Evolving Face Mask Guidance During a Pandemic and Potential Harm to Public Perception: Infodemiology Study of Sentiment and Emotion on Twitter.

BACKGROUND: Throughout the COVID-19 pandemic, US Centers for Disease Control and Prevention policies on face mask use fluctuated. Understanding how public health communications evolve around key policy decisions may inform future decisions on preventative measures by aiding the design of communication strategies (eg, wording, timing, and channel) that ensure rapid dissemination and maximize both widespread adoption and sustained adherence. OBJECTIVE: We aimed to assess how sentiment on masks evolved surrounding 2 changes to mask guidelines: (1) the recommendation for mask use on April 3, 2020, and (2) the relaxation of mask use on May 13, 2021. METHODS: We applied an interrupted time series method to US Twitter data surrounding each guideline change. Outcomes were changes in the (1) proportion of positive, negative, and neutral tweets and (2) number of words within a tweet tagged with a given emotion (eg, trust). Results were compared to COVID-19 Twitter data without mask keywords for the same period. RESULTS: There were fewer neutral mask-related tweets in 2020 (ß=-3.94 percentage points, 95% CI -4.68 to -3.21; P<.001) and 2021 (ß=-8.74, 95% CI -9.31 to -8.17; P<.001). Following the April 3 recommendation (ß=.51, 95% CI .43-.59; P<.001) and May 13 relaxation (ß=3.43, 95% CI 1.61-5.26; P<.001), the percent of negative mask-related tweets increased. The quantity of trust-related terms decreased following the policy change on April 3 (ß=-.004, 95% CI -.004 to -.003; P<.001) and May 13 (ß=-.001, 95% CI -.002 to 0; P=.008). CONCLUSIONS: The US Twitter population responded negatively and with less trust following guideline shifts related to masking, regardless of whether the guidelines recommended or relaxed mask usage. Federal agencies should ensure that changes in public health recommendations are communicated concisely and rapidly.

Cost-benefit analysis of a projected national human papilloma virus vaccination programme in Lebanon.

BACKGROUND: The adoption of a population-based human papilloma virus (HPV) vaccination programme is debated in Lebanon on epidemiological, sociocultural, logistical and economic grounds. AIMS: This cost-benefit analysis contributes to generating quantitative evidence necessary for a decision regarding costs through locally available data. METHODS: The 2 sides of the cost-benefit analysis equation are: estimation of the cost of HPV vaccination campaigns targeting 11 year-old girls, using the cheapest vaccine in 2016 and estimation of the management cost for treatment of a yearly average case-load for cervical cancer. RESULTS: A Cervarix® only campaign would cost US$ 5 407 790 to vaccinate 38 083 11-year-old girls. The estimated cost of managing a mean annual mixed case-load of 100 incident cervical cancer cases would cost US$ 1 591 336. The nearest break-even point may occur 5 years after this current analysis. CONCLUSION: This cost-benefit analysis using limited available data indicates that massive HPV vaccination would not be cost-beneficial under the circumstances existing in 2016. Nevertheless, some indications point to the need for a re-assessment around 2020. This finding will inform public health decision-makers in Lebanon and similar neighbouring countries.

A test of the epidemiological paradox in a context of forced migration: low birthweight among Syrian newborns in Lebanon.

BACKGROUND: Studies on immigrants revealed an epidemiological paradox whereby low-socioeconomic status (SES) immigrant mothers exhibit favourable birth outcomes compared with native-born mothers. We tested the epidemiological paradox in a context of forced migration, comparing associations of low birthweight (LBW) and maternal SES between Syrian and Lebanese newborns in Lebanon. METHODS: We used data from the National Collaborative Perinatal Neonatal Network (NCPNN) of 31 Lebanese hospitals, including 45 442 Lebanese and 4910 Syrian neonates born 2011-13. We assessed associations between LBW and maternal SES for both groups. Logistic regression models examined interactions between maternal origin and SES. RESULTS: Syrian births increased exponentially between 2011 and 2013, along with the group's forced migration into Lebanon. Although Syrian mothers are more socioeconomically disadvantaged compared with Lebanese mothers, Syrian LBW (6.2%) was only marginally higher than Lebanese LBW (5.6%; P = 0.059). Only 20-24-years-old Syrian women [odds ratio (OR) = 1.70 (1.22-2.36)] and those with ≥ university education [OR = 2.02 (0.98-4.16)] exhibited higher odds of delivering an LBW baby compared with Lebanese women of the same age and education. CONCLUSIONS: The findings do not provide strong evidence for the epidemiological paradox in a forced migration context. However, the relatively advantageous LBW profile among Syrian neonates, despite their mothers' low SES and exposure to acute and chronic psychological stress, points to protective mechanisms. One of these mechanisms may be a collective response by the displaced population to improve neonatal outcomes as a way of recovering from loss and death.