Reflections Since the Formation of the American College of Epidemiology (ACE) Ethics and Policy Committee, 2023-2025.

ABSTRACT Purpose This study explored how Israeli Olympic athletes constructed meaning en route to the Paris 2024 Olympics amid the Gaza–Israel war following the October 7, 2023, Hamas attack. War is conceptualized as a longitudinal, unpredictable, and negative career change event that coincided with the Olympic Games transition. Methodology Thematic analysis of 318 Instagram posts by 12 athletes (6 medallists, 6 non-medallists) was performed across three phases: pre-Games, during, and post-Games. Findings Seven themes were identified. Initially, athletes aimed to raise global awareness, counter misinformation, and express solidarity and empathy for victims. As the Games approached, themes of patriotism and national pride emerged, with athletes framing their participation as symbolic of Israeli resilience. During and after the Games, they dedicated achievements to Israel and expressed gratitude to supporters. Practical Implications The research emphasizes the need to understand athletes’ meaning-making in extreme circumstances, suggesting that sports organizations develop support systems for athletes in crisis. Contribution This study offers valuable insights into how elite athletes navigate psychological challenges during national conflict, underscoring the role of sports in fostering national resilience. It also contributes to the literature on athletes’ social media use. Originality This study is among the few to explore Olympic athletes’ construction of meaning during a war conflict.

Understanding public opposition to negative reimbursement decisions in healthcare: A systematic review.

Abstract Introduction Social media is a significant platform for health information. However, the quality and reliability of patient facing surgical content is uncertain. We evaluated the quality and reliability of TikTok and Instagram videos about three common general surgical procedures: laparoscopic appendicectomy; laparoscopic cholecystectomy; and inguinal hernia repair, and compared performance by platform, procedure, and creator type. Methods We conducted a crosssectional study of the top fifty results per procedure per platform. Videos were classified as useful, misleading, personal experience, or irrelevant and quality and reliability assessed with the Global Quality Score (GQS) and modified DISCERN (mDISCERN) score respectively. Results 300 videos, accruing 592 975 likes and 11 489 comments, were analysed. Videos were low in both quality and reliability across both platforms although higher on Instagram (GQS 1.95; mDISCERN 1.65) than TikTok (GQS 1.27; mDISCERN0.33; both P < 0.0001). 53/300 (17.7%) videos were judged to be misleading. Useful content was less frequent on TikTok than Instagram (14/150, 9.3% versus 82/150, 54.7%; P < 0.0001). Professional content was deemed more useful than that of non professionals (54/117, 46.2% versus 42/183, 23.0%; P < 0.0001) with higher quality and reliability scores (GQS 1.80 vs 1.49; mDISCERN 1.36 vs 0.76; both P < 0.0001). Conclusions Surgical educational videos across popular social media platforms are low in quality and reliability. Patients should be wary of the risk of possible health misinformation. Clinicians and professional bodies should be aware of the growing popularity of social media and consider the production of evidence-based content on these platforms to disseminatecredible information and counter misinformation.

Respected Madam, Pakistan’s polio eradication program, led by the Expanded Program on Immunization (EPI) under the Ministry of National Health Services, implements mass and routine immunization strategies in collaboration with WHO, UNICEF, and global health partners.[1] National and Sub-National Immunization Days are conducted alongside routine immunization to increase coverage, while surveillance measures, such as environmental sampling and epidemiological monitoring, help detect outbreaks early, ensuring prompt response and control. Additionally, community engagement initiatives address vaccine hesitancy and enhance immunization uptake, contributing to Pakistan’s ongoing polio eradication efforts. Polio vaccination in Pakistan faces significant challenges, including security threats, vaccine hesitancy, misinformation, and logistical barriers. Geographic inaccessibility and mistrust further hinder immunization progress. Recently, Pakistan’s polio eradication efforts face a surge in cases in Baluchistan, worsening existing challenges. In 2024, 74 polio cases were reported nationwide, with 27 from Baluchistan, including 7 from district Killa Abdullah, highlighting the region’s vulnerability.[2] New socio-political unrest, protests, and security threats in the region have further disrupted vaccination campaigns, limiting access to high-risk populations and compounding existing barriers.[3] Addressing the surge in polio cases in Baluchistan amid security challenges and socio-political unrest requires a multi-faceted, adaptive approach. Ensuring the security of vaccination teams through coordination with local authorities is essential, while integrating polio vaccination into routine healthcare services ensures continuity during disruptions. Engaging local leaders and influencers can help reduce vaccine hesitancy and counter misinformation, fostering trust within communities. A holistic, security-focused, and community-driven strategy by the government is essential for eradicating polio in Baluchistan.

