From Surveillance to Intervention: Using Social Media for Skin Cancer Prevention She r r y Pagoto, PhD Pr ofe ssor , Division of Pr e ve ntive and Be havior al Me dic ine Co- F ounde r , UMass Ce nte r for mHe alth and Soc ial Me dia
74% of US adults use social media 90% 77% 51% 35%
Healthcare Social Media #hcsm Online pa tie nt c o mmunitie s Use o f so c ia l me dia to tra c k the spre a d o f infe c tio us dise a se s Use o f so c ia l me dia to disse mina te pub lic he a lth me ssa g e s Use o f o nline g ro ups to de live r e duc a tio na l o r se lf-ma na g e me nt pro g ra mming to g ro ups o f pa tie nts
Diabetes fan pages on Facebook Rus & Cameron, 2016, accompanying comment Pagoto & Waring, 2016
How do we reach the people who need health messaging the most?
Tanning and cancer T a nning b e ds a Gro up 1 c a rc ino g e n a lo ng with to b a c c o , a rse nic , a nd ra do n (I ARC, 2008) T he numb e r o f c a se s o f skin c a nc e r a ttrib uta b le to indo o r ta nning (~450,000) no w e xc e e ds the numb e r o f c a se s o f lung c a nc e r a ttrib uta b le to smo king (~360,000). (We hne r e t a l 2014)
Tanning on Twitter Study E xtra c te d 4,691 twe e ts in 1 we e k tha t me ntio ne d the wo rds: “ta nning b e d” o r “ta nning sa lo n”
Content analysis of 1000 tweets (n=978 unique accounts) 41% re po rt e a g e rne ss to g o ta nning 12% a re c o mpla ints fro m ta nne rs a b o ut the e xpe rie nc e tweets 11% re po rt a b urn o r o the r injury are by tanners 6% re po rt fa lling a sle e p in the ta nning b e d 9% ma king fun o f ta nning o r pe o ple who a re ta n 4% c o mme nt fro m ta nning sa lo n e mplo ye e 4% me ntion the har ms of tanning 1% a nti-ta nning le g isla tio n 11% use the te rms in c o nve rsa tio n o n a no the r to pic
Implications We c a n lo c a te ta nne rs o n T witte r, with simple • ke ywo rds Mo st twe e ts using mo st c o mmo n te rms fo r indo o r • ta nning a re b y ta nne rs, fe w a re pub lic he a lth me ssa g e s No t a he a vily ha shta g g e d to pic • T a nne rs a re re po rting b urns, injurie s, a nd o the r risky • b e ha vio rs (e .g ., fa lling a sle e p)
“Tweet the Burn” Study Using T o psy Pro , twe e ts with ke ywo rds we re re tro spe c tive ly pulle d fo r 1 ye a r (2013) fro m T witte r K e ywo rd fo r indo o r ta nning (i.e ., “ta nning b e d,” “ta nning sa lo n,” “ta nning g ym,” “indo o r ta nning ”) a nd a ke ywo rd fo r b urning (i.e ., “b urn,” “b urnt,” “frie d,” “sunb urn”) Seidenberg, Pagoto et al 2015 Transl Behavioral Medicine
“Tweet the Burn” Study All twe e ts we re c o de d b y a sing le re vie we r, a • se c o nd re vie we r c o de d 5% 25,558 twe e ts inc lude d the ke ywo rds • Of whic h, 15,178 twe e ts (64.4% ) una mb ig uo usly • re po rte d a b urn inc urre d fro m a ta nning b e d
Seidenberg, Pagoto et al 2015
Implications So c ia l me dia c o nve rsa tio ns g ive us a windo w into the b e ha vio r a nd a ttitude s o f pe o ple with hig h risk b e ha vio rs ta nning o ve r the time limit b e ing misle d b y sa lo n sta ff a c kno wle dg ing a ddic tio n purpo se ful b urning
What are the public health messages for skin cancer prevention on social media?
Systematic review of skin cancer orgs Facebook pages 25 skin c a nc e r o rg s F a c e b o o k Pa g e s with 900+ fo llo we rs (e .g ., Skin Ca nc e r F o unda tio n) 13 mo nths = 753 po sts Nosrati, Pagoto et al in prep
What kind of messages do and don’t work? DON’ T WORK DO WORK So c ia l no rms He a lth risks “T a nning is so o ut o f style ! “T a nning inc re a se s yo ur Na tura l skin is in!” risk fo r skin c a nc e r” Appe a ra nc e risks “T a nning c a use s wrinkle s, spo ts, a nd pre ma ture a g ing .” E mpha size a lte rna tive s “Spra y ta nning is a he a lthie r a lte rna tive to ta nning b e ds!” Hillhouse et al 2008; Pagoto et al 2010
What are orgs posting? Pe rsua sive stra te g ie s Me ssa g e type F e a r = 38% 73% dida c tic So c ia l no rm a ppe a ls= 21% 27% na rra tive Myth b uste r =8% Ce le b rity sto rie s = 8% E ng a g e me nt Humo r = 4% Me a n like s/ po st= 137.58 Se lf-e ffic a c y b uilding = 2% Me a n sha re s/ po st= 136.05 Co mme nts/ po st= 5.84 Me ssa g e a ppe a l Skin c a nc e r risk 88% Appe a ra nc e 12%
Implications Disc o nne c t b e twe e n me ssa g e s a nd the e vide nc e . Who is the a udie nc e ? Are me ssa g e s re a c hing the pe o ple who ne e d the m mo st?
