Rachel Kornfield - Academia.edu (original) (raw)
Papers by Rachel Kornfield
Tobacco Control, 2015
This cross-sectional study examined price-related promotions for tobacco products on Twitter. Thr... more This cross-sectional study examined price-related promotions for tobacco products on Twitter. Through the Twitter Firehose, we obtained access to all public tweets posted between 6 December 2012 and 20 June 2013 that contained a keyword suggesting a tobacco-related product or behaviour (eg, cigarette, vaping) in addition to a keyword suggesting a price promotion (eg, coupon, discount). From this data set of 155 249 tweets, we constructed a stratified sampling frame based on the price-related keywords and randomly sampled 5000 tweets (3.2%). Tweets were coded for product type and promotion type. Non-English tweets and tweets unrelated to a tobacco or cessation price promotion were excluded, leaving an analytic sample of 2847 tweets. The majority of tweets (97.0%) mentioned tobacco products while 3% mentioned tobacco cessation products. E-cigarettes were the most frequently mentioned product (90.1%), followed by cigarettes (5.4%). The most common type of price promotion mentioned across all products was a discount. About a third of all e-cigarette-related tweets included a discount code. Banned or restricted price promotions comprised about 3% of cigarette-related tweets. This study demonstrates that the vast majority of tweets offering price promotions focus on e-cigarettes. Future studies should examine the extent to which Twitter users, particularly youth, notice or engage with these price promotion tweets.
Nicotine & Tobacco Research, 2015
Televised direct-to-consumer advertising (DTCA) for prescription drugs is controversial, especial... more Televised direct-to-consumer advertising (DTCA) for prescription drugs is controversial, especially for tobacco cessation products such as varenicline, given safety concerns that arose only after its market approval. We aim to quantify the extent to which DTCA influenced varenicline use. We linked monthly DTCA television ratings with monthly prescription data from IMS Health's National Prescription Audit across top 75 media markets in 2006-2009. We used Poisson models with Generalized Estimating Equations to analyze effects of exposures to DTCA for both varenicline and nicotine replacement therapies on rate of dispensed varenicline prescriptions among smokers, controlling for population characteristics and varenicline-related events. Varenicline prescriptions increased dramatically following DTCA launch and declined sharply after safety risks were publicized and US Food and Drug Administration (FDA) issued an advisory. DTCA had significant impact on new prescription dispensing in the subsequent month: before the FDA advisory, one additional exposure to varenicline DTCA was associated with a 1.8% (rate ratio [RR] = 1.018 [1.015-1.021]) higher rate of new prescriptions; no effect was observed after the advisory (RR = 1.000 [0.997-1.003]). Prior to the advisory, cross-product effects of nicotine replacement therapy advertising on varenicline prescribing were negligible (RR = 1.002 [0.999-1.004]); after the advisory, effects were positive (RR = 1.015 [1.012-1.019]). DTCA for varenicline had a significant impact on varenicline prescribing when the drug's safety profile was not well characterized, supporting arguments to limit DTCA for newly approved products whose real-world safety is unclear. We examined the fluctuations in varenicline use in association with DTCA for varenicline and other tobacco cessation aids. To our knowledge this is the first study to quantify the effects of televised DTCA for varenicline and other tobacco cessation aids on varenicline prescription dispensing. We believe that understanding these relationships is critical for formulating effective public health policy and interventions.
Tobacco Control, 2015
This cross-sectional study examined price-related promotions for tobacco products on Twitter. Thr... more This cross-sectional study examined price-related promotions for tobacco products on Twitter. Through the Twitter Firehose, we obtained access to all public tweets posted between 6 December 2012 and 20 June 2013 that contained a keyword suggesting a tobacco-related product or behaviour (eg, cigarette, vaping) in addition to a keyword suggesting a price promotion (eg, coupon, discount). From this data set of 155 249 tweets, we constructed a stratified sampling frame based on the price-related keywords and randomly sampled 5000 tweets (3.2%). Tweets were coded for product type and promotion type. Non-English tweets and tweets unrelated to a tobacco or cessation price promotion were excluded, leaving an analytic sample of 2847 tweets. The majority of tweets (97.0%) mentioned tobacco products while 3% mentioned tobacco cessation products. E-cigarettes were the most frequently mentioned product (90.1%), followed by cigarettes (5.4%). The most common type of price promotion mentioned across all products was a discount. About a third of all e-cigarette-related tweets included a discount code. Banned or restricted price promotions comprised about 3% of cigarette-related tweets. This study demonstrates that the vast majority of tweets offering price promotions focus on e-cigarettes. Future studies should examine the extent to which Twitter users, particularly youth, notice or engage with these price promotion tweets.
