State and Federal Legislators' Responses on Social Media to the Mental Health and Burnout of Health Care Workers Throughout the COVID-19 Pandemic: Natural Language Processing and Sentiment Analysis.

Background: Burnout and the mental health burden of the COVID-19 pandemic have disproportionately impacted health care workers. The links between state policies, federal regulations, COVID-19 case counts, strains on health care systems, and the mental health of health care workers continue to evolve. The language used by state and federal legislators in public-facing venues such as social media is important, as it impacts public opinion and behavior, and it also reflects current policy-leader opinions and planned legislation. Objective: The objective of this study was to examine legislators' social media content on Twitter and Facebook throughout the COVID-19 pandemic to thematically characterize policy makers' attitudes and perspectives related to mental health and burnout in the health care workforce. Methods: Legislators' social media posts about mental health and burnout in the health care workforce were collected from January 2020 to November 2021 using Quorum, a digital database of policy-related documents. The total number of relevant social media posts per state legislator per calendar month was calculated and compared with COVID-19 case volume. Differences between themes expressed in Democratic and Republican posts were estimated using the Pearson chi-square test. Words within social media posts most associated with each political party were determined. Machine-learning was used to evaluate naturally occurring themes in the burnout- and mental health-related social media posts. Results: A total of 4165 social media posts (1400 tweets and 2765 Facebook posts) were generated by 2047 unique state and federal legislators and 38 government entities. The majority of posts (n=2319, 55.68%) were generated by Democrats, followed by Republicans (n=1600, 40.34%). Among both parties, the volume of burnout-related posts was greatest during the initial COVID-19 surge. However, there was significant variation in the themes expressed by the 2 major political parties. Themes most correlated with Democratic posts were (1) frontline care and burnout, (2) vaccines, (3) COVID-19 outbreaks, and (4) mental health services. Themes most correlated with Republican social media posts were (1) legislation, (2) call for local action, (3) government support, and (4) health care worker testing and mental health. Conclusions: State and federal legislators use social media to share opinions and thoughts on key topics, including burnout and mental health strain among health care workers. Variations in the volume of posts indicated that a focus on burnout and the mental health of the health care workforce existed early in the pandemic but has waned. Significant differences emerged in the content posted by the 2 major US political parties, underscoring how each prioritized different aspects of the crisis.

Reddit language indicates changes associated with diet, physical activity, substance use, and smoking during COVID-19.

COVID-19 has adversely impacted the health behaviors of billions of people across the globe, modifying their former trends in health and lifestyle. In this paper, we compare the psychosocial language markers associated with diet, physical activity, substance use, and smoking before and after the onset of COVID-19 pandemic. We leverage the popular social media platform Reddit to analyze 1 million posts between January 6, 2019, to January 5, 2021, from 22 different communities (i.e., subreddits) that belong to four broader groups-diet, physical activity, substance use, and smoking. We identified that before the COVID-19 pandemic, posts involved sharing information about vacation, international travel, work, family, consumption of illicit substances, vaping, and alcohol, whereas during the pandemic, posts contained emotional content associated with quarantine, withdrawal symptoms, anxiety, attempts to quit smoking, cravings, weight loss, and physical fitness. Prevalent topic analysis showed that the pandemic was associated with discussions about nutrition, physical fitness, and outdoor activities such as backpacking and biking, suggesting users' focus shifted toward their physical health during the pandemic. Starting from the week of March 23, 2020, when several stay-at-home policies were enacted, users wrote more about coping with stress and anxiety, alcohol misuse and abuse, and harm-reduction strategies like switching from hard liquor to beer/wine after people were socially isolated. In addition, posts related to use of substances such as benzodiazepines (valium, xanax, clonazepam), nootropics (kratom, phenibut), and opioids peaked around March 23, 2020, followed by a decline. Of note, unlike the general decline observed, the volume of posts related to alternatives to heroin (e.g., fentanyl) increased during the COVID-19 pandemic. Posts about quitting smoking gained momentum after late March 2020, and there was a sharp decline in posts about craving to smoke. This study highlights the significance of studying social media discussions on platforms like Reddit which are a rich ecological source of human experiences and provide insights to inform targeted messaging and mitigation strategies, and further complement ongoing traditional primary data collection methods.

Design, Implementation, and Outcomes of a Volunteer-Staffed Case Investigation and Contact Tracing Initiative at an Urban Academic Medical Center.

