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      I just want to be skinny.”: A content analysis of tweets expressing eating disorder symptoms

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          Abstract

          There is increasing concern about online communities that promote eating disorder (ED) behaviors through messages and/or images that encourage a “thin ideal” (i.e., promotion of thinness as attractive) and harmful weight loss/weight control practices. The purpose of this paper is to assess the content of body image and ED-related content on Twitter and provide a deeper understanding of EDs that may be used for future studies and online-based interventions. Tweets containing ED or body image-related keywords were collected from January 1-January 31, 2015 (N = 28,642). A random sample (n = 3000) was assessed for expressions of behaviors that align with subscales of the Eating Disorder Examination (EDE) 16.0. Demographic characteristics were inferred using a social media analytics company. The comprehensive research that we conducted indicated that 2,584 of the 3,000 tweets were ED-related; 65% expressed a preoccupation with body shape, 13% displayed issues related to food/eating/calories, and 4% expressed placing a high level of importance on body weight. Most tweets were sent by girls (90%) who were ≤19 years old (77%). Our findings stress a need to better understand if and how ED-related content on social media can be used for targeting prevention and intervention messages towards those who are in-need and could potentially benefit from these efforts.

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          Most cited references17

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          Psychometric evaluation of the eating disorder examination and eating disorder examination-questionnaire: a systematic review of the literature.

          The purpose of this study was to systematically review the reliability of scores on the Eating Disorder Examination (EDE) and the Eating Disorder Examination-Questionnaire (EDE-Q) and to examine the validity of their use as measures of eating disorder symptoms. Articles describing the psychometric properties of the EDE and EDE-Q were identified in a systematic search of major computer databases and a review of reference lists. Articles were selected based on a priori inclusion and exclusion criteria. Fifteen studies were identified that examined the psychometrics of the EDE, whereas 10 studies were found that examined the psychometrics of the EDE-Q. Both instruments demonstrated reliability of scores. There is evidence that scores on the EDE and EDE-Q correlate with scores on measures of similar constructs and support for using the instruments to distinguish between cases and non-cases. Additional research is needed to broaden the generalizability of the findings. Copyright © 2011 Wiley Periodicals, Inc.
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            Reliability in Content Analysis.

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              Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples.

              In order to examine the concurrent and criterion validity of the questionnaire version of the Eating Disorders Examination (EDE-Q), self-report and interview formats were administered to a community sample of women aged 18-45 (n = 208). Correlations between EDE-Q and EDE subscales ranged from 0.68 for Eating Concern to 0.78 for Shape Concern. Scores on the EDE-Q were significantly higher than those of the EDE for all subscales, with the mean difference ranging from 0.25 for Restraint to 0.85 for Shape Concern. Frequency of both objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) was significantly correlated between measures. Chance-corrected agreement between EDE-Q and EDE ratings of the presence of OBEs was fair, while that for SBEs was poor. Receiver operating characteristic (ROC) analysis, based on a sample of 13 cases, indicated that a score of 2.3 on the global scale of the EDE-Q in conjunction with the occurrence of any OBEs and/or use of exercise as a means of weight control, yielded optimal validity coefficients (sensitivity = 0.83, specificity = 0.96, positive predictive value = 0.56). A stepwise discriminant function analysis yielded eight EDE-Q items which best distinguished cases from non-cases, including frequency of OBEs, use of exercise as a means of weight control, use of self-induced vomiting, use of laxatives and guilt about eating. The EDE-Q has good concurrent validity and acceptable criterion validity. The measure appears well-suited to use in prospective epidemiological studies.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – original draft
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: VisualizationRole: Writing – original draft
                Role: InvestigationRole: MethodologyRole: VisualizationRole: Writing – original draft
                Role: Writing – review & editing
                Role: ValidationRole: Writing – review & editing
                Role: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                16 January 2019
                2019
                : 14
                : 1
                : e0207506
                Affiliations
                [001]Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
                Institut Català de Paleoecologia Humana i Evolució Social (IPHES), SPAIN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-3352-1198
                Article
                PONE-D-17-15569
                10.1371/journal.pone.0207506
                6334988
                30650072
                5b932d08-a502-427e-8248-ac11ac945ba0
                © 2019 Cavazos-Rehg et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 21 April 2017
                : 18 October 2018
                Page count
                Figures: 2, Tables: 2, Pages: 11
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;
                Award ID: R01DA032843
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;
                Award ID: R01DA039455
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100006108, National Center for Advancing Translational Sciences;
                Award ID: UL1 TR000448
                This work was supported by the National Institutes of Health [grant numbers R01DA032843 (PCR), R01DA039455 (PCR)] and the Washington University Institute of Clinical and Translational Sciences from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) [grant number UL1 TR000448]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Social Sciences
                Sociology
                Communications
                Social Communication
                Social Media
                Twitter
                Computer and Information Sciences
                Network Analysis
                Social Networks
                Social Media
                Twitter
                Social Sciences
                Sociology
                Social Networks
                Social Media
                Twitter
                Biology and Life Sciences
                Physiology
                Physiological Processes
                Eating
                Medicine and Health Sciences
                Physiology
                Physiological Processes
                Eating
                Social Sciences
                Sociology
                Communications
                Social Communication
                Social Media
                Computer and Information Sciences
                Network Analysis
                Social Networks
                Social Media
                Social Sciences
                Sociology
                Social Networks
                Social Media
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Eating Disorders
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Pelvis
                Hip
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Pelvis
                Hip
                Medicine and Health Sciences
                Diagnostic Medicine
                Diagnostic Radiology
                Bone Imaging
                Research and Analysis Methods
                Imaging Techniques
                Diagnostic Radiology
                Bone Imaging
                Medicine and Health Sciences
                Radiology and Imaging
                Diagnostic Radiology
                Bone Imaging
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Behavioral Disorders
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Custom metadata
                Raw data (tweets from the full Twitter data stream) was purchased from Gnip, Inc. ( https://gnip.com/). Gnip collected data via their Historical PowerTrack API ( http://support.gnip.com/apis/historical_api2.0/). Data cannot be shared to comply with the Gnip\Twitter terms of service, but de-identified data for the codes assigned to the 3000 tweets, along with a codebook, are available within the Supporting Information files. Our team did not receive special privileges from Gnip; thus, we expect that future researchers interested in obtaining tweets from the full Twitter firehose could purchase such data in the same manner from Gnip, Inc. Additional data was provided by DemographicsPro. Raw data from DemographicsPro was not made available to the research team; only a report with aggregate results was provided to the research team. DemographicsPro is available to perform similar analyses. Details can be found on their website at www.demographicspro.com. They may be contacted by email at info@ 123456demographicspro.com or by phone at (919)-246-0180.

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