Social Media Use, Unhealthy Lifestyles, and the Risk of Miscarriage Among Pregnant Women During the COVID-19 Pandemic: Prospective Observational Study.

BACKGROUND: The COVID-19 pandemic has resulted in changes to normal life and disrupted social and economic function worldwide. However, little is known about the impact of social media use, unhealthy lifestyles, and the risk of miscarriage among pregnant women during the COVID-19 pandemic. OBJECTIVE: This study aims to assess the association between social media use, unhealthy lifestyles, and the risk of miscarriage among pregnant women in the early stage of the COVID-19 pandemic in China. METHODS: In this prospective cohort study, 456 singleton pregnant women in mainland China were recruited during January and February 2020. Sociodemographic characteristics, history of previous health, social media use, and current lifestyles were collected at baseline, and we followed up about the occurrence of miscarriage. Log-binomial regression models were used to estimate the risk ratios (RRs) of miscarriage for women with different exposures to COVID-19-specific information. RESULTS: Among all the 456 pregnant women, there were 82 (18.0%) who did no physical activities, 82 (18.0%) with inadequate dietary diversity, 174 (38.2%) with poor sleep quality, and 54 (11.8%) spending >3 hours on reading COVID-19 news per day. Women with excessive media use (>3 hours) were more likely to be previously pregnant (P=.03), have no physical activity (P=.003), have inadequate dietary diversity (P=.03), and have poor sleep quality (P<.001). The prevalence of miscarriage was 16.0% (n=73; 95% CI 12.6%-19.4%). Compared with women who spent 0.5-2 hours (25/247, 10.1%) on reading COVID-19 news per day, miscarriage prevalence in women who spent <0.5 hours (5/23, 21.7%), 2-3 hours (26/132, 19.7%), and >3 hours (17/54, 31.5%) was higher (P<.001). Miscarriage prevalence was also higher in pregnant women with poor sleep quality (39/174, 22.4% vs 34/282, 12.1%; P=.003) and a high education level (66/368, 17.9% vs 7/88, 8.0%; P=.02). In the multivariable model, poor sleep quality (adjusted RR 2.06, 95% CI 1.24-3.44; P=.006), 2-3 hours of media use daily (adjusted RR 1.74, 95% CI 1.02-2.97; P=.04), and >3 hours of media use daily (adjusted RR 2.56, 95% CI 1.43-4.59; P=.002) were associated with miscarriage. In the sensitivity analysis, results were still stable. CONCLUSIONS: Pregnant women with excessive media use were more likely to have no physical activity, inadequate dietary diversity, and poor sleep quality. Excessive media use and poor sleep quality were associated with a higher risk of miscarriage. Our findings highlight the importance of healthy lifestyles during the COVID-19 pandemic.

Electronic Cigarette Users' Perspective on the COVID-19 Pandemic: Observational Study Using Twitter Data.

BACKGROUND: Previous studies have shown that electronic cigarette (e-cigarette) users might be more vulnerable to COVID-19 infection and could develop more severe symptoms if they contract the disease owing to their impaired immune responses to viral infections. Social media platforms such as Twitter have been widely used by individuals worldwide to express their responses to the current COVID-19 pandemic. OBJECTIVE: In this study, we aimed to examine the longitudinal changes in the attitudes of Twitter users who used e-cigarettes toward the COVID-19 pandemic, as well as compare differences in attitudes between e-cigarette users and nonusers based on Twitter data. METHODS: The study dataset containing COVID-19-related Twitter posts (tweets) posted between March 5 and April 3, 2020, was collected using a Twitter streaming application programming interface with COVID-19-related keywords. Twitter users were classified into two groups: Ecig group, including users who did not have commercial accounts but posted e-cigarette-related tweets between May 2019 and August 2019, and non-Ecig group, including users who did not post any e-cigarette-related tweets. Sentiment analysis was performed to compare sentiment scores towards the COVID-19 pandemic between both groups and determine whether the sentiment expressed was positive, negative, or neutral. Topic modeling was performed to compare the main topics discussed between the groups. RESULTS: The US COVID-19 dataset consisted of 4,500,248 COVID-19-related tweets collected from 187,399 unique Twitter users in the Ecig group and 11,479,773 COVID-19-related tweets collected from 2,511,659 unique Twitter users in the non-Ecig group. Sentiment analysis showed that Ecig group users had more negative sentiment scores than non-Ecig group users. Results from topic modeling indicated that Ecig group users had more concerns about deaths due to COVID-19, whereas non-Ecig group users cared more about the government's responses to the COVID-19 pandemic. CONCLUSIONS: Our findings show that Twitter users who tweeted about e-cigarettes had more concerns about the COVID-19 pandemic. These findings can inform public health practitioners to use social media platforms such as Twitter for timely monitoring of public responses to the COVID-19 pandemic and educating and encouraging current e-cigarette users to quit vaping to minimize the risks associated with COVID-19.

