The American Heart Association Emergency Cardiovascular Care 2030 Impact Goals and Call to Action to Improve Cardiac Arrest Outcomes: A Scientific Statement From the American Heart Association.

Every 10 years, the American Heart Association (AHA) Emergency Cardiovascular Care Committee establishes goals to improve survival from cardiac arrest. These goals align with broader AHA Impact Goals and support the AHA's advocacy efforts and strategic investments in research, education, clinical care, and quality improvement programs. This scientific statement focuses on 2030 AHA emergency cardiovascular care priorities, with a specific focus on bystander cardiopulmonary resuscitation, early defibrillation, and neurologically intact survival. This scientific statement also includes aspirational goals, such as establishing cardiac arrest as a reportable disease and mandating reporting of standardized outcomes from different sources; advancing recognition of and knowledge about cardiac arrest; improving dispatch system response, availability, and access to resuscitation training in multiple settings and at multiple time points; improving availability, access, and affordability of defibrillators; providing a focus on early defibrillation, in-hospital programs, and establishing champions for debriefing and review of cardiac arrest events; and expanding measures to track outcomes beyond survival. The ability to track and report data from these broader aspirational targets will potentially require expansion of existing data sets, development of new data sets, and enhanced integration of technology to collect process and outcome data, as well as partnerships of the AHA with national, state, and local organizations. The COVID-19 (coronavirus disease 2019) pandemic, disparities in COVID-19 outcomes for historically excluded racial and ethnic groups, and the longstanding disparities in cardiac arrest treatment and outcomes for Black and Hispanic or Latino populations also contributed to an explicit focus and target on equity for the AHA Emergency Cardiovascular Care 2030 Impact Goals.

Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation.

Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.

Left Without Being Seen: Nurse Work Environment and Timely Outcomes in New York and Illinois Emergency Departments.

INTRODUCTION: This study determined the relationship between the emergency nurse work environment and emergency department patient left without being seen rates and lengths of stay. METHODS: Cross-sectional analysis of 215 New York and Illinois emergency departments. The work environment (abbreviated Practice Environment Scale of the Nursing Work Index) was measured by emergency nurses in the 2021 RN4CAST-NY/IL survey and linked with outcomes from Hospital Compare. Regression models estimated the relationship between the nurse work environment and emergency department patient left without being seen rates, median length of stay (in minutes), and median behavioral health patient length of stay. Model coefficients were used to estimate expected additional care minutes gained if emergency department work environments improved. RESULTS: "Mixed" work environments had the longest median overall length of stay (3.4 hours) and the highest median left without being seen rates (2.2%), while "poor" work environments had the longest median length of stay for behavioral health patients (6 hours). Improving the emergency department work environment from poor to mixed (and mixed to better) was associated with a 13-minute reduction in overall length of stay (P ≤ .05), a 33-minute reduction in behavioral health length of stay (P ≤ .01), and a 19% reduction in left without being seen rates (P ≤ .01). We estimated 11,824 to 41,071 additional patients could be seen in emergency departments associated with work environment improvements from "poor" to "better," depending on annual patient volumes. DISCUSSION: Hospital administrators should consider investing in nurse work environments as a foundation to improve timely outcomes.

Opioid-Associated Out-of-Hospital Cardiac Arrest: Distinctive Clinical Features and Implications for Health Care and Public Responses: A Scientific Statement From the American Heart Association.

Opioid overdose is the leading cause of death for Americans 25 to 64 years of age, and opioid use disorder affects >2 million Americans. The epidemiology of opioid-associated out-of-hospital cardiac arrest in the United States is changing rapidly, with exponential increases in death resulting from synthetic opioids and linear increases in heroin deaths more than offsetting modest reductions in deaths from prescription opioids. The pathophysiology of polysubstance toxidromes involving opioids, asphyxial death, and prolonged hypoxemia leading to global ischemia (cardiac arrest) differs from that of sudden cardiac arrest. People who use opioids may also develop bacteremia, central nervous system vasculitis and leukoencephalopathy, torsades de pointes, pulmonary vasculopathy, and pulmonary edema. Emergency management of opioid poisoning requires recognition by the lay public or emergency dispatchers, prompt emergency response, and effective ventilation coupled to compressions in the setting of opioid-associated out-of-hospital cardiac arrest. Effective ventilation is challenging to teach, whereas naloxone, an opioid antagonist, can be administered by emergency medical personnel, trained laypeople, and the general public with dispatcher instruction to prevent cardiac arrest. Opioid education and naloxone distributions programs have been developed to teach people who are likely to encounter a person with opioid poisoning how to administer naloxone, deliver high-quality compressions, and perform rescue breathing. Current American Heart Association recommendations call for laypeople and others who cannot reliably establish the presence of a pulse to initiate cardiopulmonary resuscitation in any individual who is unconscious and not breathing normally; if opioid overdose is suspected, naloxone should also be administered. Secondary prevention, including counseling, opioid overdose education with take-home naloxone, and medication for opioid use disorder, is important to prevent recurrent opioid overdose.

