Twitter can be useful tool for public health organizations — but must be carefully monitored

Brown School study finds coordinated responses to controversial topics may not be local

Social media marketing strategies present both challenges and opportunities for public health professionals. It’s an effective way of reaching large audiences, but social media can also be used to spread misinformation.

That’s the findings of a situational analysis by researchers at the Brown School at Washington University in St. Louis of a recent social media campaign by the Chicago Department of Public Health (CDPH). The study suggests that public health organizations need to pay close attention to how they disseminate information, and also to the response the campaign gets.


In January 2014, the Chicago City Council scheduled a vote on local regulation of electronic cigarettes as tobacco products. One week prior to the vote, the CDPH released a series of messages about electronic cigarettes through its Twitter account.

Shortly after the tweets were released, the department’s Twitter account became the target of a “Twitter bomb,” with Twitter users sending more than 600 tweets in one week against the proposed regulation.

An analysis of this data, “Tweeting for and Against Public Health Policy: Response to the Chicago Department of Public Health’s Electronic Cigarette Twitter Campaign,” was published Oct. 16 in the Journal of Medical Internet Research.

The study was conducted by Jenine Harris, PhD, assistant professor at the Brown School and scholar in the Institute for Public Health; Sarah Moreland-Russell, PhD, research assistant professor at the Brown School and associate director for the Center for Public Health Systems Science; Brown School students Mackenzie Staub and Kendall Simmons; and colleagues at the Chicago Department of Public Health.

“Twitter reaches groups not widely reached by traditional media and its use is growing in the U.S. and globally,” Harris said. “Tweets from reputable sources that include high-quality information tend to spread. Public health organizations, therefore, have a great opportunity to facilitate the spread of high-quality health information to groups not typically reached by traditional media.”

Researchers collected all the tweets mentioning the CDPH in the week between the e-cigarette campaign and the vote on the new local e-cigarette policy, and then did a content analysis to identify tweet topics and users prominent in the conversation.

They found that of the 683 tweets mentioning CDPH during the week, 609 (89.2 percent) were anti-policy. More than half of anti-policy tweets were about use of electronic cigarettes for cessation as a healthier alternative to traditional tobacco cigarettes.

Just over one-third of anti-policy tweets asserted that the health department was lying or disseminating propaganda and approximately 14 percent of the tweets used an account or included elements consistent with “astroturfing” — a strategy employed to promote a false sense of consensus around an idea.

Few Twitter users were from the Chicago area. Twitter users from Chicago were significantly more likely than expected to tweet in support of the policy.

“While the response to the campaign was overwhelmingly negative overall, tweets from local Twitter users were mostly positive,” Harris said. “Public health professionals should be aware of these sorts of coordinated responses to controversial topics and recognize that the sentiment expressed may not be that of their local constituency.”