Natural Language Processing Insight into LGBTQ+ Youth Mental Health During the COVID-19 Pandemic: Longitudinal Content Analysis of Anxiety-Provoking Topics and Trends in Emotion in LGBTeens Microcommunity Subreddit.

BACKGROUND: Widespread fear surrounding COVID-19, coupled with physical and social distancing orders, has caused severe adverse mental health outcomes. Little is known, however, about how the COVID-19 crisis has impacted LGBTQ+ youth, who disproportionately experienced a high rate of adverse mental health outcomes before the COVID-19 pandemic. OBJECTIVE: We aimed to address this knowledge gap by harnessing natural language processing methodologies to investigate the evolution of conversation topics in the most popular subreddit for LGBTQ+ youth. METHODS: We generated a data set of all r/LGBTeens subreddit posts (n=39,389) between January 1, 2020 and February 1, 2021 and analyzed meaningful trends in anxiety, anger, and sadness in the posts. Because the distribution of anxiety before widespread social distancing orders was meaningfully different from the distribution after (P<.001), we employed latent Dirichlet allocation to examine topics that provoked this shift in anxiety. RESULTS: We did not find any differences in LGBTQ+ youth anger and sadness before and after government-mandated social distancing; however, anxiety increased significantly (P<.001). Further analysis revealed a list of 10 anxiety-provoking topics discussed during the pandemic: attraction to a friend, coming out, coming out to family, discrimination, education, exploring sexuality, gender pronouns, love and relationship advice, starting a new relationship, and struggling with mental health. CONCLUSIONS: During the COVID-19 pandemic, LGBTQ+ teens increased their reliance on anonymous discussion forums when discussing anxiety-provoking topics. LGBTQ+ teens likely perceived anonymous forums as safe spaces for discussing lifestyle stressors during COVID-19 disruptions (eg, school closures). The list of prevalent anxiety-provoking topics in LGBTQ+ teens' anonymous discussions can inform future mental health interventions in LGBTQ+ youth.

COVID-19 increased censorship circumvention and access to sensitive topics in China.

Crisis motivates people to track news closely, and this increased engagement can expose individuals to politically sensitive information unrelated to the initial crisis. We use the case of the COVID-19 outbreak in China to examine how crisis affects information seeking in countries that normally exert significant control over access to media. The crisis spurred censorship circumvention and access to international news and political content on websites blocked in China. Once individuals circumvented censorship, they not only received more information about the crisis itself but also accessed unrelated information that the regime has long censored. Using comparisons to democratic and other authoritarian countries also affected by early outbreaks, the findings suggest that people blocked from accessing information most of the time might disproportionately and collectively access that long-hidden information during a crisis. Evaluations resulting from this access, negative or positive for a government, might draw on both current events and censored history.

Social media use in residency recruitment during the COVID-19 pandemic.

To investigate the extent to which dermatology programs use social media to connect with applicants, we conducted a search of all 140 residency programs on Instagram, Facebook, Twitter, and YouTube. Our search revealed 74 (53%) Instagram, 21 (15%) Facebook, 20 (14%) Twitter, and four (3%) YouTube accounts for dermatology programs, with the number of Instagram accounts increasing five-fold from the end of 2019 to present. Our results demonstrate that conditions created during the coronavirus disease 2019 (COVID-19) pandemic accelerated dermatology residency programs' acceptance of social media, particularly Instagram, as a means to communicate and share information with applicants.

How COVID-19 has transformed my science.

The COVID-19 pandemic has caused a seismic shift in my career, including its scientific focus, research approach, and efforts to communicate with non-scientists. In this NeuroView, I recount pivotal moments that have transformed the way I do science.

Dissemination of Anesthesia Information During the Coronavirus Disease 2019 Pandemic Through Twitter: An Infodemiology Study.

