July / August 2018


AJHE: American Journal of Health Education

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  July/August 2018 (Volume 49, Issue 4)

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Table of Contents

Free Access Article
/Spreading the (Fake) News: Health Misinformation on Social Media and the Challenge of Health Education
 – Silvia Sommariva, Cheryl Vamos, Alexios Mantzarlis, Lillie Uyên-Loan Đào, and Dinorah Martinez Tyson

Background/Purpose: The importance of social networking sites (SNSs) as platforms to engage in the correction of “fake news” has been documented widely. More evidence is needed to understand the popularity of health-related rumors and how Health Educators can optimize their use of SNSs.
Methods: A content analysis of Zikarelated news stories on SNSs between February 2016 and January 2017 was conducted to verify accuracy (phase 1). Phase 1 was followed by an analysis of volume of shares (phase 2) and a thematic analysis of headlines (phase 3).
Results: Rumors had three times more shares than verified stories. Popular rumors portray Zika as a conspiracy against the public and a low-risk issue 15 and connect it to the use of pesticides.
Discussion: This study identifies the value of integrating in-depth analysis of popular health-related rumors into the development of communication strategies.
Translation to Health Education Practice: Misinformation on SNSs can hinder disease prevention efforts. This study shows how information circulating on SNSs can be analyzed from a quantitative and qualitative standpoint to help Health Educators maximize the use of online 20 communication platforms.

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Reject, Correct, Redirect: Using Web Annotation to Combat Fake Health Information
Melissa Haithcox-Dennis
Misleading health news and product advertising has plagued the United States since the 19th century. Companies and individuals spent large sums of money to advertise in a variety of media, including newspapers, magazines, radio, TV, and, more recently, the Internet. Preying on the fears 10 and insecurities of consumers, these entities used manipulative marketing strategies to dupe the public and make money. Despite historical and more recent public health efforts, fake health news is pervasive and becoming more harmful every day. How, then, do we, Certified Health Education Specialists, engage in the fight against fake health products and news? One option is to directly reject and correct online stories, websites, and advertisements and redirect consumers to repu15 table alternatives using web annotation. Web annotation, a widely used tool that is very similar to the traditional use of annotations made on a paper or in the margin of a textbook, is done completely online. Annotations appear as highlights, images or videos, marginal notes or tags on an entire website, a sentence or paragraph. Using this tool, Certified Health Education Specialists can engage in the fight against fake health news by pointing out false information, adding 20 accurate information, and listing reliable alternatives for the protection of consumers.
Toward Evidence-Based Smartphone Apps to Enhance Human Health: Adoption of Behavior Change Techniques
Christopher K. Rhea, Danielle T. Felsberg & Jaclyn P. Maher
There has been a substantial increase in the number of health-related smartphone applications (apps) available to consumers in recent years. How does one decide which apps have scientific evidence backing their claims and which are “fake news”? In this Commentary, we explore the 10 hierarchy of scientific claims and review recent literature to identify areas of Health Education and health promotion in which evidence-based smartphone apps are available. Further, we present a theory-based framework to help app developers optimize their potential to enhance human health.

Research Articles

Public Perceptions of Powdered Alcohol Use and Misuse: Narrative Perspectives from YouTube
Adam E. Barry, Daenuka Muraleetharan, Jordan Nelon, Shelby Lautner, Megan Callahan, Xiaoying Zhang, Michelle Herren, Beth Chaney, and Michael Stellefson
Background: Powdered alcohol, a new form of crystalline alcohol sold under the brand name Palcohol, has yet to be widely distributed in the United States due to political and public concerns surrounding potential for misuse.
Purpose: Given the limited research on powdered alcohol, 10 researchers examined YouTube videos on this controversial substance to gain insights into its use.
Method:Researchers thematically evaluated YouTube videos describing knowledge of powdered alcohol use, its effects, as well as the cultural context surrounding its use.
Results: Of the videos that met study inclusion criteria (n = 210), 38% were coded as “news report,” 20% “opinion,” 19% “policy,” 11% “user-generated information,” 7% “education,” 3% “misuse,” 2% “development,” and 15 1% “use.” One in three videos about powdered alcohol included negative viewpoints about the product (n = 71, 34%).
Discussion: The majority of reviewed YouTube videos described negative implications of consuming powdered alcohol (eg, high potential for unintentional over consumption).
Translation to Health Education Practice: Findings suggest ways in which health researchers can use popular social media websites, such as YouTube, to address divides between 20 sensationalized public perceptions of chronic health risks and evidence-based research of new alcoholic products.