Immunization stands as one of the greatest achievements in global health and development, saving millions of lives each year and reshaping the trajectory of public health. It involves the process of making an individual immune or resistant to a particular disease through the administration of vaccines that stimulate the body’s immune system to recognise and combat pathogens. Historically, immunity could only be acquired by contracting and surviving an infectious disease; however, the development of vaccines has enabled immunity to be safely induced without exposure to the illness itself. Vaccines introduce antigens that mimic those of pathogens, thereby triggering a protective immune response and building immunological memory. Immunization can occur through active or passive mechanisms, while vaccines are broadly classified as live attenuated or inactivated. Despite remarkable global progress, immunization continues to face significant challenges that threaten its sustainability. These include vaccine hesitancy, inequitable access, logistical and infrastructural limitations, and fragmented global coordination. Overcoming these barriers requires a coordinated and multifaceted approach involving governments, international organisations, pharmaceutical companies, civil society, and communities. Strengthening healthcare infrastructure, expanding vaccination across the life course, and integrating immunization into broader health systems are essential to achieving equitable coverage. Sustaining progress also depends on comprehensive public education campaigns that raise awareness about vaccine benefits, counter misinformation, and reinforce public trust in science. Investment in surveillance, cold-chain logistics, and communication strategies will ensure vaccines remain safe, effective, and accessible. Continued global collaboration is vital for maintaining momentum towards universal immunization coverage and achieving the Sustainable Development Goals. Ultimately, immunization represents both a biomedical triumph and a moral imperative — protecting populations, promoting equity, and reaffirming health as a universal human right.

This study examines the relationship between youth exposure to social media and its influence on political engagement within a private educational institution in Lipa City, Batangas. With platforms like Facebook, TikTok, Instagram, and X (formerly Twitter) reshaping political discourse, young individuals gain access to diverse political content but also face risks of misinformation. As social media becomes a primary source of political information, this study aims to assess its role in shaping students’ political attitudes, behaviors, and awareness of misinformation. Using a descriptive-quantitative approach, the study surveyed 350 purposively selected respondents. A researcher-made questionnaire measured social media usage, political engagement, and misinformation awareness. Data analysis included descriptive statistics and correlation tests to determine significant relationships. Findings revealed that 65.7% of respondents spent over four hours daily on social media, making it a dominant source of information. While social media exposure moderately influenced political awareness and online discussions, its impact on active participation, such as attending protests or voting, was less pronounced. Despite frequent exposure to political content, respondents expressed skepticism about its credibility, highlighting the need for media literacy. The study concludes that social media significantly shapes youth political engagement but also presents challenges related to misinformation. To address this, intervention programs focusing on digital literacy and responsible social media use are recommended. By equipping youth with critical thinking skills and fostering informed civic participation, these initiatives can help counter misinformation and enhance meaningful political engagement. Keywords: Youth, Politics, Engagement, Misinformation, Social Media

Assessment of the Quality and Reliability of Social Media Videos for Patient Information on Common General Surgical Procedures.

Adenoid hypertrophy (AH) is a common condition in children, often leading to nasal obstruction, mouth breathing, and sleep disturbances. With the increasing use of YouTube as a source of medical information, concerns have arisen regarding the accuracy and reliability of video content on this platform. This study aimed to evaluate the quality, reliability, and usefulness of English-language YouTube videos related to AH. A total of 300 videos were screened using specific keywords, and 93 met the inclusion criteria. Videos were assessed for their general characteristics and classified as either useful or misleading based on scientific accuracy. The Global Quality Scale (GQS), modified DISCERN (mDISCERN), and JAMA benchmarks were used to evaluate video quality and reliability. Among the included videos, 78.5% were deemed useful, while 21.5% were misleading. Videos uploaded by academic institutions and physicians demonstrated significantly higher mDISCERN, GQS, and JAMA scores (p < 0.001). In contrast, the majority of misleading videos were uploaded by independent users. A strong correlation was found between viewer engagement metrics (likes, comments) and daily view counts (p < 0.001), though higher popularity did not consistently align with higher quality or reliability. Although YouTube offers a substantial number of informative videos on AH, the presence of misleading content remains a concern, particularly from non-professional sources. Healthcare professionals and institutions are encouraged to produce high-quality, reliable video content to enhance public health literacy and counter misinformation.

