Social Media Mining for Toxicovigilance: Automatic Monitoring of Prescription Medication Abuse from Twitter

Introduction

Prescription medication overdose is the fastest growing drug-related problem in the USA. The growing nature of this problem necessitates the implementation of improved monitoring strategies for investigating the prevalence and patterns of abuse of specific medications.

Objectives

Our primary aims were to assess the possibility of utilizing social media as a resource for automatic monitoring of prescription medication abuse and to devise an automatic classification technique that can identify potentially abuse-indicating user posts.

Methods

We collected Twitter user posts (tweets) associated with three commonly abused medications (Adderall^®, oxycodone, and quetiapine). We manually annotated 6400 tweets mentioning these three medications and a control medication (metformin) that is not the subject of abuse due to its mechanism of action. We performed quantitative and qualitative analyses of the annotated data to determine whether posts on Twitter contain signals of prescription medication abuse. Finally, we designed an automatic supervised classification technique to distinguish posts containing signals of medication abuse from those that do not and assessed the utility of Twitter in investigating patterns of abuse over time.

Results

Our analyses show that clear signals of medication abuse can be drawn from Twitter posts and the percentage of tweets containing abuse signals are significantly higher for the three case medications (Adderall^®: 23 %, quetiapine: 5.0 %, oxycodone: 12 %) than the proportion for the control medication (metformin: 0.3 %). Our automatic classification approach achieves 82 % accuracy overall (medication abuse class recall: 0.51, precision: 0.41, F measure: 0.46). To illustrate the utility of automatic classification, we show how the classification data can be used to analyze abuse patterns over time.

Conclusion

Our study indicates that social media can be a crucial resource for obtaining abuse-related information for medications, and that automatic approaches involving supervised classification and natural language processing hold promises for essential future monitoring and intervention tasks.

Below:  Distributions of abuse/non-abuse tweets for the four drugs. The numbers and percentages of abuse-indicating tweets for each drug are also shown

Below:  a Distributions of all collected tweets and automatically detected abuse-indicating tweets for Adderall® and oxycodone and b the proportions of abuse-indicating tweets over the same time periods

Full article at:  http://goo.gl/IuWsQn

By:  Abeed Sarker, Karen O’Connor, Rachel Ginn, Matthew Scotch, Karen Smith, Dan Malone, and Graciela Gonzalez

Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ USA

Center for Environmental Security, Biodesign Institute, Arizona State University, Tempe, AZ USA

Rueckert-Hartman College for Health Professions, Regis University, Denver, CO USA

Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ USA

Abeed Sarker, Phone: +1-480-884-0349, Email: ude.usa@rekras.deeba.

Corresponding author.

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Non-Prescribed Use of Opioid Substitution Medication: Patterns & Trends in Sub-Populations of Opioid Users in Germany

Background

Non-prescribed use of opioid substitution medication (NPU) appears to represent a relevant source of opioids among European drug users. Little is known about the prevalence of NPU in Germany and possible differences between subgroups of opioid users. The present study examines NPU and other drug use patterns among drug consumption room (DCR) clients, opioid substituted DCR clients, and patients recruited in opioid substitution treatment (OST) practices.

Methods

Cross-sectional data was collected in 2011 from 842 opioid users in 10 DCRs and 12 OST practices across 11 German cities. Structured interviews comprised indicators for socio-demographics, health status, drug use, motives for NPU, and the availability and price of illicit substitution medication. Group differences were examined with one-way ANOVAs, chi-square tests, or t-tests, and factors for NPU were included in a multivariate model. Over-time comparisons were performed with similar data collected in 2008.

Results

Lifetime, 30-day and 24-h NPU prevalence for the total sample was 76.5%, 21.9%, and 9.3%, respectively, with methadone being the most frequently used substance. NPU, poly-drug use and injection drug use were more common among DCR clients, especially among DCR clients not in OST. The three groups featured distinct socio-demographic characteristics, with substituted patients being more socially integrated, while few differences in health parameters emerged. Motives for NPU were mostly related to potential shortcomings of OST, such as insufficient dosages, difficulties with transportation, and lack of access. NPU prevalence was found to be higher than in 2008, while injection rate of substitution medication was similarly low. Main factors associated with NPU were not being in OST, past 24-h use of other drugs, and younger age.

