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BackgroundRacial and ethnic minority groups often face worse patient experiences compared with the general population, which is directly related to poorer health outcomes within these minority populations. Evaluation of patient experience among racial and ethnic minority groups has been difficult due to lack of representation in traditional health care surveys. ObjectiveThis study aims to assess the feasibility of Twitter for identifying racial and ethnic disparities in patient experience across the United States from 2013 to 2016. MethodsIn total, 851,973 patient experience tweets with geographic location information from the United States were collected from 2013 to 2016. Patient experience tweets included discussions related to care received in a hospital, urgent care, or any other health institution. Ordinary least squares multiple regression was used to model patient experience sentiment and racial and ethnic groups over the 2013 to 2016 period and in relation to the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014. ResultsRacial and ethnic distribution of users on Twitter was highly correlated with population estimates from the United States Census Bureau’s 5-year survey from 2016 (r2=0.99; P

BackgroundDiscrimination in the health care system contributes to worse health outcomes among lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients. ObjectiveThe aim of this study is to examine disparities in patient experience among LGBTQ persons using social media data. MethodsWe collected patient experience data from Twitter from February 2013 to February 2017 in the United States. We compared the sentiment of patient experience tweets between Twitter users who self-identified as LGBTQ and non-LGBTQ. The effect of state-level partisan identity on patient experience sentiment and differences between LGBTQ users and non-LGBTQ users were analyzed. ResultsWe observed lower (more negative) patient experience sentiment among 13,689 LGBTQ users compared to 1,362,395 non-LGBTQ users. Increasing state-level liberal political identification was associated with higher patient experience sentiment among all users but had stronger effects for LGBTQ users. ConclusionsOur findings highlight that social media data can yield insights about patient experience for LGBTQ persons and suggest that a state-level sociopolitical environment influences patient experience for this group. Efforts are needed to reduce disparities in patient care for LGBTQ persons while taking into context the effect of the political climate on these inequities.

BackgroundMore than 3.5 million Americans live with autism spectrum disorder (ASD). Major challenges persist in diagnosing ASD as no medical test exists to diagnose this disorder. Digital phenotyping holds promise to guide in the clinical diagnoses and screening of ASD. ObjectiveThis study aims to explore the feasibility of using the Web-based social media platform Twitter to detect psychological and behavioral characteristics of self-identified persons with ASD. MethodsData from Twitter were retrieved from 152 self-identified users with ASD and 182 randomly selected control users from March 22, 2012 to July 20, 2017. We conducted a between-group comparative textual analysis of tweets about repetitive and obsessive-compulsive behavioral characteristics typically associated with ASD. In addition, common emotional characteristics of persons with ASD, such as fear, paranoia, and anxiety, were examined between groups through textual analysis. Furthermore, we compared the timing of tweets between users with ASD and control users to identify patterns in communication. ResultsUsers with ASD posted a significantly higher frequency of tweets related to the specific repetitive behavior of counting compared with control users (P

As policies are adjusted throughout the COVID-19 pandemic according to public health best practices, there is a need to balance the importance of social distancing in preventing viral spread with the strain that these governmental public safety mandates put on public mental health. Thus, there is need for continuous observation of public sentiment and deliberation to inform further adaptation of mandated interventions. In this study, we explore how public response may be reflected in Massachusetts (MA) via social media by specifically exploring temporal patterns in Twitter posts (tweets) regarding sentiment and discussion of topics. We employ interrupted time series centered on (1) Massachusetts State of Emergency declaration (March 10), (2) US State of Emergency declaration (March 13) and (3) Massachusetts public school closure (March 17) to explore changes in tweet sentiment polarity (net negative/positive), expressed anxiety and discussion on risk and health topics on a random subset of all tweets coded within Massachusetts and published from January 1 to May 15, 2020 (n = 2.8 million). We find significant differences between tweets published before and after mandate enforcement for Massachusetts State of Emergency (increased discussion of risk and health, decreased polarity and increased anxiety expression), US State of Emergency (increased discussion of risk and health, and increased anxiety expression) and Massachusetts public school closure (increased discussion of risk and decreased polarity). Our work further validates that Twitter data is a reasonable way to monitor public sentiment and discourse within a crisis, especially in conjunction with other observation data.

As policies are adjusted throughout the COVID-19 pandemic according to public health best practices, there is a need to balance the importance of social distancing in preventing viral spread with the strain that these governmental public safety mandates put on public mental health. Thus, there is need for continuous observation of public sentiment and deliberation to inform further adaptation of mandated interventions. In this study, we explore how public response may be reflected in Massachusetts (MA) via social media by specifically exploring temporal patterns in Twitter posts (tweets) regarding sentiment and discussion of topics. We employ interrupted time series centered on (1) Massachusetts State of Emergency declaration (March 10), (2) US State of Emergency declaration (March 13) and (3) Massachusetts public school closure (March 17) to explore changes in tweet sentiment polarity (net negative/positive), expressed anxiety and discussion on risk and health topics on a random subset of all tweets coded within Massachusetts and published from January 1 to May 15, 2020 (n = 2.8 million). We find significant differences between tweets published before and after mandate enforcement for Massachusetts State of Emergency (increased discussion of risk and health, decreased polarity and increased anxiety expression), US State of Emergency (increased discussion of risk and health, and increased anxiety expression) and Massachusetts public school closure (increased discussion of risk and decreased polarity). Our work further validates that Twitter data is a reasonable way to monitor public sentiment and discourse within a crisis, especially in conjunction with other observation data.

