A case study of using natural language processing to extract consumer insights from tweets in American cities for public health crises.

BACKGROUND: The COVID-19 pandemic was a "wake up" call for public health agencies. Often, these agencies are ill-prepared to communicate with target audiences clearly and effectively for community-level activations and safety operations. The obstacle is a lack of data-driven approaches to obtaining insights from local community stakeholders. Thus, this study suggests a focus on listening at local levels given the abundance of geo-marked data and presents a methodological solution to extracting consumer insights from unstructured text data for health communication. METHODS: This study demonstrates how to combine human and Natural Language Processing (NLP) machine analyses to reliably extract meaningful consumer insights from tweets about COVID and the vaccine. This case study employed Latent Dirichlet Allocation (LDA) topic modeling, Bidirectional Encoder Representations from Transformers (BERT) emotion analysis, and human textual analysis and examined 180,128 tweets scraped by Twitter Application Programming Interface's (API) keyword function from January 2020 to June 2021. The samples came from four medium-sized American cities with larger populations of people of color. RESULTS: The NLP method discovered four topic trends: "COVID Vaccines," "Politics," "Mitigation Measures," and "Community/Local Issues," and emotion changes over time. The human textual analysis profiled the discussions in the selected four markets to add some depth to our understanding of the uniqueness of the different challenges experienced. CONCLUSIONS: This study ultimately demonstrates that our method used here could efficiently reduce a large amount of community feedback (e.g., tweets, social media data) by NLP and ensure contextualization and richness with human interpretation. Recommendations on communicating vaccination are offered based on the findings: (1) the strategic objective should be empowering the public; (2) the message should have local relevance; and, (3) communication needs to be timely.

Communicating Health Literacy on Prescription Medications on Social Media: In-depth Interviews With "Patient Influencers".

BACKGROUND: Historically, pharmaceutical companies have struggled with trust and brand reputation among key stakeholders and have adopted innovative marketing strategies to reach patients directly and rebuild those relationships. Social media influencers are a popular strategy to influence younger demographics, including Generation Z and millennials. It is common for social media influencers to work in paid partnerships with brands; this is a multibillion-dollar industry. Long have patients been active in online health communities and social media platforms such as Twitter and Instagram, but in recent years, pharmaceutical marketers have noticed the power of patient persuasion and begun to leverage "patient influencers" in brand campaigns. OBJECTIVE: This study aimed to explore how patient influencers communicate health literacy on pharmaceutical medications on social media to their communities of followers. METHODS: A total of 26 in-depth interviews were conducted with patient influencers using a snowball sampling technique. This study is part of a larger project using an interview guide that included a range of topics such as social media practices, logistics of being an influencer, considerations for brand partnerships, and views on the ethical nature of patient influencers. The constructs of the Health Belief Model were used in this study's data analysis: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. This study was approved by the institutional review board of the University of Colorado and adhered to ethical standards in interview practice. RESULTS: As patient influencers are a new phenomenon, it was our goal to identify how health literacy on prescription medications and pharmaceuticals is being communicated on social media. Using the constructs of the Health Belief Model to guide the analysis, 3 themes were identified: understanding disease through experience, staying informed on the science or field, and suggesting that physicians know best. CONCLUSIONS: Patients are actively exchanging health information on social media channels and connecting with other patients who share similar diagnoses. Patient influencers share their knowledge and experience in efforts to help other patients learn about disease self-management and improve their quality of life. Similar to traditional direct-to-consumer advertising, the phenomenon of patient influencers raises ethical questions that need more investigation. In a way, patient influencers are health education agents who may also share prescription medication or pharmaceutical information. They can break down complex health information based on expertise and experience and mitigate the loneliness and isolation that other patients may feel without the support of a community.

COVID-19 vaccine hesitancy and short-term and long-term intentions among unvaccinated young adults: a mixed-method approach.