Conclusion

Although diverted methadone or buprenorphine are rarely used as main drugs, NPU is prevalent among opioid users, particularly among DCR clients not in OST. OST reduces NPU if opioid users’ needs are met.

Purchase full article at:   http://goo.gl/UtybrX

By:  Bernd Schulte, Christiane S. Schmidt, Lisa Strada, Christine Götzke, Philipp Hiller, Benedikt Fischer, Jens Reimer

Affiliations

Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany

Correspondence

Corresponding author. Tel.: +49 040 7410 57906.

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Nonmedical Prescription Pain Reliever & Alcohol Consumption among Cannabis Users

BACKGROUND:

This study examined poly-drug use involving the use of cannabis with nonmedical prescription pain reliever use (NMPR) and alcohol use.

METHODS:

Computer-assisted survey data from the National Survey on Drug Use and Health were examined. The NSDUH is an annual, cross-sectional survey of non-institutionalized citizens in the United States (ages 12+). Replicate analyses were conducted using the 2013 and 2003 survey waves.

RESULTS:

Higher levels of cannabis use were consistently associated with more frequent consumption of prescription pain relievers, with findings replicating in both 2013 and 2003. While the prevalence of dual users declined from 2003 (2.5%) to 2013 (2.3%), the average number of days used among dual users increased by an average of 20 days over that period. These changes largely occurred among those aged 35 or older, males, whites, and non-illicit drug users. Past-year marijuana use increased by 16% (10.8-12.6%, p-value<.001) whereas NMPR decreased by 15% (4.9-4.2%, p-value<.001). The largest changes occurred after 2011. Persons using the most cannabis generally had higher levels of alcohol use relative to those using the least amount of cannabis. There was a significant increase in the prevalence of dual use between 2003 (10.2%) and 2013 (11.6%), while the prevalence of past-year alcohol use remained relatively stable.

CONCLUSIONS:

Clinical efforts and public health interventions should consider the possible co-ingestion of cannabis with NMPR and alcohol, as concomitant use may portend negative health effects in the short and long-term.

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By:  Novak SP1, Peiper NC2, Zarkin GA3.

• 1RTI International, Research Triangle Park, 3040 East Cornwallis Road, NC 27709, United States. Electronic address: snovak@rti.org.
• 2RTI International, Research Triangle Park, 3040 East Cornwallis Road, NC 27709, United States. Electronic address: npeiper@rti.org.
• 3RTI International, Research Triangle Park, 3040 East Cornwallis Road, NC 27709, United States. Electronic address: gaz@rti.org.

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Predictors of Transition to Heroin Use among Initially Non-Opioid Dependent Illicit Pharmaceutical Opioid Users: A Natural History Study

BACKGROUND:

Increases in illicit pharmaceutical opioid (PO) use have been associated with risk for transition to heroin use. We identify predictors of transition to heroin use among young, illicit PO users with no history of opioid dependence or heroin use at baseline.

METHODS:

Respondent-driven sampling recruited 383 participants; 362 returned for at least one biannual structured interview over 36 months. Cox regression was used to test for associations between lagged predictors and hazard of transition to heroin use. Potential predictors were based on those suggested in the literature. We also computed population attributable risk (PAR) and the rate of heroin transition.

RESULTS:

Over 36 months, 27 (7.5%) participants initiated heroin use; all were white, and the rate of heroin initiation was 2.8% per year (95% CI=1.9%-4.1%). Mean length of PO at first reported heroin use was 6.2 years (SD=1.9). Lifetime PO dependence (AHR=2.39, 95% CI=1.07-5.48; PAR=32%, 95% CI=-2% to 64%), early age of PO initiation (AHR=3.08, 95%; CI=1.26-7.47; PAR=30%, 95% CI=2%-59%), using illicit POs to get high but not to self-medicate a health problem (AHR=4.83, 95% CI=2.11-11.0; PAR=38%, 95% CI=12%-65%), and ever using PO non-orally most often (AHR=6.57, 95% CI=2.81-17.2; PAR=63%, 95% CI=31%-86%) were significant predictors.

CONCLUSION:

This is one of the first prospective studies to test observations from previous cross-sectional and retrospective research on the relationship between illicit PO use and heroin initiation among young, initially non-opioid dependent PO users. The results provide insights into targets for the design of urgently needed prevention interventions.