BACKGROUND: Twitter is a web-based social media platform that allows instantaneous sharing of user-generated messages (tweets). We performed an infodemiology study of the coronavirus disease 2019 (COVID-19) Twitter conversation related to anesthesiology to describe how Twitter has been used during the pandemic and ways to optimize Twitter use by anesthesiologists. METHODS: This was a cross-sectional study of tweets related to the specialty of anesthesiology and COVID-19 tweeted between January 21 and October 13, 2020. A publicly available COVID-19 Twitter dataset was filtered for tweets meeting inclusion criteria (tweets including anesthesiology keywords). Using descriptive statistics, tweets were reviewed for tweet and account characteristics. Tweets were filtered for specific topics of interest likely to be impactful or informative to anesthesiologists of COVID-19 practice (airway management, personal protective equipment, ventilators, COVID testing, and pain management). Tweet activity was also summarized descriptively to show temporal profiles over the pandemic. RESULTS: Between January 21 and October 13, 2020, 23,270 of 241,732,881 tweets (0.01%) met inclusion criteria and were generated by 15,770 accounts. The majority (51.9%) of accounts were from the United States. Seven hundred forty-nine (4.8%) of all users self-reported as anesthesiologists. 33.8% of all tweets included at least one word or phrase preceded by the # symbol (hashtag), which functions as a label to search for all tweets including a specific hashtag, with the most frequently used being #anesthesia. About half (52.2%) of all tweets included at least one hyperlink, most frequently linked to other social media, news organizations, medical organizations, or scientific publications. The majority of tweets (67%) were not retweeted. COVID-19 anesthesia tweet activity started before the pandemic was declared. The trend of daily tweet activity was similar to, and preceded, the US daily death count by about 2 weeks. CONCLUSIONS: The toll of the pandemic has been reflected in the anesthesiology conversation on Twitter, representing 0.01% of all COVID-19 tweets. Daily tweet activity showed how the Twitter community used the platform to learn about important topics impacting anesthesiology practice during a global pandemic. Twitter is a relevant platform through which to communicate about anesthesiology topics, but further research is required to delineate its effectiveness, benefits, and limitations for anesthesiology discussions.

Power of the collective: A review of multimodal internet-based surgical education resources in the 21st century.

Electronic resources have changed surgical education in the 21st century. Resources spanning from digital textbooks to multiple choice question banks, online society meetings, and social media can facilitate surgical education. The COVID pandemic drastically changed the paradigm for education. The ramifications of Zoom lectures and online surgical society meetings will last into the future. Educators and learners can be empowered by the many available electronic resources to enhance surgical training and education.

Political Partisanship and Antiscience Attitudes in Online Discussions About COVID-19: Twitter Content Analysis.

BACKGROUND: The novel coronavirus pandemic continues to ravage communities across the United States. Opinion surveys identified the importance of political ideology in shaping perceptions of the pandemic and compliance with preventive measures. OBJECTIVE: The aim of this study was to measure political partisanship and antiscience attitudes in the discussions about the pandemic on social media, as well as their geographic and temporal distributions. METHODS: We analyzed a large set of tweets from Twitter related to the pandemic, collected between January and May 2020, and developed methods to classify the ideological alignment of users along the moderacy (hardline vs moderate), political (liberal vs conservative), and science (antiscience vs proscience) dimensions. RESULTS: We found a significant correlation in polarized views along the science and political dimensions. Moreover, politically moderate users were more aligned with proscience views, while hardline users were more aligned with antiscience views. Contrary to expectations, we did not find that polarization grew over time; instead, we saw increasing activity by moderate proscience users. We also show that antiscience conservatives in the United States tended to tweet from the southern and northwestern states, while antiscience moderates tended to tweet from the western states. The proportion of antiscience conservatives was found to correlate with COVID-19 cases. CONCLUSIONS: Our findings shed light on the multidimensional nature of polarization and the feasibility of tracking polarized opinions about the pandemic across time and space through social media data.

Social Media and Research Publication Activity During Early Stages of the COVID-19 Pandemic: Longitudinal Trend Analysis.