Importance: The COVID-19 pandemic has claimed nearly 6 million lives globally as of February 2022. While pandemic control efforts, including contact tracing, have traditionally been the purview of state and local health departments, the COVID-19 pandemic outpaced health department capacity, necessitating actions by private health systems to investigate and control outbreaks, mitigate transmission, and support patients and communities. Objective: To investigate the process of designing and implementing a volunteer-staffed contact tracing program at a large academic health system from April 2020 to May 2021, including program structure, lessons learned through implementation, results of case investigation and contact tracing efforts, and reflections on how constrained resources may be best allocated in the current pandemic or future public health emergencies. Design, Setting, and Participants: This case series study was conducted among patients at the University of Pennsylvania Health System and in partnership with the Philadelphia Department of Public Health. Patients who tested positive for COVID-19 were contacted to counsel them regarding safe isolation practices, identify and support quarantine of their close contacts, and provide resources, such as food and medicine, needed during isolation or quarantine. Results: Of 5470 individuals who tested positive for COVID-19 and received calls from a volunteer, 2982 individuals (54.5%; median [range] age, 42 [18-97] years; 1628 [59.4%] women among 2741 cases with sex data) were interviewed; among 2683 cases with race data, there were 110 Asian individuals (3.9%), 1476 Black individuals (52.7%), and 817 White individuals (29.2%), and among 2667 cases with ethnicity data, there were 366 Hispanic individuals (13.1%) and 2301 individuals who were not Hispanic (82.6%). Most individuals lived in a household with 2 to 5 people (2125 of 2904 individuals with household data [71.6%]). Of 3222 unique contacts, 1780 close contacts (55.2%; median [range] age, 40 [18-97] years; 866 [55.3%] women among 1565 contacts with sex data) were interviewed; among 1523 contacts with race data, there were 69 Asian individuals (4.2%), 705 Black individuals (43.2%), and 573 White individuals (35.1%), and among 1514 contacts with ethnicity data, there were 202 Hispanic individuals (12.8%) and 1312 individuals (83.4%) who were not Hispanic. Most contacts lived in a household with 2 to 5 people (1123 of 1418 individuals with household data [79.2%]). Of 3324 cases and contacts who completed a questionnaire on unmet social needs, 907 (27.3%) experienced material hardships that would make it difficult for them to isolate or quarantine safely. Such hardship was significantly less common among White compared with Black participants (odds ratio, 0.20; 95% CI, 0.16-0.25). Conclusions and Relevance: These findings demonstrate the feasibility and challenges of implementing a case investigation and contact tracing program at an academic health system. In addition to successfully engaging most assigned COVID-19 cases and close contacts, contact tracers shared health information and material resources to support isolation and quarantine, thus filling local public health system gaps and supporting local pandemic control.

COVID-19 contact tracing app reviews reveal concerns and motivations around adoption.

BACKGROUND: Google and Apple's Exposure Notifications System (ENS) was developed early in the COVID-19 pandemic to complement existing contact tracing efforts while protecting user privacy. An analysis by the Associated Press released in December 2020 estimated approximately 1 in 14 people had downloaded apps in states one was available. In this study, we assessed the motivation and experience of individuals who downloaded ENS apps from the Google Play and Apple App Stores. METHODS: We collected review text, star rating, and date of rating for all the reviews on ENS apps in the Google Play and Apple App stores. We extracted the relative frequency of single words and phrases from reviews and created an open vocabulary language, with themes categorized by the research team, to study the salient themes around reviews with high (3-5 stars), neutral (3 stars), and negative (1-2 stars) ratings using logistic regression. RESULTS: Of 7622 reviews obtained from 26 states between 04/07/2020 to 03/31/2021, 6364 were from Google Play Store, and 1258 were from Apple App Store. We obtained reviews for a total of 38 apps, with 25 apps from the Google Play Store and 13 apps from the Apple Play Store. 78% of the reviews are either 1 star or 5 stars. Positive reviews were driven by ease of use, support for the state government in creating the app, and encouragement for others to download, as well as engage in other COVID-19 precautions. Negative and neutral reviews focused on issues with app functionality (i.e., installation and tracking errors). CONCLUSIONS: Uptake was the largest barrier to success for ENS apps, but states can use insight from app store reviews to better position themselves if they choose to develop further public health apps.

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. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Crowdsourced Community Support Resources Among Patients Discharged From the Emergency Department During the COVID-19 Pandemic: Pilot Feasibility Study.

BACKGROUND: The COVID-19 pandemic has placed strains on communities. During this public health crisis, health systems have created remote methods of monitoring symptom progression and delivering care virtually. OBJECTIVE: Using an SMS text message-based system, we sought to build and test a remote model to explore community needs, connect individuals to curated resources, and facilitate community health worker intervention when needed during the pandemic. The primary aims of this pilot study were to establish the feasibility (ie, engagement with the text line) and acceptability (ie, participant ratings of resources and service) of delivering automated well-being resources via smartphone technology. METHODS: Eligible patients (aged 18 years or older, having a cell phone with SMS text messaging capability, and recently visited the emergency department) were identified using the electronic health record. The patients were consented to enroll and begin receiving COVID-19-related information and links to community resources. We collected open-ended and close-ended resource and mood ratings. We calculated the frequencies and conducted a thematic review of the open-ended responses. RESULTS: In 7 weeks, 356 participants were enrolled; 13,917 messages were exchanged including 333 resource ratings (mean 4) and 673 well-being scores (mean 6.8). We received and coded 386 open-ended responses, most of which elaborated upon their self-reported mood score (29%). Overall, 77% (n=274) of our participants rated the platform as a service they would highly recommend to a family member or friend. CONCLUSIONS: This approach is designed to broaden the reach of health systems, tailor to community needs in real time, and connect at-risk individuals with robust community health support.

