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This editorial explores the implications of social media practices whereby people with mental health problems share their experiences in online public spaces and challenge mental health stigma. Social media enable individuals to bring personal experience into the public domain with the potential to affect public attitudes and mainstream media. We draw tentative conclusions regarding the use of social media by campaigning organisations. Copyright and usage (C) The Royal College of Psychiatrists 2015.
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Social media use by individuals
to challenge stigma
Social media can be defined as internet-based applications that
allow the creation and exchange of user-generated content.
Recent Ofcom
figures indicate that 47% of the adult population
in the UK use social media. However, low income families and
disabled people are less likely to use the internet,
raising concerns
that people who are already marginalised are less likely to be heard.
Despite the barriers for some, social media are inexpensive
and easy to use. They signify a trend towards more interaction
whereby people create as well as consume content. It is possible
to share stories, produce other content and influence the media
We argue that it is individuals, rather than
institutions, who are leading the way in bringing conversations
about mental health into public online spaces. We believe this is
important to highlight, as the more negative affordances of social
media are often emphasised. Although social media encompass
many different channels, we have selected case studies that
illustrate how the micro-blogging platform Twitter has been used
to challenge stigma. Twitter is an internet application that allows
140-character messages to be publicly sent and quickly shared
across many users.
Methods for challenging mental health stigma include
education, contact and protest.
Education replaces stereotypes
with accurate facts and figures; personal contact between members
of a stigmatised group and others undermines prevailing
stereotypes; protest highlights injustice and rebukes stigmatising
attitudes. Interaction on Twitter about mental health features a
dynamic blend of these approaches, with personal narratives at
the core.
A striking illustration of how social media can be used by
people with mental health problems to challenge stigma is a
protest on Twitter that took place in September 2013. Thousands
of people, offended by the ‘mental patient’ Halloween costume
advertised on the website of the national supermarket Asda’s
George clothing collection, sent tweets to show their disapproval.
The topic ‘went viral’ with tweets passed rapidly and across
networks. The story was the lead item on national news the next
day with mainstream media sourcing their information from
Asda and other retailers removed the costumes from sale,
apologised, and made donations to England’s ‘Time to Change’
anti-stigma campaign.
During the protest, a #mentalpatient hashtag was created by
people with lived experience. They posted photographs of
themselves (‘selfies’) alongside text such as ‘this is what a real
mental patient looks like’, to satirise the costume. The hashtag,
which creates a searchable string, was used 6694 times in 24 h.
The sharing of tweets by thousands of people may create a sense
of solidarity, as well as minimising a recognised limitation of
‘direct contact’, namely discounting the experience of one or a
few people as an exception, rather than the norm.
When scores
of people use a common hashtag it may be harder to ignore or
minimise their experience.
The protest was initiated by individuals on Twitter and
later backed by campaigning organisations. They amplified the
conversation and exploited journalistic interest so that the story
was taken into traditional media channels. Participants included
individuals with lived experience of mental health problems,
activists, journalists, public figures, charities and institutions.
The event suggests a willingness by many people personally
affected by mental health issues to voice their protest and to share
their experiences publically. The extent to which such incidents
have a positive effect on wider public attitudes has yet to be
measured, but it certainly illustrates an effect on the actions of
several corporations.
A striking aspect of social media sites such as Twitter is that a
spontaneous burst of protest can be initiated by one individual in a
single post and widely shared. The #DearMentalHealthProfessionals
hashtag was started on Twitter in early August 2013 by Amanda
after receiving a discharge letter from her mental health team.
She used the hashtag to voice her distress and the feedback she
would like to give to the team. It was quickly shared and added
to by a diverse mix of people with experience of using mental
health services. Although modest in comparison with the Asda
The role of social media in reducing
stigma and discrimination
Victoria Betton, Rohan Borschmann, Mary Docherty, Stephen Coleman,
Mark Brown and Claire Henderson
This editorial explores the implications of social media
practices whereby people with mental health problems
share their experiences in online public spaces and
challenge mental health stigma. Social media enable
individuals to bring personal experience into the public
domain with the potential to affect public attitudes
and mainstream media. We draw tentative conclusions
regarding the use of social media by campaigning
Declaration of interest
Copyright and usage
BThe Royal College of Psychiatrists 2015.