Combating converging crises: The role of universities in global health, climate, and equity.

The Community Engagement Alliance (CEAL) Against COVID-19 is a national initiative to address disparities and misinformation surrounding COVID-19. The South Central Texas CEAL implemented community-based interventions to engage vulnerable populations, counter misinformation, and address the health impacts of COVID-19. Through community engagement, community-driven data gathering, and health information dissemination through trusted partners, this initiative fostered trust and collaboration among diverse community organizations, shared resources, and developed culturally tailored health messaging. This community-engaged program's success highlights its sustainability. (Am J Public Health. 2026;116(1):90-94. https://doi.org/10.2105/AJPH.2025.308277).

Stunting, a consequence of chronic malnutrition, is a significant public health issue in Indonesia. Foodborne illnesses such as food poisoning can contribute to poor nutrition, particularly in young children. While the government has implemented policies to ensure food safety, reports on incidents remain limited and fragmented. Twitter offers a potential source of real-time public health data. However, existing studies have focused on short-term datasets and rarely explored food safety incidents in relation to stunting. This research presents Twitter data on food safety incidents related to stunting and provides recommendations. Tweets related to food safety and stunting were collected using Twitter API v2 and analyzed to identify trends, events, and public concerns. Malnutrition was frequently mentioned as a key contributor to stunting. Tweets reported incidents of food poisoning affecting toddlers, especially during public events such as immunization. Some users promoted traditional remedies to treat diarrhea, raising concerns about misinformation. These findings indicate the need for public education and government involvement to promote evidence-based information. A centralized database of foodborne illnesses is suggested to improve prevention efforts. Collaborative efforts involving government and non-governmental organizations are recommended to improve awareness, counter misinformation, and strengthen reporting systems.

Objective. This study investigates the dual role of social media as a primary source of information in fostering political awareness among university students at Al-Hussein Bin Talal University. Methods. A mixed-methods approach was utilized, combining a validated Likert-scale questionnaire (α = 0.947) administered to 398 students with qualitative analysis of their social media engagement practices. Results. Findings indicate moderate engagement (M = 3.26–3.44) with platforms like Facebook and X (formerly Twitter), with a strong positive correlation (r = 0.665, p &lt; 0.01) between usage frequency and political awareness, though critical source evaluation remains limited. Conclusions. Social media significantly shapes political consciousness, necessitating library-led digital literacy programs to enhance critical engagement and counter misinformation in higher education.

Abstract Introduction Social media has rapidly evolved into a primary source of health-related information. For men with concerns regarding their sexual health or fertility, consulting the internet is often felt to be an accessible first-step in exploring their symptoms. Medical misinformation and over-generalisation online remain a significant concern amongst medical professionals, particularly in the current social media era of virality and sensationalism. In the inherently sensitive field of andrology, such misinformation can lead to undue anxiety or even harmful self-treatment with unregulated supplements, medications and devices. Objective This narrative review aims to explore the growing intersection between social media and andrology, offering an overview of the current medical media landscape and the opportunity to enhance health promotion. Methods A systematic search strategy was applied to identify relevant literature within PubMed, which served as the primary electronic database, as well as online websites and social media platforms. Core search terms included “social media”, “andrology”, “men’s health” and condition-specific terms such as “erectile dysfunction” or “testosterone”. Results Social media consumption is on the rise, with users consuming over two hours daily on average worldwide. Amongst posts, there has been a shift towards highly engaging short-form video content, which is particularly popular with young adults. Social media algorithms reinforce consumption patterns by continuously delivering content based on user engagement: the more an individual interacts with a topic or creator, the more related content appears, creating a self-sustaining feedback loop; this principle underpins the concept of virality and risks the rapid dissemination of inaccuracies online. Key men’s health topics such as infertility, erectile dysfunction, testosterone supplementation, erectile dysfunction, Peyronie’s disease and semen retention are popular amongst social media posts, amassing millions-to-billions of views depending on the platform. Amongst these posts, there is a high degree of misinformation and over-generalisation, particularly amongst those published by lay individuals and/or for-profit companies, with less-accurate content often gaining increased visibility and engagement. The growing digital footprint of urologists presents an opportunity to educate the public, counter misinformation, direct individuals to appropriate services and share professional insights. However, social media operates within a system that prioritises engagement and viral appeal; unlike their lay counterparts, clinicians must balance their professional responsibilities with the need to capture attention, potentially making it more challenging for evidence-based, educational content to gain traction in an environment that could be argued to, at times, reward sensationalism over substance. A thorough understanding of the current social media landscape, including its opportunities and challenges, is essential for modern-day clinical practice; this extends beyond posting and consuming content, encompassing a deeper awareness of patient expectations and digital behaviours. Conclusions Whilst the growing presence of urologists online may have the potential to counter health-related misinformation, there are barriers inherent to social media platforms that limit the reach and impact of expert voices at present. To leverage the opportunity that social media offers, urologists are required to modernise our approach to communication in order to ensure that accurate health information is both accessible and engaging. Disclosure No

