Health activism, vaccine, and mpox discourse: BERTopic based mixed-method analyses of tweets from sexual minority men and gender diverse (SMMGD) individuals in the U.S.

Objectives: To synthesize discussions among sexual minority men and gender diverse (SMMGD) individuals on mpox, given limited representation of SMMGD voices in existing mpox literature. Methods: BERTopic (a topic modeling technique) was employed with human validations to analyze mpox-related tweets (n = 8,688; October 2020-September 2022) from 2,326 self-identified SMMGD individuals in the U.S.; followed by content analysis and geographic analysis. Results: BERTopic identified 11 topics: health activism (29.81%); mpox vaccination (25.81%) and adverse events (0.98%); sarcasm, jokes, emotional expressions (14.04%); COVID-19 and mpox (7.32%); government/public health response (6.12%); mpox symptoms (2.74%); case reports (2.21%); puns on the virus' naming (i.e., monkeypox; 0.86%); media publicity (0.68%); mpox in children (0.67%). Mpox health activism negatively correlated with LGB social climate index at U.S. state level, ρ = -0.322, p = 0.031. Conclusions: SMMGD discussions on mpox encompassed utilitarian (e.g., vaccine access, case reports, mpox symptoms) and emotionally-charged themes-advocating against homophobia, misinformation, and stigma. Mpox health activism was more prevalent in states with lower LGB social acceptance. Public Health Implications: Findings illuminate SMMGD engagement with mpox discourse, underscoring the need for more inclusive health communication strategies in infectious disease outbreaks to control associated stigma.

Digital Epidemiological Approaches in HIV Research: a Scoping Methodological Review.

PURPOSE OF REVIEW: The purpose of this scoping review was to summarize literature regarding the use of user-generated digital data collected for non-epidemiological purposes in human immunodeficiency virus (HIV) research. RECENT FINDINGS: Thirty-nine papers were included in the final review. Four types of digital data were used: social media data, web search queries, mobile phone data, and data from global positioning system (GPS) devices. With these data, four HIV epidemiological objectives were pursued, including disease surveillance, behavioral surveillance, assessment of public attention to HIV, and characterization of risk contexts. Approximately one-third used machine learning for classification, prediction, or topic modeling. Less than a quarter discussed the ethics of using user-generated data for epidemiological purposes. User-generated digital data can be used to monitor, predict, and contextualize HIV risk and can help disrupt trajectories of risk closer to onset. However, more attention needs to be paid to digital ethics and the direction of the field in a post-Application Programming Interface (API) world.

Urban Youth Perceptions of Sports and Energy Drinks: Insights for Health Promotion Messaging.

Objective: This study aimed to examine urban adolescents' beliefs about sports and energy drinks to identify factors for health messaging to discourage youth consumption. Design: Focus group study involving thirty-four adolescents in urban areas (12 female, 12 male, and 10 unreported sex; 19 Hispanic, 11 Non-Hispanic Black, 2 Asian, and 1 unknown race or ethnicity). Setting: Four focus groups were conducted with adolescents in urban areas. Method: Each on-time moderated group discussion was structured to generate an inventory of attitudinal, normative and efficacy beliefs associated with sports and energy drink consumption and reduction. Thematic analysis was used to analyse the data. Results: Attitudinal and normative beliefs were more positive towards sports drink consumption and energy drink reduction. Misperceptions about the need for sports drinks to avoid dehydration during physical activity were evident. Product accessibility and advertising pervasiveness were facilitators influencing consumption and barriers to reduction for both products. Conclusion: Results highlight important differences in perceptions about sports and energy drinks that indicate the need for different approaches and messages for interventions designed to curb consumption of these products. Recommendations for message design are provided.

Athletes Drink Gatorade: DMA Advertising Expenditures, Ad Recall, and Athletic Identity Influence Energy and Sports Drink Consumption.

Understanding why sports and energy drinks remain increasingly popular among adolescents despite declines in other sugar sweetened beverages is critical. This study points to memory for advertising exposure and adolescent athletic identity as two aspects that together help to explain consumption. An online survey of U.S. adolescents aged 14-18 (n = 503) was combined with Nielsen data for television and social media advertising expenditures by sports and energy drink brands in participants' designated market areas (DMAs). Advertisement recall mediates the relationship between social media DMA expenditures and sports and energy drink consumption. Recall for television advertisements is related to consumption but is unrelated to television DMA expenditures. Athletic identity moderated the relationship between recall and consumption such that consumption increased as both recall and athletic identity increased, suggesting a role for motivated memory and motivated processing of ad messages based on athletic identity consistent with the limited capacity model of motivated media message processing. Based on these results, we conclude that effectiveness of expenditures in influencing behavior is dependent upon both ad recall and ad relevance, and that athletic identity is an important factor in ad effectiveness in the context of sports and energy drinks advertising.