BACKGROUND: Only 63.8% of Americans who are 18-to-24-years-old have been fully vaccinated for COVID-19 as of June 1, 2022. The Grand Forks County, North Dakota is facing a similar challenge. As of June 2022, 47% of individuals in the 19-to-29-year-old age group are vaccinated. Focusing on unvaccinated individuals in their 20s, Study 1 aims to understand the ways in which receiving COVID-19 vaccines is construed using qualitative interviews; and Study 2 compares the predictors of short-term vaccination intention (i.e., next month) with those of long-term vaccination intention (i.e., three to 5 years) using an online survey. METHODS: For Study 1, we conducted five focus groups and four in-depth interviews via Zoom with a total of 26 unvaccinated individuals in their 20s living in the Grand Forks County. Constant comparison process was used to categorize data into themes and to recognize characteristics of the identified themes. The aim was to develop themes and associated characteristics. For Study 2, we conducted an online survey with a convenience sample of 526 unvaccinated individuals. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations between attitudes, perceptions, and beliefs in misinformation and short-term and long-term vaccination intentions, accounting for demographics and socioeconomic status. RESULTS: In Study 1, two themes were identified: feelings of uncertainty sparked by profits and monetization and navigating the fear of the unknown. In Study 2, an increase in the confidence of COVID-19 vaccines showed significantly higher odds of short-term intention (OR = 2.658, 95%CI 1.770, 3.990) and long-term intention (OR = 1.568, 95% CI 1.105, 2.226). Believing in misinformation had significantly lower odds of short-term intention (OR = 0.712, 95%CI 0.513, 0.990), while more positive attitudes (OR = 1.439, 95% CI 1.024, 2.024), stronger preference in calculating the benefits of COVID-19 vaccines (OR = 2.108, 95% CI 1.541, 2.882), and greater perceived susceptibility (OR = 1.471, 95% CI 1.045, 2.070) to and severity of contracting COVID-19 (OR = 1.362, 95% CI 1.020, 1.820) were significantly associated with higher odds of long-term intention. CONCLUSIONS: Short-term and long-term intentions were predicted differently. Instilling strong confidence in COVID-19 vaccines should increase both short-term and long-term intentions.

The impact of time and environmental factors on the mitochondrial vesicle and subsequent motility of amphibian sperm.

For amphibian species that display external fertilization in an aquatic environment, hypoosmotic shock to sperm cells can quickly result in damage to cellular structure and function. This study sought to determine how fertilization media osmolality, temperature, and time impact the stability of the mitochondrial vesicle's association with the sperm head and thus motility and quality of forward progression. The presence of the mitochondrial vesicle and its relationship with sperm motility and quality of forward progression were analyzed in sperm samples from the Fowler's toad (Anaxyrus fowleri) (n = 10) when held for six hours under two temperatures and four osmolalities. Results indicated that the presence of the mitochondrial vesicle is needed for sperm motility over time (p < 0.001), where higher osmolalities (p < 0.001) and lower temperatures (p < 0.001) correlated with maintaining the vesicle attachment to the spermatozoa. The higher osmolality of spermic urine was the most important factor for maintaining higher quality of forward progressive motility (p < 0.01) of spermatozoa. Sperm samples held at 4 °C and 40 mOsm/kg had the longest half-life for motility (540 min) and quality of forward progression (276 min), whereas sperm held at 22 °C and 2.5 mOsm/kg had the shortest half-life for motility (7 min) and quality of forward progression (18 min). Special attention should be given to the osmolality and temperature of fertilization solutions, or breeding tank water, when developing cold storage protocols for toad sperm or reproducing animals to ensure the retention of the mitochondrial vesicle for maximum fertilization capability.

Conceptualization of the Public Health Model of Reporting through Application: The Case of the Cincinnati Enquirer's Heroin Beat.

This case study seeks to demonstrate the Cincinnati Enquirer's use of the public health model of reporting and public health news frames. The Enquirer created the first newspaper heroin beat in January 2016. Enquirer reporters framed the heroin epidemic as a public health issue, focusing on solutions, contextualizing the issue through societal determinants of health, and incorporating the voices of constituent groups. Findings are discussed using news framing and the public health model of reporting.

Patient Influencers: The Next Frontier in Direct-to-Consumer Pharmaceutical Marketing.

