Original article
#Proana: Pro-Eating Disorder Socialization on Twitter

https://doi.org/10.1016/j.jadohealth.2016.02.012Get rights and content

Abstract

Purpose

Pro–eating disorder (ED) online movements support engagement with ED lifestyles and are associated with negative health consequences for adolescents with EDs. Twitter is a popular social media site among adolescents that provides a unique setting for Pro-ED content to be publicly exchanged. The purpose of this study was to investigate Pro-ED Twitter profiles' references to EDs and how their social connections (followers) reference EDs.

Methods

A purposeful sample of 45 Pro-ED profiles was selected from Twitter. Profile information, all tweets, and a random sample of 100 of their followers' profile information were collected for content analysis using the Twitter Application Programming Interface. A codebook based on ED screening guidelines was applied to evaluate ED references. For each Pro-ED profile, proportion of tweets with ED references and proportion of followers with ED references in their own profile were evaluated.

Results

In total, our 45 Pro-ED profiles generated 4,245 tweets for analysis. A median of 36.4% of profiles' tweets contained ED references. Pro-ED profiles had a median of 173 followers, and a median of 44.5% of followers had ED references. Pro-ED profiles with more tweets with ED references also tended to have more followers with ED references (β = .37, p < .01).

Conclusions

Findings suggest that profiles which self-identify as Pro-ED express disordered eating patterns through tweets and have an audience of followers, many of whom also reference ED in their own profiles. ED socialization on Twitter might provide social support, but in the Pro-ED context this activity might also reinforce an ED identity.

Section snippets

Setting

This descriptive study used public Twitter data from Pro-ED profiles and their followers, collected between February and April 2014. This study was determined to qualify as not human subjects' research by the University of Washington's institutional review board because public Twitter handles are avatars and are not identifiable, living individuals according to local and national regulations.

Pro-ED profile and follower sampling strategy

Our first goal was to identify a sample of Pro-ED profiles for evaluation. We used purposeful sampling

Pro-ED profile sample characteristics

Forty-five Pro-ED profiles were selected from Twitter, 86.7% (N = 39) of Pro-ED profiles displayed ED references in their profile name, screen name, or description. Furthermore, 64.4% (N = 29) displayed an ED reference in two or three of these locations, and 33.3% (N = 15) displayed an ED reference in all three of these locations. No Pro-ED profiles displayed references in their location.

Demographic data were not universally available, 13 profiles (28.9%) displayed an age; the mean was 17.7

Discussion

This study applied keywords from a validated clinical screen to Twitter content, examining a purposeful sample of Pro-ED profiles and their followers. Findings suggest that Pro-ED profiles are indeed created and expressed on the social media site of Twitter, and these online identities tend to attract an audience of followers who are like-minded individuals.

Our first finding is that more than a third (36.4%) of Pro-ED profiles' tweets were ED related. The presence of Twitter profiles dedicated

Acknowledgments

The authors thank Laura Hooper, MS, RD, CD in Adolescent Medicine at Seattle Children's Hospital, for special consultation on this project and Bradley Kerr for editing assistance. This research was presented in a poster symposium presentation at the Society for Adolescent Health and Medicine Meeting 2015, and at the Social Media and Adolescent Health Research Team Conference 2014.

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    Conflicts of Interest: The authors have no conflicts of interest or financial disclosures to report.

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