BACKGROUND: The COVID-19 pandemic has highlighted the importance of rapid dissemination of scientific and medical discoveries. Current platforms available for the distribution of scientific and clinical research data and information include preprint repositories and traditional peer-reviewed journals. In recent times, social media has emerged as a helpful platform to share scientific and medical discoveries. OBJECTIVE: This study aimed to comparatively analyze activity on social media (specifically, Twitter) and that related to publications in the form of preprint and peer-reviewed journal articles in the context of COVID-19 and gastroenterology during the early stages of the COVID-19 pandemic. METHODS: COVID-19-related data from Twitter (tweets and user data) and articles published in preprint servers (bioRxiv and medRxiv) as well as in the PubMed database were collected and analyzed during the first 6 months of the pandemic, from December 2019 through May 2020. Global and regional geographic and gastrointestinal organ-specific social media trends were compared to preprint and publication activity. Any relationship between Twitter activity and preprint articles published and that between Twitter activity and PubMed articles published overall, by organ system, and by geographic location were identified using Spearman's rank-order correlation. RESULTS: Over the 6-month period, 73,079 tweets from 44,609 users, 7164 journal publications, and 4702 preprint publications were retrieved. Twitter activity (ie, number of tweets) peaked in March 2020, whereas preprint and publication activity (ie, number of articles published) peaked in April 2020. Overall, strong correlations were identified between trends in Twitter activity and preprint and publication activity (P<.001 for both). COVID-19 data across the three platforms mainly concentrated on pulmonology or critical care, but when analyzing the field of gastroenterology specifically, most tweets pertained to pancreatology, most publications focused on hepatology, and most preprints covered hepatology and luminal gastroenterology. Furthermore, there were significant positive associations between trends in Twitter and publication activity for all gastroenterology topics (luminal gastroenterology: P=.009; hepatology and inflammatory bowel disease: P=.006; gastrointestinal endoscopy: P=.007), except pancreatology (P=.20), suggesting that Twitter activity did not correlate with publication activity for this topic. Finally, Twitter activity was the highest in the United States (7331 tweets), whereas PubMed activity was the highest in China (1768 publications). CONCLUSIONS: The COVID-19 pandemic has highlighted the potential of social media as a vehicle for disseminating scientific information during a public health crisis. Sharing and spreading information on COVID-19 in a timely manner during the pandemic has been paramount; this was achieved at a much faster pace on social media, particularly on Twitter. Future investigation could demonstrate how social media can be used to augment and promote scholarly activity, especially as the world begins to increasingly rely on digital or virtual platforms. Scientists and clinicians should consider the use of social media in augmenting public awareness regarding their scholarly pursuits.

Public Interest in Immunity and the Justification for Intervention in the Early Stages of the COVID-19 Pandemic: Analysis of Google Trends Data.

BACKGROUND: The use of social big data is an important emerging concern in public health. Internet search volumes are useful data that can sensitively detect trends of the public's attention during a pandemic outbreak situation. OBJECTIVE: Our study aimed to analyze the public's interest in COVID-19 proliferation, identify the correlation between the proliferation of COVID-19 and interest in immunity and products that have been reported to confer an enhancement of immunity, and suggest measures for interventions that should be implemented from a health and medical point of view. METHODS: To assess the level of public interest in infectious diseases during the initial days of the COVID-19 outbreak, we extracted Google search data from January 20, 2020, onward and compared them to data from March 15, 2020, which was approximately 2 months after the COVID-19 outbreak began. In order to determine whether the public became interested in the immune system, we selected coronavirus, immune, and vitamin as our final search terms. RESULTS: The increase in the cumulative number of confirmed COVID-19 cases that occurred after January 20, 2020, had a strong positive correlation with the search volumes for the terms coronavirus (R=0.786; P<.001), immune (R=0.745; P<.001), and vitamin (R=0.778; P<.001), and the correlations between variables were all mutually statistically significant. Moreover, these correlations were confirmed on a country basis when we restricted our analyses to the United States, the United Kingdom, Italy, and Korea. Our findings revealed that increases in search volumes for the terms coronavirus and immune preceded the actual occurrences of confirmed cases. CONCLUSIONS: Our study shows that during the initial phase of the COVID-19 crisis, the public's desire and actions of strengthening their own immune systems were enhanced. Further, in the early stage of a pandemic, social media platforms have a high potential for informing the public about potentially helpful measures to prevent the spread of an infectious disease and provide relevant information about immunity, thereby increasing the public's knowledge.

Ageism in COVID-Related Newspaper Coverage: The First Month of a Pandemic.

OBJECTIVES: Media sources have consistently described older adults as a medically vulnerable population during the coronavirus disease 2019 (COVID-19) pandemic, yet a lack of concern over their health and safety has resulted in dismissal and devaluation. This unprecedented situation highlights ongoing societal ageism and its manifestations in public discourse. This analysis asks how national news sources performed explicit and implicit ageism during the first month of the pandemic. METHOD: Using content and critical discourse analysis methods, we analyzed 287 articles concerning older adults and COVID-19 published between March 11 and April 10, 2020, in 4 major U.S.-based newspapers. RESULTS: Findings indicate that while ageism was rarely discussed explicitly, ageist bias was evident in implicit reporting patterns (e.g., frequent use of the term "elderly," portrayals of older adults as "vulnerable"). Infection and death rates and institutionalized care were among the most commonly reported topics, providing a limited portrait of aging during the pandemic. The older "survivor" narrative offers a positive alternative by suggesting exceptional examples of resilience and grit. However, the survivor narrative may also implicitly place blame on those unable to survive or thrive in later life. DISCUSSION: This study provides insight for policy makers, researchers, and practitioners exploring societal perceptions of older adults and how these perceptions are disseminated and maintained by the media.