Perceptions of Sports and Energy Drinks: Factors Associated with Adolescent Beliefs.

PURPOSE: To understand what factors are associated with adolescents' perceived healthfulness of sports drinks (SD) and of energy drinks (ED), with a focus on health risk, athletics, and media-related variables. DESIGN: Cross-sectional survey. SETTING: Online. SUBJECTS: U.S. adolescents ages 14-18 years (n = 501) recruited from a combination of non-probability and probability-based panels. MEASURES: Outcome variables were perceived healthfulness of SDs and of EDs. Independent variables included adolescents' health background (oral health, diabetes risk, self-reported weight); behaviors (SD and ED consumption, athletic identity, sports participation, physical activity), and media items (media literacy, exposure to advertisements on TV, YouTube, social media). RESULTS: Regression results indicated that adolescents' increased perception that SDs are healthy was significantly associated (P<.05 level) with casual sports participation (b=.56, se=.27), athletic identification (b=.28, se= .11), exposure to SD advertisements on social media (b=.55, s =.25), and higher consumption (b=.28, se= .13). For adolescents' perceptions of EDs, significantly related correlates included athletic identification (b=.26, se=10), having an increased risk of diabetes (b= -.79, s =.26), poorer oral health (b=.33, se=.16), and consumption (b=.76, s =.16); increased media literacy was associated with more accurate perceptions (b=-.35, se=.14). CONCLUSIONS: Adolescents' hold different perceptions about the healthfulness of sports and energy drink, and their beliefs about each drink are related to different types of factors that may have implications for public health interventions. Cross-sectional survey design and adolescent self-reports are limitations.

Reducing Unhealthy Normative Behavior: The Case of Sports and Energy Drinks.

American adolescents consume more sugar-sweetened beverages (SSBs) than any other age group. Sports and energy drinks consumption among adolescents is higher than other SSBs. For sports drinks, there is uncertainty about their "healthiness" and also beliefs that these drinks may provide health benefits such as hydration, enhanced athletic performance, heightened mental alertness, and rapid recovery after exercise. Confusion about relative healthiness and expectations of health benefits suggest that factors that may encourage youth to avoid drinking sports and energy drinks, such as athletic status, psychological reactance, and SSB media literacy, may necessitate different approaches to promoting avoidance of sports drinks compared with avoidance of energy drinks. Using a nationally representative U.S. probability-based web panel augmented by a volunteer nonprobability-based web panel of 500 adolescent participants aged 14 to 18 years, we used the reasoned action approach to model intention to avoid sports and to avoid energy drinks. The result show there are similarities and differences in the determinants associated with adolescents' avoidance of sports and energy drinks: attitudes and descriptive normative pressure are both related to increased avoidance for both types of drinks and perceived control over the avoidance behavior is positively associated for with intention to avoid for energy drinks. Sport identification, psychological reactance, and SSB media literacy also play a different role in the sports and energy drink models. Based on our results, the content of prevention messages in interventions to limit sports drinks will need to be quite different from those targeted at reducing energy drink consumption.

Uncoupling Inequality: Reflections on the Ethics of Benchmarks for Digital Media.

Our collaboration seeks to demonstrate shared interrogation by exploring the ethics of machine learning benchmarks from a socio-technical management perspective with insight from public health and ethnic studies. Benchmarks, such as ImageNet, are annotated open data sets for training algorithms. The COVID-19 pandemic reinforced the practical need for ethical information infrastructures to analyze digital and social media, especially related to medicine and race. Social media analysis that obscures Black teen mental health and ignores anti-Asian hate fails as information infrastructure. Despite inadequately handling non-dominant voices, machine learning benchmarks are the basis for analysis in operational systems. Turning to the management literature, we interrogate cross-cutting problems of benchmarks through the lens of coupling, or mutual interdependence between people, technologies, and environments. Uncoupling inequality from machine learning benchmarks may require conceptualizing the social dependencies that build structural barriers to inclusion.