American journal of preventive medicine, 2015
TV accounts for more than half of pharmaceutical direct-to-consumer advertising (DTCA) spending i... more TV accounts for more than half of pharmaceutical direct-to-consumer advertising (DTCA) spending in the U.S. The purpose of this study is to quantify average household exposure to branded and non-branded (help-seeking) televised prescription drug advertisements and describe variation over time and according to medication indication and geography. In 2013, Nielsen TV ratings were compiled for prescription pharmaceutical advertising that aired between 2003 and 2011 for the top 75 U.S. media markets. All advertisements were coded as branded or help-seeking. Advertisements were further coded for one of eight prevalent indications (allergies, arthritis, asthma, erectile dysfunction, high cholesterol, smoking cessation, depression, and sleep disorder) or as "other." Televised DTCA exposure increased from 2003 to 2007 and then declined 43% by 2011, to 111 monthly prescription drug advertisements per household. The examined indications were associated with varying amounts and patte...
American journal of respiratory and critical care medicine, Jan 16, 2015
The United States is one of only two countries that permit direct-to-consumer advertising (DTCA) ... more The United States is one of only two countries that permit direct-to-consumer advertising (DTCA) of prescription drugs, and many questions remain regarding its effects. To quantify the association between asthma-related DTCA, pharmacy sales and health care utilization. Ecological study from 2005 through 2009 using linked data from Nielsen (DTCA television ratings), the IMS Health National Prescription Audit (pharmacy sales) and the MarketScan® Commercial Claims data (health care utilization) for 75 designated market areas (DMAs) in the United States. We used multi-level Poisson regression to model the relationship between DTCA and rates of prescriptions and utilization within and across DMAs. (1) Volume of total, new and refilled prescriptions for advertised products based on pharmacy sales; (2) prescription claims for asthma medications; and asthma-related (3) emergency department utilization; (4) hospitalizations; and (5) outpatient encounters among the commercially insured. Four ...
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 2011
Donor livers are offered to patients with the highest risk of death. How ascites could inform ris... more Donor livers are offered to patients with the highest risk of death. How ascites could inform risk models to reduce liver transplant wait-list mortality is unclear. All adult candidates for primary liver transplantation for cirrhosis without exception points who were registered with the Organ Procurement and Transplantation Network from 2005 to 2007 composed our study cohort. Using Cox models and advanced discriminative metrics and paying attention to geographic disparities, we evaluated the additional risk discrimination of moderate ascites over that of the Model for End-Stage Liver Disease (MELD) or the Model for End-Stage Liver Disease plus serum sodium (MELD-Na) alone for the prediction of 90-day wait-list mortality. Additional analyses examined lower mortality risk candidates and those listed in high-demand, low-supply United Network for Organ Sharing regions in which accounting for ascites may most significantly affect wait-list mortality. Between 2005 and 2007, 18,124 subject...
ABSTRACT Background: A few studies have examined a small subset of e-cigarette videos on Youtube ... more ABSTRACT Background: A few studies have examined a small subset of e-cigarette videos on Youtube in the context of tobacco control, however, little is known about the extent of presence of e-cigarette videos on Youtube. Methods: An automated crawling procedure was employed to collect the metadata associated with e-cigarette videos posted on Youtube between January 1 2007 and December 31 2012 using keyword rules. View counts, ratings, number of comments, and number of e-cigarette vides over time are examined. Results: Approximately12,000 videos related to e-cigarettes were captured in the study period. Those videos were posted by about 3,700 Youtube users or accounts. They were viewed more than 66 million times, favored more than 72,000 times, and commented more than 174,000 times as of December 2012. The average view counts for these videos are 5,500 views per video, with the average rating of 2.9 on a 0-5 scale. The number of e-cigarette videos posted on Youtube per month has increased steadily since 2007, with about 300-400 videos posted on Youtube per month. However, in the March April 2012 two-month period, more than 3,000 e-cigarette related videos were posted on Youtube, corresponding to the CDC's Tips from Former Smokers campaign. The vast majority of these videos were tagged to the Technology, How To, People, Education, and Entertainment categories. Conclusions: Youtube is a major messaging and information-sharing social platform for electronic cigarettes. The presence and broad reach of e-cigarette videos on Youtube warrants serious attention from public health professionals and policy-makers.