Health misinformation on social media disproportionately impacts individuals with mental illness, increasing health care avoidance and stigma. The current integrative review aimed to identify effective, evidence-based interventions to improve mental health literacy and counter misinformation in clinical settings. A systematic search of PubMed, Embase, and CINAHL was conducted using terms related to health literacy, mental illness, and patient education. Inclusion criteria focused on adult populations and articles published from 2015 to 2025. Thirteen studies were included and appraised using the Johns Hopkins Nursing Evidence-Based Practices Evidence Rating Scale. Key components of effective interventions included audiovisual education tools, integration into routine appointments, and use of health literacy assessments. Most studies reported improvements in health literacy, anxiety, and depression. However, heterogeneity in tools and lack of theoretical frameworks limited generalizability. Brief, accessible audiovisual interventions embedded in standard care improve patient understanding and emotional outcomes. Future research should focus on theory-based design, validated tools, and mental health-specific outcomes.

Social networks, now including social media platforms, are increasingly important sources of health information for many patients, particularly patients of reproductive age. Observing and understanding conversations about contraception happening on social media can help clinicians address patient concerns and misinformation. Studies evaluating social media posts on contraception have found the most popular methods discussed across platforms are intrauterine devices and oral contraceptive pills. Side effects are the most frequently discussed topic on all social media formats, with negative effects discussed much more frequently than benefits. People viewing social media are often more drawn to posts around the logistics of contraception. Most videos are created by nonhealthcare professionals and are more likely to contain misinformation than videos created by healthcare professionals. Social media is an important tool that patients are using to access information about contraception. Physicians and clinicians should understand the themes patients are discussing so that they can address them in counseling. Physicians, clinicians, and healthcare organizations should consider contributing high-quality information to social media to improve accuracy and counter misinformation.

PS 5: Inclusivity and Diversity - Magda Robalo Correia e Silva and Kolitha Wickramage, Auditorium A & B (Rectory), September 5, 2025, 14:00 - 15:00Migration remains a key driver of economic growth and poverty reduction for many LMICs. Despite rising anti-migrant sentiment, regular migration pathways are essential for countries with aging populations, declining fertility, and labor shortages in sectors such as healthcare, construction, and caregiving, which are roles not easily replaced by AI. However, migration health data, crucial for effective public health interventions, financing, and resource allocation, is severely lacking in health systems worldwide. The ability to deliver targeted interventions, enable global health security, and counter misinformation, especially for precarious or irregular migrant workers, depends on the availability of such data.Recent bibliometric analyses and systematic reviews reveal significant evidence gaps in international labour migration and health. Although labour migrants comprise two-thirds of all international migrants, their health data is largely missing from routine health and migration management systems, with even less research available than for displaced or irregular migrants. Urgent technical cooperation is needed to help countries integrate migration modules with strong data protection into health and administrative systems. Investing in privacy-preserving data linkage to make better use of existing data can be a cost-effective way to connect health and social data for migrants.Additional evidence gaps that present opportunities include data from millions of mandatory health assessments undertaken daily for work, study, or residence, as well as employment insurance and occupational health data for migrant workers. Governments, academia, and the UN should partner with employers and industry groups, especially in precarious sectors, as the workplace remains an underutilized avenue for improving migrant health. Engaging migrant diasporas to strengthen health systems and promote inclusion is another blind spot. While remittances to LMICs now exceed foreign direct investment and aid, they also transfer skills, social capital, and networks that support integration and community inclusion.Advancing technical cooperation is challenged by the evisceration of UN and related agency programs, with global health financing reaching its lowest level in a decade. Key elements for a playbook are outlined to advance migration health data and inclusion, drawing on lessons from regions such as AU, SADC, and ASEAN, and countries including Morocco, Nepal, and Sri Lanka.

