Sherry Pagoto*, University of Massachusetts Medical School, Worcester, United States Martinus Evans*, University of Connecticut, Storrs, United States Matthew Whited, East Carolina University, Greenville, United States Michael Bauman, MB Financial Group, Southfield, United States Theodore A Vickey, National University of Ireland Galway, Galway, Ireland Kristin L Schneider, Rosalind Franklin University, Chicago, United States Track: Research Presentation Topic: Blogs, Microblogs, Twitter Presentation Type: Oral presentation Submission Type: Single Presentation Building: Mermaid Room: Room 3 - Upper River Room Date: 2013-09-23 10:30 AM – 11:15 AM Last modified: 2013-09-25

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Background. Online social networks may have potential to spread health behavior and innovations given that two-thirds of internet users visit them regularly. The term “peer-to-peer healthcare” was recently coined to capture how patients are using the internet to search for others with similar health concerns. Health-related hashtags have appeared on Twitter and seem to be used to connect with people on a health-related issue, engage in a health behavior, and disseminate health messages. The aims of this study were to 1) describe health hashtags that receive at least 3 uses per day on Twitter, 2) report the usage rates of a sample of health-related hashtags, and 3) explore the type of social influence (both positive and negative) that people using online social networks experience from their online friends relative to their in-person friends and family members. Methods. We identified 46 health hashtags on Twitter using lists compiled in blog posts and articles found via Google searches, and by searching tweet histories of health hashtag users. We then tracked the usage of 7 hashtags using Archivist software. To explore social influence, we tweeted a link to an anonymous survey for Twitter users who discuss weight, diet, or physical activity on Twitter. Results. We identified 46 health-related hashtags on Twitter and 28% are used to indicate engagement in a specific health behavior, 33% denoted membership in an informal community, and 39% were started by a company (e.g., Nike, Weight Watchers, Crossfit, etc). Of the 7 health hashtags we tracked, tweets per day ranged from 4-306 tweets. Hashtags that indicated engagement in an activity had significantly more tweets per day than other types of hashtags. The number of followers of the initiator was not related to the popularity of the hashtag. About 20% of the behavior and community hashtags could not be traced to an initiator. In terms of social influence, participants (n=79) reported that they experience significantly greater social support from Twitter followers relative to Facebook friends (p=.00), family (p=.00), and in-person friends (p=.00). Participants also rated their Twitter followers as significantly less judgmental and negative than Facebook friends, family and in-person friends (p’s<.01). Conclusions. Health hashtags are used in a variety of ways on Twitter including to spread a health behavior and engage others in a community and/or discussion. Health hashtags have created communities on Twitter which may be helpful for people who would benefit from increased social support for their health behavior changes. Hashtags may also be used as a means of identifying people with specific health interests and concerns. Research is needed to explore whether hashtags can be used as an economical way to promote healthy behavior and improve health outcomes.