The British Journal of Psychiatry (2015)
206, 443–444. doi: 10.1192/bjp.bp.114.152835
Victoria Betton (pictured) is a PhD student at the Institute of Communications,
University of Leeds and is employed by Leeds and York Partnership NHS
Foundation Trust as an mHealth programme director. Rohan Borschmann is a
postdoctoral researcher at King’s College London, Institute of Psychiatry,
Psychology and Neurology. Mary Docherty is a NIHR academic clinical fellow
at King’s College London, Institute of Psychiatry, Psychology and Neurology.
Stephen Coleman is Professor of Political Communication at the Institute
of Communications, University of Leeds. Mark Brown is the development
director of Social Spider CIC and the editor of
One in Four
Claire Henderson is a clinical senior lecturer in psychiatry in the Health
Service and Population Research Department at King’s College London,
Institute of Psychiatry, Psychology and Neurology.
episode, it reached more people than would be readily possible
through non-virtual means. One practitioner tweeted: ‘This is
the info my team needs to know. Am going to use it in my team
meeting’. This tweet indicates how online content can be spread to
an offline environment. The motivation behind hashtags is not
necessarily as simple as a desire to make services better; sharing
experiences and having one’s voice heard on social channels can
create a sense of empowerment – of feeling less alone with a
personal struggle, and more confidence in showing a part of the
self that might usually remain hidden.
Helen, a mental health nurse, shared her experience as a
psychiatric in-patient on Twitter out of both ‘boredom and
frustration’ and to elicit support she felt she was not receiving
from ward staff: ‘it was quite a surreal experience . . . all these people
who we’d [Helen and her partner] never met, reaching out and
supporting us – people who’d used services before, people who
were carers, people who were professionals and people who never
had anything to do with mental health ever, but just were for some
reason touched by what I was tweeting and were interested’. As
well as gaining support and validation, Helen was also motivated
by challenging mental health stigma. She reached people she
would never otherwise have had contact with, as illustrated by
the 800 new followers she gained on Twitter during the week,
the re-tweets and the supportive responses she received. This is
another example of how direct contact on social media enables
sharing beyond the boundaries of face-to-face interactions and
can connect with new audiences.
Anti-stigma programmes’ use of social media
Social media channels are increasingly used by anti-stigma
programmes to share their work and influence public attitudes.
New Zealand’s ‘Like Minds, Like Mine’ Facebook page entitled
‘Stigma Watch’ allows members to post and discuss media articles
of concern because of their stigmatising content, thereby providing a
space for conversation.
‘Beyondblue’, Australia’s national depression and anxiety
initiative, uses the hashtag #SmashTheStigma whenever stories
of hope and recovery are posted, and has led to others using the
hashtag to share anti-stigma efforts.
The Swedish anti-stigma campaign ‘Hja
¨rnkoll’ has 65 bloggers
who write about mental health. When researching this editorial,
¨rnkoll’s communications officer asked Facebook fans how
social media can challenge stigma; in 3 days it was viewed by more
than 5000 people, received 225 ‘likes’, 77 comments and was
shared 41 times. One respondent observed that, by providing
people with the ability to ‘peek through the window’ surrounding
mental distress, social media is ‘a great way for people to digest
mental illness in their immediate surroundings without having
to be overpowered by social discomfort’. The ‘Time to Change’
campaign was launched in England in 2008. At the time of
writing, the campaign has 57 467 followers on Twitter with 224
re-tweets of the most recent post; and 129 000 fans on Facebook
with 431 likes on the most recent status update. These figures
indicate a significant number of people with whom the campaign
can connect regularly, and high levels of interaction with posts
that can amplify their cause.
Along with advertisements on YouTube, Spain’s ‘Obertament’
campaign uses Facebook and Twitter to inform people about their
efforts to eradicate stigma. Denmark’s ‘En Af Os’ campaign’s
Facebook page has attracted 16 398 ‘likes’, making it the country’s
second highest ranking website about mental health. Figures show
that ‘feel good’ photos about mental health attract more shares
than anything else posted on the page.