Social media influencers are becoming an increasingly popular strategic communication tactic used across industry verticals, including entertainment, fashion, and beauty, to engage directly with consumers. Pharmaceutical companies have also recently entered the social media marketing arena and-within the bounds of governmental regulations-have found ways to build relationships directly with patients using covert persuasion tactics like partnering with social media influencers. Due to consumers' negative perceptions of pharmaceutical companies, it makes sense that new marketing tactics are being used to establish and improve relationships with consumers. Previous research well documents the ethical dilemmas of direct-to-consumer advertising, and there is recent burgeoning literature on online covert marketing tactics. The academic and medical literature, however, is behind in regard to social media influencers used in health and medicine. This paper highlights and defines terms used in industry practice, and also calls for more investigation and sets forward a research agenda. As consumers spend more time online and patients continue to consult social media for health information, it is important that this new marketing trend does not go unnoticed.

Underutilization of epilepsy surgery: Part I: A scoping review of barriers.

One-third of persons with epilepsy have seizures despite appropriate medical therapy. Drug resistant epilepsy (DRE) is associated with neurocognitive and psychological decline, poor quality of life, increased risk of premature death, and greater economic burden. Epilepsy surgery is an effective and safe treatment for a subset of people with DRE but remains one of the most underutilized evidence-based treatments in modern medicine. The reasons for this quality gap are insufficiently understood. In this comprehensive review, we compile known significant barriers to epilepsy surgery, originating from both patient/family-related factors and physician/health system components. Important patient-related factors include individual and epilepsy characteristics which bias towards continued preferential use of poorly effective medications, as well as patient perspectives and misconceptions of surgical risks and benefits. Health system and physician-related barriers include demonstrable knowledge gaps among physicians, inadequate access to comprehensive epilepsy centers, complex presurgical evaluations, insufficient research, and socioeconomic bias when choosing appropriate surgical candidates.

The Needle and the Damage Done: Framing the Heroin Epidemic in the Cincinnati Enquirer.

This case study focuses on the Cincinnati Enquirer's coverage of the heroin epidemic. The Enquirer started the first heroin beat in January 2016, and it could serve as a model for other news organizations. Reporters used combinations of episodic, thematic, public health, and crime and law enforcement frames in their coverage. These news frames are discussed in terms of how individualism-collectivism, geographic location, available resources, and social determinants inform journalistic and societal discussions of the heroin epidemic in terms of solutions instead of responsibility or blame.

If Everyone Is Doing It, It Must Be Safe: College Students' Development of Attitudes toward Poly-Substance Use.

Background: While binge drinking on college campuses has been a topic of concern for decades, especially among fraternity and sorority members, recreational drug use is on the rise and mixing alcohol and drugs is now more of a concern than ever. Objective: Social learning theory was used as a framework for understanding how students develop attitudes regarding the possible risks and rewards of various behaviors such as binge drinking and drug use. Method: This research reports the results of 13 focus group discussions with 63 college students. A thematic approach was used and revealed several themes: participating in college culture, experimenting is expected, ignoring risk-taking, and resisting peer pressure. Findings: Participants felt as if it was expected that college students would experiment with alcohol and drugs, and that it was just "part of going away to college." Students reported ignoring the known risks of mixing alcohol and drugs use despite prior education efforts. Conclusions: The findings of this study suggest that alcohol and drug use on college campuses is, at least in part, driven by a perception of college culture and a poor balancing of the risks and rewards associated with these behaviors.

Applying the Health Belief Model to Medication Adherence: The Role of Online Health Communities and Peer Reviews.

Millions of Americans are living with at least one chronic disease, and while the majority has been prescribed medication to control symptoms-medication adherence is a widespread problem. Medication nonadherence varies by chronic disease, patient characteristics, and insurance coverage, and previous research has identified non-financial barriers including disease-related knowledge, health literacy and polypharmacy. However, given the increasing popularity of online health communities, little research examines the influence of user-generated content on health behaviors. Many patients use the internet to seek and share information related to prescription medications. The current study examines patients' attitudes and behavioral intentions formed (in part) by the user-generated content exchanged within online health communities. Specifically, the Health Belief Model's perceived barriers and perceived benefits are explored here. Twenty members from online health communities related to arthritis are interviewed to understand how peer-to-peer communication is used in regards to medication adherence. Three themes emerged from the data, including striving for pain relief, negotiating potential side effects, and finding the new normal. Theoretical and practical implications are discussed.

