using online data to comprehend women's UTI experience. This inductive thematic analysis highlights patient behavior, self-empowerment, and online media utilization by women to address their health concerns in a safe, anonymous way. ", doi="10.2196/26781", url="https://www.jmir.org/2022/1/e26781", url="http://www.ncbi.nlm.nih.gov/pubmed/35076404" } @Article{info:doi/10.2196/34966, author="Nakayama, Kazuhiro and Yonekura, Yuki and Danya, Hitomi and Hagiwara, Kanako", title="COVID-19 Preventive Behaviors and Health Literacy, Information Evaluation, and Decision-making Skills in Japanese Adults: Cross-sectional Survey Study", journal="JMIR Form Res", year="2022", month="Jan", day="24", volume="6", number="1", pages="e34966", keywords="coronavirus", keywords="COVID-19", keywords="health literacy", keywords="health information", keywords="decision-making", keywords="health promotion", keywords="prevention", keywords="behavior", keywords="survey", keywords="evaluation", abstract="Background: Health literacy is important for the prevention of COVID-19 transmission. Research in Japan shows that health literacy is related to skills in evaluating information and decision-making (skills that are not necessarily limited to information about health). Such basic skills are important, particularly when individuals encounter new health issues for which there is insufficient evidence. Objective: We aimed to determine the extent to which COVID-19 preventive behaviors were associated with health literacy and skills in evaluating information and making decisions. Methods: A web-based questionnaire survey was conducted using a Japanese internet research company. The measures comprised 8 items on COVID-19 preventive behaviors, health literacy items (European Health Literacy Survey Questionnaire), 5 items on information evaluation, and 4 items on decision-making process. Pearson correlations between these variables were calculated. Multivariable analyses were also conducted using the COVID-19 preventive behavior score as a dependent variable. Results: A total of 3914 valid responses were received.COVID-19 preventive behaviors were significantly correlated with health literacy (r=0.23), information evaluation (r=0.24), and decision-making process (r=0.30). Standardized regression coefficients (health literacy: $\beta$=.11; information evaluation: $\beta$=.13; decision-making: $\beta$=.18) showed that decision-making process contributed the most. Conclusions: Although comprehensive health literacy is necessary for COVID-19 preventive behaviors, the skills to evaluate a wide range of information and to make appropriate decisions are no less important. Opportunities for people to acquire these skills should be available at all times. ", doi="10.2196/34966", url="https://formative.jmir.org/2022/1/e34966", url="http://www.ncbi.nlm.nih.gov/pubmed/34982036" } @Article{info:doi/10.2196/30257, author="Chew, Rob and Wenger, Michael and Guillory, Jamie and Nonnemaker, James and Kim, Annice", title="Identifying Electronic Nicotine Delivery System Brands and Flavors on Instagram: Natural Language Processing Analysis", journal="J Med Internet Res", year="2022", month="Jan", day="18", volume="24", number="1", pages="e30257", keywords="named entity recognition", keywords="ENDS", keywords="social media", keywords="brands", keywords="flavors", abstract="Background: Electronic nicotine delivery system (ENDS) brands, such as JUUL, used social media as a key component of their marketing strategy, which led to massive sales growth from 2015 to 2018. During this time, ENDS use rapidly increased among youths and young adults, with flavored products being particularly popular among these groups. Objective: The aim of our study is to develop a named entity recognition (NER) model to identify potential emerging vaping brands and flavors from Instagram post text. NER is a natural language processing task for identifying specific types of words (entities) in text based on the characteristics of the entity and surrounding words. Methods: NER models were trained on a labeled data set of 2272 Instagram posts coded for ENDS brands and flavors. We compared three types of NER models---conditional random fields, a residual convolutional neural network, and a fine-tuned distilled bidirectional encoder representations from transformers (FTDB) network---to identify brands and flavors in Instagram posts with key model outcomes of precision, recall, and F1 scores. We used data from Nielsen scanner sales and Wikipedia to create benchmark dictionaries to determine whether brands from established ENDS brand and flavor lists were mentioned in the Instagram posts in our sample. To prevent overfitting, we performed 5-fold cross-validation and reported the mean and SD of the model validation metrics across the folds. Results: For brands, the residual convolutional neural network exhibited the highest mean precision (0.797, SD 0.084), and the FTDB exhibited the highest mean recall (0.869, SD 0.103). For flavors, the FTDB exhibited both the highest mean precision (0.860, SD 0.055) and recall (0.801, SD 0.091). All NER models outperformed the benchmark brand and flavor dictionary look-ups on mean precision, recall, and F1. Comparing between the benchmark brand lists, the larger Wikipedia list outperformed the Nielsen list in both precision and recall. Conclusions: Our findings suggest that NER models correctly identified ENDS brands and flavors in Instagram posts at rates competitive with, or better than, others in the published literature. Brands identified during manual annotation showed little overlap with those in Nielsen scanner data, suggesting that NER models may capture emerging brands with limited sales and distribution. NER models address the challenges of manual brand identification and can be used to support future infodemiology and infoveillance studies. Brands identified on social media should be cross-validated