More sophisticated use of social media monitoring will see
campaigns increasingly anticipating and responding quickly to
mental health topics being discussed by individuals on social
media channels, as well as benchmarking and measuring their
This article demonstrates the potential democratising and
catalysing effects of social media in relation to public discourse
about mental health. Personal stories and unheard voices can be
made public and shared without temporal and spatial barriers.
They have significant potential to facilitate a dynamic blend of
education, contact and protest. This rise in user-generated content
means that collective action by individuals has the potential to
influence mainstream media and policy without sole reliance on
campaigning organisations. It may be that we are more likely to
adjust our attitudes because of what our peers think than because
of what organisations encourage us to think. The examples
provided in this editorial show how citizens have asked and
answered questions that organisations would not necessarily have
Campaigns are increasingly incorporating social media into
their communication channels, but perhaps their most important
role is amplifying individual-led conversations and channelling
them to mainstream media. Social media channels provide spaces
for professionals to learn and share by connecting with people
accessing services and colleagues. Further work should examine
the relationship between social media activity and changing public
attitudes to mental ill health.
Victoria Betton, PhD candidate, Institute of Communications, University of Leeds,
Leeds; Rohan Borschmann, PhD, DClinPsy, Mary Docherty, MRCP, MRCPsych,
King’s College London, Institute of Psychiatry, Psychology and Neurology, London;
Stephen Coleman, PhD, Institute of Communications, University of Leeds,
Leeds; Mark Brown, Social Spider CIC and
One in Four
magazine, London;
Claire Henderson, MRCPsych, PhD, Health Service and Population Research
Department, King’s College London, Institute of Psychiatry, Psychology and Neurology,
London, UK
Correspondence: Claire Henderson, Health Service and Population Research
Department P029, David Goldberg Centre, King’s College London, Institute of
Psychiatry, Psychology and Neurology, De Crespigny Park, London SE5 8AF, UK.
First received 1 Sep 2014, accepted 6 Nov 2014
C.H. is supported by a grant to Time To Change from the Government Department of
Health in England and Comic Relief and is an advisor for the evaluation of the En Af Os
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2Ofcom. Facts and Figures. Ofcom, 2014 (
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4Al Ramiah A, Hewstone M. Intergroup contact as a tool for reducing,
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5BBC News. Asda and Tesco withdraw Halloween costume outfits. BBC News
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6Corrigan P, Morris S, Michaels P, Rafacz JD, Rusch N. Challenging the public
stigma of mental illness: a meta-analysis of outcome studies. Psychiatr Serv
2012 63: 963–73.
Betton et al
10.1192/bjp.bp.114.152835Access the most recent version at DOI:
2015, 206:443-444.BJP
Victoria Betton, Rohan Borschmann, Mary Docherty, Stephen Coleman, Mark Brown and Claire
The role of social media in reducing stigma and discrimination
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... The results of this study indicate that a targeted approach aimed at increasing awareness about key features of TS and the importance of regular clinical surveillance in Black and Hispanic communities may reduce health disparities. Social media campaigns to improve health knowledge and promote self-care can be an effective channel to reach underrepresented communities [13][14][15] . For TS, an effective educational campaign may include a list of questions to ask at clinic visits and promulgation of the "transition passport" that was developed so that patients can anticipate their care needs [16] . ...
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Aim: Turner Syndrome (TS) is caused by partial or complete absence of the second sex chromosome in a phenotypic female. TS is associated with recognizable congenital anomalies and chronic health conditions. The principal objective of this study was to evaluate the health-related knowledge and insight of participants. Methods: In 2015, we founded the UTHealth Turner Syndrome Research Registry for longitudinal follow-up of individuals with TS. Study participants were recruited from UTHealth Houston clinics and the Turner Syndrome Society of the United States. Participants completed a questionnaire about demographics, karyotype, congenital anomalies, health history, frequency of contact with care providers, and knowledge of care providers about TS. Results: Forty percent of registry participants indicated that they did not know their karyotypes. Knowledge of karyotype, which can predict clinical outcomes in TS, markedly varied by self-reported race and ethnicity but not by age. Participants also reported significant gaps in routine medical and gynecologic care. Conclusion: We identified knowledge gaps and health disparities that could benefit from improved provider and patient education.