Separate worlds? Pe o ple a t hig h risk Pub lic he a lth o rg a niza tio ns
How to connect the worlds? Smo ke fre e .g o v study: twe e te d a to o lkit to use rs who twe e te d a n inte re st in q uitting smo king (K e e fe e t a l 2016) E ng ag e me nt with dire c t twe e ts was ne arly 5 time s g re ate r than b ro adc ast twe e ts
Delivering messages to the audience
Who is the audience? T he major ity of tanne r s ar e be twe e n the age s 14 – 30. In 27 state s, par e ntal c onse nt laws ar e in plac e that r e quir e par e nts to sign a pe r mission slip for the minor to tan. T e e ns ofte n initiate indoor tanning with the ir moms. T e e ns who have tanne d with mom star t at an e ar lie r age and ar e mor e like ly to be c ome habitual tanne r s.
Where is the audience? We pa rtne re d with 40 hig h sc ho o ls in T e nne sse e via Sc ho o l He a lth Co o rdina to rs, who c o uld a ssist us in re c ruiting mo the rs o f te e n g irls. Pr oble m: Sc ho o l He a lth Co o rdina to rs, while inte re ste d in skin c a nc e r pre ve ntio n, wa nt to inve st in mo re c o mpre he nsive he a lth e duc a tio n fo r pa re nts
What does the audience want? Co o rdina to r inte rvie ws (n=19, re pre se nting 40 hig h sc ho o ls) indic a te d tha t me nta l he a lth (stre ss, b ullying ), sub sta nc e a b use (to b a c c o , a lc o ho l, pre sc riptio n drug s), a nd o b e sity (physic a l a c tivity, nutritio n) we re the to pic s o f hig h inte re st. F o c us g ro ups with mo the rs (n=10), c ite d b o dy ima g e , sub sta nc e a b use , o b e sity, me nta l he a lth, a nd he a lthy pe e r re la tio nships a s to pic s o f hig h inte re st.
Embedded messaging Give the m what the y want and what the y ne e d 1 ye a r F a c e b o o k “se c re t” g ro up fo r mo ms o f te e n g irls 75% o f po sts fo c use d o n to pic s o f hig h inte re st 25% o f po sts fo c use d o n skin c a nc e r pre ve ntio n R01 CA192652 PI: Buller/Pagoto/Baker
Tennessee Mom’s Health Chat Study Ra ndo mize d tria l c o mpa ring two F a c e b o o k-de live re d c o nditio ns ta rg e ting mo ms (n=2000) o f te e na g e da ug hte rs: T e e n he a lth fe e d in whic h 25% o f me ssa g e s a re o n the risks o f indo o r ta nning vs 75% o the r he a lth to pic s T e e n he a lth fe e d in whic h 25% o f me ssa g e s a re o n o pia te a b use vs 75% o the r he a lth to pic s Prima ry o utc o me : mo m’ s willing ne ss to a llo w da ug hte r to g o indo o r ta nning a nd mo m a nd da ug hte r indo o r ta nning R01 CA192652 PI: Buller/Pagoto/Baker
Who is the audience? T he ma jor ity of ta nne r s a r e be twe e n the a g e s 14 – 30.
What does the audience want? F o c us g ro ups o f 30 yo ung a dult fe ma le ta nne rs will b e he ld to ide ntify to pic s o f inte re st a nd inte rve ntio n mo da lity. Surve y o f 100 yo ung a dult fe ma le ta nne rs o n T witte r to de te rmine if we c a n re c ruit the m o n T witte r a nd to ve rify the to pic s o f inte re st a nd inte rve ntio n mo da lity.
Tanner’s on Twitter Study Pilo t fe a sib ility study in whic h yo ung wo me n (n=60) who ha ve twe e te d a b o ut indo o r ta nning will b e re c ruite d to e nro ll in a pro g ra m in whic h the y re c e ive e mb e dde d inte rve ntio n (25% o f twe e ts will b e re la te d to indo o r ta nning , 75% re la te d to to pic o f inte re st) Prima ry o utc o me s: a c c e pta b ility, re c ruitme nt ra te s, a nd e ng a g e me nt with twe e ts. E xplo ra to ry o utc o me s: indo o r a nd o utdo o r ta nning a nd inte ntio ns to ta n.
Closing Remarks Pe o ple use so c ia l me dia to ta lk a b o ut he a lthy a nd unhe a lthy b e ha vio r. 1. E xpa nd the re a c h o f pub lic he a lth e ffo rts 2. E mb e d he a lth me ssa g ing into pe o ple ’ s da ily ro utine s 3. I nc re a se o ur impa c t.
Follow me/us on Twitter: @DrSherryPagoto @UMassmHealth @skinsmartcampus Or Facebook: UMassmHealthCenter Skinsmartcampus
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