Opinion
VIEWPOINT
Ramone F. Williams, MPhil, MSIV Medical student at Harvard Medical School, Boston, Massachusetts. Gideon P. Smith, MD, PhD Department of Dermatology, Massachusetts General Hospital, Boston.
Corresponding Author: Ramone F. Williams, MPhil, MSIV, Attn: Gideon P. Smith, MD, PhD, Department of Dermatology, Massachusetts General Hospital, 50 Staniford St, Ste 200, Boston MA 02114 (ramone.f [email protected]). jamadermatology.com
Using “Big Data” to Optimize Public Health Outreach Answering the Call to Action Studies show that more than 90 million Americans use the Internet as a resource for health information, often by entering queries into popular search engines. These queries are logged into mass archives of “big data” that are freely accessible to the public. New studies have shown that big data can be used to track disease incidence and to gauge America’s interest in public health concerns. Dermatology has yet to grasp hold of this wealth of information. The best-studied application of big data has been in influenza. As influenza spread, Americans assessed their symptoms with online searches. Researchers used “Google Flu Trends” to predict weekly influenza activity across the United States in real time. This was an exciting breakthrough, considering that traditional Centers for Disease Control and Prevention surveillance data are reported with a 2-week lag, often after the peak of an epidemic.1 Early Google Flu Trends models overestimated the absolute incidence of influenza. As methodology was refined to correct inaccuracies, investigators realized that online search volume reflected not only disease activity but also media publicity.2 In fact, search engine query data have proven to be an invaluable asset in gauging public interest. Google Trends has been used to gauge interest in breast cancer screening,3 bariatric surgery,4 and uterine fibroids.5 We set out herein to establish that big data offers a wealth of information on topics of dermatologic importance. Although it would be relatively simple to demonstrate the significance of infectious information relevant to dermatologists such as Lyme disease, we focus on a key dermatologic public health concern not so intuitively related to this type of data: skin cancer. Despite substantial efforts in outreach and screening, the incidence of melanoma continues to increase, resulting in avoidable morbidity and mortality. On July 29, 2014, Boris D. Lushniak, MD, MPH, acting Surgeon General, issued a call to action to prevent skin cancer. For the first time in history, we have the weight of the US government behind us—as dermatologists, we must respond quickly and effectively. We propose that search engine query data have the potential to elucidate temporal variations in public interest that can be used to optimize public health initiatives in dermatology. We prospectively investigated trends in public interest in melanoma prevention using aggregated data from Google Trends, a public web application of Google Inc that reveals how frequently a search term is entered. Users can refine search data by geographic location and by any time period between 2004 and the
present. Users can compare the volume of searches between 2 or more topics, and data on searches over time or by location can be extracted. “Related searches” are ranked by popularity at the bottom of the web page. We used this function to select representative topics for our investigation. For example, the query “sunscreen” is more popular than “sunblock”; thus, we concluded that “sunscreen” was a better proxy for public interest in the product. Using this approach, we selected the terms “melanoma,” “sunscreen,” and “tanning” for our investigation. We refined our investigation to the United States between January 2004 and December 2013. These topics reflect historical aims of melanoma prevention campaigns, namely, reducing exposure to natural sun and artificial UV. The frequency of query topic “melanoma” followed cyclic variations according to the season (Figure). For the past decade, public interest peaks most frequently in May of every year. This likely reflects substantial efforts in awareness, outreach, and screening on Melanoma Monday—held annually on the first Monday in May. As proof of principle, we searched the topic “breast cancer.” There were steep peaks every October during Breast Cancer Awareness Month. These trends reveal the impact of Melanoma Monday and similar mass media campaigns. The topic “sunscreen” had cyclic variations that largely overlapped with those of “melanoma.” Furthermore, interest in sunscreen has increased over time. This finding implies the relative efficacy of melanoma prevention campaigns. We next searched the topic “tanning.” We used the