The role of digital health technologies in COVID-19 surveillance and recovery: a specific case of long haulers.

Digital health and technologies are essential to curbing the novel coronavirus 2019 (COVID-19) pandemic especially with shelter-in-place and social distancing orders. Epidemiologists and public health officials are tapping into frequently used technologies like wearables, digital devices, digital and social media data to detect and validate COVID-19 symptoms throughout the pandemic, especially during early stages when symptoms were evolving. In this article, we review how digital technologies and social media platforms can identify and inform our understanding of COVID-19 pandemic surveillance and recovery efforts. We analyze Reddit narrative posts and comments on r/covidlonghaulers to demonstrate how social media can be used to better understand COVID-19 pandemic. Using Reddit data, we highlight long haulers' patient journeys and shed light on potential consequences of their condition. We identified 21 themes, of which the following were significantly associated with valence: COVID-19 Symptoms (r = -0.037), medical advice (r = -0.030), medical system (r = -0.029), bodily processes (r = -0.020), questions (r = 0.024), physical activity (r = 0.033), self-differentials and negations (r = 0.040) and supplements (r = 0.025). Our brief literature review and analysis of r/covidlonghaulers narrative posts demonstrate the value of digital technologies and social media platforms as they act as modern avenues for public health, safety, and well-being.

Facebook language predicts depression in medical records.

Depression, the most prevalent mental illness, is underdiagnosed and undertreated, highlighting the need to extend the scope of current screening methods. Here, we use language from Facebook posts of consenting individuals to predict depression recorded in electronic medical records. We accessed the history of Facebook statuses posted by 683 patients visiting a large urban academic emergency department, 114 of whom had a diagnosis of depression in their medical records. Using only the language preceding their first documentation of a diagnosis of depression, we could identify depressed patients with fair accuracy [area under the curve (AUC) = 0.69], approximately matching the accuracy of screening surveys benchmarked against medical records. Restricting Facebook data to only the 6 months immediately preceding the first documented diagnosis of depression yielded a higher prediction accuracy (AUC = 0.72) for those users who had sufficient Facebook data. Significant prediction of future depression status was possible as far as 3 months before its first documentation. We found that language predictors of depression include emotional (sadness), interpersonal (loneliness, hostility), and cognitive (preoccupation with the self, rumination) processes. Unobtrusive depression assessment through social media of consenting individuals may become feasible as a scalable complement to existing screening and monitoring procedures.

Partisan Differences in Twitter Language Among US Legislators During the COVID-19 Pandemic: Cross-sectional Study.

BACKGROUND: As policy makers continue to shape the national and local responses to the COVID-19 pandemic, the information they choose to share and how they frame their content provide key insights into the public and health care systems. OBJECTIVE: We examined the language used by the members of the US House and Senate during the first 10 months of the COVID-19 pandemic and measured content and sentiment based on the tweets that they shared. METHODS: We used Quorum (Quorum Analytics Inc) to access more than 300,000 tweets posted by US legislators from January 1 to October 10, 2020. We used differential language analyses to compare the content and sentiment of tweets posted by legislators based on their party affiliation. RESULTS: We found that health care-related themes in Democratic legislators' tweets focused on racial disparities in care (odds ratio [OR] 2.24, 95% CI 2.22-2.27; P<.001), health care and insurance (OR 1.74, 95% CI 1.7-1.77; P<.001), COVID-19 testing (OR 1.15, 95% CI 1.12-1.19; P<.001), and public health guidelines (OR 1.25, 95% CI 1.22-1.29; P<.001). The dominant themes in the Republican legislators' discourse included vaccine development (OR 1.51, 95% CI 1.47-1.55; P<.001) and hospital resources and equipment (OR 1.22, 95% CI 1.18-1.25). Nonhealth care-related topics associated with a Democratic affiliation included protections for essential workers (OR 1.55, 95% CI 1.52-1.59), the 2020 election and voting (OR 1.31, 95% CI 1.27-1.35), unemployment and housing (OR 1.27, 95% CI 1.24-1.31), crime and racism (OR 1.22, 95% CI 1.18-1.26), public town halls (OR 1.2, 95% CI 1.16-1.23), the Trump Administration (OR 1.22, 95% CI 1.19-1.26), immigration (OR 1.16, 95% CI 1.12-1.19), and the loss of life (OR 1.38, 95% CI 1.35-1.42). The themes associated with the Republican affiliation included China (OR 1.89, 95% CI 1.85-1.92), small business assistance (OR 1.27, 95% CI 1.23-1.3), congressional relief bills (OR 1.23, 95% CI 1.2-1.27), press briefings (OR 1.22, 95% CI 1.19-1.26), and economic recovery (OR 1.2, 95% CI 1.16-1.23). CONCLUSIONS: Divergent language use on social media corresponds to the partisan divide in the first several months of the course of the COVID-19 public health crisis.

