Twitter: an opportunity for public health campaigns
Authors: Mackenzie R Wehner, Mary-Margaret Chren, Melissa L Shive, Jack S Resneck, Sherry Pagoto, Andrew B Seidenberg, Eleni Linos
Journal: The Lancet (2014)

Twitter is a popular medium for communication and information sharing with 200 million active users and 400 million tweets per day.1Smith A Brenner J Twitter use 2012. Pew Research Center, May 31, 2012.http://pewinternet.org/∼/media//Files/Reports/2012/PIP_Twitter_Use_2012.pdfGoogle Scholar Almost a third of internet users 18–24 years old use Twitter, and 20% use it daily.2Gray NJ Klein JD Noyce PR Sesselberg TS Cantrill JA Health information-seeking behaviour in adolescence: the place of the internet.Social Sc Med. 2005; 60: 1467-1478Crossref PubMed Scopus (593) Google Scholar Indoor tanning, which is associated with an increased risk of skin cancer,3Wehner MR Shive ML Chren MM Han J Qureshi AA Linos E Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis.BMJ. 2012; 345: e5909Crossref PubMed Scopus (284) Google Scholar has reached alarming rates among young people, with about 20% of teenagers using indoor tanning.4Wehner MR Chren M Nameth D et al.International prevalence of indoor tanning: a systematic review and meta-analysis.JAMA Dermatol. 2014; 150: 390-400Crossref PubMed Scopus (227) Google Scholar We assess the frequency of mentions of indoor tanning and tanning health risks on Twitter. We used the Twitter Streaming Application Programming Interface (API) to collect in real time all tweets (English language) mentioning indoor tanning, tanning bed, tanning booth, tanning salon, sun bed, or sun lamp, over 2 weeks (March 27, 2013, to April 10, 2013). Data are presented in the table.TableTwitter data mentioning indoor tanning (March 27–April 10, 2013)NumberTwitter users posting on indoor tanning120 354Tweets about indoor tanning154 496Followers exposed to tweets about indoor tanning113 888 616Tweets about indoor tanning, also mentioning:*Categories are non-exclusive (eg, a tweet that contained both "cancer" and "danger" is listed in both categories). Listed search terms also included case and punctuation variations as well as alternate endings (eg, "ban", "bans", "banning", "banned".Cancer ("cancer", "carcinoma", "melanoma", "basal cell", "squamous cell")3956 (2·56%)"Burn"7344 (4·75%)"Danger"288 (0·19%)"Itch"2884 (1·87%)Pain ("pain", "hurt", "ouch", "ow")1856 (1·20%)Cost ("cost", "expense", "money")705 (0·46%)Bans or taxes ("ban", "prohibit", "restrict", "legal", "tax")4083 (2·64%)"Wrinkles" or "aging"405 (0·26%)"Vitamin"196 (0·13%)Spray or sunless tanning ("spray tan", "self tan", "sunless tan", "tanning lotion")4433 (2·87%)Advertisement†User name or description contains "tanning", "salon", "studio", "spa", or tweet text contains "% off".1940 (1·26%)News418 (0·27%)Data are n or n (%).* Categories are non-exclusive (eg, a tweet that contained both "cancer" and "danger" is listed in both categories). Listed search terms also included case and punctuation variations as well as alternate endings (eg, "ban", "bans", "banning", "banned".† User name or description contains "tanning", "salon", "studio", "spa", or tweet text contains "% off". Open table in a new tab Data are n or n (%). Over the 2-week collection period, 154 496 tweets mentioned indoor tanning: that is 7·7 per minute. The health themes mentioned in indoor tanning tweets are shown in the table. During the 2-week period, more than 120 000 individuals posted at least one tweet mentioning indoor tanning, potentially reaching more than 100 million individuals. Among these tweets, a very small percentage mentioned the health risks associated with indoor tanning, such as skin cancer. Because of Twitter's broad reach, especially among young adults, health advocates should consider increasing the use of Twitter and other online platforms to communicate public health and cancer prevention messages. Research is needed to explore ways to direct health messages to social network users who discuss and search for risk behaviours online. Combining the expertise of skin cancer and health communication researchers, public health advocates, and social media experts might be necessary to develop the effective cancer prevention campaigns. M-MC serves as a consultant to Genentech Inc. The other authors declare no competing interests.