Purchase full article at:   http://goo.gl/PFIKEL

By:  Carlson RG1, Nahhas RW2, Martins SS3, Daniulaityte R4.

• 1Center for Interventions, Treatment, and Addiction Research, Department of Community Health, Boonshoft School of Medicine, Wright State University, 3171 Research Park Bld, Suite 124, Kettering, OH 45420, USA. Electronic address: robert.carlson@wright.edu.
• 2Center for Global Health, Department of Community Health, Boonshoft School of Medicine, Wright State University, 3123 Research Boulevard, Department of Psychiatry, 627 Edwin C. Moses Blvd., Dayton, OH 45417, USA.
• 3Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA.
• 4Center for Interventions, Treatment, and Addiction Research, Department of Community Health, Boonshoft School of Medicine, Wright State University, 3171 Research Park Bld, Suite 124, Kettering, OH 45420, USA. 

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Associations Between the Big Five Personality Traits and the Non-Medical Use of Prescription Drugs for Cognitive Enhancement

While the number of studies of the non-medical use of prescription drugs to augment cognitive functions is growing steadily, psychological factors that can potentially help explain variance in such pharmaceutical cognitive enhancement (CE) behavior are often neglected in research. 

This study investigates the association between the Big Five personality traits and a retrospective (prior CE-drug use) as well as a prospective (willingness to use CE drugs) measure of taking prescription drugs with the purpose of augmenting one's cognitive functions (e.g., concentration, memory, or vigilance) without medical necessity. We use data from a large representative survey of German employees (N = 6454, response rate = 29.8%). 

The Five Factor Model (FFM) of Personality was measured with a short version of the Big Five Personality Traits Inventory (BFI-S), which includes: openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. Together with this, demographic variables such as gender, age, education, and income were used as potential confounders in multiple logistic regression models. 

Our results show a 2.96% lifetime prevalence of CE-drug use and a 10.45% willingness to (re)use such drugs in the future. We found that less conscientious and more neurotic respondents have a higher probability of prior CE-drug use and a greater willingness to use CE drugs in the future. 

No significant effects were found for openness, extraversion, or agreeableness. Prior CE-drug use was strongly associated with a greater willingness to take such drugs in the future. 

This study shows that specific personality traits are not only associated with prior enhancement behavior, but also affect the willingness to (re)use such drugs. It helps increase understanding of the risk factors of CE-drug use, which is a health-related behavior that can entail severe side-effects for consumers. The knowledge gathered can thus help improve interventions aimed at minimizing health problems.

Below:  Predicted probabilities of prior use and willingness (both y-axis) estimated using average marginal effects based on multivariate logistic regression models—error bars represent the 95% confidence interval. (A) shows that the predicted probability of prior CE-drug use is higher in case of lower conscientiousness [defined by the mean value (M) − 1 standard deviation (SD)] compared to the M and to higher conscientiousness (M + 1 SD), while the probability (B) is lower for lower levels of neuroticism (M – 1 SD) compared to the M and to higher neuroticism (M + 1 SD) (based on Model 1, Table ​Table2).2). (C,D) show similar effects for the willingness to use CE drugs (based on Model 2, Table ​Table22).

Full article at:   http://goo.gl/tSLn9i

By:  Sebastian Sattler1,* and Reinhard Schunck2

¹Institute of Sociology and Social Psychology, University of Cologne, Cologne, Germany

²Faculty of Sociology, Bielefeld University, Bielefeld, Germany

Edited by: Ralf Brand, University Potsdam, Germany

Reviewed by: Boris B. Quednow, Psychiatric Hospital, University of Zurich, Switzerland; Lambros Lazuras, Sheffield Hallam University, UK

*Correspondence: Sebastian Sattler ; Email: ed.nleok-inu.osiw@relttas

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"Prescription Thugs" Official Trailer - Video

More at:  http://www.prescriptionthugs.com/

Review: http://www.nytimes.com/2016/01/22/movies/prescription-thugs-review.html?_r=0

Nonmedical Prescription Opioid Use in Childhood and Early Adolescence Predicts Transitions to Heroin Use in Young Adulthood: A National Study

Objectives

To examine the relationship between nonmedical use of prescription opioids and heroin initiation from childhood to young adulthood, and to test whether certain ages, racial/ethnic, and income groups were at higher risk for this transition.