Consumer Views on Health Applications of Consumer Digital Data and Health Privacy Among US Adults: Qualitative Interview Study.

BACKGROUND: In 2020, the number of internet users surpassed 4.6 billion. Individuals who create and share digital data can leave a trail of information about their habits and preferences that collectively generate a digital footprint. Studies have shown that digital footprints can reveal important information regarding an individual's health status, ranging from diet and exercise to depression. Uses of digital applications have accelerated during the COVID-19 pandemic where public health organizations have utilized technology to reduce the burden of transmission, ultimately leading to policy discussions about digital health privacy. Though US consumers report feeling concerned about the way their personal data is used, they continue to use digital technologies. OBJECTIVE: This study aimed to understand the extent to which consumers recognize possible health applications of their digital data and identify their most salient concerns around digital health privacy. METHODS: We conducted semistructured interviews with a diverse national sample of US adults from November 2018 to January 2019. Participants were recruited from the Ipsos KnowledgePanel, a nationally representative panel. Participants were asked to reflect on their own use of digital technology, rate various sources of digital information, and consider several hypothetical scenarios with varying sources and health-related applications of personal digital information. RESULTS: The final cohort included a diverse national sample of 45 US consumers. Participants were generally unaware what consumer digital data might reveal about their health. They also revealed limited knowledge of current data collection and aggregation practices. When responding to specific scenarios with health-related applications of data, they had difficulty weighing the benefits and harms but expressed a desire for privacy protection. They saw benefits in using digital data to improve health, but wanted limits to health programs' use of consumer digital data. CONCLUSIONS: Current privacy restrictions on health-related data are premised on the notion that these data are derived only from medical encounters. Given that an increasing amount of health-related data is derived from digital footprints in consumer settings, our findings suggest the need for greater transparency of data collection and uses, and broader health privacy protections.

Online Reviews of Specialized Drug Treatment Facilities-Identifying Potential Drivers of High and Low Patient Satisfaction.

BACKGROUND: Despite the importance of high-quality and patient-centered substance use disorder treatment, there are no standardized ratings of specialized drug treatment facilities and their services. Online platforms offer insights into potential drivers of high and low patient experience. OBJECTIVE: We sought to analyze publicly available online review content of specialized drug treatment facilities and identify themes within high and low ratings. DESIGN: This was a retrospective analysis of online ratings and reviews of specialized drug treatment facilities in Pennsylvania listed within the 2016 National Directory of Drug and Alcohol Abuse Treatment Facilities. Latent Dirichlet Allocation, a machine learning approach to narrative text, was used to identify themes within reviews. Differential Language Analysis was then used to measure correlations between themes and star ratings. SETTING: Online reviews of Pennsylvania's specialized drug treatment facilities posted to Google and Yelp (July 2010-August 2018). RESULTS: A total of 7823 online ratings were posted over 8 years. The distribution was bimodal (43% 5-star and 34% 1-star). The average weighted rating of a facility was 3.3 stars. Online themes correlated with 5-star ratings were the following: focus on recovery (r = 0.53), helpfulness of staff (r = 0.43), compassionate care (r = 0.37), experienced a life-changing moment (r = 0.32), and staff professionalism (r = 0.29). Themes correlated with a 1-star rating were waiting time (r = 0.41), poor accommodations (0.26), poor phone communication (r = 0.24), medications given (0.24), and appointment availability (r = 0.23). Themes derived from review content were similar to 9 of the 14 facility-level services highlighted by the Substance Abuse and Mental Health Services Administration's National Survey of Substance Abuse Treatment Services. CONCLUSIONS: Individuals are sharing their ratings and reviews of specialized drug treatment facilities on online platforms. Organically derived reviews of the patient experience, captured by online platforms, reveal potential drivers of high and low ratings. These represent additional areas of focus which can inform patient-centered quality metrics for specialized drug treatment facilities.