The Effects of Twitter Users' Gender and Weight on Viral Behavioral Intentions Toward Obesity-Related News.

In this study, male and female participants were exposed to identical news stories covering obesity topics paired with tweets from Twitter users. Our study aimed at understanding how obesity-related news combined with user-generated social media posts (i.e., tweets) affect consumers' evaluations of online content and viral behavioral intentions (the intentions to like, share, and comment). An experiment (N = 316) explored how gender and weight of a Twitter user (tweeter) affect participants' evaluations and viral behavioral intentions toward news stories. Participants differed in their evaluations of and viral behavioral intentions for news stories as a function of Twitter users' gender and weight, as well as participants' gender. While participants expressed more favorable attitudes toward news stories paired with tweets by overweight than healthy females (with the opposite true for tweets by male users), participants expressed greater viral behavioral intentions for news stories paired with tweets by healthy weight than overweight user. These effects were more pronounced among male than female participants. Findings are discussed within the context of social media posts and their persuasive effects in relation to attitude and behavior changes.

The Power of Peers: Applying User-Generated Content to Health Behaviors "Off-Line".

Many patients seek and share information online regarding health, especially those diagnosed with chronic disease. The social cognitive theory is used as the theoretical framework for analyzing how members learn within online health communities. This study conducted in-depth interviews with members from online health communities related to arthritis to understand their motivation for participating in the community and how the content exchanged therein is applied to managing their disease. Four themes were identified: processing disease diagnosis, collaborating to solve problem, recognizing personal limitations, and appreciating that health is variable. Topical communication within the online communities was often tailored to members' situational needs with the ultimate goal being better self-management. The findings demonstrate the online health community is an environment that invites members who share common characteristics to engage with one another and with the shared content for the purpose of learning arthritis self-management strategies. Theoretical and practical implications are discussed.

Progesterone receptor and prostaglandins mediate luteinizing hormone-induced changes in messenger RNAs for ADAMTS proteases in theca cells of bovine periovulatory follicles.

Little is known about the ADAMTS (a disintegrin and metalloproteinase with thrombospondin motifs) family of extracellular proteases in ovarian follicles of non-rodent species, particularly in theca cells. In the present study, temporal changes in the abundance of mRNA encoding four ADAMTS subtypes and hormonal regulation of mRNA encoding two subtypes were investigated in theca interna cells during the periovulatory period in cattle. Gonadotropin-releasing hormone (GnRH) was injected into animals to induce a luteinizing hormone (LH)/follicle-stimulating hormone (FSH) surge, and follicles were obtained at 0 hr post-GnRH (preovulatory) or at 6, 12, 18, or 24 hr (periovulatory). ADAMTS1, -2, -7, and -9 transcript abundance was then determined in the isolated theca interna. ADAMTS1 and -9 mRNA levels were up-regulated at 24 hr post-GnRH, whereas ADAMTS2 mRNA was higher at 12-24 hr post-GnRH and ADAMTS7 mRNA increased transiently at 12 hr post-GnRH compared to other time points. Subsequent in vitro experiments using preovulatory theca interna (0 hr post-GnRH) showed that application of LH in vitro can mimic the effects of the gonadotropin surge on mRNAs encoding ADAMTS1 and -9 and that progesterone/progesterone receptor and/or prostaglandins may regulate the levels of mRNA encoding ADAMTS1 and -9 in theca interna, downstream of the LH surge. Time- and subtype-specific changes in ADAMTS mRNA abundance in vivo, and their regulation in vitro by hormones, indicate that ADAMTS family members produced by theca cells may play important roles in follicle rupture and the accompanying tissue remodeling in cattle. Mol. Reprod. Dev. 84: 55-66, 2017. © 2016 Wiley Periodicals, Inc.

Online Health Communities and Chronic Disease Self-Management.

