title: Are public health organizations tweeting to the choir? Understanding local health department Twitter followership.
abstract: BACKGROUND
  One of the essential services provided by the US local health departments is informing and educating constituents about health. Communication with constituents about public health issues and health risks is among the standards required of local health departments for accreditation. Past research found that only 61% of local health departments met standards for informing and educating constituents, suggesting a considerable gap between current practices and best practice.
  
  
  OBJECTIVE
  Social media platforms, such as Twitter, may aid local health departments in informing and educating their constituents by reaching large numbers of people with real-time messages at relatively low cost. Little is known about the followers of local health departments on Twitter. The aim of this study was to examine characteristics of local health department Twitter followers and the relationship between local health department characteristics and follower characteristics.
  
  
  METHODS
  In 2013, we collected (using NodeXL) and analyzed a sample of 4779 Twitter followers from 59 randomly selected local health departments in the United States with Twitter accounts. We coded each Twitter follower for type (individual, organization), location, health focus, and industry (eg, media, government). Local health department characteristics were adopted from the 2010 National Association of City and County Health Officials Profile Study data.
  
  
  RESULTS
  Local health department Twitter accounts were followed by more organizations than individual users. Organizations tended to be health-focused, located outside the state from the local health department being followed, and from the education, government, and non-profit sectors. Individuals were likely to be local and not health-focused. Having a public information officer on staff, serving a larger population, and "tweeting" more frequently were associated with having a higher percentage of local followers.
  
  
  CONCLUSIONS
  Social media has the potential to reach a wide and diverse audience. Understanding audience characteristics can help public health organizations use this new tool more effectively by tailoring tweet content and dissemination strategies for their audience.
authors.affiliation: Brown School, Washington University in St Louis, St Louis, MO, United States. harrisj@wustl.edu.
authors.forename: Jenine K
authors.initials: JK
authors.lastname: Harris
authors.forename: Bechara
authors.initials: B
authors.lastname: Choucair
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Maier
authors.forename: Nina
authors.initials: N
authors.lastname: Jolani
authors.forename: Jay M
authors.initials: JM
authors.lastname: Bernhardt
mesh_terms: D003142:Communication; D054626:Consumer Health Information / Q000379:methods; D009111:Local Government; D011635:Public Health Administration; D061108:Social Media; D014481:United States
keywords: Twitter; local health department; social media