A rise in social media utilization by U.S. neurology residency programs in the era of COVID-19.

OBJECTIVE: To determine how neurology departments and residency programs in the United States used virtual communication to adapt to the COVID-19 pandemic, we investigated the presence and use of social media pages, virtual outreach events, and virtual internship opportunities. METHODS: Twitter, Instagram, and Facebook accounts were identified (or noted as nonexistent) for 159 accredited neurology departments and residency programs. Google searches and social media site specific searches were performed. For existing pages, the date of creation was determined and all posts on and after March 1st, 2020, were assessed to investigate the presence of virtual open house advertisements. Each program was also assessed for virtual sub-internship and elective opportunities on the Visiting Student Application Service (VSAS). RESULTS: A majority of neurology residency programs (110) had a social media presence, particularly on Twitter and Instagram. Most residency program Twitter and Instagram accounts were created after March 1st, 2020, and this was not the case on Facebook. Twitter and Instagram were used most to advertise virtual opportunities. A correlation was observed between presence and number of social media accounts and program prestige. Few programs offered virtual opportunities on VSAS for the 2020-2021 year. CONCLUSION: Neurology residency programs adapted to the COVID-19 pandemic by creating residency social media accounts, primarily on Instagram and Twitter, and hosting virtual informational events. We recommend that neurology residency applicants create professional Instagram and Twitter accounts to network with programs and receive updates about virtual events. Similarly, going forward, we recommend continued social media use by neurology residency programs for applicant outreach.

#MaskOn! #MaskOff! Digital polarization of mask-wearing in the United States during COVID-19.

The coronavirus disease 2019 (COVID-19) has caused an unprecedented public health crisis worldwide. Its intense politicization constantly made headlines, especially regarding the use of face masks as a safety precaution. However, the extent to which public opinion is polarized on wearing masks has remained anecdotal and the verbal representation of this polarization has not been explored. This study examined the types, themes, temporal trends, and exchange patterns of hashtags about mask wearing posted from March 1 to August 1, 2020 by Twitter users based in the United States. On the one hand, we found a stark rhetorical polarization in terms of semantic antagonism between pro- and anti-mask hashtags, exponential frequency increases of both types of hashtags during the period under study, in parallel to growing COVID-19 case counts, state mask mandates, and media coverage. On the other hand, the results showed an asymmetric participatory polarization in terms of a predominance of pro-mask hashtags along with an "echo chamber" effect in the dominant pro-mask group, which ignored the subversive rhetoric of the anti-mask minority. Notwithstanding the limitations of the research, this study provides a nuanced account of the digital polarization of public opinion on mask wearing. It draws attention to political polarization both as a rhetorical phenomenon and as a participatory process.

The anti-vaccination infodemic on social media: A behavioral analysis.

Vaccinations are without doubt one of the greatest achievements of modern medicine, and there is hope that they can constitute a solution to halt the ongoing COVID-19 pandemic. However, the anti-vaccination movement is currently on the rise, spreading online misinformation about vaccine safety and causing a worrying reduction in vaccination rates worldwide. In this historical time, it is imperative to understand the reasons of vaccine hesitancy, and to find effective strategies to dismantle the rhetoric of anti-vaccination supporters. For this reason, we analyzed the behavior of anti-vaccination supporters on the platform Twitter. Here we identify that anti-vaccination supporters, in comparison with pro-vaccination supporters, share conspiracy theories and make use of emotional language. We demonstrate that anti-vaccination supporters are more engaged in discussions on Twitter and share their contents from a pull of strong influencers. We show that the movement's success relies on a strong sense of community, based on the contents produced by a small fraction of profiles, with the community at large serving as a sounding board for anti-vaccination discourse to circulate online. Our data demonstrate that Donald Trump, before his profile was suspended, was the main driver of vaccine misinformation on Twitter. Based on these results, we welcome policies that aim at halting the circulation of false information about vaccines by targeting the anti-vaccination community on Twitter. Based on our data, we also propose solutions to improve the communication strategy of health organizations and build a community of engaged influencers that support the dissemination of scientific insights, including issues related to vaccines and their safety.