ABSTRACT News coverage of health promotion campaigns is often characterized as earned media.&... more ABSTRACT News coverage of health promotion campaigns is often characterized as earned media.' Such coverage can convey the rationale or background to an issue in ways not viable through paid placement, and effectively spread the campaign's message well beyond the primary audience. Moreover, novel commenting' capacity of online media now facilitate widespread public engagement. In March 2012, the CDC launched Tips from Former Smokers,' a four-month, $54million media campaign promoting smoking cessation and initiation prevention, using graphic testimony of smoking's health consequences from actual former smokers. The Tips campaign represents the largest federal investment in a tobacco control media campaign to date. Given the size and graphic approach of the campaign, consideration of reach and engagement of earned media is clearly important. Earned media coverage of the Tips campaign was collected from a purposive, diverse sample of 5 leading policy-focused blogs and 10 traditional news media sites. Together, 37 initial media pieces on the campaign (23 news articles, 11 blog postings and 2 video reels) and 10,900 related public comments were collected for analysis. A qualitative thematic analysis of the news and blog content is ongoing. A combination of manual and computerized coding is being developed to analyze related comments for campaign position (support or opposition) and major frame (e.g. nanny state or societal costs of smoking). By facilitating the coding of thousands of public comments on earned media related to the Tips campaign, this novel mixed-methods approach represents a perspective on public discourse that has never before been possible.
ABSTRACT Background: Despite the rapid increase in awareness and use of e-cigarettes in recent ye... more ABSTRACT Background: Despite the rapid increase in awareness and use of e-cigarettes in recent years, little is known about how they are marketed and promoted, particularly on social media platforms. Methods: Keyword rules were used to collect tweets related to e-cigarettes from the Twitter Firehose between May 1, 2012 and June 30, 2012. Tweets were coded for smoking cessation and other health claims and mentions, and were classified into commercial tweets and organic tweets, using a combination of Bayesian machine learning methods, keyword algorithms, and human coding. Results: A total of 73,672 tweets related to e-cigarettes were captured in the study, 90% of which were found to be commercial tweets. Commercial e-cigarette tweets were posted on twitter feeds nearly 200 million times whereas organic electronic cigarette tweets were posted on twitter feeds only 4 million times. Accounts tweeting commercial e-cigarette content were associated with lower Klout scores. Commercial tweeting was largely driven by a small group of highly active accounts, with the top 10 accounts producing 32% of all electronic cigarette related tweets in the study period. 11% of commercial tweets and 9% of organic tweets mentioned smoking cessation. The majority (94%) of commercial tweets included links to websites that sell or promote e-cigarettes. Approximately 34% of commercial tweets included price discounts or coupons. Conclusions: Twitter appears to be a major marketing and promotional platform for e-cigarettes. Tweets related to e-cigarettes were overwhelmingly commercial, and a substantial proportion of e-cigarette tweets contained therapeutic claims, particularly related to smoking cessation.
Ethos, 2014
ABSTRACT Given concerns that Alcoholics Anonymous (AA) might disempower already disenfranchised g... more ABSTRACT Given concerns that Alcoholics Anonymous (AA) might disempower already disenfranchised groups by focusing attention on self scrutiny and away from social action, this article explores how a cohort of black women members in Chicago portray the role of individual and social forces in their addictions. Despite challenges including histories of sex work and abuse, these women describe themselves as empowered in their recovery efforts and as more successful in AA than their male peers. Their reported success reflects their innovative application of a women-only meeting. Through this meeting, members develop a practice of “openness” that is in some ways at odds with AA's customary self-focus, especially as it becomes grounds to exchange stories about social precipitants of addiction and to strategize ways to assert themselves in their relationships. Rather than enacting a pregiven version of AA, these women interpret the program in creative ways that allow them to accomplish a broad set of objectives.
The American Journal of Gastroenterology, 2013
We examined colorectal cancer (CRC) stage at presentation and mortality in a vulnerable populatio... more We examined colorectal cancer (CRC) stage at presentation and mortality in a vulnerable population compared with nationally representative data.
2014 IEEE International Conference on Data Mining, 2014
As social media is becoming an increasingly important source of public information, companies, or... more As social media is becoming an increasingly important source of public information, companies, organizations and individuals are actively using social media platforms to promote their products, services, ideas and ideologies. Unlike promotional campaigns on TV or other traditional mass media platforms, campaigns on social media often appear in stealth modes. Campaign promoters often try to influence people's behaviors/opinions/decisions in a latent manner such that the readers are not aware that the messages they see are strategic campaign posts aimed at persuading them to buy target products/services. Readers take such campaign posts as just organic posts from the general public. It is thus important to discover such campaigns, their promoter accounts and how the campaigns are organized and executed as it can uncover the dynamics of Internet marketing. This discovery is clearly useful for competitors and also the general public. However, so far little work has been done to solve this problem. In this paper, we study this important problem in the context of the Twitter platform. Given a set of tweets streamed from Twitter based on a set of keywords representing a particular topic, the proposed technique aims to identify user accounts that are involved in promotion. We formulate the problem as a relational classification problem and solve it using typed Markov Random Fields (T-MRF), which is proposed as a generalization of the classic Markov Random Fields. Our experiments are carried out using three real-life datasets from the health science domain related to smoking. Such campaigns are interesting to health scientists, government health agencies and related businesses for obvious reasons. Our results show that the proposed method is highly effective.
