The SMARxT Media Literacy Program: Improving Evidence-Based Prescribing among Medical Students

Many prescriptions written are not evidence-based, resulting in unnecessary morbidity and mortality. Media literacy may help medical trainees optimize evidence-based decision-making. In this study, we aimed to assess feasibility, acceptability, and initial efficacy of a media literacy prescribing program. We recruited 30 medical students, who completed animated video modules about pharmaceutical marketing and prescribing. We used a process evaluation and open-ended items to assess feasibility and acceptability, and knowledge tests before and after the intervention to assess efficacy. The program was feasible to implement and well-accepted. Knowledge and attitude targets around evidence-based prescribing and drug marketing improved after the intervention

The Association between Social Media Use and Eating Concerns among US Young Adults

Background The etiology of eating concerns is multifactorial, and exposure to media messages is considered to be a contributor. Although traditional media, such as television and magazines, have been examined extensively in relation to eating concerns risk, the influence of social media has received relatively less attention. Objective To examine the association between social media use and eating concerns in a large, nationally representative sample of young adults. Design Cross-sectional survey. Participants/setting Participants were 1,765 young adults aged 19 to 32 years who were randomly selected from a national probability-based online nonvolunteer panel. Outcome measures An eating concerns scale was adapted from two validated measures: the SCOFF Questionnaire and the Eating Disorder Screen for Primary Care. Social media use (including Facebook, Twitter, Google+, YouTube, LinkedIn, Instagram, Pinterest, Tumblr, Vine, Snapchat, and Reddit) was assessed using both volume (time per day) and frequency (visits per week). Statistical analyses To examine associations between eating concerns and social media use, ordered logistic regression was used, controlling for all covariates. Results Compared with those in the lowest quartile, participants in the highest quartiles for social media volume and frequency had significantly greater odds of having eating concerns (adjusted odds ratio 2.18, 95% CI 1.50 to 3.17 and adjusted odds ratio 2.55, 95% CI 1.72 to 3.78, respectively). There were significant positive overall linear associations between the social media use variables and eating concerns (P\u3c0.001). Conclusions The results from this study indicate a strong and consistent association between social media use and eating concerns in a nationally representative sample of young adults aged 19 to 32 years. This association was apparent whether social media use was measured as volume or frequency. Further research should assess the temporality of these associations. It would also be useful to examine more closely the influence of specific characteristics of social media use, including content-related and contextual features

The association between social media use and sleep disturbance among young adults

Introduction: Many factors contribute to sleep disturbance among young adults. Social media (SM) use is increasing rapidly, and little is known regarding its association with sleep disturbance. Methods: In 2014 we assessed a nationally representative sample of 1788 U.S. young adults ages 19-32. SM volume and frequency were assessed by self-reported minutes per day spent on SM (volume) and visits per week (frequency) using items adapted from the Pew Internet Research Questionnaire. We assessed sleep disturbance using the brief Patient-Reported Outcomes Measurement Information System (PROMIS®) sleep disturbance measure. Analyses performed in Pittsburgh utilized chi-square tests and ordered logistic regression using sample weights in order to estimate effects for the total U.S. population. Results: In models that adjusted for all sociodemographic covariates, participants with higher SM use volume and frequency had significantly greater odds of having sleep disturbance. For example, compared with those in the lowest quartile of SM use per day, those in the highest quartile had an AOR of 1.95 (95% CI = 1.37-2.79) for sleep disturbance. Similarly, compared with those in the lowest quartile of SM use frequency per week, those in the highest quartile had an AOR of 2.92 (95% CI = 1.97-4.32) for sleep disturbance. All associations demonstrated a significant linear trend. Discussion: The strong association between SM use and sleep disturbance has important clinical implications for the health and well-being of young adults. Future work should aim to assess directionality and to better understand the influence of contextual factors associated with SM use

Associations between positive and negative social media experiences and sleep disturbance among young adults