Study design

Among a nationally representative sample of US adolescents assessed in the 2004-2011 National Surveys on Drug Use and Health cross-sectional surveys (n = 223 534 respondents aged 12-21 years), discrete-time hazard models were used to estimate the age-specific hazards of heroin initiation associated with prior history of nonmedical use of prescription opioids. Interactions were estimated between prior history of nonmedical use of prescription opioids and age of nonmedical use of prescription opioid initiation, race/ethnicity, and income.

Results

A prior history of nonmedical use of prescription opioids was strongly associated with heroin initiation (hazard ratio 13.12, 95% CI 10.73, 16.04). Those initiating nonmedical use of prescription opioids at ages 10-12 years had the highest risk of transitioning to heroin use; the association did not vary by race/ethnicity or income group.

Conclusions

Prior use of nonmedical use of prescription opioids is a strong predictor of heroin use onset in adolescence and young adulthood, regardless of the user's race/ethnicity or income group. Primary prevention of nonmedical use of prescription opioids in late childhood may prevent the onset of more severe types of drug use such as heroin at later ages. Moreover, because the peak period of heroin initiation occurs at ages 17-18 years, secondary efforts to prevent heroin use may be most effective if they focus on young adolescents who already initiated nonmedical use of prescription opioids.

Below:  Fitted probability of A, heroin initiation and B, survival by prior nonmedical prescription opioid use among adolescents and young adults, NSDUH (2004-2001).

Below:  Fitted HRs of heroin initiation associated with prior nonmedical prescription opioid use, by age of nonmedical prescription opioid use initiation (NSDUH, 2004-2011)

Full article at:   http://goo.gl/PZjglp

By:  Magdalena Cerdá, DrPH, MPH,1,2 Julián Santaella, DVM, MSc,1 Brandon D. L. Marshall, PhD,3 June H. Kim, MHS,1and Silvia S. Martins, MD, PhD1

¹Department of Epidemiology, Mailman School of Public Health (https://www.mailman.columbia.edu/), Columbia University, New York, NY

²Department of Emergency Medicine, University of California, Davis, Sacramento, CA

³Department of Epidemiology, Brown University, Providence, RI

Reprint requests: Magdalena Cerdá, DrPH, MPH, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St, Rm 527, New York, NY, 10032. ude.aibmuloc@6223cm

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Nonmedical Use of Prescription Medication among Adolescents Using Drugs in Quebec

OBJECTIVE:

To determine the prevalence and factors associated with nonmedical use of prescription medication (NMUPM) among adolescents who use drugs (ages 12 to 17 years) in Quebec.

METHOD:

Secondary data analyses were carried out with data from a 6-month study, namely, the 2010-2011 Quebec Health Survey of High School Students-a large-scale survey that sought to gain a better understanding of the health and well-being of young Quebecers in high school. Bivariate and multivariate logistic regression analyses were conducted to study NMUPM among adolescents who use drugs, according to sociodemographic characteristics, peer characteristics, health indicators (anxiety, depression, or attention-deficit disorder [ADD] with or without hyperactivity), self-competency, family environment, and substance use (alcohol and drug use) factors.

RESULTS:

Among adolescents who had used drugs in the previous 12 months, 5.4% reported NMUPM. Based on multivariate analyses, having an ADD, anxiety disorder, low self-esteem, low self-control, low parental supervision, regular alcohol use, and polysubstance use were associated with increased odds of reporting NMUPM.

CONCLUSIONS:

The observed prevalence of NMUPM was lower than expected. However, the associations noted with certain mental health disorders and regular or heavy use of other psychoactive substances are troubling. Clinical implications are discussed.

Purchase full article at:   http://goo.gl/OoJbjq

By:   Roy É1, Nolin MA2, Traoré I3, Leclerc P4, Vasiliadis HM5.