Public Health Nutrition, 2014
Objective: To examine levels of exposure and content characteristics for recent televised obesity... more Objective: To examine levels of exposure and content characteristics for recent televised obesity-prevention campaigns sponsored by state and community health departments, federal agencies, non-profit organizations and television stations in the USA. Design: Nielsen television ratings for obesity-prevention advertising were collected for the top seventy-five US media markets and were used to calculate household exposure levels for 2010 and 2011. Governmental advertisements were coded for content. Setting: United States. Results: Average household exposure to obesity-prevention campaigns was 2·6 advertisements per month. Exposure increased by 31 % between 2010 and 2011, largely driven by increases in federal advertisements. In 2011, the federal government accounted for 62 % of obesity-prevention exposure, non-profit organizations for 9 %, community departments for 8 %, state departments for 3 %, and television stationsponsored public-service announcements for 17 %. The greatest percentage increase between 2010 and 2011 was in community advertising, reflecting efforts funded by the Communities Putting Prevention to Work (CPPW) programme. Among thirty-four state and community campaigns, the majority advocated both healthy eating and physical activity (53 %). Campaigns typically had positive or neutral emotional valence (94 %). Obesity or overweight was mentioned in 47 % of campaigns, but only 9 % specifically advocated weight loss. Conclusions: Exposure to televised obesity-prevention advertising increased from 2010 to 2011 and was higher than previously found in 1999-2003, apart from in 2003 during the federal VERB campaign. Nevertheless, exposure remains low relative to advertising for unhealthy foods. New federal campaigns have increased exposure to obesity-prevention advertising nationally, while CPPW grants have increased exposure for targeted areas.
Tobacco Control, 2014
Background Rapid increases in marketing of e-cigarettes coincide with growth in e-cigarette use i... more Background Rapid increases in marketing of e-cigarettes coincide with growth in e-cigarette use in recent years; however, little is known about how e-cigarettes are marketed on social media platforms. Methods Keywords were used to collect tweets related to e-cigarettes from the Twitter Firehose between 1 May 2012 and 30 June 2012. Tweets were coded for smoking cessation mentions, as well as health and safety mentions, and were classified as commercial or non-commercial ('organic') tweets using a combination of Naïve Bayes machine learning methods, keyword algorithms and human coding. Metadata associated with each tweet were used to examine the characteristics of accounts tweeting about e-cigarettes.
Journal of Medical Internet Research, 2015
In March 2012, the US Centers for Disease Control and Prevention (CDC) launched the first-ever pa... more In March 2012, the US Centers for Disease Control and Prevention (CDC) launched the first-ever paid national tobacco education campaign. At a cost of US $54 million, "Tips from Former Smokers" (Tips) ran for 3 months across multiple media, depicting the suffering experienced by smokers and their families in graphic detail. The potential impact and reach of the Tips campaign was not limited to that achieved through paid media placements. It was also potentially extended through "earned media", including news and blog coverage of the campaign. Such coverage can shape public understanding of and facilitate public engagement with key health issues. To better understand the contribution of earned media to the public's engagement with health issues in the current news media environment, we examined the online "earned media" and public engagement generated by one national public health campaign. We constructed a purposive sample of online media coverage of the CDC's 2012 Tips from Former Smokers television campaign, focusing on 14 influential and politically diverse US news outlets and policy-focused blogs. We identified relevant content by combining campaign and website-specific keywords for 4 months around the campaign release. Each story was coded for content, inclusion of multimedia, and measures of audience engagement. The search yielded 36 stories mentioning Tips, of which 27 were focused on the campaign. Story content between pieces was strikingly similar, with most stories highlighting the same points about the campaign's content, cost, and potential impact. We saw notable evidence of audience engagement; stories focused on Tips generated 9547 comments, 8891 Facebook "likes", 1027 tweets, and 505 story URL shares on Facebook. Audience engagement varied by story and site, as did the valence and relevance of associated audience comments. Comments were most oppositional on CNN and most supportive on Yahoo. Comment coding revealed approximately equal levels of opposition and support overall. We identified four common arguments among oppositional comments: government intrusion on personal behaviors, problematic allocation of governmental spending, questionable science, and challenges regarding campaign efficacy. Supportive comments tended to convey personal stories and emotions. The Tips campaign received limited coverage on either online news or blog sources, but the limited number of stories generated engagement among online audiences. In addition to the content and volume of blog and news coverage, audience comments and websites' mechanisms for sharing stories via social media are likely to determine the influence of online earned media. In order to facilitate meaningful evaluation of public health campaigns within the rapidly advancing media environment, there is a need for the public health community to build consensus regarding collection and assessment of engagement data.