... Public health interventions through social media can be developed to reduce HIV public stigma (Betton et al., 2015). Social media is a relatively new direction that is emerging in the field of public health; it offers novel opportunities in prevention and surveillance, responses to major public health emergencies, and health communications (Finch et al., 2016). ...
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Media exposure and news frames have been shown to influence on public stigma and discrimination. However, the mechanisms potentially resulting in HIV public stigma are not fully understood. The purpose of this research was to explore the positive role of state empathy in reducing HIV public stigma through news information engagement. The first cross-sectional study explored the relationships between news information engagement, state empathy, and HIV public stigma. A group of college students (N = 408) were invited to complete self-report measures. The results indicated that state empathy mediated the relationship between news information engagement and HIV public stigma. The follow-up experimental study examined whether reading different news, operationalized as news information engagement on social media, increased or reduced state empathy, which in turn would affect HIV public stigma. The second group of participants (N = 120) was randomly assigned to three experimental conditions (positive, neutral, and negative news). State empathy, HIV public stigma, and HIV/AIDS scientific knowledge were assessed at 20-day intervals to establish the baseline and evaluate post-experiment levels. Significant differences were observed in the three experimental groups. The results suggest that news information engagement is beneficial in reducing HIV public stigma by cultivating state empathy. News articles with positive descriptions and HIV/AIDS scientific knowledge articles reported on social media can be used to develop interventions for reducing public stigma.
... Another strategy, education, entails communi cating information about disabilities, with the primary aim of challenging negative beliefs and assumptions. Social media has facilitated an expansion of education-based anti-stig ma messages that can reach individuals via a variety of platforms and formats (e.g., Twit ter, Facebook; Betton et al., 2015). Finally, in contact-based strategies, individuals with disabilities speak about their personal experiences with disability, either in person or through another medium such as video. ...
Strategies to diminish stigma’s harm are driven by three agendas. (1) A services agenda, which seeks to decrease stigma so people better engage in care, (2) a rights agenda, which seeks to stem the injustice of stigma so people are able to meet life goals and aspirations, and (3) a self-worth agenda, which strives to replace shame with self-affirming attitudes in people impacted by stigma. With these agendas in mind, we summarize research on anti-stigma strategies in terms of public stigma and self-stigma. Two approaches have dominated efforts to lessen public stigma approaches: education and contact. Contrary to the predominance of education in public health approaches to attitude change, education effects are relatively muted, especially compared to contact. Research consistently shows that public encounters with people in recovery lead to significant improvements in stigma. Several approaches to self-stigma change have emerged, including psychoeducation, cognitive-behavioral, and strategic disclosure. Psychoeducation teaches people who internalize stereotypes about how these stereotypes are false. Cognitive-behavioral strategies then guide participants in challenging the false stereotypes they have used to cause personal shame. Strategic disclosure reflects insights on how being in the stigma closet harms self-esteem and self-efficacy. People who decide to come out with their mental health experiences report less self-stigma and greater empowerment. Unlike public stigma, research is unclear about the success of these self-stigma approaches vis-à-vis the others.
Psychological complications of chronic diseases are often underestimated because they may be interpreted as normal consequences of the underlying illness. Additionally, chronic patients may find several obstacles to healthcare access, including physical, socioeconomic, geographical and psychological barriers. Social media may be potential tools to provide psychological care extending the possibility of treatment where the offer is limited. This review aimed to explore the use of social media in administering psychological interventions to patients with chronic noncommunicable diseases. Following the PRISMA guidelines, a systematic review was conducted by searching PubMed, Embase and PsycInfo (from 2004 to 2021). Randomized controlled trials outlining the social media use in administering psychological assistance to patients with chronic noncommunicable diseases were considered eligible. Out of 9838 records identified, 75 papers were included. Peer-to-peer interaction was the most used (n = 22), mainly via chat rooms and forums. Interventions were mostly administered to patients with psychiatric (n = 41) or oncologic disorders (n = 12). This work highlighted a lack of tailored interventions based on disease, age or gender, and a use of a limited range of relatively old platforms such as emails, blogs and forums. To administer efficient interventions, it would be advisable to continuously analyze the evolving use of these tools.