• 1Full Professor, Faculty of Medicine, Université de Sherbrooke (http://www.usherbrooke.ca/), Sherbrooke, Quebec; Researcher, Research Chair on Addiction, Université de Sherbrooke, Sherbrooke, Quebec.
• 2Graduate Student, Clinical Sciences Program, Université de Sherbrooke, Sherbrooke, Quebec.
• 3Research Assistant, Direction des statistiques de santé, Institut de la statistique du Québec, Montreal, Quebec.
• 4Public Health Officer, Direction de santé publique de l'agence de la santé et des services sociaux de Montréal, Montreal, Quebec.
• 5Associate Professor, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec; Researcher, Charles LeMoyne Hospital Research Centre, Greenfield Park, Quebec.
• Can J Psychiatry. 2015 Dec 1;60(12):556-63.
• 
  
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Chasing the Bean: Prescription Drug Smoking among Socially Active Youth

PURPOSE:

Alternative consumption practices of prescription drug misuse have been less well monitored than general prevalence. We describe prescription drug smoking among socially active youth and highlight correlates of this practice. We also examine its association with drug problems, drug dependence, and mental health.

METHODS:

We surveyed 404 young adults recruited from nightlife venues in New York via time-space sampling. We use linear and logistic regression models to examine the probability of smoking prescription drugs and its association with drug problems, dependence, and mental health. Qualitative findings supplement the survey data.

RESULTS:

Males have higher odds than females (odds ratio [OR] = 3.4), and heterosexuals have higher odds than sexual minority youth (OR = 2.3) of smoking prescription drugs. Those involved in electronic dance music nightlife have higher odds (OR = 2.1) than those who do not participate in that scene, whereas those in college bar scenes have lower odds (OR = .4) of having smoked prescription drugs. Prescription drug smokers report more drug problems (β = .322) and greater symptoms of dependence net (β = .298) of the frequency of misuse and other characteristics. Prescription drug smokers do not report greater mental health problems. Qualitative interview data support these survey findings.

CONCLUSIONS:

Prescription drug smoking is a significant drug trend among socially active youth. It is associated with drug problems and symptoms of dependence net of frequency of misuse. Prevention and intervention efforts for youth who misuse prescription drugs should address the issue of prescription drug smoking, and this may be an area for clinicians to address with their adolescent patients.

...In terms of escalation to smoking prescription drugs, our results demonstrate that this mode of administration was more likely among males. Although studies have suggested that the lifetime prevalence of illicit drug use is converging between males and females [30], studies have shown that males often use a wider range of drugs [31] and have heavier patterns of substance use [32]. These findings on escalation to smoking pills cohere with this broader literature. Recent pain killer misusers also reported higher odds of smoking prescription pills.

In terms of subcultural participation, those involved in EDM scenes were much more likely to report smoking pills. This may relate to the misuse of prescription drugs to moderate the effects of “club drugs” popular in such scenes [33]. Further examinations of the role of prescription drug smoking in polydrug combinations are necessary. By contrast, those involved in the college bar scene were less likely to have smoked prescription drugs. This is somewhat surprising given that studies have regularly highlighted the high prevalence of prescription drug misuse among college students [4]; yet, college students may misuse prescription drugs primarily for functional reasons and thus may be less inclined to smoke pills.

Regarding consequences, we found no effect for smoking prescription drugs on mental health outcomes, but strong effects for the CIDI and SIP-AD measures of problem drug use. Thus, our findings provide further support to previous research identifying that transitions to non-oral modes of consumption (mostly sniffing) increase prescription drug abuse related problems [15]. Attesting to the strength of the effect, we observed increased symptoms of dependence associated with smoking prescription drugs even net of the effect of frequency of prescription drug misuse. Thus, smoking is associated with higher dependence and problems above and beyond greater recent misuse. Although the effect of frequency of misuse on drug problems is perhaps unsurprising, the effect of smoking provides clinicians and practitioners with another indicator of increased likelihood of dependence and problems associated with prescription drug misuse... 

Full article at:  http://goo.gl/4zM2dE

By:   Kelly BC¹, Vuolo M², Pawson M³, Wells BE⁴, Parsons JT⁴.

¹Department of Sociology, Purdue University (https://www.cla.purdue.edu/sociology/), West Lafayette, Indiana; Center for HIV Educational Studies & Training, New York, New York. Electronic address: bckelly@purdue.edu.

²Department of Sociology, Purdue University, West Lafayette, Indiana.

³Center for HIV Educational Studies & Training, New York, New York; The Graduate Center, City University of New York, New York, New York.

⁴Center for HIV Educational Studies & Training, New York, New York; The Graduate Center, City University of New York, New York, New York; Department of Psychology, Hunter College, City University of New York, New York, New York.

J Adolesc Health. 2015 Jun;56(6):632-8. doi: 10.1016/j.jadohealth.2015.02.008.