related searches function to shed light on the intent of the public’s online searches. “Tanning salon,” “tanning bed,” and “tanning lotion” were the most popular related queries. This finding suggests a demand for indoor tanning. In contrast, the term “smoking” was followed closely in popularity by “quit smoking,” “stop smoking,” and “smoking effects,” implying public interest in smoking cessation rather than a demand for tobacco products. This finding reflects the public health victories against tobacco use and highlights the great deal of work that needs to be done to decrease indoor tanning. We compared the topics “tanning” and “melanoma.” “Tanning” received an average normalized score of 38 over the past 10 years, more than quadruple the search volume of “melanoma,” with a normalized value of 9. (These scores are normalized values on a scale of 0 to 100thatrepresentthesearchvolumeforaparticularterm, relative to the total volume of all Google searches.) Inter-
(Reprinted) JAMA Dermatology April 2015 Volume 151, Number 4
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archderm.jamanetwork.com/ by a Monash University Library User on 11/09/2015
367
Opinion Viewpoint
Figure. Seasonal Variations in Public Interest in Melanoma and Tanning A screenshot from the Google Trends website (www.google.com/trends) displaying the relative frequencies of the search queries “melanoma,” (blue), “tanning” (yellow), and “sunscreen” (red) from January 2004 to December 2013 in the United States. The graph depicts cyclic variations in public interest. The peak interest in melanoma lags behind the peak interest in tanning annually. The x-axis is labeled on the first day of each year. Monthly variations were investigated using the interactive functions available on the Google Trends website. Weekly variations were investigated by downloading a spreadsheet of search volumes recorded in weekly increments. “Note” informs users that in 2011 Google Trends made a modification to their data collection methods. Google and the Google logo are registered trademarks of Google Inc.
estingly, “tanning” peaks most frequently in April (Figure), possibly as a result of the public’s desire not to look too pale as the summer months approach. Unfortunately, peak interest in melanoma in May lags behind this fad—suggesting that our current efforts on Melanoma Monday may be too late each year. Additional studies are needed to validate and further investigate our findings. Still, our investigation reveals striking trends that have been corroborated in other fields. On the basis of our findings, there is a need for effective mass media campaigns targeted at the prevenARTICLE INFORMATION Published Online: November 12, 2014. doi:10.1001/jamadermatol.2014.3176. Conflict of Interest Disclosures: Dr Smith has served as a consultant to Cynosure and is currently principal investigator on an industry-sponsored study by Allergan. Neither disclosure is relevant to this Viewpoint. No other disclosures are reported. REFERENCES 1. Ginsberg J, Mohebbi MH, Patel RS, Brammer L, Smolinski MS, Brilliant L. Detecting influenza
368
tion of tanning and education of the public about the increased risk of melanoma with artificial UV exposure.6,7 As we answer the Surgeon General’s call and prepare to wage a multifaceted war against skin cancer, big data should lead a strategic approach. It is time to get with the times and undertake smarter approaches to skin cancer prevention. Big data are waiting to be mined; the wealth of information may be used to revolutionize skin cancer prevention, as well as many other applications in dermatology.
epidemics using search engine query data. Nature. 2009;457(7232):1012-1014.
around the world: what Google Trends can teach us. Surg Obes Relat Dis. 2014;10(3):533-538.
2. Santillana M, Zhang DW, Althouse BM, Ayers JW. What can digital disease detection learn from (an external revision to) Google Flu Trends? Am J Prev Med. 2014;47(3):341-347.
5. Brito LG, Ferriani RA, Candido-Dos-Reis FJ, Nogueira AA. Using a search-volume tool (Google Trends) to assess global interest for uterine fibroids. Arch Gynecol Obstet. 2014;289(6):1163-1164.
3. Fazeli Dehkordy S, Carlos RC, Hall KS, Dalton VK. Novel data sources for women’s health research: mapping breast screening online information seeking through Google Trends. Acad Radiol. 2014; 21(9):1172-1176.
6. Holman DM, Fox KA, Glenn JD, et al. Strategies to reduce indoor tanning: current research gaps and future opportunities for prevention. Am J Prev Med. 2013;44(6):672-681.
4. Linkov F, Bovbjerg DH, Freese KE, Ramanathan R, Eid GM, Gourash W. Bariatric surgery interest
7. O’Leary RE, Diehl J, Levins PC. Update on tanning: more risks, fewer benefits. J Am Acad Dermatol. 2014;70(3):562-568.