Tobacco Control, 2015
This cross-sectional study examined price-related promotions for tobacco products on Twitter. Thr... more This cross-sectional study examined price-related promotions for tobacco products on Twitter. Through the Twitter Firehose, we obtained access to all public tweets posted between 6 December 2012 and 20 June 2013 that contained a keyword suggesting a tobacco-related product or behaviour (eg, cigarette, vaping) in addition to a keyword suggesting a price promotion (eg, coupon, discount). From this data set of 155 249 tweets, we constructed a stratified sampling frame based on the price-related keywords and randomly sampled 5000 tweets (3.2%). Tweets were coded for product type and promotion type. Non-English tweets and tweets unrelated to a tobacco or cessation price promotion were excluded, leaving an analytic sample of 2847 tweets. The majority of tweets (97.0%) mentioned tobacco products while 3% mentioned tobacco cessation products. E-cigarettes were the most frequently mentioned product (90.1%), followed by cigarettes (5.4%). The most common type of price promotion mentioned across all products was a discount. About a third of all e-cigarette-related tweets included a discount code. Banned or restricted price promotions comprised about 3% of cigarette-related tweets. This study demonstrates that the vast majority of tweets offering price promotions focus on e-cigarettes. Future studies should examine the extent to which Twitter users, particularly youth, notice or engage with these price promotion tweets.
Nicotine & Tobacco Research, 2015
Televised direct-to-consumer advertising (DTCA) for prescription drugs is controversial, especial... more Televised direct-to-consumer advertising (DTCA) for prescription drugs is controversial, especially for tobacco cessation products such as varenicline, given safety concerns that arose only after its market approval. We aim to quantify the extent to which DTCA influenced varenicline use. We linked monthly DTCA television ratings with monthly prescription data from IMS Health's National Prescription Audit across top 75 media markets in 2006-2009. We used Poisson models with Generalized Estimating Equations to analyze effects of exposures to DTCA for both varenicline and nicotine replacement therapies on rate of dispensed varenicline prescriptions among smokers, controlling for population characteristics and varenicline-related events. Varenicline prescriptions increased dramatically following DTCA launch and declined sharply after safety risks were publicized and US Food and Drug Administration (FDA) issued an advisory. DTCA had significant impact on new prescription dispensing in the subsequent month: before the FDA advisory, one additional exposure to varenicline DTCA was associated with a 1.8% (rate ratio [RR] = 1.018 [1.015-1.021]) higher rate of new prescriptions; no effect was observed after the advisory (RR = 1.000 [0.997-1.003]). Prior to the advisory, cross-product effects of nicotine replacement therapy advertising on varenicline prescribing were negligible (RR = 1.002 [0.999-1.004]); after the advisory, effects were positive (RR = 1.015 [1.012-1.019]). DTCA for varenicline had a significant impact on varenicline prescribing when the drug's safety profile was not well characterized, supporting arguments to limit DTCA for newly approved products whose real-world safety is unclear. We examined the fluctuations in varenicline use in association with DTCA for varenicline and other tobacco cessation aids. To our knowledge this is the first study to quantify the effects of televised DTCA for varenicline and other tobacco cessation aids on varenicline prescription dispensing. We believe that understanding these relationships is critical for formulating effective public health policy and interventions.
Tobacco Control, 2015
This cross-sectional study examined price-related promotions for tobacco products on Twitter. Thr... more This cross-sectional study examined price-related promotions for tobacco products on Twitter. Through the Twitter Firehose, we obtained access to all public tweets posted between 6 December 2012 and 20 June 2013 that contained a keyword suggesting a tobacco-related product or behaviour (eg, cigarette, vaping) in addition to a keyword suggesting a price promotion (eg, coupon, discount). From this data set of 155 249 tweets, we constructed a stratified sampling frame based on the price-related keywords and randomly sampled 5000 tweets (3.2%). Tweets were coded for product type and promotion type. Non-English tweets and tweets unrelated to a tobacco or cessation price promotion were excluded, leaving an analytic sample of 2847 tweets. The majority of tweets (97.0%) mentioned tobacco products while 3% mentioned tobacco cessation products. E-cigarettes were the most frequently mentioned product (90.1%), followed by cigarettes (5.4%). The most common type of price promotion mentioned across all products was a discount. About a third of all e-cigarette-related tweets included a discount code. Banned or restricted price promotions comprised about 3% of cigarette-related tweets. This study demonstrates that the vast majority of tweets offering price promotions focus on e-cigarettes. Future studies should examine the extent to which Twitter users, particularly youth, notice or engage with these price promotion tweets.