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Establishing a Link Between Prescription Drug Abuse and Illicit Online Pharmacies: Analysis of Twitter Data

BACKGROUND:

Youth and adolescent non-medical use of prescription medications (NUPM) has become a national epidemic. However, little is known about the association between promotion of NUPM behavior and access via the popular social media microblogging site, Twitter, which is currently used by a third of all teens.

OBJECTIVE:

In order to better assess NUPM behavior online, this study conducts surveillance and analysis of Twitter data to characterize the frequency of NUPM-related tweets and also identifies illegal access to drugs of abuse via online pharmacies.

METHODS:

Tweets were collected over a 2-week period from April 1-14, 2015, by applying NUPM keyword filters for both generic/chemical and street names associated with drugs of abuse using the Twitter public streaming application programming interface. Tweets were then analyzed for relevance to NUPM and whether they promoted illegal online access to prescription drugs using a protocol of content coding and supervised machine learning.

RESULTS:

A total of 2,417,662 tweets were collected and analyzed for this study. Tweets filtered for generic drugs names comprised 232,108 tweets, including 22,174 unique associated uniform resource locators (URLs), and 2,185,554 tweets (376,304 unique URLs) filtered for street names. Applying an iterative process of manual content coding and supervised machine learning, 81.72% of the generic and 12.28% of the street NUPM datasets were predicted as having content relevant to NUPM respectively. By examining hyperlinks associated with NUPM relevant content for the generic Twitter dataset, we discovered that 75.72% of the tweets with URLs included a hyperlink to an online marketing affiliate that directly linked to an illicit online pharmacy advertising the sale of Valium without a prescription.

CONCLUSIONS:

This study examined the association between Twitter content, NUPM behavior promotion, and online access to drugs using a broad set of prescription drug keywords. Initial results are concerning, as our study found over 45,000 tweets that directly promoted NUPM by providing a URL that actively marketed the illegal online sale of prescription drugs of abuse. Additional research is needed to further establish the link between Twitter content and NUPM, as well as to help inform future technology-based tools, online health promotion activities, and public policy to combat NUPM online.

Below:  Word cloud for generic instance

Below:  Word cloud for street instance

Full article at:   http://goo.gl/JVZFyt

By:   Katsuki T1, Mackey TK, Cuomo R.

• 1Kavli Institute for Brain and Mind (http://kibm.ucsd.edu/), University of California, San Diego, La Jolla, CA, United States.
• J Med Internet Res. 2015 Dec 16;17(12):e280. doi: 10.2196/jmir.5144.

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Reality Television Programs are Associated with Illegal Drug Use and Prescription Drug Misuse among College Students

BACKGROUND:

Reality television watching and social media use are popular activities. Reality television can include mention of illegal drug use and prescription drug misuse.

OBJECTIVES:

To determine if reality television and social media use of Twitter are associated with either illegal drug use or prescription drug misuse.

METHODS:

Survey of 576 college students in 2011. Independent variables included watching reality television (social cognitive theory), parasocial interaction (parasocial interaction theory), television hours watched (cultivation theory), following a reality television character on Twitter, and demographics. Outcome variables were illegal drug use and prescription drug misuse.

RESULTS:

Watching reality television and also identifying with reality TV program characters were each associated with greater odds for illegal drug use. Also, following a reality TV character on Twitter had greater odds for illegal drug use and also in one analytical model for prescription drug misuse. No support was seen for cultivation theory. Those born in the United States had greater odds for illegal drug use and prescription drug misuse. Women and Asians had lower odds for illegal drug use. African Americans and Asians had lower odds for prescription drug misuse. 

CONCLUSIONS/IMPORTANCE: 

Physicians, psychologists, and other healthcare practitioners may find it useful to include questions in their clinical interview about reality television watching and Twitter use. Physician and psychology groups, public health practitioners, and government health agencies should consider discussing with television broadcasting companies the potential negative impact of including content with illegal drugs and prescription drug misuse on reality television programs.

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By:   Fogel J¹, Shlivko A².

¹a Department of Business Management , Brooklyn College of the City University of New York , Brooklyn , New York , USA.

²b Department of Biology , Brooklyn College of the City University of New York , Brooklyn , New York , USA.

DOI:

10.3109/10826084.2015.1082593

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