Automatic Cohort Determination from Twitter for HIV Prevention amongst Black and Hispanic Men.

Recruiting people from diverse backgrounds to participate in health research requires intentional and culture-driven strategic efforts. In this study, we utilize publicly available Twitter posts to identify targeted populations to recruit for our HIV prevention study. Natural language processing and machine learning classification methods were used to find self-declarations of ethnicity, gender, age group, and sexually-explicit language. Using the official Twitter API we collected 47.4 million tweets posted over 8 months from two areas geo-centered around Los Angeles. Using available tools (Demographer and M3), we identified the age and race of 5,392 users as likely young Black or Hispanic men living in Los Angeles. We then collected and analyzed their timelines to automatically find sex-related tweets, yielding 2,166 users. Despite a limited precision, our results suggest that it is possible to automatically identify users based on their demographic attributes and Twitter language characteristics for enrollment into epidemiological studies.

User- and Message-Level Correlates of Endorsement and Engagement for HIV-Related Messages on Twitter: Cross-sectional Study.

BACKGROUND: Youth and young adults continue to experience high rates of HIV and are also frequent users of social media. Social media platforms such as Twitter can bolster efforts to promote HIV prevention for these individuals, and while HIV-related messages exist on Twitter, little is known about the impact or reach of these messages for this population. OBJECTIVE: This study aims to address this gap in the literature by identifying user and message characteristics that are associated with tweet endorsement (favorited) and engagement (retweeted) among youth and young men (aged 13-24 years). METHODS: In a secondary analysis of data from a study of HIV-related messages posted by young men on Twitter, we used model selection techniques to examine user and tweet-level factors associated with tweet endorsement and engagement. RESULTS: Tweets from personal user accounts garnered greater endorsement and engagement than tweets from institutional users (aOR 3.27, 95% CI 2.75-3.89; P<.001). High follower count was associated with increased endorsement and engagement (aOR 1.05, 95% CI 1.04-1.06; P<.001); tweets that discussed STIs garnered lower endorsement and engagement (aOR 0.59, 95% CI 0.47-1.74; P<.001). CONCLUSIONS: Findings suggest practitioners should partner with youth to design and disseminate HIV prevention messages on social media, incorporate content that resonates with youth audiences, and work to challenge stigma and foster social norms conducive to open conversation about sex, sexuality, and health.

Best Practices on Big Data Analytics to Address Sex-Specific Biases in Our Understanding of the Etiology, Diagnosis, and Prognosis of Diseases.

A bias in health research to favor understanding diseases as they present in men can have a grave impact on the health of women. This paper reports on a conceptual review of the literature on machine learning or natural language processing (NLP) techniques to interrogate big data for identifying sex-specific health disparities. We searched Ovid MEDLINE, Embase, and PsycINFO in October 2021 using synonyms and indexing terms for (a) "women," "men," or "sex"; (b) "big data," "artificial intelligence," or "NLP"; and (c) "disparities" or "differences." From 902 records, 22 studies met the inclusion criteria and were analyzed. Results demonstrate that the inclusion by sex is inconsistent and often unreported, although the inclusion of men in these studies is disproportionately less than women. Even though artificial intelligence and NLP techniques are widely applied in healthresearch, few studies use them to take advantage of unstructured text to investigate sex-related differences or disparities. Researchers are increasingly aware of sex-based data bias, but the process toward correction is slow. We reflect on best practices on using big data analytics to address sex-specific biases in understanding the etiology, diagnosis, and prognosis of diseases.

Methods to Establish Race or Ethnicity of Twitter Users: Scoping Review.