American journal of preventive medicine, 2015
TV accounts for more than half of pharmaceutical direct-to-consumer advertising (DTCA) spending i... more TV accounts for more than half of pharmaceutical direct-to-consumer advertising (DTCA) spending in the U.S. The purpose of this study is to quantify average household exposure to branded and non-branded (help-seeking) televised prescription drug advertisements and describe variation over time and according to medication indication and geography. In 2013, Nielsen TV ratings were compiled for prescription pharmaceutical advertising that aired between 2003 and 2011 for the top 75 U.S. media markets. All advertisements were coded as branded or help-seeking. Advertisements were further coded for one of eight prevalent indications (allergies, arthritis, asthma, erectile dysfunction, high cholesterol, smoking cessation, depression, and sleep disorder) or as "other." Televised DTCA exposure increased from 2003 to 2007 and then declined 43% by 2011, to 111 monthly prescription drug advertisements per household. The examined indications were associated with varying amounts and patte...
American journal of respiratory and critical care medicine, Jan 16, 2015
The United States is one of only two countries that permit direct-to-consumer advertising (DTCA) ... more The United States is one of only two countries that permit direct-to-consumer advertising (DTCA) of prescription drugs, and many questions remain regarding its effects. To quantify the association between asthma-related DTCA, pharmacy sales and health care utilization. Ecological study from 2005 through 2009 using linked data from Nielsen (DTCA television ratings), the IMS Health National Prescription Audit (pharmacy sales) and the MarketScan® Commercial Claims data (health care utilization) for 75 designated market areas (DMAs) in the United States. We used multi-level Poisson regression to model the relationship between DTCA and rates of prescriptions and utilization within and across DMAs. (1) Volume of total, new and refilled prescriptions for advertised products based on pharmacy sales; (2) prescription claims for asthma medications; and asthma-related (3) emergency department utilization; (4) hospitalizations; and (5) outpatient encounters among the commercially insured. Four ...
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 2011
Donor livers are offered to patients with the highest risk of death. How ascites could inform ris... more Donor livers are offered to patients with the highest risk of death. How ascites could inform risk models to reduce liver transplant wait-list mortality is unclear. All adult candidates for primary liver transplantation for cirrhosis without exception points who were registered with the Organ Procurement and Transplantation Network from 2005 to 2007 composed our study cohort. Using Cox models and advanced discriminative metrics and paying attention to geographic disparities, we evaluated the additional risk discrimination of moderate ascites over that of the Model for End-Stage Liver Disease (MELD) or the Model for End-Stage Liver Disease plus serum sodium (MELD-Na) alone for the prediction of 90-day wait-list mortality. Additional analyses examined lower mortality risk candidates and those listed in high-demand, low-supply United Network for Organ Sharing regions in which accounting for ascites may most significantly affect wait-list mortality. Between 2005 and 2007, 18,124 subject...
ABSTRACT Background: A few studies have examined a small subset of e-cigarette videos on Youtube ... more ABSTRACT Background: A few studies have examined a small subset of e-cigarette videos on Youtube in the context of tobacco control, however, little is known about the extent of presence of e-cigarette videos on Youtube. Methods: An automated crawling procedure was employed to collect the metadata associated with e-cigarette videos posted on Youtube between January 1 2007 and December 31 2012 using keyword rules. View counts, ratings, number of comments, and number of e-cigarette vides over time are examined. Results: Approximately12,000 videos related to e-cigarettes were captured in the study period. Those videos were posted by about 3,700 Youtube users or accounts. They were viewed more than 66 million times, favored more than 72,000 times, and commented more than 174,000 times as of December 2012. The average view counts for these videos are 5,500 views per video, with the average rating of 2.9 on a 0-5 scale. The number of e-cigarette videos posted on Youtube per month has increased steadily since 2007, with about 300-400 videos posted on Youtube per month. However, in the March April 2012 two-month period, more than 3,000 e-cigarette related videos were posted on Youtube, corresponding to the CDC's Tips from Former Smokers campaign. The vast majority of these videos were tagged to the Technology, How To, People, Education, and Entertainment categories. Conclusions: Youtube is a major messaging and information-sharing social platform for electronic cigarettes. The presence and broad reach of e-cigarette videos on Youtube warrants serious attention from public health professionals and policy-makers.
