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IntroductionThe expansion of mobile health technologies, particularly for diabetes-related applications (apps), grew exponentially in the past decade. This study sought to examine the extent to which current mobile apps for diabetes have health literate features recommended by participants in an Institute of Medicine Roundtable and compare the health literate features by app cost (free or not).MethodsWe used diabetes-related keywords to identify diabetes-related apps for iOS devices. A random sample of 110 apps (24% of total number of apps identified) was selected for coding. The coding scheme was adapted from the discussion paper produced by participants in the Institute of Medicine Roundtable.ResultsMost diabetes apps in this sample addressed diabetes management and therapeutics, and paid apps were more likely than free apps to use plain language strategies, to label links clearly, and to have at least 1 feature (a “back” button) that helps with the organization.ConclusionPaid apps were more likely than free apps to use strategies that should be more useful and engaging for people with low health literacy. Future work can investigate ways to make free diabetes mobile apps more user-friendly and accessible.

Social media interactions can inform public health risk perceptions. While research has examined the risk relationships between obesity and cancer, public attitudes about their associations remain largely unknown. We explored how these constructs were discussed together on two social media platforms. Publicly accessible Facebook and Twitter posts from a 2-month period in 2012 containing references to obesity ("obese/obesity," "overweight," and "fat") and cancer-related words were extracted (N = 3702 posts). Data cleaning yielded a final set of 1382 posts (Facebook: N = 291; Twitter: N = 1091). Using a mixed-methods approach, themes were inductively generated, and sentiment valence, structural elements, and epistemic stance were coded. Seven relational themes emerged: obesity is associated with cancer (n = 389), additional factors are associated with both obesity and cancer (n = 335), obesity causes cancer (n = 85), cancer causes obesity (n = 6), obesity is not linked to cancer (n = 13), co-occurrence (n = 492), and obesity is valued differently than cancer (n = 60). Fifty-nine percent of posts focused on an associative or causal link between obesity and cancer. Thirty-one percent of posts contained positive and/or negative sentiment. Facebook was more likely to contain any sentiment, but Twitter contained proportionately more negative sentiment. Concurrent qualitative analysis revealed a dominance of individual blame for overweight/obese persons and more support and empathy for cancer survivors. Our study reflects wide recognition of the evidence linking obesity to increased risk of cancer, a diverse set of factors perceived to be dually associated with both conditions and differing attribution of responsibility. We demonstrate that social media monitoring can provide an important gauge of public health risk perception.

Objective Self-affirmation can promote health behavior change and yield long-term improvements in health via its effect on receptiveness to risk information in behavior change interventions. Across two studies, we examined whether the emotional state of the person presented with health risk information moderates self-affirmation effectiveness. Methods Data were collected from two U.S. national samples (n=652, n=448) via GfK, an internet-based survey company. Female alcohol consumers completed an emotion induction (fear, anger, or neutral). They then completed a standard self-affirmation (or no-affirmation) essay-writing task, and subsequently received a health message linking alcohol to breast cancer. Results There was a significant interaction between emotion and self-affirmation conditions, such that self-affirmation reduced the specificity of health behavior change plans among those experiencing negative emotion (Study 1: B= −0.55, p<.001), with consistent but not significant effects for anger (Study 2: B= −.47, p=.069. Among self-affirmed participants, essays were rated as significantly less self-affirming for individuals experiencing negative emotion (or anger). Mediation analyses limited to the self-affirmation condition revealed an indirect effect of negative emotion condition on health behavior change plan specificity via self-affirmation ratings of essay content in Study 1: β=0.04, p=.041. Conclusions The salutary effect of self-affirmation on plan specificity was reversed with negative emotion. These findings may be attributed to disruption of the self-affirmation process. Individuals who enter interventions employing self-affirmation in a negative emotion state may be less prepared to benefit from other intervention content, and may even be less likely to change health behaviors as a result of the intervention.