JAMA Dermatology April 2015 Volume 151, Number 4 (Reprinted)
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archderm.jamanetwork.com/ by a Monash University Library User on 11/09/2015
jamadermatology.com
VIEWPOINT
Ramone F. Williams, MPhil, MSIV Medical student at Harvard Medical School, Boston, Massachusetts. Gideon P. Smith, MD, PhD Department of Dermatology, Massachusetts General Hospital, Boston.
Corresponding Author: Ramone F. Williams, MPhil, MSIV, Attn: Gideon P. Smith, MD, PhD, Department of Dermatology, Massachusetts General Hospital, 50 Staniford St, Ste 200, Boston MA 02114 (ramone.f [email protected]). jamadermatology.com
Using “Big Data” to Optimize Public Health Outreach Answering the Call to Action Studies show that more than 90 million Americans use the Internet as a resource for health information, often by entering queries into popular search engines. These queries are logged into mass archives of “big data” that are freely accessible to the public. New studies have shown that big data can be used to track disease incidence and to gauge America’s interest in public health concerns. Dermatology has yet to grasp hold of this wealth of information. The best-studied application of big data has been in influenza. As influenza spread, Americans assessed their symptoms with online searches. Researchers used “Google Flu Trends” to predict weekly influenza activity across the United States in real time. This was an exciting breakthrough, considering that traditional Centers for Disease Control and Prevention surveillance data are reported with a 2-week lag, often after the peak of an epidemic.1 Early Google Flu Trends models overestimated the absolute incidence of influenza. As methodology was refined to correct inaccuracies, investigators realized that online search volume reflected not only disease activity but also media publicity.2 In fact, search engine query data have proven to be an invaluable asset in gauging public interest. Google Trends has been used to gauge interest in breast cancer screening,3 bariatric surgery,4 and uterine fibroids.5 We set out herein to establish that big data offers a wealth of information on topics of dermatologic importance. Although it would be relatively simple to demonstrate the significance of infectious information relevant to dermatologists such as Lyme disease, we focus on a key dermatologic public health concern not so intuitively related to this type of data: skin cancer. Despite substantial efforts in outreach and screening, the incidence of melanoma continues to increase, resulting in avoidable morbidity and mortality. On July 29, 2014, Boris D. Lushniak, MD, MPH, acting Surgeon General, issued a call to action to prevent skin cancer. For the first time in history, we have the weight of the US government behind us—as dermatologists, we must respond quickly and effectively. We propose that search engine query data have the potential to elucidate temporal variations in public interest that can be used to optimize public health initiatives in dermatology. We prospectively investigated trends in public interest in melanoma prevention using aggregated data from Google Trends, a public web application of Google Inc that reveals how frequently a search term is entered. Users can refine search data by geographic location and by any time period between 2004 and the
present. Users can compare the volume of searches between 2 or more topics, and data on searches over time or by location can be extracted. “Related searches” are ranked by popularity at the bottom of the web page. We used this function to select representative topics for our investigation. For example, the query “sunscreen” is more popular than “sunblock”; thus, we concluded that “sunscreen” was a better proxy for public interest in the product. Using this approach, we selected the terms “melanoma,” “sunscreen,” and “tanning” for our investigation. We refined our investigation to the United States between January 2004 and December 2013. These topics reflect historical aims of melanoma prevention campaigns, namely, reducing exposure to natural sun and artificial UV. The frequency of query topic “melanoma” followed cyclic variations according to the season (Figure). For the past decade, public interest peaks most frequently in May of every year. This likely reflects substantial efforts in awareness, outreach, and screening on Melanoma Monday—held annually on the first Monday in May. As proof of principle, we searched the topic “breast cancer.” There were steep peaks every October during Breast Cancer Awareness Month. These trends reveal the impact of Melanoma Monday and similar mass media campaigns. The topic “sunscreen” had cyclic variations that largely overlapped with those of “melanoma.” Furthermore, interest in sunscreen has increased over time. This finding implies the relative efficacy of melanoma prevention campaigns. We next searched the topic “tanning.” We used the related