Twitter discourse reveals geographical and temporal variation in concerns about COVID-19 vaccines in the United States.

The speed at which social media is propagating COVID-19 misinformation and its potential reach and impact is growing, yet little work has focused on the potential applications of these data for informing public health communication about COVID-19 vaccines. We used Twitter to access a random sample of over 78 million vaccine-related tweets posted between December 1, 2020 and February 28, 2021 to describe the geographical and temporal variation in COVID-19 vaccine discourse. Urban suburbs posted about equitable distribution in communities, college towns talked about in-clinic vaccinations near universities, evangelical hubs posted about operation warp speed and thanking God, exurbs posted about the 2020 election, Hispanic centers posted about concerns around food and water, and counties in the ACP African American South posted about issues of trust, hesitancy, and history. The graying America ACP community posted about the federal government's failures; rural middle American counties posted about news press conferences. Topics related to allergic and adverse reactions, misinformation around Bill Gates and China, and issues of trust among Black Americans in the healthcare system were more prevalent in December, topics related to questions about mask wearing, reaching herd immunity and natural infection, and concerns about nursing home residents and workers increased in January, and themes around access to black communities, waiting for appointments, keeping family safe by vaccinating and fighting online misinformation campaigns were more prevalent in February. Twitter discourse around COVID-19 vaccines in the United States varied significantly across different communities and changed over time; these insights could inform targeted messaging and mitigation strategies.

Characterizing COVID-19 Content Posted to TikTok: Public Sentiment and Response During the First Phase of the COVID-19 Pandemic.

PURPOSE: The purpose of this study was to characterize COVID-19 content posted by users and disseminated via TikTok, a social media platform that has become known largely as an entertainment platform for viral video-sharing. We sought to capture how TikTok videos posted during the initial months of the COVID pandemic changed over time as cases accelerated. METHODS: This study is an observational analysis of sequential TikTok videos with #coronavirus from January to March 2020. Videos were independently coded to assess content (e.g., health relatedness, humor, fear, empathy), misinformation, and public sentiment. To assess engagement, we also codified how often videos were shared relative to their content. RESULTS: We coded 750 videos and approximately one in four videos tagged with #coronavirus featured health-related content such as featuring objects such as face masks, hand sanitizer, and other cleaning products. Most videos evoked "humor/parody," whereas 15% and 6% evoked "fear" and "empathy", respectively. TikTok videos posted in March 2020 had the largest number of shares and comments compared with January and February 2020. The proportion of shares and comments for "misleading and incorrect information" featured in videos was lower in March than in January and February 2020. There was no statistical difference between the share and comment counts of videos coded as "incorrect/incomplete" and "correct" over the entire time period. CONCLUSIONS: Analyzing readily available social media platforms, such as TikTok provides real-time insights into public views, frequency and types of misinformation, and norms toward COVID-19. Analyzing TikTok videos has the potential to be used to inform public health messaging and public health mitigation strategies.

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.

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.

Improving Mood Through Community Connection and Resources Using an Interactive Digital Platform: Development and Usability Study.

BACKGROUND: COVID-19 continues to disrupt global health and well-being. In April-May 2020, we generated a digital, remote interactive tool to provide health and well-being resources and foster connectivity among community members through a text messaging platform. OBJECTIVE: This study aimed to prospectively investigate the ability of a health system-based digital, remote, interactive tool to provide health and well-being resources to local community participants and to foster connectivity among them during the early phases of COVID-19. METHODS: We performed descriptive and nonparametric longitudinal statistical analyses to describe and compare the participants' mood ratings over time and thematic analysis of their responses to text messages to further assess mood. RESULTS: From among 393 individuals seeking care in an urban emergency department in an academic setting, engaged in a two-way text messaging platform, we recorded 287 mood ratings and 368 qualitative responses. We observed no difference in the initial mood rating by week of enrollment [Kruskal-Wallis chi-square H(5)=1.34; P=.93], and the average mood rating did not change for participants taken together [Friedman chi-square Q(3)=0.32; P=.96]. However, of participants providing mood ratings at baseline, mood improved significantly among participants who reported a low mood rating at baseline [n=25, 14.97%; Q(3)=20.68; P<.001] but remained stable among those who reported a high mood rating at baseline [n=142, 85.03%; Q(3)=2.84; P=.42]. Positive mood elaborations most frequently included words related to sentiments of thankfulness and gratitude, mostly for a sense of connection and communication; in contrast, negative mood elaborations most frequently included words related to anxiety. CONCLUSIONS: Our findings suggest the feasibility of engaging individuals in a digital community with an emergency department facilitation. Specifically, for those who opt to engage in a text messaging platform during COVID-19, it is feasible to assess and respond to mood-related queries with vetted health and well-being resources.