with Nielsen and other data sources to differentiate emerging brands that have become established from those with limited sales and distribution. ", doi="10.2196/30257", url="https://www.jmir.org/2022/1/e30257", url="http://www.ncbi.nlm.nih.gov/pubmed/35040793" } @Article{info:doi/10.2196/31381, author="Decker, J. Martha and Harrison, Salish and Price, Melisa and Gutmann-Gonzalez, Abigail and Yarger, Jennifer and Tenney, Rachel", title="Educators' Perspectives on Integrating Technology Into Sexual Health Education: Implementation Study", journal="JMIR Hum Factors", year="2022", month="Jan", day="12", volume="9", number="1", pages="e31381", keywords="adolescent", keywords="sex education", keywords="technology", keywords="mobile app", keywords="implementation", keywords="California", keywords="health educator", abstract="Background: In the last decade, the use of technology-based sexual health education has increased. Multiple studies have shown the feasibility of technology-based interventions, while a subset has also shown efficacy in improving youths' sexual health outcomes such as increased condom use and knowledge. However, little is known about health educators' experiences in integrating technology to augment sexual health curricula. Objective: The purpose of this study was to assess the perceptions and experiences of health educators regarding the incorporation of technology into a sexual health education program designed for underserved youth in Fresno County, California, and to identify facilitators and challenges to incorporating technology into the in-person curriculum. Methods: This implementation study used data collected as part of a cluster randomized controlled trial to evaluate In the Know (ITK), an in-person sexual health education curriculum that includes technology-based content, such as a resource locator, videos, and games, which can be accessed through a mobile app or website. Data from implementation logs from each cohort (n=51) and annual interviews (n=8) with health educators were analyzed to assess the health educators' experiences using the technology and adaptations made during the implementation. Results: The health educators reported that technological issues affected implementation to some degree: 87\% of the time in the first year, which decreased to 47\% in the third year as health educators' familiarity with the app increased and functionality improved. Technology issues were also more common in non--school settings. Successes and challenges in 3 domains emerged: managing technology, usability of the ITK app, and youth engagement. The health educators generally had positive comments about the app and youth engagement with the technology-based content and activities; however, they also noted certain barriers to adolescents' use of the mobile app including limited data storage and battery life on mobile phones. Conclusions: Health educators require training and support to optimize technology as a resource for engaging with youth and providing sensitive information. Although technology is often presented as a solution to reach underserved populations, educational programs should consider the technological needs and limitations of the participants, educators, and settings. International Registered Report Identifier (IRRID): RR2-10.2196/18060 ", doi="10.2196/31381", url="https://humanfactors.jmir.org/2022/1/e31381", url="http://www.ncbi.nlm.nih.gov/pubmed/35019842" } @Article{info:doi/10.2196/27952, author="Shaikh, Ahmed and Bhatia, Abhishek and Yadav, Ghanshyam and Hora, Shashwat and Won, Chung and Shankar, Mark and Heerboth, Aaron and Vemulapalli, Prakash and Navalkar, Paresh and Oswal, Kunal and Heaton, Clay and Saunik, Sujata and Khanna, Tarun and Balsari, Satchit", title="Applying Human-Centered Design Principles to Digital Syndromic Surveillance at a Mass Gathering in India: Viewpoint", journal="J Med Internet Res", year="2022", month="Jan", day="10", volume="24", number="1", pages="e27952", keywords="mHealth", keywords="design", keywords="human centered design", keywords="intervention", keywords="syndromic surveillance", keywords="digital health", doi="10.2196/27952", url="https://www.jmir.org/2022/1/e27952", url="http://www.ncbi.nlm.nih.gov/pubmed/35006088" } @Article{info:doi/10.2196/24126, author="Restar, Arjee and Surace, Anthony and Adia, Alexander and Goedel, William and Ogunbajo, Adedotun and Jin, Harry and Edeza, Alberto and Hernandez, Laufred and Cu-Uvin, Susan and Operario, Don", title="Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men", journal="J Med Internet Res", year="2022", month="Jan", day="7", volume="24", number="1", pages="e24126", keywords="HIV prevention", keywords="PrEP", keywords="men who have sex with men", keywords="the Philippines", abstract="Background: The Philippines is experiencing an HIV crisis and is considering implementing pre-exposure prophylaxis (PrEP) as a national public health strategy for HIV prevention for cisgender men who have sex with men (cis-MSM). However, critical information on the awareness of PrEP among cis-MSM is needed to roll out this public health initiative. Objective: This study aims to assess PrEP awareness and related correlates (ie, sociodemographic variables, social factors, and health care access and use) among Filipino cis-MSM. Methods: We conducted a web-based survey with Filipino cis-MSM (n=179) residing in the cities of Manila and Cebu, Philippines. Multivariable analysis procedures were performed to examine the factors associated with PrEP awareness. Results: Our sample demonstrated high awareness (134/179, 74.9\%) and interest (159/179, 88.8\%) in taking PrEP. The adjusted model showed that greater odds of PrEP awareness were associated with having a college education or higher versus a high school education or lower (adjusted odds ratio [aOR] 7.30, 95\% CI 1.01-52.47), earning between PHP 10,000 (US \$198.6) and PHP 20,000 (US \$397.2) versus