searches function to shed light on the intent of the public’s online searches. “Tanning salon,” “tanning bed,” and “tanning lotion” were the most popular related queries. This finding suggests a demand for indoor tanning. In contrast, the term “smoking” was followed closely in popularity by “quit smoking,” “stop smoking,” and “smoking effects,” implying public interest in smoking cessation rather than a demand for tobacco products. This finding reflects the public health victories against tobacco use and highlights the great deal of work that needs to be done to decrease indoor tanning. We compared the topics “tanning” and “melanoma.” “Tanning” received an average normalized score of 38 over the past 10 years, more than quadruple the search volume of “melanoma,” with a normalized value of 9. (These scores are normalized values on a scale of 0 to 100thatrepresentthesearchvolumeforaparticularterm, relative to the total volume of all Google searches.) Inter-
(Reprinted) JAMA Dermatology April 2015 Volume 151, Number 4
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archderm.jamanetwork.com/ by a Monash University Library User on 11/09/2015
367
Opinion Viewpoint
Figure. Seasonal Variations in Public Interest in Melanoma and Tanning A screenshot from the Google Trends website (www.google.com/trends) displaying the relative frequencies of the search queries “melanoma,” (blue), “tanning” (yellow), and “sunscreen” (red) from January 2004 to December 2013 in the United States. The graph depicts cyclic variations in public interest. The peak interest in melanoma lags behind the peak interest in tanning annually. The x-axis is labeled on the first day of each year. Monthly variations were investigated using the interactive functions available on the Google Trends website. Weekly variations were investigated by downloading a spreadsheet of search volumes recorded in weekly increments. “Note” informs users that in 2011 Google Trends made a modification to their data collection methods. Google and the Google logo are registered trademarks of Google Inc.
estingly, “tanning” peaks most frequently in April (Figure), possibly as a result of the public’s desire not to look too pale as the summer months approach. Unfortunately, peak interest in melanoma in May lags behind this fad—suggesting that our current efforts on Melanoma Monday may be too late each year. Additional studies are needed to validate and further investigate our findings. Still, our investigation reveals striking trends that have been corroborated in other fields. On the basis of our findings, there is a need for effective mass media campaigns targeted at the prevenARTICLE INFORMATION Published Online: November 12, 2014. doi:10.1001/jamadermatol.2014.3176. Conflict of Interest Disclosures: Dr Smith has served as a consultant to Cynosure and is currently principal investigator on an industry-sponsored study by Allergan. Neither disclosure is relevant to this Viewpoint. No other disclosures are reported. REFERENCES 1. Ginsberg J, Mohebbi MH, Patel RS, Brammer L, Smolinski MS, Brilliant L. Detecting influenza
368
tion of tanning and education of the public about the increased risk of melanoma with artificial UV exposure.6,7 As we answer the Surgeon General’s call and prepare to wage a multifaceted war against skin cancer, big data should lead a strategic approach. It is time to get with the times and undertake smarter approaches to skin cancer prevention. Big data are waiting to be mined; the wealth of information may be used to revolutionize skin cancer prevention, as well as many other applications in dermatology.
epidemics using search engine query data. Nature. 2009;457(7232):1012-1014.
around the world: what Google Trends can teach us. Surg Obes Relat Dis. 2014;10(3):533-538.
2. Santillana M, Zhang DW, Althouse BM, Ayers JW. What can digital disease detection learn from (an external revision to) Google Flu Trends? Am J Prev Med. 2014;47(3):341-347.
5. Brito LG, Ferriani RA, Candido-Dos-Reis FJ, Nogueira AA. Using a search-volume tool (Google Trends) to assess global interest for uterine fibroids. Arch Gynecol Obstet. 2014;289(6):1163-1164.
3. Fazeli Dehkordy S, Carlos RC, Hall KS, Dalton VK. Novel data sources for women’s health research: mapping breast screening online information seeking through Google Trends. Acad Radiol. 2014; 21(9):1172-1176.
6. Holman DM, Fox KA, Glenn JD, et al. Strategies to reduce indoor tanning: current research gaps and future opportunities for prevention. Am J Prev Med. 2013;44(6):672-681.
4. Linkov F, Bovbjerg DH, Freese KE, Ramanathan R, Eid GM, Gourash W. Bariatric surgery interest
7. O’Leary RE, Diehl J, Levins PC. Update on tanning: more risks, fewer benefits. J Am Acad Dermatol. 2014;70(3):562-568.
JAMA Dermatology April 2015 Volume 151, Number 4 (Reprinted)
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archderm.jamanetwork.com/ by a Monash University Library User on 11/09/2015
jamadermatology.com