BACKGROUND: A growing amount of health research uses social media data. Those critical of social media research often cite that it may be unrepresentative of the population; however, the suitability of social media data in digital epidemiology is more nuanced. Identifying the demographics of social media users can help establish representativeness. OBJECTIVE: This study aims to identify the different approaches or combination of approaches to extract race or ethnicity from social media and report on the challenges of using these methods. METHODS: We present a scoping review to identify methods used to extract the race or ethnicity of Twitter users from Twitter data sets. We searched 17 electronic databases from the date of inception to May 15, 2021, and carried out reference checking and hand searching to identify relevant studies. Sifting of each record was performed independently by at least two researchers, with any disagreement discussed. Studies were required to extract the race or ethnicity of Twitter users using either manual or computational methods or a combination of both. RESULTS: Of the 1249 records sifted, we identified 67 (5.36%) that met our inclusion criteria. Most studies (51/67, 76%) have focused on US-based users and English language tweets (52/67, 78%). A range of data was used, including Twitter profile metadata, such as names, pictures, information from bios (including self-declarations), or location or content of the tweets. A range of methodologies was used, including manual inference, linkage to census data, commercial software, language or dialect recognition, or machine learning or natural language processing. However, not all studies have evaluated these methods. Those that evaluated these methods found accuracy to vary from 45% to 93% with significantly lower accuracy in identifying categories of people of color. The inference of race or ethnicity raises important ethical questions, which can be exacerbated by the data and methods used. The comparative accuracies of the different methods are also largely unknown. CONCLUSIONS: There is no standard accepted approach or current guidelines for extracting or inferring the race or ethnicity of Twitter users. Social media researchers must carefully interpret race or ethnicity and not overpromise what can be achieved, as even manual screening is a subjective, imperfect method. Future research should establish the accuracy of methods to inform evidence-based best practice guidelines for social media researchers and be guided by concerns of equity and social justice.

A content analysis of sports and energy drink advertising.

This study identifies constructs from key persuasion theories that are present in popular sports and energy drink advertising. A theory-driven content analysis was conducted on 315 popular television and social media sports and energy drink advertisements from top selling brands. The advertisements were analyzed for the presence of persuasive cues as per the Elaboration Likelihood Model (e.g, onscreen consumption, presence of celebrities) as well as Reasoned Action behavioral expectancies and normative beliefs Approach related to consumption. Descriptive statistics were calculated. Differences between sports and energy drinks were assessed and reliability statistics for all codes were calculated. Advertisements relied on peripheral cues like sports and celebrities that were not related to the drinks themselves. Theory-relevant beliefs about improved athletic performance and consumption of the drinks onscreen were common. Sports drinks were more likely to focus on mainstream sports; energy drinks featured extreme sports, and energy drink advertisements promoted the drinks for use beyond sports (e.g., work settings). The cues and beliefs identified in these ads help to clarify the role of advertising in beliefs about sports drinks being healthy and energy drinks being helpful to achieve goals. Future research is needed that links exposure to coded advertisement features to adolescents' beliefs about sports and energy drinks.

A Systematic Review of Neighborhood-Level Influences on HIV Vulnerability.

A better understanding of the social-structural factors that influence HIV vulnerability is crucial to achieve the goal of ending the HIV epidemic by 2030. Given the role of neighborhoods in HIV outcomes, synthesis of findings from such research is key to inform efforts toward HIV eradication. We conducted a systematic review to examine the relationship between neighborhood-level factors (e.g., poverty) and HIV vulnerability (via sexual behaviors and substance use). We searched six electronic databases for studies published from January 1, 2007 through November 30, 2017 (PROSPERO CRD42018084384). We also mapped the studies' geographic distribution to determine whether they aligned with high HIV prevalence areas and/or the "Ending the HIV Epidemic: A Plan for the United States". Fifty-five articles met inclusion criteria. Neighborhood disadvantage, whether measured objectively or subjectively, is one of the most robust correlates of HIV vulnerability. Tests of associations more consistently documented a relationship between neighborhood-level factors and drug use than sexual risk behaviors. There was limited geographic distribution of the studies, with a paucity of research in several counties and states where HIV incidence/prevalence is a concern. Neighborhood influences on HIV vulnerability are the consequence of centuries-old laws, policies and practices that maintain racialized inequities (e.g., racial residential segregation, inequitable urban housing policies). We will not eradicate HIV without multi-level, neighborhood-based approaches to undo these injustices. Our findings inform future research, interventions and policies.

Are Sexual Minority Stressors Associated with Young Men who Have Sex with Men's (YMSM) Level of Engagement in PrEP?

