Clinical Toxicology

ISSN: 1556-3650 (Print) 1556-9519 (Online) Journal homepage: http://www.tandfonline.com/loi/ictx20

Online social networking and US poison control centers: Facebook as a means of information distribution Kathy Vo & Craig Smollin To cite this article: Kathy Vo & Craig Smollin (2015) Online social networking and US poison control centers: Facebook as a means of information distribution, Clinical Toxicology, 53:5, 466-469, DOI: 10.3109/15563650.2015.1014906 To link to this article: http://dx.doi.org/10.3109/15563650.2015.1014906

Published online: 12 Mar 2015.

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Date: 08 October 2015, At: 03:08

Clinical Toxicology (2015), 53, 466–469 Copyright © 2015 Informa Healthcare USA, Inc. ISSN: 1556-3650 print / 1556-9519 online DOI: 10.3109/15563650.2015.1014906

POISON CENTRE

Online social networking and US poison control centers: Facebook as a means of information distribution* kathy vo1 and craig smollin2 1Department

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2San

of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA Francisco Division, California Poison Control System, University of California, San Francisco, CA, USA­

Background. Online social networking services such as Facebook provide a novel medium for the dissemination of public health information by poison control centers in the United States. We performed a cross-sectional study of poison control center Facebook pages to describe and assess the use of this medium. Methods. Facebook pages associated with poison control centers were identified during a continuous two-week period from December 24, 2012 to January 7, 2013. Data were extracted from each page, including affiliated poison control center; page duration, measured in years since registration; number of subscribers; number of postings by general toxicological category; and measures of user-generated activity including “likes”, “shares”, and comments per posting. Results. Among the 56 US poison control centers, 39 Facebook pages were identified, of which 29 were currently active. The total number of active pages has increased by 140% from 2009 to 2013 (average of 25% per year). The total number of all subscribers to active pages was 11,211, ranging from 40 to 2,456 (mean 387, SD 523), equal to 0.006% of all Facebook users in the United States. The number of subscribers per page was associated with page duration, number of postings, and type of postings. The types of toxicological postings were public education (45%), self-promotion (28%), childhood safety (12%), drugs of abuse (8%), environmental poisonings (6%), and general overdoses (1%). Conclusion. Slightly over half of all poison control centers in the United States are supplementing their outreach and education efforts through Facebook. In general, the more active the poison control center on Facebook, the more page followers and follower engagement gained. Keywords   Poison control centers; Facebook; Social media; Social networking

Introduction

Since its launch in 2004, Facebook has grown into the world’s largest social networking service, citing over one billion users worldwide as of October 2012.4 Prior studies have described Facebook’s use in creating online communities that play a role in patient care,5–7 but none have investigated US poison control centers. The purpose of this study is to describe the ways in which poison control centers are currently using Facebook.

For decades, United States poison control centers have been providing patient care while making a sizeable impact on the reduction of health care dollar utilization.1,2 Much of this cost savings stems from the diversion of unnecessary emergency department visits, which is dependent upon efficient and actionable communication with both individual callers and the public at large.1 Traditionally, the majority of distributed information has primarily been through the poison control centers’ toll-free hotline. Each year, approximately 3.5 million calls are made to poison control centers by health care providers and the public.3 It remains to be seen how the emergence of new means of information dissemination, such as Facebook, will impact poison control center discourse with the general public.

Methods This study was granted exemption from review by the University of California, San Francisco Committee on Human Research. Data collection occurred during a continuous 2-week period ending in January 7, 2013. Each poison control center’s main website page was manually searched for a Facebook link; if none was present, various combinations of the name of the poison center and host state were used to perform a search using the Facebook search toolbar. In general, each Facebook page contains a profile space, termed a wall, where content can be posted or displayed by the wall owner. “Posts” can be messages or attachments of pictures, videos, or external website links. Individuals interested in following a particular Facebook page can choose to “like” it, and any page updates will appear on the individual’s home page upon login to their Facebook account. In addition to “liking” an entire page, users can also “like”

Received 5 August 2014; accepted 29 January 2015. *Presentations: Abstract previously presented at the 2013 Annual Meeting of the North American Congress of Clinical Toxicology. Address correspondence to Kathy Vo, MD, Department of Emergency Medicine, University of California, 500 Parnassus Avenue, San Francisco, CA 94143, USA. Tel:  909-210-8548. Fax:  415-206-5818. E-mail: [email protected] This article is linked to the Commentary - “My Child Ate Poop!” — How One Poison Center Established Its Social Media Presence (DOI: 10.3109/15563650.2015.1014909) - LEON GUSSOW, also published in Clinical toxicology.