Purpose This study aims to examine the factors that influence the adoption of social media to meet the service needs of persons with disabilities. Design/methodology/approach This study outlines the social media adoption model in disability services by using theories of persons with disabilities’ resistance, extreme-ableist expressions and exploit-ecological theories. A questionnaire survey is conducted among citizens who participate in disability-related activities. Findings The adoption of social media is influenced by disability norms, administrative and platform support. Emerging trends, such as disability politics and inclusion, are inconsequential. Research limitations/implications Results implicate that frequent sharing of disability rights perspectives and awareness initiatives can enhance social media platforms for disability services. Practical implications In regional disability services, the scope of social media is hampered by a lack of reporting capabilities and a paucity of digital content sensitive to disability. Originality/value The disability interest group reported less specialised services enabled by social media from developing nations. The current study addresses this research gap.
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Background Electroconvulsive therapy (ECT) is an effective and safe medical procedure that mainly indicated for depression, but is also indicated for patients with other conditions. However, ECT is among the most stigmatized and controversial treatments in medicine. Our objective was to examine social media contents on Twitter related to ECT to identify and evaluate public views on the matter. Methods We collected Twitter posts in English and Spanish mentioning ECT between January 1, 2019 and October 31, 2020. Identified tweets were subject to a mixed method quantitative–qualitative content and sentiment analysis combining manual and semi-supervised natural language processing machine-learning analyses. Such analyses identified the distribution of tweets, their public interest (retweets and likes per tweet), and sentiment for the observed different categories of Twitter users and contents. Results “Healthcare providers” users produced more tweets (25%) than “people with lived experience” and their “relatives” (including family members and close friends or acquaintances) (10% combined), and were the main publishers of “medical” content (mostly related to ECT’s main indications). However, more than half of the total tweets had “joke or trivializing” contents, and such had a higher like and retweet ratio. Among those tweets manifesting personal opinions on ECT, around 75% of them had a negative sentiment. Conclusions Mixed method analysis of social media contents on Twitter offers a novel perspective to examine public opinion on ECT, and our results show attitudes more negative than those reflected in studies using surveys and other traditional methods.
There remains a persistent need for mental health services among youth, with the majority of youth untreated. Digital mental health interventions (DMHIs) have the potential to revolutionize mental health care for adolescents. DMHIs are digital tools aiding in detection, prevention, and treatment of mental health problems for adolescents. DMHIs provide interventions and services that are accessible, low-cost, and available to adolescents. This chapter discusses barriers to mental health care among adolescents, followed by a discussion of how DMHIs can address these barriers to improve access to and quality of adolescent mental health services. It reviews research on DMHIs and digital frameworks used to collect and deliver psychoeducation, assessment, and interventions across hardware (e.g., smartphones, computers) and modalities (e.g., online, text, apps). It concludes with a discussion of current limitations of DMHIs and directions for the field to improve the development, dissemination, and implementation of adolescent mental health care using DMHIs.
The persistence of stigma of mental illness and seeking therapy perpetuates suffering and keeps people from getting the help they need and deserve. This volume, analysing the most up-to-date research on this process and ways to intervene, is designed to give those who are working to overcome stigma a strong, research-based foundation for their work. Chapters address stigma reduction efforts at the individual, community, and national levels, and discuss what works and what doesn't. Others explore how holding different stigmatized identities compounds the burden of stigma and suggest ways to attend to these differences. Throughout, there is a focus on the current state of the research knowledge in the field, its applications, and recommendations for future research. The Handbook provides a compelling case for the benefits reaped from current research and intervention, and shows why continued work is needed.
The case for population-level approaches to reduce the stigma associated with mental illness is based on the need for cultural change, whether the culture is within organizations, communities, or families. As such, stigma is a multi-level phenomenon requiring intervention at these many levels. In this chapter we present the case for stigma reduction efforts at the population level; present some considerations for such efforts in terms of methods and content; and describe some recent population-level anti-stigma programs, with results of evaluation where available.