Public awareness of calories in food sold in retail establishments is a primary objective of the menu labeling law. This study explores the extent to which we can use social media and internet search queries to understand whether the federal calorie labeling law increased awareness of calories. To evaluate the association of the federal menu labeling law with tweeting about calories we retrieved tweets that contained the term "calorie(s)" from the CompEpi Geo Twitter Database from 1 January through 31 December in 2016 and 2018. Within the same time period, we also retrieved time-series data for search queries related to calories via Google Trends (GT). Interrupted time-series analysis was used to test whether the federal menu labeling law was associated with a change in mentions of "calorie(s)" on Twitter and relative search queries to calories on GT. Before the implementation of the federal calorie labeling law on 7 May 2018, there was a significant decrease in the baseline trend of 4.37 × 10-8 (SE = 1.25 × 10-8, p < 0.001) mean daily ratio of calorie(s) tweets. A significant increase in post-implementation slope of 3.19 × 10-8 (SE = 1.34 × 10-8 , p < 0.018) mean daily ratio of calorie(s) tweets was seen compared to the pre-implementation slope. An interrupted time-series (ITS) analysis showed a small, statistically significant upward trend of 0.0043 (SE = 0.036, p < 0.001) weekly search queries for calories pre-implementation, with no significant level change post-implementation. There was a decrease in trend of 1.22 (SE = 0.27, p < 0.001) in search queries for calories post-implementation. The federal calorie labeling law was associated with a 173% relative increase in the trend of mean daily ratio of tweets and a -28381% relative change in trend for search queries for calories. Twitter results demonstrate an increase in awareness of calories because of the addition of menu labels. Google Trends results imply that fewer people are searching for the calorie content of their meal, which may no longer be needed since calorie information is provided at point of purchase. Given our findings, discussions online about calories may provide a signal of an increased awareness in the implementation of calorie labels.

Limited research has evaluated these equitable policies because of the difficulty of capturing LGBTQ patient experience. Previous studies have shown that LGBTQ persons report increased rates of discrimination across a wide variety of healthcare settings which may prevent them from disclosing their LGBTQ status. The goal of this research was to use a social media big dataset to evaluate the impact of equitable policies on patient experiences for LGBTQ persons.

Air pollution is a serious public health concern. Innovative and scalable methods for detecting harmful air pollutants such as PM2.5 are necessary. This study assessed the feasibility of using social media to monitor outdoor air pollution in an urban area by comparing data from Twitter and validating it against established air monitoring stations. Data were collected from London, England from July 29, 2016 to March 17, 2017. Daily mean PM2.5 data was downloaded from the LondonAir platform consisting of 26 air pollution monitoring sites throughout Greater London. Publicly available tweets geo-located to Greater London containing air pollution terms were captured from the Twitter platform. Tweets with media URL links were excluded to minimize influence of news stories. Sentiment of the tweets was examined as negative, positive, or neutral. Cross-correlation analyses were used to compare the relationship between trends of tweets about air pollution and levels of PM2.5 over time. There were 16,448 tweets without a media URL link, with a mean of 498.42 (SD = 491.08) tweets per week. A significant cross-correlation coefficient of 0.803 was observed between PM2.5 data and the non-media air pollution tweets (p

Digital technologies hold promise for supporting the detection and management of schizophrenia. This exploratory study aimed to generate an initial understanding of whether patterns of communication about depression and anxiety on popular social media among individuals with schizophrenia are consistent with offline representations of the illness. From January to July 2016, posts on Twitter were collected from a sample of Twitter users who self-identify as having a schizophrenia spectrum disorder (n = 203) and a randomly selected sample of control users (n = 173). Frequency and timing of communication about depression and anxiety were compared between groups. In total, the groups posted n = 1,544,122 tweets and users had similar characteristics. Twitter users with schizophrenia showed significantly greater odds of tweeting about depression compared with control users (OR = 2.69; 95% CI 1.76-4.10), and significantly greater odds of tweeting about anxiety compared with control users (OR = 1.81; 95% CI 1.20-2.73). This study offers preliminary insights that Twitter users with schizophrenia may express elevated symptoms of depression and anxiety in their online posts, which is consistent with clinical characteristics of schizophrenia observed in offline settings. Social media platforms could further our understanding of schizophrenia by informing a digital phenotype and may afford new opportunities to support early illness detection.

Novel approaches are needed to address elevated tobacco use among people with schizophrenia. This exploratory study examined the frequency, timing, and type of communication about tobacco-related content on Twitter among users who self-identify as having schizophrenia compared with users from the general population. Over a 200-day period from January to July 2016, Twitter users who self-identify as having a schizophrenia spectrum disorder (n = 203) and a randomly selected group of general population control users (n = 173) posted 1,544,122 tweets. Communication frequency did not differ between groups. Tweets containing tobacco-related keywords were extracted. Twitter users with schizophrenia posted significantly more tweets containing any tobacco-related terms (mean = 3.74; SD = 16.3) compared with control users (mean = 0.82; SD = 1.8). A significantly greater proportion of Twitter users with schizophrenia (45%; n = 92) posted tweets containing any tobacco terms compared with control users (30%; n = 52). Schizophrenia users showed significantly greater odds of tweeting about tobacco compared with control users (OR = 1.99; 95% CI 1.29-3.07). These findings suggest that online communication about tobacco may parallel real world trends of elevated tobacco use observed among people with schizophrenia. By showing that Twitter users who self-identify as having schizophrenia discuss tobacco-related content online, popular social media could inform smoking cessation efforts targeting this at-risk group.