A Comprehensive Analysis of How Environmental Risks of Breast Cancer are Portrayed on the Internet
NinShibani Kulkarni, Kaleea Lewis, Swann Arp Adams, Heather M. Brandt, Jamie R. Lead, John R. Ureda, Delores Fedrick, Chris Mathews, and Daniela B. Friedman
Background: Effective online communication about the environmental risk factors of breast cancer is essential because of the multitude of environmental exposures and debate regarding the conclusiveness of scientific evidence.
Purpose: The aim of this study was to assess the content, 10 readability, and cultural sensitivity of online resources focused on the environmental risks factors of breast cancer.
Methods:: A purposive sample of webpages focused on environmental risk factors of breast cancer was obtained through a Google search using 17 search terms. Using nonparametric statistics, we assessed the content, readability, and cultural appropriateness of 235 webpages.
Results: Eighty-two percent of webpages referred to research studies in their content. For 15 the majority of sites, readability was at a high school reading grade level. Webpages were not explicitly intended for specific racial/ethnic groups.
Discussion: Technical language and nonculturally specific messages may hinder users’ attention to and comprehension of online breast cancer information. Additional research is needed to examine in-depth the accuracy of this online content.
Translation to Health Education Practice: Findings suggest that collaborations 20 between scientists, Health Educators, website designers/media professionals, and the community will be critical to the delivery of accurate, up-to-date, plain-language, and culturally sensitive information about breast cancer and the environment.

Understanding Misinformation in the Protanning Communication Environment
Dannielle E. Kelley, Seth M. Noar, and Andrew B. Seidenberg
Background: To respond to the Surgeon General’s call to develop, disseminate, and evaluate messages to reduce indoor tanning (IT) in the 2014 Call to Action to Prevent Skin Cancer, an understanding of the IT communication environment is necessary.
Purpose: The purpose of this study was to identify the most prevalent false or misleading IT claims.
Methods: Pro-tanning 10 websites (N = 78) were identified in a Google search. Using systematic quantitative content analysis, website characteristics were coded, as well as claims regarding health, safety, appearance/social, and mood/relaxation benefits of IT. All text appearing on the websites was reviewed and coded.
Results: ReTwo prominent types of claims emerged: health (86%) and IT safety (90%) benefits of IT. Within health, the most common claims were: (1) good source of vitamin D (69%); 15 and (2) a base tan provides protection from the sun (41%).Within safety, the most common claims were: (1) safe because it is controlled (81%); (2) government regulation ensures safety (56%).
Discussion: An abundance of misleading claims were identified, prompting concern from a public health perspective, because tanners may use these claims to justify their tanning behavior.
Translation to Health Education Practice: By understanding the prevalence of these claims, 20 prevention efforts may be more effective in creating a disruptive association between IT and many advertised “benefits” of engaging in this dangerous behavior.

Alcohol Advertising on Twitter – A Topic Model
Adam E. Barry, Danny Valdez, Alisa A. Padon, and Alex M. Russell
Background: Exposure to alcohol-related advertising is consistently linked to adolescent drinking initiation and alcohol-related consequences. Since the advent of social networking sites, the alcohol industry has adapted its advertising efforts and allocated large portions of advertising budgets and efforts on digital and online media.
Purpose: This investigation employed a novel, objective content analysis to examine the advertising practices of leading alcohol brands on Twitter.
Methods: Latent 10 Dirichlet allocation (LDA) was utilized to examine the entire Twitter post history for 13 alcohol brands.
Results: Very distinct, clear themes emerged for each brand. Each brand had a unique approach to marketing that was representative of the brand itself. Insufficient alcohol brand messaging on Twitter focused on moderation (ie, drink responsibly).
Discussion: Our analysis of tweets from 2010 to 2017 by 13 distinct alcohol brands echoes previous documenting utilization of 15 content appealing to youth and violation of the alcohol industry’s self-developed marketing code.
Translation to Health Education Practice: Public health practitioners and policymakers should utilize these findings and those of previous peer-reviewed studies to advocate for clear externally monitored advertising regulations and guidelines protecting adolescents from alcohol advertising exposure.

Intention to Use Emergency Contraptions: The Important Role of Accurate Knowledge and Information Credibility
Kyla P. Garrett Wagner, Laura Widman, Jacqueline Nesi, and Seth M. Noar
Background: Emergency contraception (EC) is a highly effective form of birth control that may lower rates of unintended pregnancy among young women. But efforts to disseminate EC to women are hampered by misinformation and inadequate information.
Purpose: The purpose of this study was to determine the sources from which young women learn about EC (including 10 health care providers, friends/interpersonal sources, media sources, or no information sources) and to examine associations between source credibility with the accuracy of EC knowledge and intentions to use EC.
Methods: Using a computer-based survey, 339 college women (M age = 18.4) reported their EC information sources, knowledge about EC, and behavioral intentions to use EC.
Results: In total, 97% of participants had heard of EC from at least one source and 49% indicated 15 that they were highly likely to use EC in the future if needed. Results demonstrated that EC knowledge mediated the relationship between EC information source credibility and intentions to use EC.
Discussion: This study contributes important insights to a scarce literature on EC information sources and the factors that predict intentions to use EC.
Translation to Health Education Practice: Future EC promotion efforts should target Health Education sources instead 20 of media or interpersonal sources to promote EC knowledge and use among young sexually atrisk populations.