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This report summarizes the findings of the 2013 Oxford Internet Survey. Currently 78% of the British population are online, however the percentage varies according to age, education, income, and a host of other factors. The Report summarizes types of use, social networks and friendships, regulation and control, and digital divides. In a special report it identifies 5 cultures of the Internet. Each group represents a different cultural understanding of the Internet. The five groups and the estimated portion of the British population are: e-Mersives (12%) are fully at home in a digital environment, using it for entertainment as well as work and social life. They see the Internet as entirely positive. Techno-pragmatists (17%) use the Internet for instrumental and work-related purposes. Cyber-savvy (19%) understand and use all aspects of the Internet, but they are also aware of the risks that they run online. Cyber-moderates (37%) don’t respond strongly to either the positive or negative aspects of the Internet. They use the Internet but without enthusiasm. Adigitals (14%) respond only to the negative aspects of the Internet. These cultures are distinguished by their demographic characteristics, patterns of use and attitudes toward government regulation of the Internet.
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We propose that intergroup contact provides an effective means by which to reduce, resolve, and prevent conflict of all kinds, including violent conflict. We review the vast literature on the effectiveness of intergroup contact and discuss when and how it reduces prejudice. We also discuss key features of successful interventions, highlighting examples from conflict zones around the world. Rather than accepting, as some scholars do, that conflict is inevitable, we argue that intergroup contact, in its various forms, can play a pivotal and preemptive role in conflict prevention. We suggest that a blunt application of contact theory, particularly when groups are of unequal status, can have some unfortunate consequences, and contact interventions can, and should, be designed to overcome these pitfalls. We argue that, ultimately, contact is a powerful tool that needs to be used alongside other means of conflict reduction, resolution, and prevention in order to frame sound public policy and build lasting peace. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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The concept of Social Media is top of the agenda for many business executives today. Decision makers, as well as consultants, try to identify ways in which firms can make profitable use of applications such as Wikipedia, YouTube, Facebook, Second Life, and Twitter. Yet despite this interest, there seems to be very limited understanding of what the term “Social Media” exactly means; this article intends to provide some clarification. We begin by describing the concept of Social Media, and discuss how it differs from related concepts such as Web 2.0 and User Generated Content. Based on this definition, we then provide a classification of Social Media which groups applications currently subsumed under the generalized term into more specific categories by characteristic: collaborative projects, blogs, content communities, social networking sites, virtual game worlds, and virtual social worlds. Finally, we present 10 pieces of advice for companies which decide to utilize Social Media.
OBJECTIVE: Public stigma and discrimination have pernicious effects on the lives of people with serious mental illnesses. Given a plethora of research on changing the stigma of mental illness, this article reports on a meta-analysis that examined the effects of antistigma approaches that included protest or social activism, education of the public, and contact with persons with mental illness. METHODS: The investigators heeded published guidelines for systematic literature reviews in health care. This comprehensive and systematic review included articles in languages other than English, dissertations, and population studies. The search included all articles from the inception of the databases until October 2010. Search terms fell into three categories: stigma, mental illness (such as schizophrenia and depression), and change program (including contact and education). The search yielded 72 articles and reports meeting the inclusion criteria of relevance to changing public stigma and sufficient data and statistics to complete analyses. Studies represented 38,364 research participants from 14 countries. Effect sizes were computed for all studies and for each treatment condition within studies. Comparisons between effect sizes were conducted with a weighted one-way analysis of variance. RESULTS: Overall, both education and contact had positive effects on reducing stigma for adults and adolescents with a mental illness. However, contact was better than education at reducing stigma for adults. For adolescents, the opposite pattern was found: education was more effective. Overall, face-to-face contact was more effective than contact by video. CONCLUSIONS: Future research is needed to identify moderators of the effects of both education and contact.
Cultures of the Internet: The Internet in Britain
  • W Dutton
  • B Blank
Dutton W, Blank B. Cultures of the Internet: The Internet in Britain. Oxford Internet Institute, 2013 ( OxIS-2013.pdf).
Asda and Tesco withdraw Halloween costume outfits
  • Bbc News
BBC News. Asda and Tesco withdraw Halloween costume outfits. BBC News 2013; September 26 (