This research uses content analysis (N = 1,960) to examine the computer-mediated communication within online health communities for evidence of chronic disease self-management behaviors, including the perceived benefits and perceived barriers to participating in such behaviors. Online health communities act as informal self-management programs led by peers with the same chronic disease through the exchange of health information. Online health communities provide opportunities for health behavior change messages to educate and persuade regarding chronic disease self-management behaviors.

Up in Vapor: Exploring the Health Messages of E-Cigarette Advertisements.

Electronic cigarettes (e-cigarettes) have gained popularity in the United States, and marketers are using advertising to recruit new users to their products. Despite outright bans on traditional cigarette advertisements, e-cigarettes have no specific regulations. This study uses framing theory to explore the themes in e-cigarette advertisements. Also, practical implications are discussed.

Visual elements in direct-to-consumer advertising: Messages communicated to patients with arthritis.

Direct-to-consumer (DTC) advertising saturates popular health magazines, communicating persuasive messages to readers that may influence attitudes and behaviors. This research used a two-prong approach to investigate the visual elements used in DTC advertising and their influence on consumers' understanding of a disease and its treatment options. An analysis was conducted of DTC advertisements (N = 62) from a population sample of Arthritis Today magazine, 2000-2010. Three panels of people with arthritis were used to validate the findings and discuss implications for health literacy. Pharmaceutical companies have an opportunity to communicate tailored messages to readers of niche publications and improve disease management.

Mourning and Grief on Facebook: An Examination of Motivations for Interacting With the Deceased.

Facebook not only changed the way we communicate but also the way we mourn and express grief. The social networking site allows users to interact with deceased users' walls after death. This study utilized textual analysis to categorize Facebook posts ( N = 122) on 30 deceased users' walls according to uses and gratifications theory. Most posts were found to be motivated by entertainment, followed by integration and social interaction. Facebook users posted memories, condolences, and interacted with friends and family members in the deceased user's network. Implications and potential future research are discussed.

Patients' self-efficacy within online health communities: facilitating chronic disease self-management behaviors through peer education.

In order to combat the growing burden of chronic disease, evidence-based self-management programs have been designed to teach patients about the disease and its affect on their lives. Self-efficacy is a key component in chronic disease self-management. This research used online ethnography and discourse analysis (N = 8,231) to examine self-efficacy within the computer-mediated communication (CMC) of four online health communities used by people with arthritis. Specifically, online opinion leaders were identified for examination. Across the four communities, there was a cyclical process that involved "disease veterans" sharing their experiences and gaining credibility within the community, new(er) members suffering from disease symptoms and sharing their experiences online, and finally, asking others for help with arthritis self-management behaviors. Three themes follow: (1) sharing disease experience, (2) suffering from disease symptoms, and (3) asking for help. Practical implications for health promotion and education are discussed.

Neuromyelitis Optica Spectrum Disorder in a Pediatric Patient.

Neuromyelitis optica in the pediatric population is rare. Patients present with acute neurological deficits predominantly involving the optic nerves and spinal cord, usually with a relapsing course. Clinical overlap between multiple sclerosis and other autoimmune disorders can occur and must be ruled out as NMO requires a more aggressive treatment plan. We present a pediatric patent with NMO spectrum disorder in order to draw awareness to this potentially neurologi- cally devastating disease.

Localized Health News Releases and Community Newspapers: A Method for Rural Health Promotion.

Newspaper health stories often originate with news releases from health organizations. Tailoring news releases to a particular mass media outlet increases the possibility that the release will result in a published story. This study describes a 2-year effort to promote coverage of health through dissemination of localized health news releases to newspapers. Each newspaper received stories tailored to that community. Localized elements of stories included local headlines and local data. Nearly half of newspapers in our study (48.2%) published at least one of our health news stories, and 541 health news stories were published as a result of the project. We also examined which types of newspapers were most likely to publish health news stories. Newspapers in rural versus suburban and urban areas were more likely to publish health news stories, as were midsized newspapers. In addition, rural newspapers were more likely than urban newspapers to publish stories about aging, specifically arthritis and heart disease. Our findings indicate that tailoring health news releases with local information and targeting releases to align with newspaper audience demographics could increase the quantity and quality of health-promoting information available to rural residents, who experience disparities in health care access and health outcomes.