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Facebook as a means of information distribution  467 status updates, comments, photographs, or links that have been posted, giving users the ability to engage and give feedback to the poster. We searched for a Facebook page for each United States poison control center. For all pages, the date of registration was recorded, if available. We categorized pages as “active” or “inactive.” Active pages were defined as those with at least one posting in the preceding year. Inactive pages were those with no postings within the prior year. For all active pages, we recorded the following information: number of subscribers; number of postings per page; and number of “likes,” “shares,” and comments per posting. We summed “likes,” “shares,” and comments per posting and defined the composite as the posting’s user-generated activity. For each active page, a single investigator (KV) categorized each posting into one of six general toxicological categories: childhood safety, drugs of abuse, environmental poisonings, general overdoses, public education, and self-promotion or promotional activities (Table 1). The above categorization scheme was established prior to initiation of the study. Postings were sorted into the public education group if they contained information regarding general toxicological facts, current events, and information not pertaining to the other five categories. Self-promotion and promotional activity postings contained advertisements, information about staff, and local centers’ involvement in the community. Environmental poisoning postings were those that provided information about toxic effects of ingestion or exposure to plant-based substances and animals (e.g., spider and snake). The general overdoses category contained information about medication overdoses not related to illicit drug use. The childhood safety category contained anything related to poisonings in infants and children, including educational information relating to childhood safety and prevention of poisoning in the home. Finally, the drugs of abuse category primarily included posts pertaining to illicit substances.

Results We identified 39 Facebook pages among 56 poison control centers, of which 29 were currently active. Since 2009, the number of total active pages per year steadily increased, with a 140% increase in active pages from 2009 to 2013, averaging a 25% per year growth rate. There were 11,211 subscribers in total, ranging from 40 to 2,456 subscribers per page, with an average of 387 subscribers. This number does not take into account users who visit but do not subscribe to the page. There were a total of 2,892 postings that generated 4,774 “likes,” 1,498 “shares,” and 1,085 comments from Facebook users, for a total of 7,357 user-generated activities. The frequency of postings and user-generated activity by category is illustrated in Table 2. Postings that related to public education made up the largest proportion of posts followed by selfpromotion, childhood safety, drugs of abuse, environmental poisonings, and general overdoses. General overdoses, promotional activities, and public education accounted for the most user-generated activity per post. As mentioned previously and shown in Table 1, a total of nearly three thousand posts in 2012 spanned a variety of information. Popular posts generating greater than five usergenerated activity, or those that likely made the most impact, within the public education category related toxicology to popular characters in the media and movies, gave general poisoning statistics, and reminded followers of poison control center-recognized public holidays. Poison control center promotional posts reminding followers of the Poison Helpline and posts asking followers to name new poison center pets had the most impact within that category. Information regarding laundry detergent pods and button batteries were among those generating the most activity within the category of childhood safety. While teen drug abuse and synthetic marijuana were among the most popular within the drugs of abuse category, posts containing information on carbon monoxide had the most impact within “environmental

Table 1.  Examples of postings by toxicological category. Category Childhood safety

Drugs of abuse Environmental poisonings General overdose Public education Promotional activities

Copyright © Informa Healthcare USA, Inc. 2015

Sample items Preventing poisonings in the home Product recall of acetaminophen infant suspension liquid Glow stick warning Hazards of button batteries Nicotine poisoning due to e-cigarets up dramatically Link to video of drugs of abuse discussion Link to carbon monoxide poisoning video Potential toxic effects from wild mushrooms Salmonella linked to small turtles Suicide related to acetaminophen overdose Calls to poison control centers from accidental/unintentional overdoses “Poison free” tips for travelers Holiday safety radio show Top 10 toxins in the kitchen National poison prevention week poster contest Calls to poison control centers are anonymous Link to poison control handbook Reminder to input poison control phone number to speed dial

468  K. Vo & C. Smollin Table 2.  Postings and user-generated activity by general toxicological subject.

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Public education Promotional activities Childhood safety Drugs of abuse Environmental poisonings General overdose Total

Postings (%)