ABSTRACT News coverage of health promotion campaigns is often characterized as earned media.&... more ABSTRACT News coverage of health promotion campaigns is often characterized as earned media.' Such coverage can convey the rationale or background to an issue in ways not viable through paid placement, and effectively spread the campaign's message well beyond the primary audience. Moreover, novel commenting' capacity of online media now facilitate widespread public engagement. In March 2012, the CDC launched Tips from Former Smokers,' a four-month, $54million media campaign promoting smoking cessation and initiation prevention, using graphic testimony of smoking's health consequences from actual former smokers. The Tips campaign represents the largest federal investment in a tobacco control media campaign to date. Given the size and graphic approach of the campaign, consideration of reach and engagement of earned media is clearly important. Earned media coverage of the Tips campaign was collected from a purposive, diverse sample of 5 leading policy-focused blogs and 10 traditional news media sites. Together, 37 initial media pieces on the campaign (23 news articles, 11 blog postings and 2 video reels) and 10,900 related public comments were collected for analysis. A qualitative thematic analysis of the news and blog content is ongoing. A combination of manual and computerized coding is being developed to analyze related comments for campaign position (support or opposition) and major frame (e.g. nanny state or societal costs of smoking). By facilitating the coding of thousands of public comments on earned media related to the Tips campaign, this novel mixed-methods approach represents a perspective on public discourse that has never before been possible.
ABSTRACT Background: Despite the rapid increase in awareness and use of e-cigarettes in recent ye... more ABSTRACT Background: Despite the rapid increase in awareness and use of e-cigarettes in recent years, little is known about how they are marketed and promoted, particularly on social media platforms. Methods: Keyword rules were used to collect tweets related to e-cigarettes from the Twitter Firehose between May 1, 2012 and June 30, 2012. Tweets were coded for smoking cessation and other health claims and mentions, and were classified into commercial tweets and organic tweets, using a combination of Bayesian machine learning methods, keyword algorithms, and human coding. Results: A total of 73,672 tweets related to e-cigarettes were captured in the study, 90% of which were found to be commercial tweets. Commercial e-cigarette tweets were posted on twitter feeds nearly 200 million times whereas organic electronic cigarette tweets were posted on twitter feeds only 4 million times. Accounts tweeting commercial e-cigarette content were associated with lower Klout scores. Commercial tweeting was largely driven by a small group of highly active accounts, with the top 10 accounts producing 32% of all electronic cigarette related tweets in the study period. 11% of commercial tweets and 9% of organic tweets mentioned smoking cessation. The majority (94%) of commercial tweets included links to websites that sell or promote e-cigarettes. Approximately 34% of commercial tweets included price discounts or coupons. Conclusions: Twitter appears to be a major marketing and promotional platform for e-cigarettes. Tweets related to e-cigarettes were overwhelmingly commercial, and a substantial proportion of e-cigarette tweets contained therapeutic claims, particularly related to smoking cessation.
Ethos, 2014
ABSTRACT Given concerns that Alcoholics Anonymous (AA) might disempower already disenfranchised g... more ABSTRACT Given concerns that Alcoholics Anonymous (AA) might disempower already disenfranchised groups by focusing attention on self scrutiny and away from social action, this article explores how a cohort of black women members in Chicago portray the role of individual and social forces in their addictions. Despite challenges including histories of sex work and abuse, these women describe themselves as empowered in their recovery efforts and as more successful in AA than their male peers. Their reported success reflects their innovative application of a women-only meeting. Through this meeting, members develop a practice of “openness” that is in some ways at odds with AA's customary self-focus, especially as it becomes grounds to exchange stories about social precipitants of addiction and to strategize ways to assert themselves in their relationships. Rather than enacting a pregiven version of AA, these women interpret the program in creative ways that allow them to accomplish a broad set of objectives.
The American Journal of Gastroenterology, 2013
We examined colorectal cancer (CRC) stage at presentation and mortality in a vulnerable populatio... more We examined colorectal cancer (CRC) stage at presentation and mortality in a vulnerable population compared with nationally representative data.
2014 IEEE International Conference on Data Mining, 2014
As social media is becoming an increasingly important source of public information, companies, or... more As social media is becoming an increasingly important source of public information, companies, organizations and individuals are actively using social media platforms to promote their products, services, ideas and ideologies. Unlike promotional campaigns on TV or other traditional mass media platforms, campaigns on social media often appear in stealth modes. Campaign promoters often try to influence people's behaviors/opinions/decisions in a latent manner such that the readers are not aware that the messages they see are strategic campaign posts aimed at persuading them to buy target products/services. Readers take such campaign posts as just organic posts from the general public. It is thus important to discover such campaigns, their promoter accounts and how the campaigns are organized and executed as it can uncover the dynamics of Internet marketing. This discovery is clearly useful for competitors and also the general public. However, so far little work has been done to solve this problem. In this paper, we study this important problem in the context of the Twitter platform. Given a set of tweets streamed from Twitter based on a set of keywords representing a particular topic, the proposed technique aims to identify user accounts that are involved in promotion. We formulate the problem as a relational classification problem and solve it using typed Markov Random Fields (T-MRF), which is proposed as a generalization of the classic Markov Random Fields. Our experiments are carried out using three real-life datasets from the health science domain related to smoking. Such campaigns are interesting to health scientists, government health agencies and related businesses for obvious reasons. Our results show that the proposed method is highly effective.