Vaccine hesitancy remains a major public health concern across Africa, driven by misinformation, cultural beliefs, and limited access to accurate health communication. With growing mobile and internet access, AI-powered conversational agents (chatbots) offer a promising means of improving vaccine literacy and trust in low-resource settings such as Nigeria. A qualitative review of studies from PubMed, Scopus, and IEEE Xplore, along with WHO and Africa CDC reports, was conducted to examine chatbot applications in healthcare. Findings informed the design of a multimodal framework that integrates text, voice, and visuals in indigenous languages (Igbo, Yoruba, Hausa) for inclusive communication. A pilot design covering urban (Lagos) and rural (Abia) populations was proposed to evaluate comprehension, engagement, and accessibility. The review shows that culturally localized chatbots can substantially enhance vaccine literacy. Projected outcomes indicate up to a 70% improvement in comprehension and a 60% increase in engagement when multimodal features and linguistic adaptation are incorporated. Ethical and infrastructural considerations remain key for sustainable deployment. AI-driven conversational agents provide a scalable, low-cost solution to vaccine hesitancy in Africa. By aligning technology with cultural and linguistic diversity, they can bridge communication gaps, counter misinformation, and strengthen public health awareness. This study contributes a context-driven framework for integrating AI into community-based vaccine education.

Social media informs 77% of patients with cancer, yet one third of posts contain misinformation. MedNews Week (MNW) is a volunteer virtual platform that delivers expert hematology-oncology content while intentionally pursuing gender balance. We analyzed program metrics (January 2022-June 2023) for 36 biweekly keynotes by oncology leaders (mean H-index 50.1). Aggregated audience demographics and engagement data were exported from X (Twitter), LinkedIn, YouTube, and Clubhouse. Unique reach, geographic distribution, and growth were calculated after deduplicating cross-platform IDs. Attendance and engagement were compared by speaker gender with χ2 tests and linear regression. MNW reached 743,991 unique viewers across 95 countries, including 23 low- and middle-income nations, and rose 10.5-fold in attendance over 18 months. Speakers achieved gender parity (18 women, 18 men); female-led sessions drew similar live attendance and video views (P = .41). MNW ranks in the top 0.07 percentile for health care influence on X. Participants included clinicians (40%), patients/advocates (22%), students (18%), and nonmedical stakeholders (20%). A no-cost, volunteer, gender-balanced platform can rapidly scale credible oncology education worldwide, counter misinformation, and engage under-resourced audiences. Sustained partnerships and outcome assessments are warranted.

This study examined country-level geo-temporal sentiment trends in community water fluoridation (CWF) discussions on 'X' from 2014 to 2023 and generated a five-year forecast to anticipate future shifts. Sentiment analysis was conducted using the VADER 'SentimentIntensityAnalyzer', with polarity thresholds defined as negative (< -0.05), neutral (-0.05 to +0.05) and positive (> +0.05). Data were collected via the 'X' API and examined for sentiment distribution, country-level geo-temporal patterns based on user location information, and engagement metrics (likes, retweets, replies). Ethical approval was obtained, and only publicly available data were analysed in compliance with the platform's terms of service. Limitations include restriction to English-language tweets and the non-representativeness and demographic biases of 'X' users compared with national populations. Of 72 309 original tweets analysed, 37.4% were negative, 34.4% positive and 28.2% neutral. Countries with low tweet volumes (e.g., Venezuela, Cyprus, Croatia, Pakistan, Vietnam) showed predominantly positive sentiment. In contrast, high-volume countries (the US, Canada, Australia, Brazil and the United Kingdom) displayed mixed sentiment without a clear majority. Predictive modelling indicated a modest shift toward less positive sentiment polarity over the next 5 years, with average polarity projected to decrease from 0.43 in 2024 to 0.38 in 2028. Supplementary analysis of more recent tweets (Jan 2024-Aug 2025) provided further insight into emerging patterns, broadly consistent with the projected trends. CWF discourse on 'X' is polarised and varies across countries and time. The expected decline in positivity underscores the need for tailored country-specific public health communication strategies to strengthen engagement and counter misinformation.