User activity

1,287 (44.5) 798 (27.6) 361 (12.5) 219 (7.6) 185 (6.4) 42 (1.5) 2,892

3,151 2,488 899 313 364 142 7,357

poisonings.” Posts having the strongest impact within the minority of general overdose postings detailed information on acetaminophen and caffeine toxicity. Pages that displayed more postings overall attracted more subscribers independent of how long the page had existed. The Illinois and Oklahoma Poison Control Center pages had the largest number of overall postings, and enjoyed the first and second highest number of subscribers, at 2,456 and 1,211 users, respectively. Both centers carried a strong majority of total followers in 2012. This majority also holds true when correcting for population, as illustrated in Table 3. Interestingly, Oklahoma and Illinois had a proportionally greater amount of user-generated activity related to environmental poisonings compared with that of other centers. The pages belonging to the National Capital Poison Center, Palmetto Poison Center, New Jersey Poison Information and Education System, Illinois Poison Center, and the Oklahoma Poison Center shared a higher-than-average number of subscribers compared with pages of similar duration. These five poison control centers differed in that they generated twice as much user activity per environmental poisoning posting compared with the average.

Discussion Fifty-two percent of United States Poison Control Centers maintain active Facebook pages. Some attrition has occurred, however, with ten previously active pages no longer maintained by their respective poison control centers. Users seemed most interested in general overdose, promotional activities, and public education topics based on the volume of Table 3.  US Poison Control Centers with the highest number of followers. Followers Illinois Oklahoma New Jersey Palmetto National Capital California The Poison Control Center Northern New England North Texas Arizona

2456 1211 1170 1169 679 675 379 355 299 283

Followers corrected Total user for population* activity 19.1 31.7 13.2 24.7 4.6 1.8 2.8 10.8 1.1 5.9

923 1871 125 71 364 686 112 301 715 371

*Population estimates are taken from the 2012 United States’ Census Bureau. Population correction is based on the number of followers per 100,000 people. Values are rounded to the nearest tenth.

User activity per posting 2.6 3.1 2.5 1.4 1.0 3.4

user-generated activity garnered by postings of these types. Childhood safety postings gained nearly as much attention from users, while drugs of abuse and environmental poisonings received the lowest number of user activity per posting. The theoretical benefits of maintaining a Facebook page include the ability to supplement their already existing promotional and educational activities; increasing public visibility; providing a new avenue for fundraising and information dissemination; and reaching younger users, as the Facebook community disproportionately includes users under 55 years of age.4 The main disadvantage is the cost in time and resources of maintaining an active Facebook presence such as the hiring of extra staff, increasing posting efforts, and obtaining proper equipment and technical support. This is especially of concern given the current fiscal climate wherein increasing state and federal budget cuts have resulted in diminished funding to poison control centers.8,9 This study has several limitations. The definition of “active” was broad for our data collection. It can be argued that effectiveness should be measured by a much larger standard than having only at least one post in the previous year. However, this broad inclusion criterion did not exclude many centers from the study; only two “active” centers had 5 or less posts in 2012. Furthermore, the study was unable to examine in detail the sociodemographic features of Facebook users of poison control center pages given the proprietary nature of such information. Other limitations include those inherent to cross-sectional studies of this type, such as inability to establish causation, or determine the directionality of relationships. Additionally, as our methodology involved a single investigator, we did not assess for agreement or intra-relater reliability of our data. We were also unable to account for contributions to each page (postings and user-generated activity) by staff of poison control centers and the centralized American Association of Poison Control Centers, which maintains an active Facebook presence. There are a number of potential benefits of continued use of Facebook and other social media platforms as a supplement to both promotional and educational efforts of poison control centers. It will be interesting to see how poison control centers continue to use these social media platforms as we move forward in the digital age.

Conclusions Slightly more than half of poison control centers maintain an active Facebook presence, but the number of new US poison Clinical Toxicology vol. 53 no. 5 2015

Facebook as a means of information distribution  469 control center Facebook pages per year has decreased since 2009. The majority of postings by poison control centers are related to public education and promotional activities; however, general overdose postings resulted in the highest usergenerated activity. In general, the more active the poison control center on Facebook is, the more page followers and follower engagement gained.­­

Declaration of interest The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.

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Online social networking and US poison control centers: Facebook as a means of information distribution.

Online social networking services such as Facebook provide a novel medium for the dissemination of public health information by poison control centers...
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