Sexual minority stressors (community homophobia, sexuality-related discrimination, and internalized homonegativity) are negatively associated with accessing HIV prevention services among men who have sex with men (MSM). Few studies have tested minority stressors' associations with PrEP engagement among high-HIV risk young MSM (YMSM). Therefore, we assessed the associations between PrEP-indicated YMSM's progression along the PrEP continuum and their experiences of minority stress. N = 229 YMSM completed a web-survey on PrEP-related behaviors and minority stress. Adjusted for covariates, we developed two partial-proportional odds models examining the associations between PrEP continuum progression and minority stressors, as a composite, and community homophobia, sexuality-related discrimination, and internalized homonegativity, respectively. Our multivariable model demonstrated minority stress levels to be negatively associated with PrEP continuum location (AOR = 0.76, 95% CI: 0.58-0.99). Broken down, discrimination was positively associated with reporting being at an advanced location along the continuum (AOR = 1.39, 95% CI: 1.06-1.82). Internalized homonegativity was negatively associated with continuum location between PrEP-aware participants with no intention to initiate and participants who intended to initiate PrEP (AOR = 0.45, 95% CI: 0.27-0.77) and between those who intended to initiate and those who had ever used PrEP (AOR = 0.39, 95% CI: 0.22-0.69). Our findings suggest that minority stress, especially internalized homonegativity, remains a barrier to PrEP among PrEP-indicated YMSM. Sexuality-related discrimination was associated with PrEP continuum progression, suggesting potentially well-developed, adaptive coping skills (e.g., ability to locate sexuality-affirming providers). Coupled with stigma reduction efforts, HIV prevention services aiming to promote PrEP should incorporate internalized homonegativity screenings and referrals into sexuality-affirming resources for PrEP-indicated YMSM.

Association Between HIV-Related Tweets and HIV Incidence in the United States: Infodemiology Study.

BACKGROUND: Adolescents and young adults in the age range of 13-24 years are at the highest risk of developing HIV infections. As social media platforms are extremely popular among youths, researchers can utilize these platforms to curb the HIV epidemic by investigating the associations between the discourses on HIV infections and the epidemiological data of HIV infections. OBJECTIVE: The goal of this study was to examine how Twitter activity among young men is related to the incidence of HIV infection in the population. METHODS: We used integrated human-computer techniques to characterize the HIV-related tweets by male adolescents and young male adults (age range: 13-24 years). We identified tweets related to HIV risk and prevention by using natural language processing (NLP). Our NLP algorithm identified 89.1% (2243/2517) relevant tweets, which were manually coded by expert coders. We coded 1577 HIV-prevention tweets and 17.5% (940/5372) of general sex-related tweets (including emojis, gifs, and images), and we achieved reliability with intraclass correlation at 0.80 or higher on key constructs. Bivariate and multivariate analyses were performed to identify the spatial patterns in posting HIV-related tweets as well as the relationships between the tweets and local HIV infection rates. RESULTS: We analyzed 2517 tweets that were identified as relevant to HIV risk and prevention tags; these tweets were geolocated in 109 counties throughout the United States. After adjusting for region, HIV prevalence, and social disadvantage index, our findings indicated that every 100-tweet increase in HIV-specific tweets per capita from noninstitutional accounts was associated with a multiplicative effect of 0.97 (95% CI [0.94-1.00]; P=.04) on the incidence of HIV infections in the following year in a given county. CONCLUSIONS: Twitter may serve as a proxy of public behavior related to HIV infections, and the association between the number of HIV-related tweets and HIV infection rates further supports the use of social media for HIV disease prevention.

Exploring Substance Use Tweets of Youth in the United States: Mixed Methods Study.

BACKGROUND: Substance use by youth remains a significant public health concern. Social media provides the opportunity to discuss and display substance use-related beliefs and behaviors, suggesting that the act of posting drug-related content, or viewing posted content, may influence substance use in youth. This aligns with empirically supported theories, which posit that behavior is influenced by perceptions of normative behavior. Nevertheless, few studies have explored the content of posts by youth related to substance use. OBJECTIVE: This study aimed to identify the beliefs and behaviors of youth related to substance use by characterizing the content of youths' drug-related tweets. Using a sequential explanatory mixed methods approach, we sampled drug-relevant tweets and qualitatively examined their content. METHODS: We used natural language processing to determine the frequency of drug-related words in public tweets (from 2011 to 2015) among youth Twitter users geolocated to Pennsylvania. We limited our sample by age (13-24 years), yielding approximately 23 million tweets from 20,112 users. We developed a list of drug-related keywords and phrases and selected a random sample of tweets with the most commonly used keywords to identify themes (n=249). RESULTS: We identified two broad classes of emergent themes: functional themes and relational themes. Functional themes included posts that explicated a function of drugs in one's life, with subthemes indicative of pride, longing, coping, and reminiscing as they relate to drug use and effects. Relational themes emphasized a relational nature of substance use, capturing substance use as a part of social relationships, with subthemes indicative of drug-related identity and companionship. We also identified topical areas in tweets related to drug use, including reference to polysubstance use, pop culture, and antidrug content. Across the tweets, the themes of pride (63/249, 25.3%) and longing (39/249, 15.7%) were the most popular. Most tweets that expressed pride (46/63, 73%) were explicitly related to marijuana. Nearly half of the tweets on coping (17/36, 47%) were related to prescription drugs. Very few of the tweets contained antidrug content (9/249, 3.6%). CONCLUSIONS: Data integration indicates that drugs are typically discussed in a positive manner, with content largely reflective of functional and relational patterns of use. The dissemination of this information, coupled with the relative absence of antidrug content, may influence youth such that they perceive drug use as normative and justified. Strategies to address the underlying causes of drug use (eg, coping with stressors) and engage antidrug messaging on social media may reduce normative perceptions and associated behaviors among youth. The findings of this study warrant research to further examine the effects of this content on beliefs and behaviors and to identify ways to leverage social media to decrease substance use in this population.

