This paper introduces the use of social network analysis theory and tools for implementation research. The social network perspective is useful for understanding, monitoring, influencing, or evaluating the implementation process when programs, policies, practices, or principles are designed and scaled up or adapted to different settings. We briefly describe common barriers to implementation success and relate them to the social networks of implementation stakeholders. We introduce a few simple measures commonly used in social network analysis and discuss how these measures can be used in program implementation. Using the four stage model of program implementation (exploration, adoption, implementation, and sustainment) proposed by Aarons and colleagues [1] and our experience in developing multi-sector partnerships involving community leaders, organizations, practitioners, and researchers, we show how network measures can be used at each stage to monitor, intervene, and improve the implementation process. Examples are provided to illustrate these concepts. We conclude with expected benefits and challenges associated with this approach.

Background: Due in part to declining vaccination rates, in 2018 over 20 states reported at least one case of measles, and over 40,000 cases have been confirmed in Europe. Antivaccine posts on social media may be facilitating anti-vaccination behaviour. This study aimed to systematically characterize (1) individuals known to publicly post antivaccination content on Facebook, (2) the information they convey, and (3) the spread of this content. Methods: Our data set consisted of 197 individuals who posted anti-vaccination comments in response to a message promoting vaccination. We systematically analysed publicly-available content using quantitative coding, descriptive analysis, social network analysis, and an in-depth qualitative assessment. The final codebook consisted of 26 codes; Cohen's κ ranged 0.71-1.0 after double-coding. Results: The majority (89%) of individuals identified as female. Among 136 individuals who divulged their location, 36 states and 8 other countries were represented. In a 2mode network of individuals and topics, modularity analysis revealed 4 distinct subgroups labelled as "trust," "alternatives," "safety," and "conspiracy." For example, a comment representative of "conspiracy" is that poliovirus does not exist and that pesticides caused clinical symptoms of polio. An example from the "alternatives" subgroup is that eating yogurt cures human papillomavirus. Deeper qualitative analysis of all 197 individuals' profiles found that these individuals also tended to post material against other health-related practices such as water fluoridation and circumcision.

Introduction This study documented images posted on Instagram of electronic cigarettes (e-cigarette) and vaping (activity associated with e-cigarette use). Although e-cigarettes have been studied on Twitter, few studies have focused on Instagram, despite having 500 million users. Instagram’s emphasis on images warranted investigation of e-cigarettes, as past tobacco industry strategies demonstrated that images could be used to mislead in advertisements, or normalise tobacco-related behaviours. Findings should prove informative to tobacco control policies in the future. Methods 3 months of publicly available data were collected from Instagram, including images and associated metadata (n=2208). Themes of images were classified as (1) activity, for example, a person blowing vapour; (2) product, for example, a personal photo of an e-cigarette device; (3) advertisement; (4) text, for example, ‘meme’ or image containing mostly text and (5) other. User endorsement (likes) of each type of image was recorded. Caption text was analysed to explore different trends in vaping and e-cigarette-related text. Results Analyses found that advertisement-themed images were most common (29%), followed by product (28%), and activity (18%). Likes were more likely to accompany activity and product-themed images compared with advertisement or text-themed images (p<0.01). Vaping-related text greatly outnumbered e-cigarette-related text in the image captions. Conclusions Instagram affords its users the ability to post images of e-cigarette-related behaviours and gives advertisers the opportunity to display their product. Future research should incorporate novel data streams to improve public health surveillance, survey development and educational campaigns.

In the US Instagram posts with the hashtag #hookah regularly depicted waterpipe use in conjunction with alcohol use. Instagram's focus on images facilitates picture-based advertising where hookah lounges promote drink specials at the same time nightclubs promote waterpipe specials. Instagram users often document the variety of shapes, sizes, and styles, of waterpipes, suggesting users take pride in their purchases and like to show their customized, and often times elaborate, waterpipes to their followers. Instagram has been underutilized in understanding tobacco related-behaviors and identifying tobacco-related promotional material.

BackgroundLittle cigar and cigarillo use is becoming more prevalent in the United States and elsewhere, with implications for public health. As little cigar and cigarillo use grows in popularity, big social media data (eg, Instagram, Google Web Search, Twitter) can be used to capture and document the context in which individuals use, and are marketed, these tobacco products. Big social media data may allow people to organically demonstrate how and why they use little cigars and cigarillos, unprimed by a researcher, without instrument bias and at low costs.ObjectiveThis study characterized Swisher (the most popular brand of cigars in the United States, controlling over 75% of the market share) little cigar- and cigarillo-related posts on Instagram to inform the design of tobacco education campaigns and the development of future tobacco control efforts, and to demonstrate the utility in using big social media data in understanding health behaviors.MethodsWe collected images from Instagram, an image-based social media app allowing users to capture, customize, and post photos on the Internet with over 400 million active users. Inclusion criteria for this study consisted of an Instagram post with the hashtag “#swisher”. We established rules for coding themes of images.ResultsOf 1967 images collected, 486 (24.71%) were marijuana related, 348 (17.69%) were of tobacco products or promotional material, 324 (16.47%) showed individuals smoking, 225 (11.44%) were memes, and 584 (29.69%) were classified as other (eg, selfies, food, sexually explicit images). Of the marijuana-related images, 157/486 (32.3%) contained a Swisher wrapper, indicating that a Swisher product was used in blunt making, which involves hollowing out a cigar and refilling it with marijuana.ConclusionsImages from Instagram may be used to complement and extend the study of health behaviors including tobacco use. Images may be as valuable as, or more valuable than, words from other social media platforms alone. Posts on Instagram showing Swisher products, including blunt making, could add to the normalization of little cigar and cigarillo use and is an area of future research. Tobacco control researchers should design social media campaigns to combat smoking imagery found on popular sites such as Instagram.