Capturing Real-Time Emergency Department Sentiment: A Feasibility Study Using Touch-Button Terminals.

STUDY OBJECTIVE: Providing care in emergency departments (EDs) affects patients and providers. Providers experience high rates of work-related stress. Little is known about the feasibility of measuring real-time sentiment within busy clinical environments. We test the feasibility of measuring sentiment with touch-button terminals in an academic, urban ED. METHODS: Terminals offered a choice of 4 sentiment buttons (very positive, positive, negative, and very negative). They were placed central to physician workstations, nursing workstations, and the patient exit. Pearson correlation coefficients (r) were calculated to estimate correlation between sentiment and volume metrics (arrivals, length of stay, waiting patients, and number of boarding patients) over time. RESULTS: A total of 13,849 sentiments were recorded (June 2018 to October 2018); 9,472 came from providers (52.6% nursing) and 4,377 from patients. The majority of provider sentiments were negative (58.7%). Negative provider sentiment was associated with increasing number of patients waiting to be seen (r=0.45) and boarding (r=0.68). Positive provider sentiment was associated with increasing numbers of patients who left without being seen (r=0.48). Increased boarding was associated with more recorded sentiments (r=0.73). Negative patient sentiment was associated with increasing number waiting (r=0.55), boarding (r=0.67), and leaving without being seen (r=0.46). CONCLUSION: This study demonstrates the feasibility of a novel approach to measuring "on-shift" sentiment in real time and provides a sample comparison to traditional volume metrics.

Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association.

The formula for survival in resuscitation describes educational efficiency and local implementation as key determinants in survival after cardiac arrest. Current educational offerings in the form of standardized online and face-to-face courses are falling short, with providers demonstrating a decay of skills over time. This translates to suboptimal clinical care and poor survival outcomes from cardiac arrest. In many institutions, guidelines taught in courses are not thoughtfully implemented in the clinical environment. A current synthesis of the evidence supporting best educational and knowledge translation strategies in resuscitation is lacking. In this American Heart Association scientific statement, we provide a review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation. For each topic, we provide suggestions for improving provider performance that may ultimately optimize patient outcomes from cardiac arrest.

Health-related Google searches performed by parents of pediatric oncology patients.

BACKGROUND: Little is known about the specific information parents of children with cancer search for online. Understanding the content of parents' searches over time could offer insight into what matters most to parents and identify knowledge gaps that could inform more comprehensive approaches to family education and support. METHODS: We describe parents' health-related Google searches starting six months before cancer diagnosis and extending through the date of study enrollment, which was at least one month after initiating cancer treatment. Searches were obtained retrospectively and grouped into health-related and non-health-related categories. The median time to parent enrollment from date of cancer diagnosis was 264 days. RESULTS: Parents searched for health-related topics more frequently than the general population (13% vs 5%). Health-related searches increased in the months preceding the child's cancer diagnosis and most commonly pertained to symptoms and logistics, "directions to hospital." Health-related search volume peaked about a month after cancer diagnosis when general health-related searches were present in addition to cancer-specific searches. Eighteen percent of health-related searches were cancer specific, and of these cancer-specific searches, 54% pertained to support, for example "cancer quote for son." CONCLUSIONS: Google search content offers insight into what matters to parents of cancer patients. Understanding search content could inform more comprehensive approaches to family education and support initiatives.

Online Ratings of the Patient Experience: Emergency Departments Versus Urgent Care Centers.

STUDY OBJECTIVE: Individuals increasingly use online rating platforms to rate and review hospitals. We seek to describe and compare publicly available online review content and ratings of emergency departments (EDs) and urgent care centers. METHODS: We analyzed Yelp reviews of EDs and urgent care centers to identify topics most correlated with 1- and 5-star ratings. Latent Dirichlet Allocation, a method of identifying groups of co-occurring words in narrative text, was used to identify and label 25 topics across 1- and 5-star reviews of urgent care centers and EDs. Differential Language Analysis was then used to measure the correlation of these topics with 1- and 5-star reviews for urgent care centers and EDs. RESULTS: We analyzed 100,949 Yelp reviews, 16,447 from 1,566 EDs and 84,502 from 5,601 urgent care centers. There were significantly more 5-star urgent care center reviews (n=43,487; 51%) than 5-star ED reviews (n=4,437; 27%). Themes associated with 5-star reviews among EDs and urgent care centers were similar for comfort, professionalism, facilities, pediatric care, and staff interactions. Themes associated with 1-star reviews among EDs and urgent care centers were similar for communication, telephone experience, waiting, billing, pain management, and diagnostic testing. Themes unique to 5-star ED reviews included bedside manner, care for family members, and access. Themes unique to 5-star urgent care center reviews were based on recommendation and prescription refills. Themes unique to 1-star ED reviews were service and speed of care. Themes unique to 1-star urgent care center reviews were lack of confidence and reception experience. CONCLUSION: Understanding drivers for high and low online ratings and what patients value in their ED and urgent care center experiences offers insights for health systems and providers to improve acute care delivery. Patients' perspectives may become increasingly important as they seek care in the expanding urgent care markets.