The Role of Networks in Racial Disparities in HIV Incidence Among Men Who Have Sex with Men in the United States.

Network factors have been proposed as potential drivers of racial disparities in HIV among Black and Latino men who have sex with men (MSM). This review aimed to synthesize the extant literature on networks and racial disparities in HIV among MSM and identify potential directions for future research. We searched databases for peer-reviewed articles published between January 1, 2008 and July 1, 2018. Articles were included if the sample was comprised primarily of racial/ethnic minority MSM and measured one or more network characteristics. (n = 25). HIV prevalence in networks, social support, and structural barriers were linked to disparities in HIV for Black MSM. Future research should focus on intervention development around social support and other strategies for risk reduction within networks. Given the contribution of structural factors to racial/ethnic HIV disparities, network-level interventions should be paired with policies that improve access to housing, jobs, and education for MSM.

Mixed studies review of factors influencing receipt of pain treatment by injured black patients.

AIM: To explore the factors that influence provider pain treatment decision-making and the receipt of pain management by injured Black patients in the United States. DESIGN: We completed a systematic mixed studies review using a results-based convergent synthesis design. DATA SOURCES: PubMed, SCOPUS and CINAHL were searched for articles published between 2007-2017 using the search terms 'African American', 'Black American', 'race', 'pain treatment', 'pain management' and 'analgesia'. Twenty studies were included in this review. REVIEW METHOD: A search of databases and hand-searching identified peer-reviewed published papers. The Mixed Method Appraisal Tool was used to appraise the studies. RESULTS: The results indicate that healthcare provider characteristics, racial myths about pain sensitization and assumed criminality all impact provider treatment decision-making and the receipt of pain treatment by injured Black patients. IMPACT: This review addresses racial disparities in pain management by focusing on the factors that impact the receipt of pain treatment by injured Black patients. The findings will have an impact on providers who prescribe pain treatment and on the patients they treat. These findings suggest that assumed criminality of certain patients can negatively impact care, which is a type of bias not frequently explored or discussed in health disparities research. This review will help inform further research in healthcare disparities and prompt providers to examine their assumptions about the patients for whom they care. CONCLUSION: These results provide important areas for further study, including how assumed criminality of certain patients can have a negative impact on care.

#digital hood: Engagement with Risk Content on Social Media among Black and Hispanic Youth.

The digital neighborhood is the amalgamation of the spaces online where youth connect with others. Just as Black and Hispanic youth live in neighborhoods that influence their health, they are also influenced by online digital neighborhoods. Youth are exposed to social media content featuring substance use, sexual risk, and violence, yet little is known about the extent to which youth engage with such content. Using a modified venue sampling strategy, we administered CASI surveys to 145 Black and Hispanic youth aged 13-24 living in low-income urban neighborhoods. Across social media platforms, respondents reported high levels of exposure to sexual, alcohol, drug, and violence-related content (65-84%). Users reported lower levels of engagement with risk-related content (on an engagement continuum), ranging from passive exposure to dissemination. While negative risks may be amplified in the digital neighborhood, youth appear to strategically limit their engagement with that content. However, because risk behavior messaging is common in these digital neighborhoods, these spaces provide opportunities for health promotion interventions.