Objectives: We sought to examine the association of positive and negative experiences using social media (SM) and sleep disturbance in a national survey of U.S. young adults. Methods: Experiences using SM were assessed with 2 items asking participants about the percentage of time using SM that involved a negative/positive experience that they were personally involved in. Sleep disturbance was assessed using the validated PROMIS 4-item short form. Ordinal logistic regression was used to examine associations between positive and negative SM experiences and high sleep disturbance, while controlling for relevant covariates. Results: Although reporting high levels of negative experiences was significantly associated with greater odds of high sleep disturbance (AOR = 1.49, 95%CI = 1.18-1.89), reporting high levels of positive experiences was not associated with sleep disturbance. Conclusions: These findings suggest that more robust examinations of negative SM experiences—especially as they relate to sleep disturbance—may be warranted

Temporal Associations Between Social Media Use and Depression

Introduction: Previous studies have demonstrated cross-sectional associations between social media use and depression, but their temporal and directional associations have not been reported. Methods: In 2018, participants aged 18–30 years were recruited in proportion to U.S. Census characteristics, including age, sex, race, education, household income, and geographic region. Participants self-reported social media use on the basis of a list of the top 10 social media networks, which represent \u3e95% of social media use. Depression was assessed using the 9-Item Patient Health Questionnaire. A total of 9 relevant sociodemographic covariates were assessed. All measures were assessed at both baseline and 6-month follow-up. Results: Among 990 participants who were not depressed at baseline, 95 (9.6%) developed depression by follow-up. In multivariable analyses conducted in 2020 that controlled for all covariates and included survey weights, there was a significant linear association (p\u3c0.001) between baseline social media use and the development of depression for each level of social media use. Compared with those in the lowest quartile, participants in the highest quartile of baseline social media use had significantly increased odds of developing depression (AOR=2.77, 95% CI=1.38, 5.56). However, there was no association between the presence of baseline depression and increasing social media use at follow-up (OR=1.04, 95% CI=0.78, 1.38). Results were robust to all sensitivity analyses. Conclusions: In a national sample of young adults, baseline social media use was independently associated with the development of depression by follow-up, but baseline depression was not associated with an increase in social media use at follow-up. This pattern suggests temporal associations between social media use and depression, an important criterion for causality

Sustained Waterpipe Tobacco Smoking and Trends over Time

Introduction Use of waterpipe tobacco smoking (WTS) is now prevalent among U.S. adolescents. However, the more clinically relevant questions are whether users exhibit sustained patterns of use and whether use is increasing over time relative to other tobacco products. We aimed to examine factors associated with sustained WTS among U.S. adolescents and to compare prevalence trends between WTS and other tobacco products. Methods The Monitoring the Future project began assessing WTS among 12th-grade students in 2010. In 2014, we conducted multivariable regression analyses to examine correlates of sustained WTS, which we defined as use at least six times in the past 12 months. We used trend analysis to compare use of WTS and other types of tobacco. Results Of the 8,737 participants queried from 2010 to 2013, 18.8% (1,639) reported past-year WTS, whereas 7.2% (627) reported sustained use. Sustained WTS was inversely associated with female sex (versus male, OR=0.78, 95% CI=0.63, 0.96); African American race (versus Caucasian, OR=0.26, 95% CI=0.14, 0.48); and increased number of parents in the home (p\u3c0.001). Sustained WTS was positively associated with increased school-level parental education (p=0.002); lower grades (p=0.005); truancy (p\u3c0.001); lower religiosity (p\u3c0.001); more evenings out per week (p\u3c0.001); and dating (p=0.03). Visual inspection and non-overlapping CIs suggest that both past-year and sustained WTS are significantly increasing relative to cigarette use but not small cigar use. Conclusions Given the prevalence of sustained WTS and indications of its increase over time, it should be included in efforts related to tobacco surveillance and intervention

Pennsylvania policymakers’ knowledge, attitudes and likelihood for action regarding waterpipe tobacco smoking and electronic nicotine delivery systems