Patients' willingness to share digital health and non-health data for research: a cross-sectional study.

BACKGROUND: Patients generate large amounts of digital data through devices, social media applications, and other online activities. Little is known about patients' perception of the data they generate online and its relatedness to health, their willingness to share data for research, and their preferences regarding data use. METHODS: Patients at an academic urban emergency department were asked if they would donate any of 19 different types of data to health researchers and were asked about their views on data types' health relatedness. Factor analysis was used to identify the structure in patients' perceptions of willingness to share different digital data, and their health relatedness. RESULTS: Of 595 patients approached 206 agreed to participate, of whom 104 agreed to share at least one types of digital data immediately, and 78% agreed to donate at least one data type after death. EMR, wearable, and Google search histories (80%) had the highest percentage of reported health relatedness. 72% participants wanted to know the results of any analysis of their shared data, and half wanted their healthcare provider to know. CONCLUSION: Patients in this study were willing to share a considerable amount of personal digital data with health researchers. They also recognize that digital data from many sources reveal information about their health. This study opens up a discussion around reconsidering US privacy protections for health information to reflect current opinions and to include their relatedness to health.

Social Media for Hepatitis B Awareness: Young Adult and Community Leader Perspectives.

Screening for hepatitis B (HBV) among high-risk young adults can help prevent its transmission and lead to earlier treatment and better long-term health outcomes. Yet few interventions have focused on increasing HBV awareness among young adults. Social media (SM) may be an effective method for disseminating information and engaging young adults about HBV. In this pilot study, qualitative and quantitative methods were applied to collect information on current use and perceptions toward SM through semistructured interviews and focus groups with young Chinese and Vietnamese adults and community leaders from local organizations in Philadelphia. Additionally, survey items were collected during the interviews and focus groups to provide quantitative data. Results from the interviews provided evidence that young adults and local organizations are already using SM and are open to using it to share general health information that is specific to their community. The focus groups suggested that using group pages or chats could be most appropriate for reaching young adults and that credible sources should be used to deliver messages that are tailored to the audience. The findings from this study will support the development of an SM intervention aimed at increasing HBV awareness.

Relationship Between State-Level Google Online Search Volume and Cancer Incidence in the United States: Retrospective Study.

BACKGROUND: In the United States, cancer is common, with high morbidity and mortality; cancer incidence varies between states. Online searches reflect public awareness, which could be driven by the underlying regional cancer epidemiology. OBJECTIVE: The objective of our study was to characterize the relationship between cancer incidence and online Google search volumes in the United States for 6 common cancers. A secondary objective was to evaluate the association of search activity with cancer-related public events and celebrity news coverage. METHODS: We performed a population-based, retrospective study of state-level cancer incidence from 2004 through 2013 reported by the Centers for Disease Control and Prevention for breast, prostate, colon, lung, and uterine cancers and leukemia compared to Google Trends (GT) relative search volume (RSV), a metric designed by Google to allow interest in search topics to be compared between regions. Participants included persons in the United States who searched for cancer terms on Google. The primary measures were the correlation between annual state-level cancer incidence and RSV as determined by Spearman correlation and linear regression with RSV and year as independent variables and cancer incidence as the dependent variable. Temporal associations between search activity and events raising public awareness such as cancer awareness months and cancer-related celebrity news were described. RESULTS: At the state level, RSV was significantly correlated to incidence for breast (r=.18, P=.001), prostate (r=-.27, P<.001), lung (r=.33, P<.001), and uterine cancers (r=.39, P<.001) and leukemia (r=.13, P=.003) but not colon cancer (r=-.02, P=.66). After adjusting for time, state-level RSV was positively correlated to cancer incidence for all cancers: breast (P<.001, 95% CI 0.06 to 0.19), prostate (P=.38, 95% CI -0.08 to 0.22), lung (P<.001, 95% CI 0.33 to 0.46), colon (P<.001, 95% CI 0.11 to 0.17), and uterine cancers (P<.001, 95% CI 0.07 to 0.12) and leukemia (P<.001, 95% CI 0.01 to 0.03). Temporal associations in GT were noted with breast cancer awareness month but not with other cancer awareness months and celebrity events. CONCLUSIONS: Cancer incidence is correlated with online search volume at the state level. Search patterns were temporally associated with cancer awareness months and celebrity announcements. Online searches reflect public awareness. Advancing understanding of online search patterns could augment traditional epidemiologic surveillance, provide opportunities for targeted patient engagement, and allow public information campaigns to be evaluated in ways previously unable to be measured.