Public Health Nutrition, 2014
Objective: To examine levels of exposure and content characteristics for recent televised obesity... more Objective: To examine levels of exposure and content characteristics for recent televised obesity-prevention campaigns sponsored by state and community health departments, federal agencies, non-profit organizations and television stations in the USA. Design: Nielsen television ratings for obesity-prevention advertising were collected for the top seventy-five US media markets and were used to calculate household exposure levels for 2010 and 2011. Governmental advertisements were coded for content. Setting: United States. Results: Average household exposure to obesity-prevention campaigns was 2·6 advertisements per month. Exposure increased by 31 % between 2010 and 2011, largely driven by increases in federal advertisements. In 2011, the federal government accounted for 62 % of obesity-prevention exposure, non-profit organizations for 9 %, community departments for 8 %, state departments for 3 %, and television stationsponsored public-service announcements for 17 %. The greatest percentage increase between 2010 and 2011 was in community advertising, reflecting efforts funded by the Communities Putting Prevention to Work (CPPW) programme. Among thirty-four state and community campaigns, the majority advocated both healthy eating and physical activity (53 %). Campaigns typically had positive or neutral emotional valence (94 %). Obesity or overweight was mentioned in 47 % of campaigns, but only 9 % specifically advocated weight loss. Conclusions: Exposure to televised obesity-prevention advertising increased from 2010 to 2011 and was higher than previously found in 1999-2003, apart from in 2003 during the federal VERB campaign. Nevertheless, exposure remains low relative to advertising for unhealthy foods. New federal campaigns have increased exposure to obesity-prevention advertising nationally, while CPPW grants have increased exposure for targeted areas.
Tobacco Control, 2014
Background Rapid increases in marketing of e-cigarettes coincide with growth in e-cigarette use i... more Background Rapid increases in marketing of e-cigarettes coincide with growth in e-cigarette use in recent years; however, little is known about how e-cigarettes are marketed on social media platforms. Methods Keywords were used to collect tweets related to e-cigarettes from the Twitter Firehose between 1 May 2012 and 30 June 2012. Tweets were coded for smoking cessation mentions, as well as health and safety mentions, and were classified as commercial or non-commercial ('organic') tweets using a combination of Naïve Bayes machine learning methods, keyword algorithms and human coding. Metadata associated with each tweet were used to examine the characteristics of accounts tweeting about e-cigarettes.
Journal of Medical Internet Research, 2015
In March 2012, the US Centers for Disease Control and Prevention (CDC) launched the first-ever pa... more In March 2012, the US Centers for Disease Control and Prevention (CDC) launched the first-ever paid national tobacco education campaign. At a cost of US $54 million, "Tips from Former Smokers" (Tips) ran for 3 months across multiple media, depicting the suffering experienced by smokers and their families in graphic detail. The potential impact and reach of the Tips campaign was not limited to that achieved through paid media placements. It was also potentially extended through "earned media", including news and blog coverage of the campaign. Such coverage can shape public understanding of and facilitate public engagement with key health issues. To better understand the contribution of earned media to the public's engagement with health issues in the current news media environment, we examined the online "earned media" and public engagement generated by one national public health campaign. We constructed a purposive sample of online media coverage of the CDC's 2012 Tips from Former Smokers television campaign, focusing on 14 influential and politically diverse US news outlets and policy-focused blogs. We identified relevant content by combining campaign and website-specific keywords for 4 months around the campaign release. Each story was coded for content, inclusion of multimedia, and measures of audience engagement. The search yielded 36 stories mentioning Tips, of which 27 were focused on the campaign. Story content between pieces was strikingly similar, with most stories highlighting the same points about the campaign's content, cost, and potential impact. We saw notable evidence of audience engagement; stories focused on Tips generated 9547 comments, 8891 Facebook "likes", 1027 tweets, and 505 story URL shares on Facebook. Audience engagement varied by story and site, as did the valence and relevance of associated audience comments. Comments were most oppositional on CNN and most supportive on Yahoo. Comment coding revealed approximately equal levels of opposition and support overall. We identified four common arguments among oppositional comments: government intrusion on personal behaviors, problematic allocation of governmental spending, questionable science, and challenges regarding campaign efficacy. Supportive comments tended to convey personal stories and emotions. The Tips campaign received limited coverage on either online news or blog sources, but the limited number of stories generated engagement among online audiences. In addition to the content and volume of blog and news coverage, audience comments and websites' mechanisms for sharing stories via social media are likely to determine the influence of online earned media. In order to facilitate meaningful evaluation of public health campaigns within the rapidly advancing media environment, there is a need for the public health community to build consensus regarding collection and assessment of engagement data.