Introduction Use of waterpipe tobacco smoking (WTS, or hookah smoking) and electronic nicotine delivery systems (ENDS, such as e-cigarettes) is rapidly increasing. However, legislatures have been slow to update policy measures related to them. Therefore, we aimed to assess knowledge, attitudes and likelihood to take future action regarding WTS and ENDS among Pennsylvania legislators. Methods We approached all Standing Members of key Pennsylvania House and Senate health and welfare committees to complete a survey about substances of abuse, including WTS and ENDS. Closed-ended knowledge, attitude and action items used a 100-point scale. Responses to open-ended items were assessed using thematic analysis by three independently working researchers. Results We received responses from 13 of 27 eligible policymakers (48%). Participants answered a mean of only 27% (SD=20%) of knowledge items correctly. When asked to rank by priority eight issues in substance abuse, WTS ranked eighth (least urgent) and ENDS ranked fifth. Participants reported low likelihood to introduce legislation on WTS (mean=29, median=25) and/or ENDS (mean=28, median=10). Thematic analysis revealed that participants readily acknowledged lack of understanding of WTS and ENDS, and were eager for additional information. Conclusions Policymakers exhibit a lack of knowledge concerning newer forms of tobacco and nicotine delivery systems and consider them to be relatively low legislative priorities. However, respondents expressed a desire for more information, suggesting the potential for public health entities to promote effective policy development via improved dissemination of information

I wake up and hit the JUUL: Analyzing Twitter for JUUL nicotine effects and dependence

Background: JUUL—a novel electronic nicotine delivery system (ENDS)—comprises most of the ENDS market share. Additionally, JUUL has a high nicotine content and utilizes a patented nicotine salt formulation aimed to speed absorption. Many JUUL users are not aware of the nicotine content and therefore may not be expecting acute nicotine effects or potential for dependence. This study sought to analyze Twitter messages (“tweets”) regarding nicotine, symptoms of dependence, and withdrawal related to JUUL use. Methods: Data were collected from Twitter\u27s Filtered Streams interface 4/11–6/16/2018 by retrieving tweets matching the terms “juul,” “juuls,” and “juuling” that also used words consistent with nicotine effects, symptoms of dependence, and withdrawal. A random 5% subsample (n = 1986) was coded by 2 independent coders. Cohen\u27s κ for inter-rater reliability ranged 0.62–1.00 for all coded variables. Tweets were assessed using a qualitative content analysis approach. Results: A total of 335 tweets mentioned dependence-related themes, including use upon waking and compulsion to use. A total of 189 tweets mentioned themes related to nicotine, with almost 15% of these tweets describing physical effects. Additionally, 42 tweets mentioned themes related to quitting JUUL and/or withdrawal from JUUL. Discussion: This qualitative analysis suggests that users of JUUL are experiencing symptoms of nicotine exposure and dependence. Considering the high nicotine content of JUUL and the rising popularity among young people, more research around initiation of and dependence on JUUL, as well as the impact of recent FDA policy changes, should be conducted

Puff Bars, Tobacco Policy Evasion, and Nicotine Dependence: Content Analysis of Tweets

BackgroundPuff Bars are e-cigarettes that continued marketing flavored products by exploiting the US Food and Drug Administration exemption for disposable devices. ObjectiveThis study aimed to examine discussions related to Puff Bar on Twitter to identify tobacco regulation and policy themes as well as unanticipated outcomes of regulatory loopholes. MethodsOf 8519 original tweets related to Puff Bar collected from July 13, 2020, to August 13, 2020, a random 20% subsample (n=2661) was selected for qualitative coding of topics related to nicotine dependence and tobacco policy. ResultsOf the human-coded tweets, 2123 (80.2%) were coded as relevant to Puff Bar as the main topic. Of those tweets, 698 (32.9%) discussed tobacco policy, including flavors (n=320, 45.9%), regulations (n=124, 17.8%), purchases (n=117, 16.8%), and other products (n=110, 15.8%). Approximately 22% (n=480) of the tweets referenced dependence, including lack of access (n=273, 56.9%), appetite suppression (n=59, 12.3%), frequent use (n=47, 9.8%), and self-reported dependence (n=110, 22.9%). ConclusionsThis study adds to the growing evidence base that the US Food and Drug Administration ban of e-cigarette flavors did not reduce interest, but rather shifted the discussion to brands utilizing a loophole that allowed flavored products to continue to be sold in disposable devices. Until comprehensive tobacco policy legislation is developed, new products or loopholes will continue to supply nicotine demand