Opioid Discussion in the Twittersphere.

BACKGROUND: The rise in opioid use and overdose has increased the importance of improving data collection methods for the purpose of targeting resources to high-need populations and responding rapidly to emerging trends. OBJECTIVE: To determine whether Twitter data could be used to identify geographic differences in opioid-related discussion and whether opioid topics were significantly correlated with opioid overdose death rate. METHODS: We filtered approximately 10 billion tweets for keywords related to opioids between July 2009 and October 2015. The content of the messages was summarized into 50 topics generated using Latent Dirchlet Allocation, a machine learning analytic tool. The correlation between topic distribution and census region, census division, and opioid overdose death rate were quantified. RESULTS: We evaluated a tweet cohort of 84,023 tweets from 72,211 unique users across the US. Unique opioid-related topics were significantly correlated with different Census Bureau divisions and with opioid overdose death rates at the state and county level. Drug-related crime, language of use, and online drug purchasing emerged as themes in various Census Bureau divisions. Drug-related crime, opioid-related news, and pop culture themes were significantly correlated with county-level opioid overdose death rates, and online drug purchasing was significantly correlated with state-level opioid overdoses. CONCLUSIONS: Regional differences in opioid-related topics reflect geographic variation in the content of Twitter discussion about opioids. Analysis of Twitter data also produced topics significantly correlated with opioid overdose death rates. Ongoing analysis of Twitter data could provide a means of identifying emerging trends related to opioids.

Twitter as a Tool for Health Research: A Systematic Review.

BACKGROUND: Researchers have used traditional databases to study public health for decades. Less is known about the use of social media data sources, such as Twitter, for this purpose. OBJECTIVES: To systematically review the use of Twitter in health research, define a taxonomy to describe Twitter use, and characterize the current state of Twitter in health research. SEARCH METHODS: We performed a literature search in PubMed, Embase, Web of Science, Google Scholar, and CINAHL through September 2015. SELECTION CRITERIA: We searched for peer-reviewed original research studies that primarily used Twitter for health research. DATA COLLECTION AND ANALYSIS: Two authors independently screened studies and abstracted data related to the approach to analysis of Twitter data, methodology used to study Twitter, and current state of Twitter research by evaluating time of publication, research topic, discussion of ethical concerns, and study funding source. MAIN RESULTS: Of 1110 unique health-related articles mentioning Twitter, 137 met eligibility criteria. The primary approaches for using Twitter in health research that constitute a new taxonomy were content analysis (56%; n = 77), surveillance (26%; n = 36), engagement (14%; n = 19), recruitment (7%; n = 9), intervention (7%; n = 9), and network analysis (4%; n = 5). These studies collectively analyzed more than 5 billion tweets primarily by using the Twitter application program interface. Of 38 potential data features describing tweets and Twitter users, 23 were reported in fewer than 4% of the articles. The Twitter-based studies in this review focused on a small subset of data elements including content analysis, geotags, and language. Most studies were published recently (33% in 2015). Public health (23%; n = 31) and infectious disease (20%; n = 28) were the research fields most commonly represented in the included studies. Approximately one third of the studies mentioned ethical board approval in their articles. Primary funding sources included federal (63%), university (13%), and foundation (6%). CONCLUSIONS: We identified a new taxonomy to describe Twitter use in health research with 6 categories. Many data elements discernible from a user's Twitter profile, especially demographics, have been underreported in the literature and can provide new opportunities to characterize the users whose data are analyzed in these studies. Twitter-based health research is a growing field funded by a diversity of organizations. Public health implications. Future work should develop standardized reporting guidelines for health researchers who use Twitter and policies that address privacy and ethical concerns in social media research.